NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation

Haematopoietic stem cell transplantation (HSCT) is a treatment option for many haematological conditions in patients of all ages. Nutritional support is important at each stage of treatment, but particular nutritional needs and dictated support occur during the preparatory (conditioning regimen) and post-transplant periods. Patients may require nutritional treatment by the enteral or parenteral route. The quantitative and qualitative composition of meals may change. Vitamin requirements, including vitamin D and vitamin C, might also be different. An adequately composed diet, adapted to the needs of the patient, may influence the occurrence of complications such as graft-versus-host disease (GvHD), gastrointestinal disorders, infections, and reduced survival time. Haematological diseases as well as transplantation can negatively affect the intestinal flora, with negative consequences in the form of mucosal inflammation and disorders of a functional nature. Currently, aspects related to nutrition are crucial in the care of patients after HSCT, and numerous studies, including randomized trials on these aspects, are being conducted. This study serves the critical analysis of current scientific evidence regarding nutritional support for patients after HSCT.

Nutritional problems and their non-pharmacological treatment in adults undergoing haematopoietic stem cell transplantation-A systematic review

Objective

This systematic review aimed to identify the most relevant problems related to malnutrition in adult patients undergoing haematopoietic stem cell transplantation (HSCT) and to identify non‐pharmacological interventions to treat these problems.

Methods

A systematic search for each research question was performed in MEDLINE, CINAHL, Embase, the Cochrane Library, Google Scholar and reference lists in the period 2009–2019.

Results

Six and nine studies were included respectively. Quantitative pooling of data was not possible due to the heterogeneity of the studies. Oral mucositis (OM), nausea/vomiting, diarrhoea and dysgeusia were the most frequently reported nutritional problems. Cryotherapy and laser therapy seem to be effective in the prevention and treatment of OM. Recommendations for or against the use of mouth rinses and light therapy in the treatment of OM cannot be made, as too few studies have been conducted in this area. The evidence for non‐pharmacological treatment options in the case of nausea/vomiting and diarrhoea is rather limited. No study was identified with regard to treatment of dysgeusia.

Conclusion

Nutrition in HSCT patients has not yet been studied to a satisfactory extent. There is an urgent need for high‐quality studies to be conducted in this area to optimise the care of patients undergoing haematopoietic stem cell transplantation.

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

INTRODUCTION

Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors.

METHODS

A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status.

RESULTS

PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition.

CONCLUSION

Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.

Refeeding syndrome in hematological cancer patients - current approach

Introduction: According to estimates based on the GLOBOCAN database of the International Agency for Research on Cancer, in 2018 alone, 18 100 000 cancers were globally diagnosed. Importantly, the majority of cancer patients experience unintended weight loss that leads to many adverse clinical consequences, including malnutrition and cancer cachexia. At the same time, each nutritional intervention must be carried out individually, as it can lead to critical complications, resulting in a threat to the health and life of the cachectic patient. An example of this type of risk is refeeding syndrome.Areas covered: Three factors seem to be crucial in this case: early identification of patients at risk of malnutrition, the introduction of an individualized diet regimen and constant monitoring of nutritional intervention. It seems equally important to spread awareness about the possibility of refeeding syndrome and knowledge about its patomechanisms and consequences among medical staff. This should lead to minimizing the risk of refeeding syndrome.Expert opinion: It should be noted that current guidelines on the pathogenesis, risk factors and methods of prevention and treatment of refeeding syndrome require further modifications, that would harmonize the management regimen in both prevention and therapy of refeeding syndrome.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults

The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.

Patient-generated subjective global assessment versus nutritional risk screening 2002 for gastric cancer in Chinese patients

Aim: Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS2002) are used to evaluate patients' nutritional status. Materials & methods: The data of 114 gastric cancer patients with pyloric obstruction treated between July 2016 and July 2017 were assessed retrospectively. Results: Based on clinical evaluation, 70.1% had malnutrition, with 61.4% at nutritional risk by NRS2002 and 66.7% by PG-SGA. The area under the receiver operating characteristic curve was 0.858 for PG-SGA and 0.706 for NRS2002. Sensitivity and specificity were 89 and 85% for PG-SGA and 78 and 76% for NRS2002. In both assessments, patients at risk showed more postoperative complications. Conclusion: PG-SGA was more suitable for evaluating the preoperative nutritional status of gastric cancer patients with pyloric obstruction, with higher diagnostic efficacy.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods

OBJECTIVES

Due to their increased energy expenditure, chronic obstructive pulmonary disease (COPD) patients with respiratory failure are susceptible to malnutrition. This study aimed to compare the predictive values of the following three widely used nutritional assessment methods for the clinical prognosis of COPD patients with respiratory failure: body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and serum albumin (ALB) level.

METHODS

COPD patients with respiratory failure treated in our center from June 2013 to June 2016 were retrospectively included. Patient BMI, NRS 2002 and ALB values were measured to assess their nutritional status. A multivariable analysis was conducted, and receiver operating characteristic (ROC) curves were generated to explore the predictive factors for clinical prognoses.

