Liu Jie-Qiong, He Meng-Jun, Zhang Xue-Qing, Zeng Feng-Hua, Mo Hui, Shen Jin-Hua
Department of Orthopedics, Changde Hospital, Xiangya School of Medicine, Central South University（The first people's hospital of Changde city), Changde, Hunan Province, China.
Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University（The first people's hospital of Changde city), Changde, Hunan Province, China.
J Health Popul Nutr. 2024 Dec 27;43(1):229. doi: 10.1186/s41043-024-00726-w.
The association between nutritional risk status assessment and hospital mortality in older patients remains controversial. The aim of this study was to assess the relationship between nutritional risk on admission and in-hospital mortality, and explore the best Nutritional Risk Status Screening 2002 (NRS2002) threshold for predicting in-hospital mortality of older inpatients in China.
The elderly inpatients were recruited from a hospital in Hunan Province, China. Nutritional risk was screened and assessed using the NRS2002. Logistic regression was used to analyze whether NRS2002 scores were independently associated with hospital mortality, and the results were expressed as odds ratios (OR) and 95% confidence intervals (CIs). Receiver operating characteristic curve (ROC) was used to determine the best NRS2002 threshold for predicting in-hospital mortality in elderly inpatients. And 500 bootstrap re-samplings were performed for ROC analysis.
In total, 464 elderly inpatients completed the survey (15 of whom died, 205 males and 259 females, mean age = 72.284 ± 5.626 years). Multifactorial analysis revealed that age, the NRS2002 score, and length of hospital stay significantly influenced in-hospital mortality among older inpatients (P < 0.05). The results also showed that higher NRS2002 scores were associated with an increased risk of in-hospital mortality in both the unadjusted (OR = 1.731,95%CI = 1.362-2.20, P < 0.0001), adjusted model I (OR = 1.736, 95% CI = 1.354-2.206, P < 0.0001) and model II (OR = 1.602, 95% CI = 1.734-2.488, P = 0.0005). The optimal NRS2002 threshold for predicting in-hospital mortality in older inpatients was 3.5, with the largest ROC area of 0.84.
Our findings indicated that nutritional risk was an independent predictor of in-hospital mortality, with a cut-off value of 3.50 for the NRS2002 nutritional risk assessment being more appropriate than a cut-off value of 3.0.
老年患者营养风险状态评估与医院死亡率之间的关联仍存在争议。本研究旨在评估入院时营养风险与住院死亡率之间的关系，并探索预测中国老年住院患者住院死亡率的最佳2002年营养风险状态筛查（NRS2002）阈值。
从中国湖南省的一家医院招募老年住院患者。使用NRS2002进行营养风险筛查和评估。采用逻辑回归分析NRS2002评分是否与医院死亡率独立相关，结果以比值比（OR）和95%置信区间（CI）表示。采用受试者工作特征曲线（ROC）确定预测老年住院患者住院死亡率的最佳NRS2002阈值。并对ROC分析进行500次自抽样重采样。
共有464名老年住院患者完成调查（其中15人死亡，男性205人，女性259人，平均年龄=72.284±5.626岁）。多因素分析显示，年龄、NRS2002评分和住院时间对老年住院患者的住院死亡率有显著影响（P<0.05）。结果还显示，在未调整模型（OR=1.731，95%CI=1.362-2.20，P<0.0001）、调整模型I（OR=1.736，95%CI=1.354-2.206，P<0.0001）和模型II（OR=1.602，95%CI=1.734-2.488，P=0.0005）中，较高的NRS2002评分与住院死亡率增加相关。预测老年住院患者住院死亡率的最佳NRS2002阈值为3.5，最大ROC面积为0.84。
我们的研究结果表明，营养风险是住院死亡率的独立预测因素，NRS2002营养风险评估的临界值为3.50比临界值3.0更合适。
