Petra Georgia, Kritsotakis Evangelos I, Gouvas Nikolaos, Schizas Dimitrios, Toutouzas Konstantinos, Karanikas Michael, Pappas-Gogos George, Stylianidis Georgios, Zacharioudakis George, Laliotis Aggelos, Christodoulidis Grigorios, Kehagias Ioannis, Lasithiotakis Konstantinos
Department of General Surgery, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece.
Laboratory of Biostatistics, Medical School, University of Crete, Heraklion, Crete, Greece.
Br J Surg. 2025 Feb 1;112(2). doi: 10.1093/bjs/znaf013.
Malnutrition is a risk factor for postoperative morbidity but the optimal tool for the assessment of malnutrition is unclear.
This is a prospective multicentre cohort study. Consecutive patients undergoing elective or emergency major abdominal surgery for benign or malignant disease in 12 Greek hospitals between January 2022 and December 2023 were included. Patients unable to provide nutrition history and/or informed consent were excluded. Subjective global assessment (SGA) was used as a reference standard for malnutrition diagnosis. GLIM (global leadership initiative on malnutrition), MNA-SF (mini nutrition assessment short form), MST (malnutrition screening tool), MUST (malnutrition universal screening tool), NRI (nutritional risk index), NRS-2002 (nutrition risk scale 2002), PONS (perioperative nutrition screen) and SNAQ (short nutrition assessment questionnaire) tools were applied for malnutrition risk assessments. Indicators of diagnostic accuracy (sensitivity, specificity, diagnostic odds ratio, areas under the receiver operating characteristic curve-AUC), construct validity (convergent associations with relevant variables) and prognostic validity (logistic regression) were appraised.
1649 patients were included (58% colorectal, 21% upper gastrointestinal, 14% hepatobiliary operations). SGA defined 562 (34.1%) patients as malnourished with excellent construct and prognostic validity. Malnutrition risk assessments varied from 24.0% using NRS-2002 to 58.6% with the MNA-SF. On their ordinal scales, MNA-SF (AUC = 0.83, 95% c.i. 0.81 to 0.85) and MUST (AUC = 0.79, 95% c.i. 0.77 to 0.82) had the best discriminatory abilities with minimal between-centre heterogeneity. As binary classifiers, MNA-SF (OR = 30.2; 95% c.i. 20.2 to 45.1) and MUST (OR = 16.1; 95% c.i. 12.4 to 21.1) had the highest diagnostic ORs but only MUST had sensitivity and specificity close to 80%. MUST performed well in construct and prognostic validity appraisals.
This study supports the use of the MUST as it is the most valid nutritional screening tool in patients after major abdominal surgery.
营养不良是术后发病的一个风险因素，但评估营养不良的最佳工具尚不清楚。
这是一项前瞻性多中心队列研究。纳入了2022年1月至2023年12月期间在12家希腊医院因良性或恶性疾病接受择期或急诊大腹部手术的连续患者。无法提供营养史和/或知情同意书的患者被排除。主观全面评定法（SGA）被用作营养不良诊断的参考标准。应用全球营养不良领导倡议（GLIM）、微型营养评定简表（MNA-SF）、营养不良筛查工具（MST）、营养不良通用筛查工具（MUST）、营养风险指数（NRI）、营养风险评估量表2002（NRS-2002）、围手术期营养筛查（PONS）和简短营养评估问卷（SNAQ）工具进行营养不良风险评估。评估诊断准确性指标（敏感性、特异性、诊断优势比、受试者工作特征曲线下面积-AUC）、结构效度（与相关变量的收敛关联）和预后效度（逻辑回归）。
纳入1649例患者（58%为结直肠手术，21%为上消化道手术，14%为肝胆手术）。SGA将562例（34.1%）患者定义为营养不良，其结构效度和预后效度良好。营养不良风险评估范围从使用NRS-2002的24.0%到使用MNA-SF的58.6%。在其顺序量表上，MNA-SF（AUC = 0.83，95%置信区间0.81至0.85）和MUST（AUC = 0.79，95%置信区间0.77至0.82）具有最佳的区分能力，中心间异质性最小。作为二元分类器，MNA-SF（优势比=30.2；95%置信区间20.2至45.1）和MUST（优势比=16.1；95%置信区间12.4至21.1）具有最高的诊断优势比，但只有MUST的敏感性和特异性接近80%。MUST在结构效度和预后效度评估中表现良好。
本研究支持使用MUST，因为它是大腹部手术后患者中最有效的营养筛查工具。
