[Comparison of two nutritional screening tools for predicting the development of complications in hospitalized patients]. / Comparación de dos herramientas de cribado nutricional para predecir la aparición de complicaciones en pacientes hospitalizados.

BACKGROUND: The prevalence of malnutrition in hospitalized patients is high and has been associated with higher morbimortality. Currently no nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate the prevalence of nutritional risk in hospitalized patients using the nutritional screening tools Mini Nutritional Assessment (MNA) and Nutrition Risk Screenig 2002 (NRS 2002) and to identify the ability for predicting development of complications. METHODS: We evaluated 57 patients admitted within the first 48 h in different medical or surgical wards of the hospital. The patients were assessed by MNA and NRS 2002 and using anthropometric and laboratory parameters. Agreement between MNA and NRS 2002 was analyzed with the kappa index. ROC curves were used for assessing the validity of the both tools in predicting complications with determination of the area under the curve (AUC). RESULTS: The prevalence of patients at nutritional risk was 38.6% with the NRS-2002 and 49.1% with the MNA. The agreement between two tools was moderate (κ = 0.436, p = 0.001). The incidence of complications was significantly higher in patients at nutritional risk defined by the NRS 0,002) but not according to the MNA (28.6% vs. = 2002 (40.9% vs. 5.7%; p 0.08). Sensitivity for predicting complications was 81.8% with = 10.3%, p the NRS 2002 and 72.7% with the MNA and specificity was 71.7% and 56.5% respectively. By ROC curve, both tests were valid to identify the risk of complications: NRS 2002 AUC = 0.768 (confidence interval (IC) 95%: 0.637-0.869) and MNA AUC = 0.646 (IC 95%: 0.508-0.768), but the AUC was significantly higher with the NRS 2002 (p = 0.047). CONCLUSIONS: The prevalence of nutritional risk in hospitalized patients is high. NRS 2002 is a screening tool more valid than MNA to predict the development of complications.

Comparacion de dos herramientas de cribado nutricional para predecir la aparicion de complicaciones en pacientes hospitalizados / Comparison of two nutritional screening tools for predicting the development of complications in hospitalized patients

Introducción: La prevalencia de desnutrición en el paciente hospitalizado es elevada y se asocia con una mayor morbimortalidad. En la actualidad no existe un método de cribado nutricional considerado de elección para identificar el riesgo nutricional. El objetivo de este estudio fue evaluar la prevalencia de riesgo de desnutrición en pacientes hospitalizados mediante las herramientas de cribado nutricional Mini Nutritional Assessment (MNA) y Nutrition Risk Screenig 2002 (NRS 2002) e identificar su capacidad para predecir la aparición de complicaciones. Métodos: Se analizaron 57 pacientes admitidos dentro de las primeras 48 horas en distintos servicios médicos y quirúrgicos del hospital. Se realizó un cribado nutricional con los test MNA y NRS 2002 y una valoración nutricional con parámetros antropométricos y analíticos. La concordancia entre MNA y NRS 2002 se evaluó mediante el índice kappa. La validez de los tests para identificar el riesgo de complicaciones se analizó mediante curvas ROC, con determinación del área bajo la curva (AUC). Resultados: La prevalencia de pacientes en riesgo de desnutrición fue 38,6% con el NRS 2002 y 49,1% con el MNA. La concordancia entre ambos test fue moderada (kappa = 0,436, p = 0,001). La incidencia acumulada de complicaciones fue significativamente mayor en los pacientes en riesgo de desnutrición según el NRS 2002 (40,9% vs. 5,7%; p = 0,002) pero no según el MNA (28,6% v.s 10,3%; p = 0,08). La sensibilidad para predecir complicaciones fue 81,8%con el NRS 2002 y 72,7% con el MNA y la especificidad 71,7% y 56,5% respectivamente. Mediante curva ROC, ambos test fueron válidos para identificar el riesgo de aparición de complicaciones: NRS 2002 AUC = 0,768 (intervalo de confianza (IC) 95%: 0,637-0,869) y MNA AUC = 0,646 (IC 95%: 0,508-0,768), pero el AUC fue significativamente superior con el NRS 2002 (p = 0,047). Conclusiones: La prevalencia de riesgo de desnutrición en los pacientes hospitalizados es elevada. El NRS 2002 es un instrumento más válido que el MNA para predecir la aparición de complicaciones hospitalarias (AU)

Background: The prevalence of malnutrition in hospitalized patients is high and has been associated with higher morbimortality. Currently no nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate the prevalence of nutritional risk in hospitalized patients using the nutritional screening tools Mini Nutritional Assessment (MNA) and Nutrition Risk Screenig 2002 (NRS 2002) and to identify the ability for predicting development of complications. Methods: We evaluated 57 patients admitted within the first 48 h in different medical or surgical wards of the hospital. The patients were assessed by MNA and NRS 2002 and using anthropometric and laboratory parameters. Agreement between MNA and NRS 2002 was analyzed with the kappa index. ROC curves were used for assessing the validity of the both tools in predicting complications with determination of the area under the curve (AUC). Results: The prevalence of patients at nutritional risk was 38.6% with the NRS-2002 and 49.1% with the MNA. The agreement between two tools was moderate (κ = 0.436, p = 0.001). The incidence of complications was significantly higher in patients at nutritional risk defined by the NRS 0,002) but not according to the MNA (28.6% vs. = 2002 (40.9% vs. 5.7%; p 0.08). Sensitivity for predicting complications was 81.8% with = 10.3%, p the NRS 2002 and 72.7% with the MNA and specificity was 71.7% and 56.5% respectively. By ROC curve, both tests were valid to identify the risk of complications: NRS 2002 AUC = 0.768 (confidence interval (IC) 95%: 0.637-0.869) and MNA AUC = 0.646 (IC 95%: 0.508-0.768), but the AUC was significantly higher with the NRS 2002 (p = 0.047). Conclusions: The prevalence of nutritional risk in hospitalized patients is high. NRS 2002 is a screening tool more valid than MNA to predict the development of complications (AU)