Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Step 1: Derivative Cohort
2.2. Step 2: Model Development
2.3. Step 3: Validation Cohort
2.4. Ethical Considerations
2.5. Statistical Analysis
3. Results
3.1. Participant Characteristics
3.2. Model Development
The Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score
3.3. Model Validation
3.3.1. The Internal Validation of the PHaM Risk Score
3.3.2. The External Validation of the PHaM Risk Score
3.4. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Patients in Derivative Cohort [N = 444], n (%) | Patients in Validation Cohort [N = 373], n (%) | p-Value |
---|---|---|---|
Sex | 0.002 | ||
Male | 265 (59.7%) | 181 (48.5%) | |
Female | 180 (40.3%) | 192 (51.5%) | |
Age | 0.864 | ||
Age ≤ 1 year | 72 (16.2%) | 68 (18.2%) | |
Age 1–5 years | 163 (36.7%) | 129 (34.6%) | |
Age 5–12 years | 129 (29.1%) | 109 (29.2%) | |
Age 12 years | 80 (18.0%) | 67 (18.0%) | |
Median (IQR) (years) | 4.3 (8.7) | 4.7 (9.4) | 0.484 |
Underlying disease * | 322 (72.5%) | 220 (59.0%) | <0.001 |
Disease severity | <0.001 | ||
Mild | 355 (80.0%) | 184 (49.3%) | |
Moderate | 82 (18.5%) | 169 (45.3%) | |
Severe | 7 (1.5%) | 20 (5.4%) | |
History of weight loss | 105 (23.6%) | 65 (17.4%) | 0.029 |
Decreased food intake | 152 (34.2%) | 169 (45.3%) | 0.001 |
Nutritional status on admission | |||
HAZ # | −0.91 (2.17) | −1.14 (2.26) | 0.003 |
WAZ # | −0.76 (1.95) | −0.96 (2.21) | 0.004 |
WHZ # | −0.34 (2.08) | −0.54 (2.10) | 0.054 |
BMIZ # | −0.51 (2.24) | −0.53 (2.26) | 0.499 |
Wasting (WHZ < −2) | 69 (15.5%) | 74 (19.8%) | 0.107 |
Stunting (HAZ < −2) | 111 (25.0%) | 119 (31.9%) | 0.029 |
Underweight (WAZ < −2) | 93 (20.9%) | 111 (29.8%) | 0.003 |
Obesity (BMIZ > 2) | 26 (5.6%) | 26 (7.0%) | 0.515 |
Nosocomial infection, number | 85 (19.1.%) | 89 (23.9%) | 0.100 |
Pneumonia | 22 (4.9%) | 38 (10.2%) | |
Surgical wound infection | 11 (2.5%) | 9 (2.4%) | |
Bloodstream infection or CLABSI | 21 (4.7%) | 18 (4.8%) | |
Diarrhea/AAC | 6 (1.4%) | 4 (1.1%) | |
Clinical sepsis | 19 (4.3%) | 14 (3.8%) | |
Urinary tract infection | 6 (1.4%) | 6 (1.6%) | |
Length of hospital stay, days # | 5 (4) | 7 (10) | <0.001 |
Nutritional intervention | 47 (10.6%) | 104 (27.9%) | <0.001 |
Patient Characteristics | Coefficient | Odds Ratio (95% CI) | p-Value | Score Value |
---|---|---|---|---|
Gastrointestinal symptom | <0.001 | |||
No symptom | 1 | 0 | ||
1 symptom | 1.201 | 3.325 (1.815 to 6.088) | 1.5 | |
≥2 symptoms | 1.235 | 3.440 (1.304 to 9.076) | 1.5 | |
Disease severity | <0.001 | |||
Mild | 1 | 0 | ||
Moderate to severe | 1.444 | 4.237 (2.374 to 7.563) | 2 | |
Fever | <0.001 | |||
No fever or fever ≤ 39 °C | 1 | 0 | ||
Fever > 39 °C | 2.700 | 14.828 (5.811 to 37.836) | 3.5 | |
Lower respiratory tract infection | 0.024 | |||
No | 1 | 0 | ||
Yes | 0.767 | 2.153 (1.108 to 4.186) | 1 | |
Decreased food intake | 0.001 | |||
No | 1 | 0 | ||
Yes | 0.817 | 2.264 (1.379 to 3.716) | 1 | |
Constant | −1.832 |
