Elsevier

Clinical Nutrition

Volume 27, Issue 3, June 2008, Pages 340-349
Clinical Nutrition

ORIGINAL ARTICLE
EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome

https://doi.org/10.1016/j.clnu.2008.03.012Get rights and content

Summary

Background & aims

The aim of the study was to implement nutritional risk screening (NRS-2002) and to assess the association between nutritional risk and clinical outcome.

Methods

NRS-2002 was implemented in 26 hospital departments (surgery, internal medicine, oncology, intensive care, gastroenterology and geriatrics) in Austria, the Czech Republic, Egypt, Germany, Hungary, Lebanon, Libya, Poland, Romania, Slovakia, Spain and Switzerland. Being a prospective cohort study, randomly selected adult patients were included at admission and followed during their hospitalisation. Data were collected on the nutritional risk screening, complications, mortality, length of stay and discharge. The correlation between risk status and clinical outcome was assessed and adjusted for confounders (age, speciality, diagnoses, comorbidity, surgery, cancer and region) by multivariate regression analysis.

Results

Of the 5051 study patients, 32.6% were defined as ‘at-risk’ by NRS-2002. ‘At-risk’ patients had more complications, higher mortality and longer lengths of stay than ‘not at-risk’ patients and these variables were significantly related to components of NRS-2002, also when adjusted for confounders.

Conclusions

Components of NRS-2002 are independent predictors of poor clinical outcome.

Introduction

Several studies have shown a prevalence of undernutrition of 20–50% among hospitalised patients.1, 2, 3, 4, 5 Undernutrition tends to worsen during the course of admission6, 7 and has been associated with increased morbidity and mortality, prolonged hospital stay and increased health care costs.8, 9 Hospital undernutrition can be treated, which leads to improved clinical outcome,9 but it tends to be underdiagnosed and inappropriately addressed.10, 11

Nutritional risk screening is an essential first step in the structured process of nutrition care12 for identifying patients that will likely benefit from nutrition therapy, but it is not routine in most European hospitals.11 The Committee of Ministers of the Council of Europe adopted a resolution on Food and Nutrition Care in Hospitals in November 2003.13 This resolution contains a number of recommendations that promote proper nutrition care practice starting with nutritional risk screening. The main objective of the present study was to implement nutritional risk screening (NRS-2002) in hospital departments in Europe and the Middle East. NRS-2002 is based on the outcome observed in controlled trials and identifies patients who are likely to benefit from nutritional support by an improved clinical outcome, i.e., they are at-risk of nutrition-related complications and/or other indices of worsened outcome if untreated.12, 14 It was chosen because it is endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN) for use in hospitals12 and validated by a literature analysis of 128 controlled clinical trials14 and a separate controlled clinical trial.15

The other objective of this study was to demonstrate the association between nutritional risk and clinical outcome. Earlier prospective studies have shown that undernutrition is an independent predictor of nosocomial infections16 and complications.5 The present study is much larger than these earlier studies, including more than 5000 patients. This allows for adjustment for a large number of potentially confounding variables, adding specificity to the association between nutritional risk screening and clinical outcome. In addition, being a multicentre, multinational and multiregional study, the results are more generally applicable than results from a single centre.

Section snippets

Study group

Of the 26 participating hospital departments, 21 were originally recruited by the sponsor, Fresenius-Kabi, since they were interested in implementing nutrition screening, but had limited experience in this and nutrition care. The remaining five departments were recruited later amongst acquaintances of the study coordinators (J.K. and J.S.) with the intention of increasing representation from Western Europe.

The departments (surgery, internal medicine, oncology, intensive care, gastroenterology

Pre-study questionnaire and inter-rater reliability

The pre-study questionnaire on nutrition care practice was completed by 25 of the 26 departments and revealed that: 28% had an interdisciplinary nutrition support team (i.e., comprising of physicians, nurses, dietitians and pharmacists), 16% routinely performed nutrition screening or assessment for all patients at admission and 68% monitored nutrition status and intake during the admission with 24% monitoring intake daily.

Of the 30 physicians that trained in screening with NRS-2002 at the

Discussion

This multicentre collaboration from 12 countries in Europe and the Middle East allowed for the analysis of 5051 patients, making this study the largest of its kind to relate nutritional risk to clinical outcome. Despite the diversity in speciality, country and clinical nutrition practice of the departments involved in the present study, the implementation of nutritional risk screening at admission was successful since 92.8% of patients were screened within 36 h after admission.

This study confers

Conflict of interest statement

There is no financial conflict of interest for any of the authors.

Acknowledgements

This study was supported by funding from Fresenius-Kabi. Fresenius-Kabi assisted in recruitment of the participating hospital departments, but had no role in development of the study design, data collection, statistical analysis, interpretation of the results, writing of the manuscript or the decision to submit the manuscript for publication. Most members of the EuroOOPS study group and all of the authors contributed to the study design, data analysis and writing of the manuscript. J.P., M.S.,

References (26)

Cited by (0)

Presented at the 27th ESPEN Congress, Brussels, Belgium, 2005.

g

OOPS is a phonetically spelt Danish acronym for Undernutrition in Hospitals.

h

The EuroOOPS study group in addition included: Julia Álvarez, Hospital Principe de Asturias, Madrid, Spain; Lajos Bogar, Department of Anaesthesia and Intensive Care, University of Pécs, Pécs, Hungary; Pierre Bou-Khalil, American University Hospital, Beirut, Lebanon; Thomas Frühwald, Abteilung für Akutgeriatrie des Krankenhauses Lainz im Geriatriezentrum am Wienerwald, Wien, Austria; Sabine Gabor, Uni-Klinik Graz, Graz, Austria; Pilar Garcia-Peris, Hospital Gregorio Marañon; Madrid, Spain; Irina Isacu, Oncological Institute Bucharest, Bucharest, Romania; Abdul Azis Ali Ismaeel, Tripoli Medical Center, Tripoli, Libya; Mohamed Abdel Khalek, Ain Shams University Specialized Hospital, Cairo, Egypt; Martin Kliment, Roosevelt Hospital, Banska Bystrica, Slovakia; Miguel León Sanz, Hospital Universitario 12 de Octubre, Madrid, Spain; Frantisek Novak, Vseobecna Fakultni Nemocnice, IV.Interni Klinika Jip, Praha, Czech Republic; Johann Ockenga, Charité, Campus Mitte Universitätsmedizin, Berlin, Germany; Atef Radwan, Zagazig University Hospital, Zagazig, Egypt; Peter Rittler, Klinikum Grosshadern, Klinikum der Ludwig-Maximilians-Universität, München, Germany; Robert Schnabel, Nyírõ Gyula Hospital, Budapest, Hungary; Abdul Shaban and Ismail Siala, Tripoli Medical Center, Tripoli, Libya; Cornel Sieber, Klinikum Nürnberg Nord, Nürnberg, Germany; Mohammed A. Sultan, Mansura University Emergency Hospital, Mansura, Egypt; Patricia Yazbeck, Hotel Dieu Hosp.: Saint Joseph's French University Hospital, Beirut, Lebanon.

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