不同营养评估工具对ICU重症肺炎患者的预后预测价值比较

Comparison of the prognostic predictive value of different nutritional assessment tools for patients with severe pneumonia in the ICU

目的比较预后营养指数(prognostic nutritional index,PNI)、(老年)营养风险指数(geriatric nutritional risk index,GNRI/NRI)及改良版危重症营养风险评分表(the modified nutrition risk in the critically ill,mNUTRIC)对重症监护室(ICU)重症肺炎患者预后预测价值。方法回顾性分析了2017年1月1日至2020年8月1日广东省中医院芳村分院ICU收治的重症肺炎患者288例,根据28天生存情况分成生存组(n=220)和死亡组(n=68)。采用二元Logistic回归分析影响重症肺炎预后因素,绘制ROC曲线对比PNI、GNRI/NRI和mNUTRIC评分对重症肺炎患者预后的判断价值。结果回归分析显示低BMI、使用抗生素≥2类、并发ARDS、mNUTRIC评分高是影响重症肺炎预后的独立危险因素(P<0.05),静脉使用氨基酸是其保护性因素(P<0.05)。PNI、GNRI/NRI及mNUTRIC评分评估患者28天预后的曲线下面积(AUC)分别为0.580、0.606、0.676。Kaplan-Meier生存分析显示,以mNUTRIC≥5.5为界值划分的高营养风险组预后不良(P<0.001)。结论三种不同营养评估工具中mNUTRIC评分对ICU重症肺炎患者28天预后预测价值最高。

Objective To compare the Prognostic Nutritional Index(PNI),the(Geriatric)Nutritional Risk Index(GNRI/NRI),and the modified Nutrition Risk in the Critically Ill(mNUTRIC)on the prognosis of patients with severe pneumonia in the intensive care unit(ICU).Methods A total of 288 patients with severe pneumonia admitted to the ICU of Fangcun Branch of Guangdong Hospital of Traditional Chinese Medicine from January 1,2017,to August 1,2020,were retrospectively analyzed and divided into survival group(n=220)and death group(n=68)according to their 28-day survival.Binary Logistic regression was used to analyze the prognostic factors of severe pneumonia,and a ROC curve was drawn to compare the prognostic value of PNI,GNRI/NRI,and mNUTRIC scores in patients with severe pneumonia.Results The results of regression analyses showed that low BMI,use of antibiotics≥category 2,complicated ARDS,and high mNUTRIC score were independent risk factors for the prognosis of severe pneumonia(P<0.05),and intravenous use of amino acids was a protective factor(P<0.05).The area under the curve(AUC)of the PNI,GNRI/NRI,and mNUTRIC scores for the 28-day prognosis were 0.580,0.606,and 0.676,respectively.Kaplan-Meier survival analysis showed a poor prognosis for the high nutritional risk group divided by a cut-off value of mNUTRIC≥5.5(P<0.001).Conclusion The mNUTRIC score has the highest predictive value for 28-day prognosis in patients with severe pneumonia in the ICU among the three different nutritional assessment tools.