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Risk score predicts need for nutrition support after cardiac surgery
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Researchers have developed a risk score that predicts which patients are at most risk of needing nutrition support after cardiac surgery.
“Malnutrition resulting from inadequate caloric intake during the postoperative period is associated with high morbidity and mortality,” Glenn J. R. Whitman, MD, director of cardiovascular surgical intensive care unit/adult heart transplant at Johns Hopkins Hospital, and colleagues wrote. “Previous studies suggest that earlier initiation of nutrition supplementation may improve malnutrition-related morbidity and mortality. Conceptually, then, the ability to reliably identify patients who may need nutrition supplementation, either enteral or parenteral, may enable caregivers to improve time to initiation.”
Whitman and colleagues developed the Johns Hopkins Hospital Nutrition Support (JHH NS) scoring system by identifying 87 of 1,056 (8%) adult cardiac surgery patients at the institution in 2012 who required postoperative nutrition support. To create the score, they used relative odds ratios generated by independent variables, including previous cardiac intervention, total serum albumin less than 4 g/dL, total serum bilirubin of at least 1.2 mg/dL, at least 11,000 white blood cells/µL, hematocrit level less than 27%, urgent or emergent operative status, and cardiopulmonary bypass time of at least 100 minutes.
The JHH NS scores range from 0 to 36, with each 1-point increase being associated with a 20% greater risk for requiring nutrition support.
The researchers tested their predictive score on 1,336 patients who underwent cardiac surgery in 2015. Of the participants, 8.6% (n = 115) required nutrition support. The JHH NS score showed significant prediction reliability (r = 0.89).
“The JHH NS score is an easily calculable risk score that reliably identified patients with specific preoperative and intraoperative characteristics that were associated with an increased risk for the need for [nutrition support] after cardiac surgery,” the researchers wrote. “Our internal validation with a contemporaneous cohort of cardiac surgery patients reaffirmed that his novel risk score may be applied, with excellent results, to a cardiac surgery population undergoing a variety of operations. Most importantly, this risk score can be applied to patients immediately on arrival to the cardiac surgery [ICI], allowing providers to stratify patients into risk groups to determine the likelihood of requiring nutritional support during the postoperative course.” – by Cassie Homer
Disclosure: The researchers report no relevant financial disclosures.
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