A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery

Rika E. Ohkuma, Todd C. Crawford, Patricia M. Brown, Joshua C. Grimm, J. Trent Magruder, Arman Kilic, Alejandro Suarez-Pierre, Sukyee Snyder, Justin D. Wood, Eric Schneider, Marc S. Sussman, Glenn J.R. Whitman

Research output: Contribution to journalArticle

Abstract

Background: In specific patients, early postoperative nutrition mitigates malnutrition-related morbidity and mortality. The goal of this study was to develop and validate a prediction score designed to stratify patients immediately after cardiac surgery according to risk for nutrition support (NS). Methods: We identified adult cardiac surgery patients at our institution in 2012 requiring postoperative NS, enteral or parenteral. Using multivariable logistic regression modeling, we developed a Johns Hopkins Hospital Nutrition Support (JHH NS) score from relative odds ratios generated by variables that independently predicted the need for NS. The JHH NS score was then prospectively validated using all patients undergoing cardiac surgery in 2015. Results: Among 1,056 patients in the derivation cohort, 87 (8%) required postoperative NS. Seven variables were identified on multivariable analysis as independent predictors of NS need and were used to create the JHH NS score. Scores ranged from 0 to 36. Each 1-point increase in the JHH NS score was associated with a 20% increase in the risk of requiring NS (odds ratio 1.20, p < 0.001). The c-statistic of the regression model for NS was 0.85. In all, 115 of 1,336 patients (8.6%) in the validation cohort required NS. Observed rates of NS in the validation group correlated positively with predicted rates (r = 0.89). Conclusions: The JHH NS score reliably stratified patients at risk for the need for postoperative NS. This easily calculable and highly predictive screening tool may expedite timing of initiation of NS in patients at high risk for not being able to physically take in adequate nutrition.

LanguageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Thoracic Surgery
Odds Ratio
Parenteral Nutrition
Enteral Nutrition
Malnutrition
Logistic Models
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Ohkuma, R. E., Crawford, T. C., Brown, P. M., Grimm, J. C., Magruder, J. T., Kilic, A., ... Whitman, G. J. R. (Accepted/In press). A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery. Annals of Thoracic Surgery. DOI: 10.1016/j.athoracsur.2017.03.013

A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery. / Ohkuma, Rika E.; Crawford, Todd C.; Brown, Patricia M.; Grimm, Joshua C.; Magruder, J. Trent; Kilic, Arman; Suarez-Pierre, Alejandro; Snyder, Sukyee; Wood, Justin D.; Schneider, Eric; Sussman, Marc S.; Whitman, Glenn J.R.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Ohkuma, RE, Crawford, TC, Brown, PM, Grimm, JC, Magruder, JT, Kilic, A, Suarez-Pierre, A, Snyder, S, Wood, JD, Schneider, E, Sussman, MS & Whitman, GJR 2017, 'A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery' Annals of Thoracic Surgery. DOI: 10.1016/j.athoracsur.2017.03.013
Ohkuma RE, Crawford TC, Brown PM, Grimm JC, Magruder JT, Kilic A et al. A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery. Annals of Thoracic Surgery. 2017. Available from, DOI: 10.1016/j.athoracsur.2017.03.013
Ohkuma, Rika E. ; Crawford, Todd C. ; Brown, Patricia M. ; Grimm, Joshua C. ; Magruder, J. Trent ; Kilic, Arman ; Suarez-Pierre, Alejandro ; Snyder, Sukyee ; Wood, Justin D. ; Schneider, Eric ; Sussman, Marc S. ; Whitman, Glenn J.R./ A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery. In: Annals of Thoracic Surgery. 2017
@article{1ad42d010aaa4279b07b3ded5b122000,
title = "A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery",
abstract = "Background: In specific patients, early postoperative nutrition mitigates malnutrition-related morbidity and mortality. The goal of this study was to develop and validate a prediction score designed to stratify patients immediately after cardiac surgery according to risk for nutrition support (NS). Methods: We identified adult cardiac surgery patients at our institution in 2012 requiring postoperative NS, enteral or parenteral. Using multivariable logistic regression modeling, we developed a Johns Hopkins Hospital Nutrition Support (JHH NS) score from relative odds ratios generated by variables that independently predicted the need for NS. The JHH NS score was then prospectively validated using all patients undergoing cardiac surgery in 2015. Results: Among 1,056 patients in the derivation cohort, 87 (8{\%}) required postoperative NS. Seven variables were identified on multivariable analysis as independent predictors of NS need and were used to create the JHH NS score. Scores ranged from 0 to 36. Each 1-point increase in the JHH NS score was associated with a 20{\%} increase in the risk of requiring NS (odds ratio 1.20, p < 0.001). The c-statistic of the regression model for NS was 0.85. In all, 115 of 1,336 patients (8.6{\%}) in the validation cohort required NS. Observed rates of NS in the validation group correlated positively with predicted rates (r = 0.89). Conclusions: The JHH NS score reliably stratified patients at risk for the need for postoperative NS. This easily calculable and highly predictive screening tool may expedite timing of initiation of NS in patients at high risk for not being able to physically take in adequate nutrition.",
author = "Ohkuma, {Rika E.} and Crawford, {Todd C.} and Brown, {Patricia M.} and Grimm, {Joshua C.} and Magruder, {J. Trent} and Arman Kilic and Alejandro Suarez-Pierre and Sukyee Snyder and Wood, {Justin D.} and Eric Schneider and Sussman, {Marc S.} and Whitman, {Glenn J.R.}",
year = "2017",
doi = "10.1016/j.athoracsur.2017.03.013",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery

