营养风险评估在新型冠状病毒肺炎治疗中的应用价值

Application value of nutritional risk assessment in the treatment of COVID-19

目的探讨营养风险评估在新型冠状病毒肺炎(COVID-19)患者治疗中的应用价值。方法选择成人重型COVID-19患者55例。收集患者临床资料、生化指标、血常规、感染指标及营养风险评分,分析不同营养状态患者的治疗及结局特点。根据重型COVID-19患者是否进展为危重型将患者分为重型组与危重型组,比较两组患者的临床资料、营养风险评分、感染学指标、免疫学指标等对结局的影响情况。结果(1)55例重型COVID-19患者,男35例、女20例,年龄33~84岁,中位年龄61岁;15例进展为危重型,40例治愈出院。(2)营养风险评估:危重型组NRS2002[(7.47±1.81)分]、改良NUTRIC评分[(5.40±1.18)分]明显高于重型组[(2.80±3.41)分]、[(2.69±1.39)分]。(3)危重型组确诊前淋巴细胞绝对值、白蛋白、总蛋白、APACHEⅡ评分及营养评分均明显高于重型组患者,危重型组患者淋巴细胞绝对值明显低于重型组,差异均有统计学意义(P<0.05)。(4)多因素二元logistic回归分析显示:确诊前改良NUTRIC评分:OR=9.629,P=0.028,95%CI:1.273~72.813;确诊时APACHEⅡ评分:OR=1.483,P=0.024,95%CI:1.053~2.088。即确诊前改良NUTRIC评分及确诊时APACHEⅡ评分是提示COVID-19危重型的独立影响因素。logistic回归方程为:logistic(P)=2.265×确诊前改良NUTRIC评分+0.394×确诊时APACHEⅡ评分-12.292。其ROC曲线下面积(AUC)分别为0.956、0.932,有较好的预测价值(P<0.01)。结论营养风险评估能更早发现普通型COVID-19患者的重症倾向,故尽早并且动态对普通型COVID-19患者进行营养风险评估可及时发现存在高营养风险患者,更好制定营养治疗方案,从而改善患者预后。

Objective To evaluate the novel coronavirus pneumonia(COVID-19)patients with nutritional risk assessment.Methods Fifty-five adult patients with severe COVID-19 were selected.The clinical data,biochemical indexes,blood routine test,infection indexes and nutritional risk scores were collected to analyze the treatment and outcome of patients with different nutritional status.According to whether the novel coronavirus pneumonia patients were progressing to severe danger,they were divided into severe group and critical group.The clinical data,nutritional risk score,infectious index,immunological index and blood glucose level of two groups were compared.Results There were 55 patients with severe COVID-19(male=35),aged 33-84 years.Fifteen cases developed severe cases and 40 cases were cured and discharged.The NRS2002(7.47±1.81)and NUTRIC score(5.40±1.18)in critical group were significantly higher than those in severe group(2.80±3.41 and 2.69±1.39).The absolute count of lymphocytes,albumin,total protein,APACHEⅡscore and nutritional score in the critical group were significantly higher than those in the severe group(P<0.05).Multivariate binary logistic regression analysis showed that the modified NUTRIC score was significant independent risk factor for critical progression before diagnosis(OR=9.629,P=0.028,95%CI:1.273,72.813);so was APACHEⅡscore at diagnosis(OR=1.483,P=0.024,95%CI:1.053,2.088).The logistic regression equation was established as logistic(P)=2.265×Modified NUTRIC score before diagnosis+0.394×APACHEⅡscore at diagnosis-12.292.The area under ROC curve(AUC)was 0.956 and 0.932,respectively(P<0.01).Conclusion Nutritional risk assessment can anticipate the severe progression of ordinary COVID-19 patients earlier.Therefore,nutritional risk assessment of ordinary COVID-19 patients as soon as possible so as to improve the prognosis of patients.