Malnutrition is a major problem in hospitalised older people. Many nutrition screening tools are available for malnutrition identification, however little is known about their prognostic ability. This prospective, observational study investigated the prognostic value of three nutritional screening tools in a Geriatric Evaluation and Management Unit: the Geriatric Nutritional Risk Index (GNRI), the Mini Nutritional Assessment (MNA) and the Mini Nutritional Assessment short form (MNA-SF), incorporating either body mass index or calf circumference. Poor six- month outcome was defined as new admission to higher level residential care or mortality at six months post-discharge. Predictive ability of poor outcome was assessed by logistic regression models, adjusting for age, gender, cognition and co-morbidity. Predictive accuracy was determined by area under Receiver Operator Characteristic curves, sensitivity, specificity, predictive values and Youden Index. One hundred and seventy-two consecutive patients with a mean (SD) age=85.2 (6.4) years were included in the study. Malnutrition was identified in 31% of patients using the MNA and was associated with a higher risk of poor six-month outcome when identified by the MNA (OR, 95% CI=3.29, 1.17-9.23) and the GNRI (OR, 95% CI=2.84, 1.31-6.19), but not by the MNA-SF. All screening tools lacked discriminative power for outcome prediction. The MNA and GNRI were useful clinical predictors of poor six-month outcome, although their accuracy of prediction was low. Nutritional screening remains a priority in the routine assessment of hospitalised older people.
营养不良是住院老年人最大的问题。许多营养筛查工具可用于营养不良鉴别， 但很少有人知道他们的预测力。本前瞻性观察研究调查了在老年医学评估和管 理处三个营养筛查工具： 老年营养风险指数（GNRI） ， 迷你营养评估 （MNA）和迷你营养评估简化版（MNA-SF），结合BMI 或小腿围的预测价 值。六个月预后不良定义为出院六个月后以更高层次的居住护理重新入院或者 死亡。用Logistic 回归模型评估校正年龄、性别、认知和合并症后，其对预后 不良的预测力。用受试者特征工作曲线下面积、灵敏度、特异度、预测值和 Youden 指数确定其预测精度。本研究纳入了172 例长期病号，平均年龄为 85.2±6.4 岁。用MNA 确诊31%的患者有营养不良，较高的六个月预后不良的 风险与用MNA（OR, 95% CI=3.29, 1.17-9.23）和GNRI（OR, 95% CI=2.84, 1.31-6.19）确诊的营养不良与有关，但与MNA-SF 确诊的营养不良无关。所 有的筛查工具缺乏对结果预测的分辨别力。MNA 和GNRI 是六个月不良预后 有用的临床预测工具，虽然他们的预测精度较低。营养筛查仍然是住院老年人 优先的常规评估项目。