Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation

BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.

Value of the controlling nutritional status score and psoas muscle thickness per height in predicting prognosis in liver transplantation

BACKGROUND Patients with end-stage liver disease usually have varying degrees of malnutrition,and severe malnutrition may affect the prognosis of patients after liver transplantation(LT).However,there is no recommended standard for the nutrition assessment of patients waiting for LT,and it is unknown whether malnutrition has an impact on the occurrence of postoperative complications.AIM The study aim was to investigate the value of the controlling nutritional status(CONUT)score and psoas muscle thickness per height(PMTH)in predicting prognosis in LT.METHODS We retrospectively analyzed the clinical data of 313 patients who underwent classic orthotopic LT from January 2016 to December 2018 in Tianjin First Central Hospital affiliated with Tianjin Medical University.The CONUT score is derived from the preoperative serum albumin and total cholesterol levels,and total lymphocyte count.Patients were divided into low(≤4),medium(5–8),and high(9–12)CONUT score groups perioperative characteristics,Clavien-Dindo grade III/IV/V postoperative complications,graft loss and infection,and cumulative postoperative survival in the three groups were compared 3 mo after LT.PMTH was calculated as the ratio of the transverse thickness of the psoas muscle in the umbilical plane to the height of the patient.The cutoff values of receiver operating characteristic curves were determined separately for men and women.The values were 14.1 cm/m2 for women and 17.9 cm/m2 for men.The patients were then divided into low and high PMTH groups by the cutoff values.The comparison of data between the two groups was the same as above.RESULTS Patients with medium and high CONUT scores had lower preoperative serum hemoglobin,more intraoperative red blood cell(RBC)transfusions,longer postoperative intensive care unit stay and hospital stays,higher 7 and 14 preoperative-day serum bilirubin levels,and a higher incidence of postoperative grade III/IV complications and infections than patients with low CONUT scores.Differences in the 3-mo cumulative survival among the three groups were not significant.Patients with a low PMTH had higher preoperative serum urea nitrogen,more intraoperative packed RBC and frozen plasma transfusions,longer times to postoperative ventilator extubation,higher incidence of total postoperative complications,and a lower 3-mo cumulative survival than those with a high PMTH.CONCLUSION A CONUT score≥5 and a low PMTH were both associated with poor prognosis in LT.The CONUT score had no predictive value for short-term patient survival after LT,but the PMTH was predictive of short-term patient survival after LT.

Nutritional Support Treatment for Severe Chronic Hepatitis and Posthepatitic Cirrhosis

The therapeutic effectiveness of nutritional support in the treatment of severe chronic hepatitis and posthepatitic cirrhosis was evaluated. 143 patients with severe chronic hepatitis and 83 with posthepatitic cirrhosis were evaluated with SGA for assessing the nutritional status before the treatment. Patients with severe chronic hepatitis were divided into three groups： group A subject to enteral nutrition （EN） and parenteral nutrition （PN）, group B subject to comprehensive treatment （CT） ＋PN; group C subject to CT＋EN. The patients with posthepatitic cirrhosis were divided in- to two groups： group D receiving CT and group E receiving CT＋ PN ＋ EN. The function of liver and kidney and nutritional status were monitored to assess the therapy in 6 weeks. The results showed before treatment, over 90% patients had moderate to severe malnutrition. After nutritional support, the liver function （ALT, T-bil） and nutritional status （TP, TC） in group A was improved significantly as compared with that in groups B and C （P〈0.05）. Compared with group D, the values of TP and Alb were increased significantly in group E （P〈0. 05）, but the levels of ALT, AST and T-bil had no obvious change. It was suggested that most patients with severe chronic hepatitis or posthepatitic cirrhosis had malnutrition to varying degrees. The nutritional support treatment could obviously improve the nutritional status of these patients, and was helpful to ameliorate the liver function of the patients with severe chronic hepatitis. Among the methods of nutritional support treatment, PN combined with EN had the best effectiveness.

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Aim: To review the supporting evidence for protein requirements in hospitalised adults, and compare the findings with commonly-used guidelines and resources. Methods: a systematic review was conducted based on a computerised bibliographic search of MEDLINE, EMBASE and CINAHL from 1950 to October 2011, as well as a citation review of relevant articles and guidelines. Studies were included if they were randomised clinical trials in hospitalised or chronically ill adults, comparing two or more different levels of protein intake. Information about study quality, setting, and findings was extracted using standardised protocols. Due to the heterogeneity of study characteristics, no meta-analysis was undertaken. Results: 116 papers were obtained in the search and 33 of these met all inclusion criteria. Five studies could not be obtained. The remainder reported outcome measures such as nitrogen balance, anthropometric measurements (including body weight, BMI, and mid-arm circumference), blood electrolyte levels and serum urea, which provide support for recommended protein intakes in various clinical conditions. The results were summarized and compared with current recommendations. Conclusion: high-level evidence to support current recommendations is lacking. The studies reviewed generally agreed with current guidelines and resources.

