Across 178,607 hospitalizations at the University of Leipzig Medical Center (2017–2023), patients scoring ≥3 on the Nutritional Risk Screening 2002 (NRS-2002) tool faced dramatically worse outcomes: 3.62-fold higher odds of in-hospital mortality (95% CI 2.69–4.99), 1.85-fold higher ICU admission odds, 2.07-fold higher mechanical ventilation odds, and 1.57-fold higher 30-day readmission odds — all persisting after adjustment for age and sex. Critically, 12.2% of admissions had a positive initial screen but no completed final NRS assessment, and this incomplete-screening group also showed elevated adverse outcome rates.
This large real-world dataset adds meaningful statistical weight to a well-established clinical concern: malnutrition in hospitalized patients is both common and consequential. The NRS-2002 has been validated across European hospital settings since 2003, and guidelines from ESPEN have long recommended its routine use — yet this study confirms that implementation remains incomplete even a decade after formal adoption. The finding that incomplete screening itself correlates with worse outcomes suggests documentation gaps may reflect sicker, more chaotic admissions, or that missed nutritional intervention compounds underlying disease severity.
Key limitations include the observational, retrospective design — causality cannot be established — and confounding by indication, since malnourished patients are inherently sicker at baseline. Age-and-sex adjustment alone is insufficient to disentangle severity effects. As a preprint not yet peer-reviewed, these effect sizes should be interpreted cautiously. Still, for health systems, the practical signal is clear: completing nutritional screening — not merely initiating it — may be a low-cost lever with measurable outcome implications.
