Multicentre prospective study on the diagnostic and prognostic validity of malnutrition assessment tools in surgery.

IF 8.8 1区医学 Q1 SURGERY British Journal of Surgery Pub Date : 2025-02-01 DOI:10.1093/bjs/znaf013

Georgia Petra, Evangelos I Kritsotakis, Nikolaos Gouvas, Dimitrios Schizas, Konstantinos Toutouzas, Michael Karanikas, George Pappas-Gogos, Georgios Stylianidis, George Zacharioudakis, Aggelos Laliotis, Grigorios Christodoulidis, Ioannis Kehagias, Konstantinos Lasithiotakis

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Abstract

Background: Malnutrition is a risk factor for postoperative morbidity but the optimal tool for the assessment of malnutrition is unclear.

Methods: This is a prospective multicentre cohort study. Consecutive patients undergoing elective or emergency major abdominal surgery for benign or malignant disease in 12 Greek hospitals between January 2022 and December 2023 were included. Patients unable to provide nutrition history and/or informed consent were excluded. Subjective global assessment (SGA) was used as a reference standard for malnutrition diagnosis. GLIM (global leadership initiative on malnutrition), MNA-SF (mini nutrition assessment short form), MST (malnutrition screening tool), MUST (malnutrition universal screening tool), NRI (nutritional risk index), NRS-2002 (nutrition risk scale 2002), PONS (perioperative nutrition screen) and SNAQ (short nutrition assessment questionnaire) tools were applied for malnutrition risk assessments. Indicators of diagnostic accuracy (sensitivity, specificity, diagnostic odds ratio, areas under the receiver operating characteristic curve-AUC), construct validity (convergent associations with relevant variables) and prognostic validity (logistic regression) were appraised.

Results: 1649 patients were included (58% colorectal, 21% upper gastrointestinal, 14% hepatobiliary operations). SGA defined 562 (34.1%) patients as malnourished with excellent construct and prognostic validity. Malnutrition risk assessments varied from 24.0% using NRS-2002 to 58.6% with the MNA-SF. On their ordinal scales, MNA-SF (AUC = 0.83, 95% c.i. 0.81 to 0.85) and MUST (AUC = 0.79, 95% c.i. 0.77 to 0.82) had the best discriminatory abilities with minimal between-centre heterogeneity. As binary classifiers, MNA-SF (OR = 30.2; 95% c.i. 20.2 to 45.1) and MUST (OR = 16.1; 95% c.i. 12.4 to 21.1) had the highest diagnostic ORs but only MUST had sensitivity and specificity close to 80%. MUST performed well in construct and prognostic validity appraisals.

Conclusion: This study supports the use of the MUST as it is the most valid nutritional screening tool in patients after major abdominal surgery.

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手术中营养不良评估工具诊断和预后有效性的多中心前瞻性研究。

背景：营养不良是术后发病率的危险因素，但评估营养不良的最佳工具尚不清楚。方法：这是一项前瞻性多中心队列研究。研究纳入了2022年1月至2023年12月在12家希腊医院连续接受选择性或紧急腹部大手术治疗良性或恶性疾病的患者。不能提供营养史和/或知情同意的患者被排除在外。采用主观总体评价（SGA）作为营养不良诊断的参考标准。采用GLIM（全球营养不良领导倡议）、MNA-SF（迷你营养评估简表）、MST（营养不良筛查工具）、MUST（营养不良通用筛查工具）、NRI（营养风险指数）、NRS-2002（营养风险量表2002）、PONS（围手术期营养筛查）和SNAQ（营养短期评估问卷）等工具进行营养不良风险评估。评估诊断准确性指标（敏感性、特异性、诊断优势比、受试者工作特征曲线下面积- auc）、结构效度（与相关变量的收敛关联）和预后效度（逻辑回归）。结果：共纳入1649例患者（58%为结肠手术，21%为上消化道手术，14%为肝胆手术）。SGA将562例（34.1%）患者定义为营养不良，具有良好的结构和预后有效性。营养不良风险评估从NRS-2002的24.0%到MNA-SF的58.6%不等。在其有序量表上，MNA-SF （AUC = 0.83, 95% ci = 0.81 ~ 0.85）和MUST （AUC = 0.79, 95% ci = 0.77 ~ 0.82）具有最好的区分能力，中心间异质性最小。作为二元分类器，MNA-SF (OR = 30.2；95% ci: 20.2 - 45.1)和MUST (OR = 16.1；95%（12.4 ~ 21.1）的诊断or最高，但只有MUST的敏感性和特异性接近80%。MUST在结构和预后有效性评估中表现良好。结论：本研究支持MUST的使用，因为它是腹部大手术后患者最有效的营养筛查工具。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.