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PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 29 | POJ_0023.html) Issue July 2016 - December 2016: 134-136

Preliminary Report / Short Communication

The prognostic capacity of the Nutrition Risk Score and SGA grade of the PhilSPEN modified SGA (Subjective Global Assessment) on mortality outcomes – An Initial Report

Abstract | Introduction | Methodology | Results | Observations | Conclusion | References | PDF () |Back to Articles Page

Submitted October 11, 2016 | Posted October 16, 2016

Author: Joyce Bernardino, M.D.

Institution where research was conducted:

  1. Clinical Nutrition Fellowship Training Program, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, Metro Manila, Philippines 1102
  2. Clinical Nutrition Service, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, Metro Manila, Philippines 1102

 

ABSTRACT: | Back

Background: The modified SGA nutritional assessment form designed by PhilSPEN (Philippine Society of Parenteral and Enteral Nutrition) has been in use in the clinical nutrition process for the past ten years. There is a need to know if its SGA grading and Nutrition Risk Scores are able to make prognostic assessment on the patient's outcome of mortality.

Objectives: The aim of this study is to correlate the SGA grade and Nutrition Risk Score with mortality outcomes and to establish the capacity of this tool to predict odds of mortality.

Methodology: The nutritional assessment tool (PhilSPEN modified SGA ) has been described elsewhere and validated (5). It is now the standard nutritional assessment tool of the institution. The data collected are the SGA grade and nutrition risk score of the patient and the patient outcome on discharge whether dead or alive.

Results: Total subjects=72

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Observations:

  • This study showed the ability of the PhilSPEN modified SGA to predict mortality at 22% when the nutrition risk score is from 4 to 6 and 31% when the nutrition risk score is at 7 to 9.
  • When the nutrition risk score is less than five (<5) the odds of mortality is 0.08 (very low), however, when score of nutrition risk is above five (>5), the odds of mortality is 11.9 (very high)
  • This study further strengthens the value of the PhilSPEN modified SGA as a nutritional assessment tool and a good prognostic tool for mortality.

KEYWORDS: Nutrition Risk Score, SGA, Mortality, Modified SGA form, nutritional assessment, PhilSPEN

 

INTRODUCTION | Back

Nutrition assessment identifies the level of nutrition risk in patients and classifies them as mild, moderate to severe risk of malnutrition and developing malnutrition related complications (1,2). This process defines the degree of urgency with which nutrition intervention should be delivered to the patient in order to correct or prevent complications and also identifies the patients who would most likely benefit from nutrition intervention. This helps to ensure the proper route and timing for nutrition therapy and to achieve favorable outcomes (3). Recent guidelines recommend that nutrition assessment be done in all patients admitted to the ICU for whom volitional intake is anticipated to be insufficient. High nutrition risk identifies those patients most likely to benefit from early enteral nutrition therapy (4)

At St. Luke’s Medical Center, a tertiary care hospital, patients are screened using the Nutrition Risk Screening 2002, and those identified to be at risk are referred to the Clinical Nutrition Services. The Modified Subjective Global Assessment, developed for use by the Philippine Society of Enteral and Parenteral Nutrition (PhilSPEN), is done to stratify the patient’s risk level. (5) The study by Lacuesta-Corro et al. showed that the modified SGA nutritional assessment form had a very good ability to determine nutritional status and risk level determination: Sensitivity - 94.7%, Specificity – 95.2%, Positive Predictive Value – 95.7%, Negative Predictive Value – 94.1%, Diagnostic Accuracy – 95%.  (6)

One of the components of the modified SGA form is the SGA grade and Nutrition Risk Score. The aim of this study is to correlate the SGA grade and Nutrition Risk Score with mortality outcomes and to establish the capacity of this tool to predict odds of mortality, if possible.

 

METHODOLOGY | Back

This study was conducted at the Clinical Nutrition Services of St. Luke’s Medical Center Quezon City, which is a tertiary care center.  Subjects include all adult patients (>18 years old) seen from Dec 2015 by the Clinical Nutrition Fellows on admission. The nutritional assessment tool has been described elsewhere and validated (5). It is now the standard nutritional assessment tool of the institution. The data collected are the nutrition risk score of the patient and the patient outcome on discharge whether dead or alive. The cases are mixed - medical and/or surgical and selected through a block randomized format.

Nutrition risk score is categorized as follows: Score of 1 to 3: Low Risk, Score of 4 to 6: Moderate Risk, and Score of 7 to 9: High Risk.

Since this was a retrospective study using available data already collected as part of routine patient care, ethical approval may not be required. The data is organized in Excel software, to be analyzed via NCSS software (7). The statistical measures to be taken are the mean, standard deviation, odd’s ratios and correlation analysis. Differences were considered statistically significant if p <0.05.

 

RESULTS | Back

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OBSERVATIONS: | Back

  • The first study on outcome using the PhilSPEN modified SGA in surgical patients showed mortality when the nutrition risk level of “High Risk” was made. (8)
  • Validation study by Lacuesta-Corro showed the modified SGA to have sensitivity of 94.7%, specificity of 95.2% and positive predictive value of 95.7% (5).
  • This current study showed the ability of the PhilSPEN modified SGA to predict mortality at 22% when the nutrition risk score is from 4 to 6 and 31% when the nutrition risk score is at 7 to 9.
  • When the nutrition risk score is less than five the odds of mortality is 0.08 (very low), however, when score of nutrition risk is above 5, the odds of mortality is 11.9 (very high)
  • This study further strengthens the value of the PhilSPEN modified SGA as a nutritional assessment tool and a good prognostic tool for mortality

 

REFERENCES: | Back

  1. Soeters, PB, Reijven PL et al. A rational approach to nutrition assessment. Clinical Nutrition 2008; 27: 706-16.
  2. Mueller C, Compher C, American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) Board of Directors. A.S.P.E.N. Clinical Guidelines. Nutrition screening, assessment, and intervention in adults. J Parenter Enteral Nutr 2011; 35; 16-24.
  3. Seres DS. Nutrition Support for the Critically Ill. 2016. Humana Press.
  4. McClave SA et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient, Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr February 2016 40: 159-211.
  5. Lacuesta-Corro L and Llido LO.  The results of the validation process of a Modified SGA (Subjective Global Assessment) Nutrition Assessment and Risk Level Tool designed by the Clinical Nutrition Service of St. Luke’s Medical Center, a tertiary care hospital in the Philippines. PhilSPEN Online Journal of Parenteral and Enteral Nutrition; (Article 12 | POJ_0002.html) Issue February 2012 - December 2014: 1-7. Available at http://dpsys120991.com/POJ_0002.html. Accessed September 24, 2016.
  6. Dawson B, Trapp RG. Basic and clinical biostatistics, 3rd ed. Lange Medical Books/McGraw-Hill; 2001.
  7. NCSS Software. Available at https://www.ncss.com/software/ncss/
  8. Ocampo et al. Predicting Post-operative Complications Based on Surgical Nutritional Risk Level using the SNRAF in Colon Cancer Patients: A Chinese General Hospital & Medical Center Experience. . PhilSPEN Online Journal of Parenteral and Enteral Nutrition; (Article 7 | POJ_0012.html) Issue January 2010 - January 2012: 55-66. Accessed September 24, 2016. Available at http://dpsys120991.com/POJ_0012.html

Abstract | Introduction | Methodology | Results | Observations | References | Back to Articles Page