„Nutritional Risk Screening 2002“ in der Hand des Pneumologen

Zusammenfassung

Mangelernährung (ME) ist ein Problem bei Krankenhauspatienten und stellt einen Risikofaktor für Morbidität und Mortalität dar.

Ziel der Studie war es, die Häufigkeit von Unterernährung und das Risiko einer ME bei konsekutiven, stationären Patienten einer pneumologischen Fachklinik zu überprüfen.

Die Unterernährung wurde mittels Body-Mass-Index (BMI), das ME-Risiko mittels „Nutritional Risk Screening 2002“ (NRS) überprüft und in Bezug auf Alter, Geschlecht, Dauer des Krankenhausaufenthaltes und der pneumologischen Erkrankung untersucht.

Das NRS wurde bei 680 von 705 Patienten überprüft. Es zeigte bei 14,3 % ein ME-Risiko. Bei 689 Patienten wurde der BMI bestimmt, bei 2,5 % lag eine Unterernährung vor. Bei den über 65-jährigen (n = 326) war das NRS in 19,6 % der Fälle positiv, der BMI (< 18,5 kg/m²) in 1,5 %. Alter stellte einen signifikanten Risikofaktor für ein ME-Risiko dar (OR 1,054 pro Lebensjahr), das Geschlecht nicht.

In einer Subanalyse zeigte sich bei Pneumonie- und COPD-Patienten ein ME-Risiko in 23 % bzw. 16 %. Tumorpatienten waren häufiger von einem ME-Risiko betroffen, Patienten mit einer schlafbezogenen Atmungsstörung (SBAS) seltener (OR 2,33 bei Tumor, OR 0,04 bei SBAS). Ein ME-Risiko war mit einem signifikant längeren Krankenhausaufenthalt assoziiert (10,2 ± 9,5 vs. 5,4 ± 6,0 Tage).

Das NRS erweitert neben dem BMI die Beurteilung einer ME.

Abstract

Malnutrition is a frequent problem for hospitalized patients. It is a relevant risk factor for morbidity and mortality.

The aim of this study was to detect undernutrition and the risk of malnutrition (RM) in patients admitted to a university-affiliated respiratory care clinic. Undernutrition was assessed by body mass index (BMI < 18.5 kg/m²) and RM by using the “Nutritional Risk Screening 2002” (NRS 2002) in 705 consecutive patients (BMI: measured in 689 patients/NRS: 680 patients assessed).

Data was analysed with regard to age, sex, length of hospital stay as well as underlying pneumological disorders. In 14.3 % of 680 patients, RM was detected by NRS. In 2.5 % out of 689 patients, undernutrition was identified by BMI. In patients older than 65 years (n = 365), these numbers were 19.6 % (NRS) and 1.5 % (BMI < 18.5 kg/m²). Age was a significant risk factor for RM (OR 1.054 per year). Gender, however, was not associated with undernutrition or RM.

In a sub-analysis, RM was more frequent in patients with pneumonia and chronic obstructive lung disease (23 % and 16 %, respectively).

Patients with cancer were more frequently at RM as compared to patients with sleep-disordered breathing (OR: 2.33 in cancer, OR: 0.04 in sleep-disordered breathing). RM was associated with a significant increase in length of hospital stay (10.2 ± 9.5 vs. 5.4 ± 6.0 days).

Besides the BMI, the NRS provides a valid tool for screening patients at RM.

• Literatur

• 1 Coats KG, Morgan SL, Bartolucci AA et al. Hospital-associated malnutrition: a reevaluation 12 years later. J Am Diet Assoc 1993; 93: 27-33
• 2 Kondrup J, Rasmussen HH, Hamberg O et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22: 321-336
• 3 Pirlich M, Schutz T, Norman K et al. The German hospital malnutrition study. Clin Nutr 2006; 25: 563-572
• 4 Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition 2001; 17: 573-580
• 5 Kruizenga HM, Wierdsma NJ, van Bokhorst MA et al. Screening of nutritional status in The Netherlands. Clin Nutr 2003; 22: 147-152
• 6 Norman K, Pichard C, Lochs H et al. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27: 5-15
• 7 Kyle UG, Pirlich M, Schuetz T et al. Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population-based study. . JPEN J Parenter Enteral Nutr 2004; 28: 99-104
• 8 Ockenga J, Freudenreich M, Zakonsky R et al. Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality. Clin Nutr 2005; 24: 913-919
• 9 Lim SL, Ong KC, Chan YH et al. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012; 31: 345-350
• 10 Kitson AL, Schultz TJ, Long L et al. The prevention and reduction of weight loss in an acute tertiary care setting: protocol for a pragmatic stepped wedge randomised cluster trial (the PRoWL project). BMC Health Serv Res 2013; 13: 299
• 11 Almeida AI, Correia M, Camilo M et al. Nutritional risk screening in surgery: valid, feasible, easy!. Clin Nutr 2012; 31: 206-211
• 12 Rasmussen HH, Holst M, Kondrup J. Measuring nutritional risk in hospitals. Clin Epidemiol 2010; 2: 209-216
• 13 Kollef MH, Shorr A, Tabak YP et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128: 3854-3862
• 14 Melsen WG, Rovers MM, Koeman M et al. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 2011; 39: 2736-2742
• 15 American Thoracic S, Infectious Diseases Society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005 ; 171: 388-416
• 16 Almirall J, Bolibar I, Serra-Prat M et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J 2008; 31: 1274-1284
• 17 Almirall J, Bolibar I, Balanzo X et al. Risk factors for community-acquired pneumonia in adults: a population-based case-control study. Eur Respir J 1999; 13: 349-355
• 18 Corrales-Medina VF, Valayam J, Serpa JA et al. The obesity paradox in community-acquired bacterial pneumonia. Int J Infect Dis 2011; 15: e54-57
• 19 Celli BR, Cote CG, Lareau SC et al. Predictors of Survival in COPD: more than just the FEV1. Respir Med 2008; 102 (Suppl. 01) S27-S35
• 20 Yang L, Zhou M, Smith M et al. Body mass index and chronic obstructive pulmonary disease-related mortality: a nationally representative prospective study of 220,000 men in China. Int J Epidemiol 2010; 39: 1027-1036
• 21 Breeze E, Clarke R, Shipley MJ et al. Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants. Int J Epidemiol 2006; 35: 169-178
• 22 Mannino DM, Buist AS, Petty TL et al. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax 2003; 58: 388-393
• 23 Schols AM, Broekhuizen R, Weling-Scheepers CA et al. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005; 82: 53-59
• 24 Landbo C, Prescott E, Lange P et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160: 1856-1861
• 25 Schols AM, Slangen J, Volovics L et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157: 1791-1797
• 26 Schols AM. Nutritional rehabilitation: from pulmonary cachexia to sarcoPD. Eur Respir J 2009; 33: 949-950
• 27 Bagan P, Berna P, De Dominicis F et al. Nutritional status and postoperative outcome after pneumonectomy for lung cancer. Ann Thorac Surg 2013; 95: 392-396
• 28 Sanchez-Lara K, Turcott JG, Juarez E et al. Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer 2012; 64: 526-534
• 29 Itoh M, Tsuji T, Nemoto K et al. Undernutrition in patients with COPD and its treatment. Nutrients 2013; 5: 1316-1335