目的:探讨基于年龄、体质指数、进食情况、体重减少情况的营养风险评估工具(Assessment of Nutritional Risk based on BodyMass Index,Intake and Weight loss,AIWW)和营养风险筛查2002(NRS2002)用于胃癌住院病人营养风险筛查的效果,...目的:探讨基于年龄、体质指数、进食情况、体重减少情况的营养风险评估工具(Assessment of Nutritional Risk based on BodyMass Index,Intake and Weight loss,AIWW)和营养风险筛查2002(NRS2002)用于胃癌住院病人营养风险筛查的效果,分析其在胃癌病人中的适用性。方法:采用便利抽样法,选取2023年10月—2024年4月在广西某三级甲等肿瘤医院胃及腹部肿瘤病区就诊的376例胃癌病人,于病人入院后24 h内用AIWW和NRS2002进行营养筛查,以改良版病人主观整体评估(MPG-SGA)评估结果为营养不良的诊断标准,计算AIWW和NRS2002的灵敏度、特异度、阳性预测值和阴性预测值、阳性似然比和阴性似然比、Kappa值以及受试者特征(ROC)曲线和曲线下面积。结果:共纳入376例胃癌病人,以MPG-SGA为诊断标准,254例(67.6%)病人出现营养不良;使用AIWW、NRS2002诊断胃癌病人营养不良风险分别为67.0%、34.8%。AIWW、NRS2002诊断营养不良的灵敏度分别为0.98,0.51,特异度分别为0.97,0.98;AIWW和NRS2002与MPG-SGA的Kappa一致性结果分别为0.928,0.389;ROC曲线下面积分别为0.982,0.788。结论:AIWW、NRS2002均能为胃癌病人营养不良风险筛查提供依据,且两种工具的一致性较好。诊断效能评价中,AIWW灵敏度较高,与MPG-SGA的一致性较好,且条目简单易于评估。因此,建议使用AIWW于胃癌病人的营养筛查。展开更多
Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-t...Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed.Based on the previous 25 nutrition-screening tools,the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category.According to these results,we built a nutrition-screening tool named age,intake,weight,and walking(AIWW).Malnutrition was defined based on the scored patient-generated subjective global assessment(PG-SGA).Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW,nutritional risk screening 2002(NRS-2002),and malnutrition screening tool(MST).Clinical benefit was calculated by the decision curve analysis(DCA),integrated discrimination improvement(IDI),and continuous net reclassification improvement(c NRI).A total of 11,360 patients(male,n=6,024(53.0%)were included in the final study cohort,and 6,363 patients had malnutrition based on PG-SGA.Based on AIWW,NRS-2002,and MST,7,545,3,469,and1,840 patients were at risk of malnutrition,respectively.The sensitivities of AIWW,NRS-2002,and MST risks were 0.910,0.531,and 0.285,and the specificities were 0.768,0.946,and 0.975.The Kendall tau coefficients of AIWW,NRS-2002,and MST risks were 0.588,0.501,and 0.326,respectively.The area under the curve of AIWW,NRS-2002,and MST risks were0.785,0.739,and 0.630,respectively.The IDI,c NRI,and DCA showed that AIWW is non-inferior to NRS-2002(IDI:0.002(-0.009,0.013),c NRI:-0.015(-0.049,0.020)).AIWW scores can also predict the survival of patients with cancer.The missed diagnosis rates of AIWW,NRS-2002,and MST were 0.09%,49.0%,and 73.2%,respectively.AIWW showed a better nutritionscreening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutritionscreening tool for this population.展开更多
文摘目的:探讨基于年龄、体质指数、进食情况、体重减少情况的营养风险评估工具(Assessment of Nutritional Risk based on BodyMass Index,Intake and Weight loss,AIWW)和营养风险筛查2002(NRS2002)用于胃癌住院病人营养风险筛查的效果,分析其在胃癌病人中的适用性。方法:采用便利抽样法,选取2023年10月—2024年4月在广西某三级甲等肿瘤医院胃及腹部肿瘤病区就诊的376例胃癌病人,于病人入院后24 h内用AIWW和NRS2002进行营养筛查,以改良版病人主观整体评估(MPG-SGA)评估结果为营养不良的诊断标准,计算AIWW和NRS2002的灵敏度、特异度、阳性预测值和阴性预测值、阳性似然比和阴性似然比、Kappa值以及受试者特征(ROC)曲线和曲线下面积。结果:共纳入376例胃癌病人,以MPG-SGA为诊断标准,254例(67.6%)病人出现营养不良;使用AIWW、NRS2002诊断胃癌病人营养不良风险分别为67.0%、34.8%。AIWW、NRS2002诊断营养不良的灵敏度分别为0.98,0.51,特异度分别为0.97,0.98;AIWW和NRS2002与MPG-SGA的Kappa一致性结果分别为0.928,0.389;ROC曲线下面积分别为0.982,0.788。结论:AIWW、NRS2002均能为胃癌病人营养不良风险筛查提供依据,且两种工具的一致性较好。诊断效能评价中,AIWW灵敏度较高,与MPG-SGA的一致性较好,且条目简单易于评估。因此,建议使用AIWW于胃癌病人的营养筛查。
基金supported by the Key Research and Development Program of Beijing Municipal Science and Technology Commission(D181100000218004)General Surgery Clinical Medical Center of Yunnan Province(ZX2019-03-03)the National Key Research and Development Program of China(2022YFC2009600)。
文摘Malnutrition is a common comorbidity among patients with cancer.However,no nutrition-screening tool has been recognized in this population.A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed.Based on the previous 25 nutrition-screening tools,the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category.According to these results,we built a nutrition-screening tool named age,intake,weight,and walking(AIWW).Malnutrition was defined based on the scored patient-generated subjective global assessment(PG-SGA).Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW,nutritional risk screening 2002(NRS-2002),and malnutrition screening tool(MST).Clinical benefit was calculated by the decision curve analysis(DCA),integrated discrimination improvement(IDI),and continuous net reclassification improvement(c NRI).A total of 11,360 patients(male,n=6,024(53.0%)were included in the final study cohort,and 6,363 patients had malnutrition based on PG-SGA.Based on AIWW,NRS-2002,and MST,7,545,3,469,and1,840 patients were at risk of malnutrition,respectively.The sensitivities of AIWW,NRS-2002,and MST risks were 0.910,0.531,and 0.285,and the specificities were 0.768,0.946,and 0.975.The Kendall tau coefficients of AIWW,NRS-2002,and MST risks were 0.588,0.501,and 0.326,respectively.The area under the curve of AIWW,NRS-2002,and MST risks were0.785,0.739,and 0.630,respectively.The IDI,c NRI,and DCA showed that AIWW is non-inferior to NRS-2002(IDI:0.002(-0.009,0.013),c NRI:-0.015(-0.049,0.020)).AIWW scores can also predict the survival of patients with cancer.The missed diagnosis rates of AIWW,NRS-2002,and MST were 0.09%,49.0%,and 73.2%,respectively.AIWW showed a better nutritionscreening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutritionscreening tool for this population.
