Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial
type: Article
item type: journalArticle
is part of: Clin Nutr
authors: Person
  surname: Hersberger
  given name: L.
authors: Person
  surname: Bargetzi
  given name: L.
authors: Person
  surname: Bargetzi
  given name: A.
authors: Person
  surname: Tribolet
  given name: P.
authors: Person
  surname: Fehr
  given name: R.
authors: Person
  surname: Baechli
  given name: V.
authors: Person
  surname: Geiser
  given name: M.
authors: Person
  surname: Deiss
  given name: M.
authors: Person
  surname: Gomes
  given name: F.
authors: Person
  surname: Kutz
  given name: A.
authors: Person
  surname: Kagi-Braun
  given name: N.
authors: Person
  surname: Hoess
  given name: C.
authors: Person
  surname: Pavlicek
  given name: V.
authors: Person
  surname: Schmid
  given name: S.
authors: Person
  surname: Bilz
  given name: S.
authors: Person
  surname: Sigrist
  given name: S.
authors: Person
  surname: Brandle
  given name: M.
authors: Person
  surname: Benz
  given name: C.
authors: Person
  surname: Henzen
  given name: C.
authors: Person
  surname: Nigg
  given name: M.
authors: Person
  surname: Thomann
  given name: R.
authors: Person
  surname: Brand
  given name: C.
authors: Person
  surname: Rutishauser
  given name: J.
authors: Person
  surname: Aujesky
  given name: D.
authors: Person
  surname: Rodondi
  given name: N.
authors: Person
  surname: Donze
  given name: J.
authors: Person
  surname: Stanga
  given name: Z.
authors: Person
  surname: Mueller
  given name: B.
authors: Person
  surname: Schuetz
  given name: P.
subject: *Mass Screening
subject: *Nutrition Assessment
subject: Aged
subject: Aged, 80 and over
subject: Clinical outcomes
subject: Female
subject: Humans
subject: Length of Stay
subject: Male
subject: Malnutrition
subject: Malnutrition/*diagnosis/mortality/therapy
subject: Middle Aged
subject: Mortality
subject: Nrs
subject: Nutritional Support
subject: Patient Readmission
subject: Precision Medicine
subject: Prognosis
subject: Proportional Hazards Models
subject: Prospective Studies
subject: Standard of Care
subject: Switzerland
abstract: INTRODUCTION: The Nutritional Risk Screening 2002 (NRS 2002) identifies patients at risk of malnutrition. We studied the prognostic implications of this score with regard to short-term and long-term clinical outcomes in a well-characterised cohort of medical inpatients from a previous trial. METHODS: This is a secondary analysis of an investigator-initiated, prospective randomised controlled multicenter trial in Switzerland (EFFORT) that compared the effects of an individualised nutritional support intervention with standard of care. We investigated associations between admission NRS and several short-term and long-term outcomes using multivariable regression analyses. RESULTS: Of the 2028 patients, 31% had an NRS of 3, 38% of 4 and 31% of >/=5 points, and 477 (24%) died during the 180 days of follow-up. For each point increase in NRS, we found a stepwise increase in risk of 30-day mortality (adjusted Hazard Ratio (HR) 1.22 (95% CI 1.00 to 1.48), p = 0.048) and 180-day mortality (adjusted HR 1.37 (95% CI 1.22 to 1.55), p < 0.001). NRS was associated with length of hospital stay (adjusted difference of 0.60 days per NRS point increase, 95%CI 0.23 to 0.97, p = 0.002) and functional outcomes at 180 days (adjusted decrease in Barthel index of -4.49 points per NRS point increase, 95%CI -6.54 to -2.45, p < 0.001). In a subgroup analysis, associations of NRS and short-term adverse outcomes were less pronounced in patients receiving nutritional support (intervention group) compared to control group patients (adjusted HR for 30-day mortality 1.12 [95%CI 0.83 to 1.52, p = 0.454] vs. 1.33 [95%CI 1.02 to 1.72, p = 0.032]). CONCLUSION: The NRS is a strong and independent risk score for malnutrition-associated mortality and adverse outcomes over 180 days. Our data provide strong evidence that the nutritional risk, however, is modifiable and can be reduced by the provision of adequate nutritional support.
date: 2019-12-29
pages: 2720-2729
coverage: 31882232

Clin Nutr
type: Journal
volume: 39
number: 9
identifier: DOI 10.1016/j.clnu.2019.11.041
identifier: ISSN 1532-1983 (Electronic) 0261-5614 (Linking)