栄養学ジャーナル

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Nutrition risk in hospitalized patients with acute exacerbation of COPD: a comparative analysis of the nutritional screening tools accuracy

Veronnike Hossa Kowalski1 , Simone Bernardes2 *, Paula Portal Teixeira3 , Kamila Valduga4 , Bruna Espíndola de Araújo5 and Flávia Moraes Silva6

Background: Around half of chronic obstructive pulmonary disease (COPD) patients present nutritional risk when evaluated by Nutritional Risk Screening 2002 (NRS-2002) in the majority of studies. However, the performance of other nutritional screening tools has not been explored in the detail according to the literature. This study aimed to compare the concurrent validity of four nutritional risk screening tools in hospitalized patients with acute exacerbation of COPD.

Methods: A cross-sectional study with patients admitted for exacerbation of COPD. Nutritional risk screening was performed in the first 72 hours of hospitalization by NRS-2002 (reference method), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutritional Risk in Emergency 2017 (NRE-2017), and Short Nutritional Assessment Questionnaire (SNAQ).

Results: We evaluated 241 patients (68.3 ± 10.2 years, 53.5% women), and the prevalence of nutritional risk ranged from 36.1 to 54.8%. MST, MUST, and SNAQ showed similar accuracy (AUC ROC >0.790), and were significantly higher than the NRE-2017 (AUC=0.742) when compared to the NRS-2002. The MST showed substantial agreement with the NRS-2002, while the other tools demonstrated moderate agreement (Kappa<0.600).

Conclusion: More than 35% of patients hospitalized for exacerbation of COPD presented a nutritional risk. The use of the MST is suggested for nutritional screening in this population due to its accuracy and sensitivity consistent with NRS-2002 screening tool in addition to it being simple, fast, and with easy applicability.