营养风险与老年重症肺炎患者预后的相关性

Correlation of nutritional risk and prognosis in elderly patients with severe pneumonia

目的分析老年重症肺炎患者机体营养风险与其预后的相关性,研究老年营养风险指数(GNRI)在老年重症肺炎中的应用价值。方法将佛山复星禅诚医院2020年1月至2022年1月收治的133例老年重症肺炎患者纳为研究对象,入院后24 h内采用GNRI调查营养风险,将高危营养风险者纳为高危组,其余患者作为其余分级组。高危营养风险者均进行营养支持治疗,按照营养支持干预时机分为早期、中期及晚期,比较不同营养支持干预时机者预后情况;统计患者28 d死亡率,根据患者生存情况分为死亡组及存活组。采用SPSS 19.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。采用二元logistic回归模型分析影响老年重症肺炎患者预后(28 d内死亡)的相关因素,绘制受试者工作特征(ROC)曲线,分析GNRI在预测老年重症肺炎患者28 d内死亡中的价值。结果133例老年重症肺炎患者中,高危营养风险者共28例(21.05%),对比发现,GNRI高危分级组年龄、革兰阴性菌检出率、机械通气、休克发生率高于其他分级组,体质量指数、血清白蛋白以及前白蛋白水平低于其他分级组,差异均有统计学意义(P<0.05);高危营养风险者均行营养支持治疗,其中早期、中期及晚期进行营养干预者机械通气时间、血管活性药物使用时间、住院时间均呈依次升高趋势,且早期干预者死亡率低于晚期干预者,差异均有统计学意义(P<0.05);133例老年重症肺炎患者中,28 d内死亡者35例(26.32%)。二元logistic回归模型分析证实,入院时急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分(OR=1.906,95%CI 1.350~2.691)、多器官功能障碍综合征(MODS)评分(OR=2.079,95%CI 1.254~3.448)、机械通气(OR=2.177,95%CI 1.313~3.610)以及高危GNRI分级(OR=2.575,95%CI 1.778~3.730)是老年重症肺炎患者28 d内死亡的危险因素(均P<0.05);绘制ROC曲线发现,GNRI在预测老年重症肺炎患者28 d死亡中价值(AUC=0.706,95%CI 0.607~0.806)明显高于APACHEⅡ评分(AUC=0.534,95%CI 0.428~0.641)、MODS评分(AUC=0.564,95%CI 0.460~0.668)以及机械通气(AUC=0.628,95%CI 0.518~0.737)等其他危险因素(均P<0.05)。结论建议临床在老年重症肺炎患者入院后尽早利用GNRI进行营养风险筛查,并及时对存在高风险营养不良者尽早进行营养干预,进而改善患者预后。

Objective To analyze the correlation between body nutritional risk and prognosis in elderly patients with severe pneumonia,and to study the application value of geriatric nutritional risk index(GNRI)for elderly patients with severe pneumonia.Methods A total of 133 elderly patients with severe pneumonia admitted to Foshan Fosun Chancheng Hospital from January 2020 to January 2022 were recruited,and according to their GNRI within 24 h after admission,the patients with high nutritional risk were assigned into high-risk group,and the other patients were into other classification groups.The patients with high nutritional risk were given nutritional support treatment,and based on the intervention timing of nutritional support,they were divided into early-,middle-and late-stage subgroups.The prognosis was compared among the patients of different timing of nutritional support.After the 28-day mortality rate was counted,the patients were grouped into death and survival groups.SPSS statistics 19.0 was used to process the data.Data comparison between two groups was perfomed using t test orχ^(2) test depending on data type.Binary logistic regression model was applied to analyze the related factors affecting the prognosis(death within 28 d)in elderly patients with severe pneumonia,and receiver operating characteristic(ROC)curve was drawn to analyze the value of GNRI in predicting the 28-day mortality in these elderly patients.Results Among the 133 elderly patients with severe pneumonia,there were 28 cases(21.05%)with high nutritional risk.The patients with high nutritional risk had advanced age,higher detection rate of Gram-negative bacteria,larger ratio of mechanical ventilation and higher incidence of shock,but lower body mass index,serum albumin and pre-albumin levels when compared with the other classification groups(P<0.05).After the patients with high nutritional risk were treated with nutritional support,the times for mechanical ventilation and vasoactive drug use and length of hospital stay were all in increasing trends in the patients with early,middle and late nutritional interventions in turn,and the death rate was lower in the patients with early intervention than those with late intervention(P<0.05).Among the 133 elderly patients with severe pneumonia,35 cases(26.32%)eventually died within 28 d after admission.Binary logistic regression analysis confirmed that Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score at admission(OR=1.906,95%CI 1.350-2.691),multiple organ dysfunction syndrome(MODS)score(OR=2.079,95%CI 1.254-3.448),mechanical ventilation(OR=2.177,95%CI 1.313-3.610)and high-risk GNRI grade(OR=2.575,95%CI 1.778-3.730)were risk factors for 28-day death in elderly patients with severe pneumonia.ROC curve analysis found that the AUC value of GNRI(AUC=0.706,95%CI 0.607-0.806)in predicting 28-day death in elderly patients with severe pneumonia was significantly higher(P<0.05)than that of APACHEⅡscore(AUC=0.534,95%CI 0.428-0.641),MODS score(AUC=0.564,95%CI 0.460-0.668)and mechanical ventilation(AUC=0.628,95%CI 0.518-0.737).Conclusion It is suggested that GNRI should be used for nutritional risk screening in elderly patients with severe pneumonia as soon as possible after admission,and nutritional intervention should be carried out in time for those with high-risk malnutrition so as to improve the prognosis of patients.