AU - Ohkuma,Rika E.

AU - Crawford,Todd C.

AU - Brown,Patricia M.

AU - Grimm,Joshua C.

AU - Magruder,J. Trent

AU - Kilic,Arman

AU - Suarez-Pierre,Alejandro

AU - Snyder,Sukyee

AU - Wood,Justin D.

AU - Schneider,Eric

AU - Sussman,Marc S.

AU - Whitman,Glenn J.R.

PY - 2017

Y1 - 2017

N2 - Background: In specific patients, early postoperative nutrition mitigates malnutrition-related morbidity and mortality. The goal of this study was to develop and validate a prediction score designed to stratify patients immediately after cardiac surgery according to risk for nutrition support (NS). Methods: We identified adult cardiac surgery patients at our institution in 2012 requiring postoperative NS, enteral or parenteral. Using multivariable logistic regression modeling, we developed a Johns Hopkins Hospital Nutrition Support (JHH NS) score from relative odds ratios generated by variables that independently predicted the need for NS. The JHH NS score was then prospectively validated using all patients undergoing cardiac surgery in 2015. Results: Among 1,056 patients in the derivation cohort, 87 (8%) required postoperative NS. Seven variables were identified on multivariable analysis as independent predictors of NS need and were used to create the JHH NS score. Scores ranged from 0 to 36. Each 1-point increase in the JHH NS score was associated with a 20% increase in the risk of requiring NS (odds ratio 1.20, p < 0.001). The c-statistic of the regression model for NS was 0.85. In all, 115 of 1,336 patients (8.6%) in the validation cohort required NS. Observed rates of NS in the validation group correlated positively with predicted rates (r = 0.89). Conclusions: The JHH NS score reliably stratified patients at risk for the need for postoperative NS. This easily calculable and highly predictive screening tool may expedite timing of initiation of NS in patients at high risk for not being able to physically take in adequate nutrition.

AB - Background: In specific patients, early postoperative nutrition mitigates malnutrition-related morbidity and mortality. The goal of this study was to develop and validate a prediction score designed to stratify patients immediately after cardiac surgery according to risk for nutrition support (NS). Methods: We identified adult cardiac surgery patients at our institution in 2012 requiring postoperative NS, enteral or parenteral. Using multivariable logistic regression modeling, we developed a Johns Hopkins Hospital Nutrition Support (JHH NS) score from relative odds ratios generated by variables that independently predicted the need for NS. The JHH NS score was then prospectively validated using all patients undergoing cardiac surgery in 2015. Results: Among 1,056 patients in the derivation cohort, 87 (8%) required postoperative NS. Seven variables were identified on multivariable analysis as independent predictors of NS need and were used to create the JHH NS score. Scores ranged from 0 to 36. Each 1-point increase in the JHH NS score was associated with a 20% increase in the risk of requiring NS (odds ratio 1.20, p < 0.001). The c-statistic of the regression model for NS was 0.85. In all, 115 of 1,336 patients (8.6%) in the validation cohort required NS. Observed rates of NS in the validation group correlated positively with predicted rates (r = 0.89). Conclusions: The JHH NS score reliably stratified patients at risk for the need for postoperative NS. This easily calculable and highly predictive screening tool may expedite timing of initiation of NS in patients at high risk for not being able to physically take in adequate nutrition.

UR - http://www.scopus.com/inward/record.url?scp=85020748682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020748682&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2017.03.013

DO - 10.1016/j.athoracsur.2017.03.013

M3 - Article

JO - Annals of Thoracic Surgery

T2 - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -