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

Lara Hersberger; Laura Bargetzi; Annika Bargetzi; Pascal Tribolet; Rebecca Fehr; Valerie Baechli; Martina Geiser; Manuela Deiss; Filomena Gomes; Alexander Kutz; Nina Kägi-Braun; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Brändle; Carmen Benz; Christoph Henzen; Melina Nigg; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.clnu.2019.11.041

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

Clin Nutr. 2020 Sep;39(9):2720-2729. doi: 10.1016/j.clnu.2019.11.041. Epub 2019 Dec 14.

Authors

Lara Hersberger¹, Laura Bargetzi¹, Annika Bargetzi¹, Pascal Tribolet², Rebecca Fehr³, Valerie Baechli³, Martina Geiser³, Manuela Deiss³, Filomena Gomes⁴, Alexander Kutz¹, Nina Kägi-Braun⁵, Claus Hoess⁵, Vojtech Pavlicek⁵, Sarah Schmid⁵, Stefan Bilz⁶, Sarah Sigrist⁶, Michael Brändle⁶, Carmen Benz⁶, Christoph Henzen⁷, Melina Nigg⁷, Robert Thomann⁸, Claudia Brand⁸, Jonas Rutishauser⁹, Drahomir Aujesky¹⁰, Nicolas Rodondi¹¹, Jacques Donzé¹², Zeno Stanga¹³, Beat Mueller¹, Philipp Schuetz¹⁴

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
² Internal Medicine, Spital Lachen, Switzerland.
³ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA.
⁵ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁶ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
⁷ Internal Medicine, Kantonsspital Luzern, Switzerland.
⁸ Internal Medicine, Buergerspital Solothurn, Switzerland.
⁹ Internal Medicine, Kantonsspital Baselland, Switzerland.
¹⁰ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹¹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 31882232
DOI: 10.1016/j.clnu.2019.11.041

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.

Keywords: Clinical outcomes; Malnutrition; NRS; Nutritional support.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Humans
Length of Stay
Male
Malnutrition / diagnosis*
Malnutrition / mortality
Malnutrition / therapy
Mass Screening*
Middle Aged
Mortality
Nutrition Assessment*
Nutritional Support
Patient Readmission
Precision Medicine
Prognosis
Proportional Hazards Models
Prospective Studies
Standard of Care
Switzerland