重症患者急性期能量平衡对住院期间死亡的影响

Analysis of total calories balance and in-hospital mortality in critically ill patients during acute phase

目的分析重症患者急性期(7 d内)不同阶段能量供给与院内病死率的相关性。方法选取2019年4月至2021年4月收治于清华大学附属北京清华长庚医院重症医学科住重症加强护理病房(intensive care unit,ICU)时间≥7 d的重症患者作为研究对象。收集患者一般人口学资料以及入院7 d内的营养相关资料。采用多因素Logistic回归分析筛选出影响ICU患者院内死亡的独立危险因素。结果共纳入ICU住院时间≥7 d的重症患者61例,其中死亡18例。多因素Logistic回归分析显示入ICU时营养风险筛查(Nutrition Risk Screening,NRS)2002评分(P=0.018)、连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)时间(P=0.013)以及ICU住院前3 d累计能量平衡(P=0.044)是院内死亡的独立危险因素,前3 d累计能量平衡每增加500 kcal(1 kcal=4.186 kJ),患者的院内死亡风险增加120%。此外,对于高营养风险患者(NRS 2002≥5),前3 d累计能量平衡(P=0.042)、CRRT时间(P=0.019)是其死亡的独立预测因素。而在低营养风险患者中(NRS 2002<5),各项指标与院内死亡无相关关系。结论入ICU最初3 d累计能量平衡、NRS 2002评分以及CRRT时间是影响ICU患者预后的独立危险因素,特别是对高营养风险的重症患者有重要意义。

Objective To analyze the correlation of energy delivery and in-hospital mortality in acute phase of critical illness in intensive care unit(ICU).Methods The patients who were admitted to general ICU,Beijing Tsinghua Changgung Hospital for more than 7 days from April 2019 to April 2021 were enrolled.The clinical and nutritional data on the first 7 days were retrospectively collected.Multivariate Logistic regression was used to analyze the risk factors of in-hospital mortality.Results A total of 61 patients were recruited,and 18 of them died during hospitalization.The results of multivariate logistic regression showed that Nutrition Risk Screening(NRS)2002 score(P=0.018),days of continuous renal replacement therapy(CRRT)(P=0.013)and total calories risk(TCB)in the first 3d(P=0.044)were the risk factors of in-hospital mortality.The risk of in-hospital mortality increased by 120%per each 500 kcal(1 kcal=4.186 kJ)of total calories balance during the first 3 days of ICU.For the patients with high nutritional risk(NRS 2002≥5),TCB in the first-3d(P=0.042)and days of CRRT(P=0.019)were also the high risk factors of in-hospital mortality.While they were no predictive values in the patients with lower nutrition risk(NRS 2002<5).Conclusion NRS 2002 score,days of CRRT and TCB in the first-3d were the risk factors of in-hospital mortality for critically ill patients in ICU,particularly for the high nutritional risk one.