mNUTRIC评分在老年重症肺炎病人营养风险筛查及预后分析中的应用

The application of mNUTRIC score in nutritional risk screening and clinical outcomes analysis of elderly patients with severe pneumonia

目的:利用改良危重症营养风险(mNUTRIC)评分对老年重症肺炎病人进行营养风险筛查,并分析其与临床预后之间的关联。方法:回顾性分析南京医科大学附属无锡人民医院重症医学科(ICU)收治的68例老年重症肺炎病人的相关临床资料。采用mNUTRIC评分对病人进行营养风险评估,并将病人分为高营养风险组(≥5分)和低营养风险组(<5分),分析比较两组病人相关指标的差异,采用受试者工作特征(ROC)曲线评价mNUTRIC评分对病人预后的判断价值,Logistic回归分析影响病人不良预后的相关因素。结果:老年重症肺炎病人的mNUTRIC评分为5.0(3.3,6.0),其中44例(64.7%)病人存在高营养风险;高营养风险组和低营养风险组的mNUTRIC评分分别为6.0(5.3,7.0)和3.0(3.0,4.0)。高营养风险组在死亡和机械通气时间上与低营养风险组存在显著差异(P<0.05)。mNUTRIC评分预测病人死亡的ROC曲线下面积为0.803(95%CI:0.698~0.909,P<0.001)。多因素Logistic回归分析显示mNUTRIC评分(OR=2.081,95%CI:1.171~3.698,P=0.013)是老年重症肺炎病人死亡的独立危险因素。结论:老年重症肺炎病人可采用mNUTRIC评分进行营养风险筛查,筛查结果可用于判断病人的临床预后,或能有助于临床营养治疗。

Objective: This study aimed to apply the modified nutritional risk in critical illness(mNUTRIC) score in the nutritional risk screening of elderly patients with severe pneumonia and to analyze the association between it and clinical outcomes. Methods: The clinical data of 68 elderly patients with severe pneumonia admitted to the intensive care unit(ICU) of Wuxi People’s Hospital affiliated to Nanjing Medical University were retrospectively analyzed. The mNUTRIC score was used to assess the nutritional risk, and the included patients were divided into the high nutritional risk group(mNUTRIC score ≥ 5) and the low risk group(mNUTRIC score < 5) accordingly, and the differences in the relevant parameters between the two groups were analyzed and compared. Receiver operating characteristic curve(ROC)was used to determine the predictive value of mNUTRIC on the adverse clinical outcomes. Logistic regression was used to analyze predictors for clinical outcomes. Results: The median mNUTRIC score of elderly patients with severe pneumonia was 5.0(3.3, 6.0), and 44(64.7%) of them were at high nutritional risk. The mNUTRIC scores of the high and low nutritional risk groups were 6.0(5.3, 7.0) and 3.0(3.0, 4.0), respectively. There were significant differences between the two groups in mortality and duration of mechanical ventilation(P < 0.05). Higher mNUTRIC score predicted mortality with an area under the ROC curve of 0.803(95% CI: 0.698 ~ 0.909, P < 0.001). Multivariate logistic regression analysis showed that higher m NUTRIC score(OR = 2.081,95%CI:1.171 ~ 3.698,P = 0.013) was an independent risk factor for mortality in elderly patients with severe pneumonia. Conclusion: Elderly patients with severe pneumonia can be screened for nutritional risk using the mNUTRIC score, which may help predict the clinical outcomes and therefore promote the implementation of clinical nutrition of these patients.