癌症成人患者中应用 NRS2002、MUST、PG-SGA 与 GLIM 标准评估营养不良的患病率：一项多中心研究。

Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study.

机构信息

Department of Nursing, Shanghai Proton and Heavy Ion Center, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.

Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institution, Liaoning, China.

出版信息

Nutrition. 2021 Mar;83:111072. doi: 10.1016/j.nut.2020.111072. Epub 2020 Nov 19.

DOI:10.1016/j.nut.2020.111072

PMID:33360034

Abstract

OBJECTIVES

This study aimed to evaluate the diagnostic capacity of the Nutritional Risk Screening 2002 (NRS2002), Malnutrition Universal Screening Tool (MUST), and Patient-generated Subjective Global Assessment (PG-SGA) in light of the Global Leader Initiative on Malnutrition (GLIM) criteria in adult patients with cancer.

METHODS

A multicenter observational study was conducted. Nutritional screening and assessment were performed at the time of admission to hospitals with the NRS2002, MUST, PG-SGA, and GLIM criteria. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio, and Kappa (K) values were used to evaluate the performance of these tools.

RESULTS

Of the 637 included patients, 24.8% and 15.4% of patients were at moderate and high risk of malnutrition, respectively, using the NRS2002 and MUST. The NRS2002 was better correlated to the GLIM criteria with a higher value of Kappa (K = 0.823 vs. 0.596) and area under the receiver operating characteristic curve (K = 0.896 vs. 0.757) than the MUST. Meanwhile, 28.3% of patients were diagnosed as malnourished at the time of admission per the GLIM criteria, and 43.3% were malnourished per the PG-SGA. The PG-SGA had a fair agreement with the GLIM criteria (K = 0.453), revealing a positive predictive value of 52.9% and negative predictive value of 90.6%.

CONCLUSIONS

The NRS2002 was better correlated with the GLIM diagnostic criteria of malnutrition than the MUST. The PG-SGA was too sensitive to detect nutrition-related deteriorations, leading to a low positive predictive value in the malnutrition diagnosis. Thus, the GLIM criteria could be used to confirm the presence of malnutrition identified by the PG-SGA in adults with cancer.

摘要

目的

本研究旨在根据全球营养不良领导者倡议（GLIM）标准，评估营养风险筛查 2002 版（NRS2002）、营养不良通用筛查工具（MUST）和患者主观整体评估（PG-SGA）在癌症成年患者中的诊断能力。

方法

进行了一项多中心观察性研究。在患者入院时，使用 NRS2002、MUST、PG-SGA 和 GLIM 标准进行营养筛查和评估。使用灵敏度、特异性、阳性和阴性预测值、阳性和阴性似然比以及 Kappa（K）值来评估这些工具的性能。

结果

在纳入的 637 名患者中，NRS2002 和 MUST 分别有 24.8%和 15.4%的患者处于中高度营养不良风险。NRS2002 与 GLIM 标准的相关性更好，Kappa 值（K=0.823 比 0.596）和受试者工作特征曲线下面积（K=0.896 比 0.757）更高。同时，根据 GLIM 标准，有 28.3%的患者在入院时被诊断为营养不良，根据 PG-SGA 有 43.3%的患者被诊断为营养不良。PG-SGA 与 GLIM 标准具有中等一致性（K=0.453），阳性预测值为 52.9%，阴性预测值为 90.6%。