控制营养状况评分对急性胰腺炎患者病情评估及预后的影响

The impact of controlling nutritional status scores on the evaluation and prognosis of patients with acute pancreatitis

目的探讨控制营养状况(controlling nutritional status,CONUT)评分对急性胰腺炎(acute pancreatitis,AP)患者病情评估及预后的影响。方法以收治的300例AP患者为研究对象,分为非重度急性胰腺炎(SAP)组和SAP组、存活组和死亡组。分析入院时非SAP组与SAP组、存活组和死亡组的临床资料以及AP病情严重程度及预后的影响因素和AP病情的预测价值。结果除性别、年龄及TC外,SAP组患者的ALB及LYM低于非SAP组(P<0.01)而CONUT评分、BISAP评分及APACHEⅡ评分高于非SAP组(P<0.01);除性别和TC外,死亡组患者ALB及LYM低于存活组(P<0.01),而CONUT评分、年龄、BISAP评分及APACHEⅡ评分高于存活组(P<0.01);二元Logistic回归分析表明,高BISAP评分及APACHEⅡ评分是SAP发生的危险因素(P<0.05),高ALB、LYM和CONUT评分≤2分是SAP发生的保护因素(P<0.05);高龄、BISAP评分及APACHEⅡ评分是AP患者28 d死亡发生的危险因素(P<0.05),高ALB、LYM和CONUT评分≤2分是AP患者28 d死亡发生的保护因素(P<0.05)。联合指标检测预测SAP发生和28 d死亡的敏感度分别为89.3%和91.7%,特异度分别为79.4%和90.5%。结论CONUT评分是AP患者的病情严重程度及28 d死亡的危险因素,可被用作评估AP患者病情的营养筛查工具,联合指标预测AP患者的病情严重程度及死亡风险价值较好。

Objective To explore the impact of controlling nutritional status(CONUT)score on the evaluation and prognosis of acute pancreatitis(AP)patients.Methods 300 AP patients admitted were divided into non SAP group non-severe acute pancreatitis(non-SAP)and SAP groups,as well as survival and death groups.We compared clinical data at admission between these groups and evaluated factors influencing AP severity and prognosis,along with the predictive value of various indicators for AP condition.Results Except for gender,age,and TC,the SAP group showed significantly lower albumin(ALB)and lymphocyte(LYM)levels,but higher CONUT,Bedside Index for Severity in Acute Pancreatitis(BISAP),and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores compared to the non-SAP group(P<0.01).Except for gender and TC,the death group exhibited lower ALB and LYM levels,but higher CONUT,BISAP,and APACHEⅡscores,as well as higher age,compared to the survival group(P<0.01).Binary logistic regression analysis showed that high BISAP and APACHEⅡscores were risk factors for SAP occurrence(P<0.05),while high ALB,LYM,and CONUT scores≤2 were protective factors(P<0.05).For 28-day mortality,advanced age and high BISAP and APACHEⅡscores were risk factors(P<0.05),whereas high ALB,LYM,and CONUT scores≤2 were protective(P<0.05).The combined indicators demonstrated high predictive value,with sensitivity and specificity of 89.3%and 79.4%for SAP occurrence,and 91.7%and 90.5%for 28-day mortality,respectively.Conclusion The CONUT score serves as risk factors of AP severity and 28-day mortality.It proves to be an effective nutritional screening tool for AP patients.Moreover,the combination of CONUT with other indicators offers valuable predictive power for assessing AP severity and mortality risk,potentially improving patient management and outcomes.