三种营养评估工具在重症脑卒中患者中的应用价值

Application value of three nutritional assessment tools in patients with severe stroke

目的:应用营养控制状态评分(CONUT)、那不勒斯预后评分(NPS)和预后营养指数(PNI)对重症脑卒中患者进行营养评估,比较三种工具的应用效果,为重症脑卒中患者的营养评估提供依据。方法:选取166例重症脑卒中患者,使用CONUT、NPS和PNI进行营养评估,计算三种工具的最佳临界值、灵敏度、特异度和受试者工作特征(ROC)曲线下面积(AUC);采用Logistic回归分析影响患者院内死亡的危险因素。结果:三种评估工具的AUC分别为0.880、0.717、0.898。采用逼近理想解的排序(TOPSIS)法对三种评估工具AUC、灵敏度、特异度、阴性预测值、阳性预测值和Kappa值进行综合评价,优劣排序PNI最优,CONUT次之,NPS最差;Logistic回归分析结果显示,PNI≤40.25分(OR=10.358)、高CCI(OR=1.531)和高总蛋白(OR=1.062)是重症脑卒中患者院内死亡的危险因素(P<0.05)。结论:三种评估工具中,PNI在评估重症脑卒中患者营养状况和预测院内死亡风险中具有最高价值。

Objective:To evaluate the nutrition status of patients with severe stroke by using Controlling Nutritional Status Score(CONUT),Naples Prognostic Score(NPS)and Prognostic Nutritional Index(PNI),and compare the application effects of the three tools so as to provide relevant basis for evaluation of the nutrition in patients with severe stroke.Methods:166 patients with severe stroke were included as research subjects,and undergone nutritional evaluation using CONUT,NPS and PNI.The optimal critical value,sensitivity,specificity,and area under receiver operating characteristic curve(AUC)of the three tools were calculated.Logistic regression model was used to analyze the risk factors of in-hospital death.Results:The AUC of three tools were 0.880,0.717 and 0.898,respectively.Comprehensive evaluation of AUC,sensitivity,specificity,negative and positive predictive values,and Kappa value of three tools by the Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)indicated that PNI was the best,followed by CONUT and NPS.Logistic regression analysis showed that PNI≤40.25points,high CCI score,and high total protein level were risk factors for in-hospital death in patients with severe stroke(P<0.05).Conclusion:Among the three assessment tools,PNI has the highest value in assessing the nutritional status and predicting the risk of in-hospital death in patients with severe stroke.