Cut-Off Score | Sensitivity (95% CI) | Specificity (95% CI) | Youden’s Index | PPV (95% CI) | NPV (95% CI) | LR+ (95% CI) | LR− (95% CI) |
---|---|---|---|---|---|---|---|
1 | 82.1% (75.3% to 87.7%) | 57.3% (51.3% to 63.2%) | 0.394 | 52.6% (46.2% to 58.9%) | 84.7% (78.8% to 89.5%) | 1.92 (1.65 to 2.24) | 0.31 (0.22 to 0.44) |
1.5 | 74.1% (66.6% to 80.6%) | 75.8% (70.4% to 80.7%) | 0.499 | 63.8% (56.5% to 70.7%) | 83.5% (78.4% to 87.9%) | 3.06 (2.44 to 3.84) | 0.34 (0.26 to 0.45) |
2 | 67.9% (60.1% to 75.0%) | 81.1% (76.1% to 85.5%) | 0.490 | 67.5% (59.7% to 74.6%) | 81.4% (76.4% to 85.8%) | 3.60 (2.76 to 4.69) | 0.40 (0.31 to 0.50) |
2.5 | 63.0% (55.0% to 70.4%) | 88.6% (84.3% to 92.1%) | 0.516 | 76.1% (68.0% to 83.1%) | 80.6% (75.7% to 84.8%) | 5.53 (3.91 to 7.82) | 0.42 (0.34 to 0.51) |
3 | 53.1% (45.1% to 61.0%) | 94.3% (90.9% to 96.7%) | 0.474 | 84.3% (75.8% to 90.8%) | 77.7% (72.9% to 82.0%) | 9.32 (5.67 to 15.3) | 0.50 (0.42 to 0.59) |
3.5 | 43.2% (35.5% to 51.2%) | 96.4% (93.6% to 98.3%) | 0.396 | 87.5% (78.2% to 93.8%) | 74.7% (69.9% to 79.1%) | 12.14 (6.44 to 22.88) | 0.59 (0.51 to 0.67) |
4 | 31.5% (24.4% to 39.2%) | 97.9% (95.4% to 99.2%) | 0.294 | 89.5% (78.5% to 96.0%) | 71.2% (66.4% to 75.7%) | 14.74 (6.47 to 33.59) | 0.70 (0.63 to 0.78) |
4.5 | 28.4% (21.6% to 36.0%) | 97.9% (95.4% to 99.2%) | 0.263 | 88.5% (76.6% to 95.6%) | 70.3% (65.5% to 74.8%) | 13.30 (5.81 to 30.45) | 0.73 (0.66 to 0.81) |
5 | 17.3% (11.8% to 24.0%) | 98.6% (96.4% to 99.6%) | 0.159 | 87.5% (71.0% to 96.5%) | 67.4% (62.6% to 71.9%) | 12.14 (4.34 to 34.00) | 0.84 (0.78 to 0.90) |
5.5 | 16.1% (10.8% to 22.6%) | 98.6% (96.4% to 99.6%) | 0.147 | 86.7% (69.3% to 96.2%) | 67.1% (62.3% to 71.6%) | 11.27 (4.01 to 31.73) | 0.85 (0.80 to 0.91) |
6 | 11.7% (7.2% to 17.7%) | 98.9% (96.9% to 99.8%) | 0.106 | 86.4% (65.1% to 97.1%) | 66.0% (61.3% to 70.5%) | 10.99 (3.30 to 36.55) | 0.89 (0.84 to 0.94) |
6.5 | 9.9% (5.8% to 15.5%) | 99.6% (98.0% to 100.0%) | 0.095 | 94.1% (71.3% to 99.9%) | 65.7% (61.0% to 70.2%) | 27.75 (3.71 to 207.34) | 0.90 (0.86 to 0.95) |
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Saengnipanthkul, S.; Sirikarn, P.; Chongviriyaphan, N.; Densupsoontorn, N.; Phosuwattanakul, J.; Apiraksakorn, A.; Sitthikarnkha, P.; Techasatian, L.; Uppala, R.; Lumbiganon, P. Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study. Nutrients 2024, 16, 2898. https://doi.org/10.3390/nu16172898
Saengnipanthkul S, Sirikarn P, Chongviriyaphan N, Densupsoontorn N, Phosuwattanakul J, Apiraksakorn A, Sitthikarnkha P, Techasatian L, Uppala R, Lumbiganon P. Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study. Nutrients. 2024; 16(17):2898. https://doi.org/10.3390/nu16172898
Chicago/Turabian StyleSaengnipanthkul, Suchaorn, Prapassara Sirikarn, Nalinee Chongviriyaphan, Narumon Densupsoontorn, Jeeraparn Phosuwattanakul, Amnuayporn Apiraksakorn, Phanthila Sitthikarnkha, Leelawadee Techasatian, Rattapon Uppala, and Pagakrong Lumbiganon. 2024. "Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study" Nutrients 16, no. 17: 2898. https://doi.org/10.3390/nu16172898