RESULTS

A total of 438 qualified patients were enrolled in our study. Multivariable analysis revealed that the BMI and ALB values independently predicted in-hospital mortality, the BMI and NRS 2002 predicted 1-year mortality, and all three methods (BMI, NRS 2002, and ALB) predicted 30-day readmission after discharge (P < 0.05). Regarding the results of the AUROC analysis, the optimal cutoff values that maximized the ability to predict the prognosis were an ALB level of 30.5 g/L for in-hospital mortality, an NRS 2002 score of 3 points for 1-year mortality, and an ALB level of 30.1 g/L for readmission within 30 days following discharge.

CONCLUSIONS

For COPD patients with respiratory failure, ALB level was superior for predicting in-hospital mortality and 30-day readmission after discharge, and NRS 2002 was superior for long-term prognosis of 1-year mortality.

Incidence and risk factors of incontinence-associated dermatitis among patients in the intensive care unit

OBJECTIVE

To investigate the incidence of incontinence-associated dermatitis (IAD) among patients in the intensive care unit (ICU) and to identify potential risk factors to establish a reference for clinical nursing work.

BACKGROUND

Patients in the ICU are susceptible to IAD. IAD is painful, reduces the patient's quality of life and adds to the workload of clinical medical staff. However, risk factors associated with IAD may differ between countries and healthcare settings.

DESIGN

Prospective cohort study METHODS: From November 2016 to November 2017, a prospective cohort study was conducted among109 patients in three Class 3, Grade A hospitals (comprising 9 ICUs in total) in Beijing. The Incontinence-associated Dermatitis and Its Severity (IADS) instrument in Chinese was applied to assess IAD. Univariate and multivariate logistic regression analyses were performed to identify risk factors for IAD.

RESULTS

The study population had 29 community-acquired and 80 nosocomial infections, and 26 (incidence: 23.9%) of these had IAD. On univariate analysis, a significant difference was observed between patients with and without IAD with respect to the following indices: Barthel index, Braden scale score, Nutritional Risk Screening 2002 (NRS2002) score, serum albumin level, occurrence of infection, faecal incontinence, frequency of faecal incontinence, stool property and double (faecal and urinary) incontinence and perineal assessment tool (PAT) score (p < 0.05). Multivariate logistic regression analysis showed that three factors entered the regression equation-that is, the Braden Scale Score, serum albumin level and double incontinence. Of these, the Braden Scale Score and serum albumin level were protective factors for IAD. Thus, the higher the Braden Scale Score, the lower the risk of IAD (OR = 0.678, 95% confidence interval [CI] = 0.494-0.931); a higher level of serum albumin implies a lower risk of IAD, provided it is within the normal range (OR = 0.884, 95%CI = 0.797-0.981). Double incontinence was an independent risk factor for IAD (OR = 10.512, 95% CI = 2.492-44.342).

CONCLUSION

A higher morbidity of IAD is seen in the ICU. Specific preventive and nursing measures are required to maintain the skin integrity of critically ill patients in daily nursing practice to improve patient quality of life and the quality of nursing care.

RELEVANCE TO CLINICAL PRACTICE

Incontinence-associated dermatitis is characterised by inflammation and tissue damage due to prolonged/repeated exposure to urine and/or stool. Not every patient with urine and/or stool incontinence develops IAD. Medical staff can use research-based evidence to identify ICU patients at risk of IAD to reduce morbidity and improve health outcomes.

Impact Exerted by Nutritional Risk Screening on Clinical Outcome of Patients with Esophageal Cancer

Objective

Preoperative nutritional status of patients is closely associated with their recovery after the surgery. This study aims to ascertain the impact exerted by the nutritional risk screening on clinical outcome of patients with esophageal cancer.

Methods

160 patients with esophageal cancer aged over 60, having got therapy at the First Hospital of Jilin University from Jun 2016 to Feb 2017 were evaluated by adopting the NRS2002. 80 cases of patients got active therapy of nutritional support, and the other patients not supported nutritionally were selected as the control group. The comparison was drawn between two groups in serum albumin, serum immunoglobulin, postoperative complications, hospitalization, and hospitalization expenses.

Results

For all the patients, in 3 and 7 days after the surgery, the serum albumin in the nutritionally supported group outstripped that in group without nutritional support (P < 0.05) regardless of the nutritional risk. For the patients in the risk of nutrition, the IgA in the nutritionally supported group outstripped that of group without nutritional support (P < 0.05) in 3 and 7 days before the surgery, and the serum IgG outstripped that of the group without nutritional support in 1 and 3 days before the surgery (P < 0.05). In terms of the patients in the risk of nutrition, the average hospitalization of nutritionally supported group was shorter (P < 0.05), and the average hospitalization expenses were lower compared with those of the group without nutritional support. And for the patients in no risk, the hospitalization expenses of supported group surmounted those of group without nutritional support (P < 0.05), whereas the average hospitalization took on no statistic difference (P > 0.05).

