The Comparison of Reliabilities of Nutritional Risk Scoring and Physiological Severity Score in Critical Care Patients

Öz

Objective: APACHE II is most commonly used severity prognostic model in ICU patients. Nutritional risk screening 2002 NRS-2002 score is widely suggested for screening of nutritional risk in general hospitalized patients. In this study, we aimed to compare the reliability of NRS-2002 with APACHE II on outcome in critical care patients.Material and Methods: Discrimination and calibration characteristics of the scoring systems were evaluated.Results: APACHE II on admission had moderate power of discrimination and calibration for mortality and complication prediction in critical care patients. On the other hand, NRS-2002 had insufficient discrimination statistics.Conclusion: APACHE II is superior in outcome prediction compared to NRS-2002 in ICU patient population

Anahtar Kelimeler

• APACHE II, NRS-2002, Mortality, Complication, Intensive care

Yoğun Bakım Hastalarında Nütrisyonel Risk Skorlaması ve Fizyolojik Ciddiyet Skorunun Güvenilirliklerinin Karşılaştırılması

Öz

Amaç: APACHE II yoğun bakım hastalarında en yaygın kullanılan hastalık ciddiyet skoru ve prognostik modeldir. Nütrisyonel risk tarama 2002 NRS-2002 skoru hastaneye yatan hastalarda nütrisyonel riskin belirlenmesi amacı ile kullanılmaktadır. Çalışmada yoğun bakım hastalarında NRS2002 ve APACHE II skorlarının mortalite ve komplikasyon öngörü güçlerinin ve güvenilirliğinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Skorlama sistemlerinin mortalite ve komplikasyon tahminindeki diskriminasyon ve kalibrasyon karakteristikleri değerlendirildi.Bulgular: Yatış sırasında hesaplanan APACHE II skoru yoğun bakım hastalarında mortalite ve komplikasyon tahmininde orta düzeyde diskriminasyon ve kalibrasyon kuvvetine sahiptir. Diğer taraftan NRS-2002 skoru yetersiz discrimination istatistikleri ortaya koymuştur.Sonuç: NRS-2002 ile karşılaştırıldığında APACHE II skorunun yoğun bakım hastalarında mortalite öngörü gücü daha yüksektir

Anahtar Kelimeler

• APACHE II, NRS-2002, Mortalite, Komplikasyon, Yoğun bakım

Kaynakça

1. Boyd O, Jackson N. How is risk defined in high-risk surgical patient management? Crit Care 2005;9:390-6.
2. Le Gall JR. The use of severity scores in the intensive care unit. Intensive Care Med 2005;31:1618-23.
3. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-9.
4. Reilly JJ Jr, Hull SF, Albert N, Waller A, Bringardener S. Economic impact of malnutrition: A model system for hospitalized patients. J Parenter Enteral Nutr 1988;12:371-6.
5. Kuzu MA, Terzioğlu H, Genç V, Erkek AB, Ozban M, Sonyürek P, Elhan AH, Torun N. Preoperative nutritional risk assessment in predicting postoperative outcome in patients undergoing major surgery. World J Surg 2006;30:378-90.
6. Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J, van Obberghen E, Hébuterne X. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 2004;92:105-11.
7. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-9.
8. Waitzberg DL, Saito H, Plank LD, Jamieson GG, Jagannath P, Hwang TL, Mijares JM, Bihari D. Postsurgical infections are reduced with specialized nutrition support. World J Surg 2006;30:1592-1604.

9. Xu J, Zhong Y, Jing D, Wu Z. Preoperative enteral immunonutrition improves postoperative outcome in patients with gastrointestinal cancer. World J Surg 2006; 30:1284-9.
10. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21.
11. Johansen N, Kondrup J, Plum LM, Bak L, Nİrregaard P, Bunch E, Baernthsen H, Andersen JR, Larsen IH, Martinsen A. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 2004;23:539-50.
12. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36.
13. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M; EuroOOPS Study Group. EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008;27:340-9.
14. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29-36.
15. Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982;115:92-106.
16. den Boer S, de Keizer NF, de Jonge E. Performance of prognostic models in critically ill cancer patients - a review. Crit Care 2005;9:R458-63.
17. Rutledge R, Fakhry S, Rutherford E, Muakkassa F, Meyer A. Comparison of APACHE II, Trauma Score, and Injury Severity Score as predictors of outcome in critically injured trauma patients. Am J Surg 1993;166:244-7.
18. Altomare DF, Serio G, Pannarale OC, Lupo L, Palasciano N, Memeo V, Rubino M. Prediction of mortality by logistic regression analysis in patients with postoperative enterocutaneous fistulae. Br J Surg 1990;77:450-3.
19. Koperna T, Semmler D, Marian F. Risk stratification in emergency surgical patients: Is the APACHE II score a reliable marker of physiological impairment? Arch Surg 2001;136:55-9.
20. Grant CA, Dempsey GA, Lowe D, Brown JS, Vaughan ED, Rogers SN. APACHE II scoring for the prediction of immediate surgical complications in head and neck cancer patients. Plast. Reconstr. Surg 2007;119:1751-8.
21. Goffi L, Saba V, Ghiselli R, Necozione S, Mattei A, Carle F. Preoperative APACHE II and ASA scores in patients having major general surgical operations: prognostic value and potential clinical applications. Eur J Surg 1999;165:730-5.
22. Schiesser M, Müller S, Kirchhoff P, Breitenstein S, Schäfer M, Clavien PA. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr 2008;27:565-70.
23. Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: A population study. Clin Nutr 2006;25:409-17.
24. Köseoğlu Z, Özdoğan M, Kuvvetli A, Kösenli Ö, Oruç C, Önel S, Daş K, Akova A. Increased nutritional risk in major trauma: Correlation with complications and prolonged length of stay. Ulus Travma Acil Cerrahi Derg 2011;17:521-4.
25. Özdoğan M, Gündoğdu RH, Karateke F, Ersoy E, Menekşe E, Özdoğan, HK, Devay AÖ, Kuvvetli A. Reliability of different predictive systems in Major gastrointestinal surgical patients. Gaziantep Med J 2015;21:21-5.