Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients

입원환자의 영양불량위험 검색도구의 개발 및 평가

  • Han, Jin-Soon (Department of Food and Nutrition, Sungshin Women's University) ;
  • Lee, Song-Mi (Nutrition Team, Gangnam Severance Hospital) ;
  • Chung, Hye-Kyung (Nutrition Team, Gangnam Severance Hospital) ;
  • Ahn, Hong-Seok (Department of Food and Nutrition, Sungshin Women's University) ;
  • Lee, Seung-Min (Department of Food and Nutrition, Sungshin Women's University)
  • 한진순 (성신여자대학교 식품영양학과) ;
  • 이송미 (강남세브란스병원 영양팀) ;
  • 정혜경 (강남세브란스병원 영양팀) ;
  • 안홍석 (성신여자대학교 식품영양학과) ;
  • 이승민 (성신여자대학교 식품영양학과)
  • Published : 2009.03.31
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Abstract

Malnutrition of hospitalized patients can adversely affect clinical outcomes and cost. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those possess practical pitfalls of requiring much time and labor to administer and may not be highly applicable to a Korean population. This study sought to develop and evaluate a Nutrition Risk Screening Tool (NRST) which is simple and quick to administer and widely applicable to Korean hospitalized patients with various diseases. The study was also designed to generate a screening tool predictable of various clinical outcomes and to validate it against the Nutritional Risk Screening 2002 (NRS 2002). Electronic medical records of 424 patients hospitalized at a general hospital in Seoul during a 14-month period were abstracted for anthropometric, medical, biochemical, and clinical outcome variables. The study employed a 4-step process consisting of selecting NRST components, searching a scoring scheme, validating against a reference tool, and confirming clinical outcome predictability. NRST components were selected by stepwise multiple regression analysis of each clinical outcome (i.e., hospitalization period, complication, disease progress, and death) on several readily available patient characteristics. Age and serum levels of albumin, hematocrit (Hct), and total lymphocyte count (TLC) remained in the last model for any of 4 dependent variables were decided as NRST components. Odds ratios of malnutrition risk based on NRS 2002 according to levels of the selected components were utilized to frame a scoring scheme of NRST. A NRST score higher than 3.5 was set as a cut-off score for malnutrition risk based on sensitivity and specificity levels against NRS 2002. Lastly differences in clinical outcomes by patients' NRST results were examined. The results showed that the NRST can significantly predict the in-hospital clinical outcomes. It is concluded that the NRST can be useful to simply and quickly screen patients at high-nutritional risk in relation to prospective clinical outcomes.

이 연구는 다양한 병명을 가진 입원환자의 영양불량위험의 진단을 간단하고 신속하게 실시할 수 있고 재원기간 내의 임상결과를 유의하게 예측하며 NRS 2002와 비교하여 평가하였을 때 일정 수준 이상의 타당도를 가지는 영양불량 위험 검색도구를 (Nutritional Risk Screening Tool, NRST) 개발하고자 하였다. NRST의 개발 및 평가는 서울 소재 일개 종합병원에 1년여의 기간 동안 입원한 성인 환자를 대상으로 수집된 자료를 이용하여 NRST 구성요소의 선정, NRST scoring scheme의 탐색, NRST 평가의 기준점 설정, NRST의 임상결과 예측력 재확인 등의 총 4단계의 과정을 통하여 실시되었다. 아래에 본 연구의 결과 및 결론을 요약하였다. 1) 재원일수, 사망여부, 합병증 유무, 질병예후를 각각 종속변수로 하는 stepwise multiple regression을 시행한 결과 나이와 혈청 내 albumin, TLC, Hct 농도가 NRST의 구성요소로 선정되었다. 2) 선정된 각 NRST 구성요소의 수준에 따른 NRS 2002의 OR에 기준하여 NRST의 scoring scheme을 아래와 같이 설정하였다. $NRST=Albumin{\times}1+Age{\times}2.5+Hct{\times}1.5+TLC{\times}2{\ast}$ ${\ast}$ Coding:Albumin <3.5:1, ${\geqq}$ 3.5：0.Age>65:1, ${\leqq}$65:0.Hct<37:1, ${\geqq}$37：0.TLC<1800：1, ${\geqq}$1800：0. 3) NRST의 점수변화에 따른 NRS 2000에 대한 민감도와 특이도를 바탕으로 NRST에 의한 영양불량 위험의 진단 기준점수를 3.5 이상으로 정하였다. 4) NRST 결과에 따른 재원일수, 합병증여부, 질병 예후, 사망여부 등의 차이를 검토한 결과 개발된 NRST가 만족할 만한 수준의 임상결과 예측력을 가지는 것으로 나타났다. 5) NRST는 다양한 진단명을 가진 입원환자의 영양불량 위험 여부를 향후의 임상결과와 관련하여 신속하게 진단하는데 유용하리라 사료된다.

Keywords

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