Conclusion

For the patients in the risk of nutrition, preoperative nutritional support can facilitate the nutritional status and immunization-relative result after surgery, which shall also decrease the average hospitalization and hospitalization cost.

Nutritional status and hyperglycemia in the peritransplant period: a review of associations with parenteral nutrition and clinical outcomes

Hematopoietic stem cell transplantation is an established treatment option for various hematological diseases. This therapy involves complex procedures and is associated with several systemic complications. Due to the toxic effects of the conditioning regimen used in allogeneic transplantations, patients frequently suffer from severe gastrointestinal complications and are unable to feed themselves properly. This complex clinical scenario often requires specialized nutritional support, and despite the increasing number of studies available, many questions remain regarding the best way to feed these patients. Parenteral nutrition has been traditionally indicated when the effects on gastrointestinal mucosa are significant; however, the true benefits of this type of nutrition in reducing clinical complications have been questioned. Hyperglycemia is a common consequence of parenteral nutrition that seems to be correlated to poor transplantation outcomes and a higher risk of infections. Additionally, nutrition-related pre-transplantation risk factors are being studied, such as impaired nutritional status, poorly controlled diabetes mellitus and obesity. This review aims to discuss some of these recent issues. A real case of allogeneic transplant was used to illustrate the scenario and to highlight the most important topics that motivated this literature review.

A multidisciplinary team approach for nutritional interventions conducted by specialist nurses in patients with advanced colorectal cancer undergoing chemotherapy: A clinical trial

BACKGROUND & AIMS

Nutritional interventions for malnutrition in cancer patients can be helpful. However, concise intervention recommendations remain controversial. Thus, the aim of this study was to report on a nutrition intervention conducted by a multidisciplinary team of specialist nurses and to explore the effect of nutritional intervention on cancer patients.

METHODS

This prospective clinical trial study enrolled 110 colorectal cancer patients undergoing chemotherapy. The patients were evaluated upon admission using the 2002 Nutritional Risk Screening system (NRS-2002). The patients were randomly divided into intervention and control groups including 55 patients each. Patients in the control group were administered a normal diet, while those in the intervention group received individual recipes developed by a team of professional nurses, clinical doctors, dietitian, family caregivers, and the patients themselves. Patient weight and serum albumin and prealbumin levels were compared between the 2 groups at different time points.

RESULTS

There was a significant difference in patient weight and serum albumin and prealbumin levels before and after nutrition intervention in the intervention group (P < .05). In the control group, weight did not change during ordinary diet guidance. Serum albumin level was slightly improved after 12 cycles of chemotherapy, similar to the prealbumin results. There were statistically significant differences in serum albumin and prealbumin levels between the intervention and control groups after nutrition intervention (P < .05). However, there was no statistically significant difference in weight between the groups after nutrition intervention (P > .05).

CONCLUSION

A multidisciplinary team approach for nutrition intervention conducted by specialist nurses improved prealbumin levels in colorectal cancer patients undergoing chemotherapy, with no weight change.

Nutritional Risk Screening 2002 as a Predictor of Outcome During General Ward-Based Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease with Respiratory Failure

BACKGROUND Noninvasive ventilation (NIV) may reduce the need for intubation and mortality associated with chronic obstructive pulmonary disease (COPD) with type II respiratory failure. Early and simple predictors of NIV outcome could improve clinical management. This study aimed to assess whether nutritional risk screening 2002 (NRS2002) is a useful outcome predictor in COPD patients with type II respiratory failure treated by noninvasive positive pressure ventilation (NIPPV). MATERIAL AND METHODS This prospective observational study enrolled COPD patients with type II respiratory failure who accepted NIPPV. Patients were submitted to NRS2002 evaluation upon admission. Biochemical tests were performed the next day and blood gas analysis was carried out prior to NIPPV treatment and 4 hours thereafter. Patients were divided into NRS2002 score ≥3 and NRS2002 score <3 groups and NIV failure rates were compared between both groups. RESULTS Of the 233 patients, 71 (30.5%) were not successfully treated by NIPPV. The failure rate was significantly higher in the NRS2002 score ≥3 group (35.23%) in comparison with patients with NRS2002 score <3 (15.79%) (p<0.05). Multivariate analysis indicated that PaCO2 (OR 1.25, 95%CI 1.172-1.671, p<0.05) prior to NIPPV treatment and NRS2002 score ≥3 (OR 1.76, 95%CI 1.303-2.374, p<0.05) were independent predictive factors for NIPPV treatment failure. CONCLUSIONS NRS2002 score ≥3 and PaCO2 values at admission may predict unsuccessful NIPPV treatment of COPD patients with type II respiratory failure and help to adjust therapeutic strategies. NRS2002 is a noninvasive and simple method for predicting NIPPV treatment outcome.