İNCİ TÜRKOĞLU, FATMA ILGAZ, TUBA YALÇIN, ARMAĞAN AYTUĞ YÜRÜK, Ayşegül AKSAN, Aylin ÇERÇİ, HÜLYA GÖKMEN ÖZEL, EMİNE YILDIZ, FATMA GÜLHAN SAMUR

Hastanede Yatan Yetişkin Hastalarda Malnütrisyon Prevelansı: Dört Farklı Beslenme Tarama Aracının Karşılaştırılması

Amaç: Hastanede yatan hastalarda malnütrisyon görülme oranı yüksektir. Bugüne kadar birçok nütrisyonel tarama aracı geliştirilmiş olmasına rağmen nütrisyonel riskin tanımlanması için altın standart olduğu düşünülen bir tarama aracı bulunmamaktadır. Bu çalışma dört farklı tarama aracı kullanılarak hastanede yatan hastalarda malnütrisyon riskinin değerlendirilmesi amacıyla planlanmıştır. Bireyler ve Yöntem: Bu çalışmanın örneklemini Hacettepe Üniversitesi Erişkin Hastanesinde yatan 200 hasta oluşturmaktadır. Hastanede yatan hastalara malnütrisyon riskini değerlendirmek amacıyla Malnütrisyon Tarama Aracı (Malnutrition Screening Tool, MST), Nütrisyonel Risk Taraması-2002 (Nutritional Risk Screening 2002, NRS-2002), Kısa Nütrisyonel Değerlendirme Anketi (Short Nutritional Assessment Questionnaire, SNAQ) ve Malnütrisyon Evrensel Tarama Aracı (Malnutrition Universal Screening Tool, MUST) olmak üzere dört farklı tarama aracı kullanılmıştır. Duyarlılık ve seçiciliğin değerlendirilmesi için NRS-2002 altın standart olarak seçilmiştir. Tarama araçları arasındaki uyum χ (kappa) istatistiği kullanılarak saptanmıştır. İyi bir beslenme aracı için ön koşul duyarlılığın ≥%80 ve seçiciliğin ≥%60 olarak tanımlanmıştır. Her bir ROC eğrisi için eğrinin altında kalan alana (AUC) ilişkin değerin 0.70-0.80 olması durumunda kabul edilebilir şeklinde yorumlanmıştır. Bulgular: Çalışmaya katılan hastaların (%52 erkek) yaş ortalaması 49.2±16.1 yıldır. NRS-2002, MST, MUST ve SNAQe göre malnütrisyon riski altında olan hastaların oranları sırasıyla %26, %31, %28 ve %29.5 olarak saptanmıştır. Dört tarama aracı arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p>0.05). Hasta örnekleminde araçlar arası uyumun orta düzeyde olduğu saptanmıştır (MST-NRS-2002 χ= 0.448, MUST-NRS-2002 χ= 0.463, SNAQ-NRS-2002 χ= 0.434). NRS-2002 ile karşılaştırıldığında her üç tarama aracının duyarlılıklarının düşük, seçiciliklerinin yüksek olduğu belirlenmiştir (sırasıyla MST %68 ve %80.2, MUST %64 ve %83.8, SNAQ %64 ve %81.7). Tartışma: Bu çalışma tüm tarama araçlarının malnütrisyon riskini tanımlamada kabul edilebilir olduğunu ve hastanede yatan erişkin hastalarda kullanımının önerilebileceğini göstermiştir. Tüm araçların performanslarının birbirine yakın olması nedeniyle malnütrisyon riski altındaki hastaların saptanabilmesi için MST ve SNAQ gibi hızlı ve kolay tarama araçları da tercih edilebilir.

Prevalence of Malnutrition in Hospitalized Adult Patients: A Comparison of Four Nutritional Screening Tools

Aim: The prevalence of hospital malnutrition is high. Although several nutritional screening tools have been developed, none of them is considered as a gold standard for identifying nutritional risk. The aim of the present study was to evaluate malnutrition risk in hospitalized patients by using four nutritional screening tools. Subjects and Methods: The sample of this study was 200 hospitalized adult patients who admitted to Hacettepe University Adult Hospital. Four commonly used screening tools were administered to the hospitalized adult patients to assess malnutrition risk; such as, Malnutrition Screening Tool (MST), Nutritional Risk Screening 2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ) and Malnutrition Universal Screening Tool (MUST). NRS-2002 was considered as gold standard for evaluation of the sensitivity and specificity of tools. The agreement between tools was determined by χ(kappa) statistics. A sensitivity of ≥80% and specificity of ≥60% were set as precondition for good performance and area under the curve (AUC) values between 0.70-0.80 were interpreted as acceptable for each ROC curve. Results: The mean age of the patients was 49.2±16.1 years (52% men). The prevalence of patients at nutritional risk with the NRS-2002, MST, MUST and SNAQ was 26%, 31%, 28% and 29.5%, respectively. Statistically significant differences were not found between four nutritional screening tools (p>0.05). In this sample of 200 patients the agreement between the tools was moderate (MST-NRS-2002 χ= 0.448, MUST-NRS-2002 χ= 0.463, SNAQ-NRS-2002 χ= 0.434). All screening tools showed higher specificity than sensitivity compared to NRS-2002 (MST 68% and 80.2%; MUST 64% and 83.8%; SNAQ 64% and 81.7%, respectively).Conclusion: This study showed that all screening tools were acceptable to define malnutrition and can be suggested for use in hospitalized adult patients. Since the performance of all tools was similar, easy-to-use screening tools such as MST and SNAQ may be chosen for identification of patients at malnutrition risk.

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