mNUTRIC评分对老年脓毒症患者发生慢重症的预测价值

Predictive value of mNUTRIC score for chronic critical illness in elderly patients with sepsis

目的探讨改良版危重症营养风险(the modified NUTrition Risk in the Critically ill, mNUTRIC)评分对老年脓毒症患者发生慢重症(chronic critical illness, CCI)的预测价值。方法前瞻性观察性研究2019年8月至2021年1月南部战区总医院重症监护室内科病区(medical intensive care unit, MICU)连续收治的住院时间大于24 h的老年脓毒症患者。统计患者入院时的年龄、性别、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation Ⅱ, APACHE Ⅱ)、序贯器官衰竭评分(sequential organ failure assessment, SOFA)、急性胃肠功能损伤(acute gastrointestinal injury, AGI)分级、临床衰弱评分(clinical frailty score, CFS)、mNUTRIC评分以及ICU住院时间、脏器支持情况。根据有无发生CCI将患者分为CCI组与快速康复(rapid recovery, RAP)组, 比较两组间各指标的差异。采用log-binomial回归分析老年脓毒症患者发生CCI的独立危险因素。利用受试者工作曲线(ROC)评价mNUTRIC评分对老年脓毒症患者发生CCI的预测价值。以P<0.05为差异有统计学意义。结果共纳入患者91例, 其中14例(15%)在入住ICU一周内死亡, 37例(41%)快速康复, 40例(44%)发展为CCI。CCI组年龄、APACHE Ⅱ评分、mNUTRIC评分、CFS评分、机械通气与血液滤过比例显著高于RAP组(P<0.05)。多因素分析显示mNUTRIC评分是老年脓毒症患者发生CCI独立危险因素, 现患比为1.503(95%CI:1.007~2.244), 其ROC曲线下面积(AUC)为0.706(95%CI:0.592~0.805)。结论 mNUTRIC评分对老年脓毒症患者CCI的发生具有预测价值。

Objective To explore the predictive value of the modified NUTrition risk in the critically ill(mNUTRIC)score for chronic critical illness(CCI)in elderly sepsis patients.Methods A prospective observational study was conducted.Elderly sepsis patients admitted to Medical Intensive Care Unit(MICU)of General Hospital of Southern Theatre Command for more than 24 h from August 2019 to January 2021 were enrolled.Age,sex,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,acute gastrointestinal injury(AGI)score,clinical frailty score and mNUTRIC score at admission,length of ICU stay,usage of mechanical ventilation and renal replacement therapy were recorded.According to the occurrence of CCI,patients were divided into the CCI group and rapid recovery(RAP)group,and the differences between the two groups were compared.The risk factor of CCI after sepsis in elderly patients were analyzed by log-binomial regression analysis.Receiver operating characteristic(ROC)analysis was performed for mNUTRIC score.Differences were considered significant at P<0.05.Results Of the enrolled 91 sepsis patients,14(15%)patients died within the first week,37(41%)exhibited RAP and 40(44%)developed CCI.The CCI patients were significantly older and presented a higher APACHE Ⅱ score,CFS score,mNUTRIC score,and usage of mechanical ventilation and renal replacement therapy compared with the RAP patients(P<0.05).Multivariate regression analysis revealed that mNUTRIC score was an independent risk factor for the development of CCI in elderly sepsis patients,prevalence ratio was 1.503(95%CI:1.007-2.244).The area under the curve(AUC)of mNUTRIC score was 0.706(95%CI:0.592-0.805).Conclusions The mNUTRIC score at the time of admission in the intensive care unit can be used to predict CCI after sepsis in elderly sepsis patients.