Prognostic Nutritional Index Predicts Life Expectancy of Patients with End-Stage Oral Cancer: A Retrospective Study

Background: Generally, clinicians do not accurately estimate life expec-tancy in terminally ill patients with cancer. Aim: To evaluate the value of the Prognostic Nutritional Index (PNI) for accurately estimating the life expectancy of patients with end-stage oral cancer. Design: A longitudinal section study. Setting/participants: Fifteen patients (12 men;mean age: 71.7 years) who died of oral cancer between 2005 and 2014 (the terminal group) were included. The mean PNI values at the initial visit and at 3, 2, and 1 months before the deaths were comparatively analyzed. Results: The mean follow-up period was 133 days. At the initial examination, the PNI values were 49.1 ± 4.5 (p = 0.6723). The PNI value of the terminal group was 35.6 ± 5.1 at 2 months before death and 28.6 ± 3.0 at 1 month before death. The PNI values at 3, 2, and 1 months before death in the terminal group significantly differed from each other and from that at the initial visit and steadily decreased until death. Conclusions: Our findings suggest the utility of PNI as a prognostic index in patients with end-stage oral cancer patients. Furthermore, the PNI should be routinely considered in the nutritional management of patients with oral cancer nearing death.

Nutrition support in surgical patients with colorectal cancer

AIM: To review the application of nutrition support in patients after surgery for colorectal cancer, and to propose appropriate nutrition strategies. METHODS: A total of 202 consecutive surgical patients admitted to our hospital with a diagnosis of colon cancer or rectal cancer from January 2010 to July 2010, meeting the requirements of Nutrition Risk Screening 2002, were enrolled in our study. Laboratory tests were performed to analyze the nutrition status of each patient, and the clinical outcome variables, including postoperative complications, hospital stay, cost of hospitalization and postoperative outcome, were analyzed. RESULTS: The "non-risk" patients who did not receive postoperative nutrition support had a higher rate of postoperative complications than patients who received postoperative nutrition support (2.40 ± 1.51 vs 1.23 ± 0.60, P = 0.000), and had a longer postoperative hospital stay (23.00 ± 15.84 d vs 15.27 ± 5.89 d, P = 0.009). There was higher cost of hospitalization for patients who received preoperative total parenteral nutrition (TPN)than for patients who did not receive preoperative TPN (62 713.50 ± 5070.66 RMB Yuan vs 43178.00 ± 3596.68 RMB Yuan, P = 0.014). Applying postoperative enteral nutrition significantly shortened postoperative fasting time (5.16 ± 1.21 d vs 6.40 ± 1.84 d, P = 0.001) and postoperative hospital stay (11.92 ± 4.34 d vs 15.77 ± 6.03 d, P = 0.002). The patients who received postoperative TPN for no less than 7 d had increased serum glucose levels (7.59 ± 3.57 mmol/L vs 6.48 ± 1.32 mmol/L, P = 0.006) and cost of hospitalization (47 724.14 ± 16 945.17 Yuan vs 38 598.73 ± 8349.79 Yuan, P = 0.000). The patients who received postoperative omega-3 fatty acids had a higher rate of postoperative complications than the patients who did not (1.33 ± 0.64 vs 1.13 ± 0.49, P = 0.041). High level of serum glucose was associated with a high risk of postoperative complications of infection. CONCLUSION: Appropriate and moderate nutritional intervention can improve the postoperative outcome of colorectal cancer patients.

Nutrition in alcohol-related liver disease:Physiopathology and management

Malnutrition encompassing both macro-and micro-nutrient deficiency,remains one of the most frequent complications of alcohol-related liver disease(ArLD).Protein-energy malnutrition can cause significant complications including sarcopenia,frailty and immunodepression in cirrhotic patients.Malnutrition reduces patient’s survival and negatively affects the quality of life of individuals with ArLD.Moreover,nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis.Prompt recognition of at-risk individuals,early diagnosis and treatment of malnutrition remains a key component of ArLD management.In this review,we describe the pathophysiology of malnutrition in ArLD,review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD,ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.

Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

Prognostic significance of hemoglobin,albumin,lymphocyte,platelet in gastrointestinal stromal tumors:A propensity matched retrospective cohort study

BACKGROUND The combined index of hemoglobin,albumin,lymphocyte,and platelet(HALP)can reflect systemic inflammation and nutritional status simultaneously,with some evidence revealing its prognostic value for some tumors.However,the effect of HALP on recurrence-free survival(RFS)in patients with gastrointestinal stromal tumors(GISTs)has not been reported.AIM To investigate the prognostic value of HALP in GIST patients.METHODS Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included.Clinicopathological data,preoperative albumin,blood routine information,postoperative treatment,and recurrence status were recorded.To eliminate baseline inequivalence,the propensity scores matching(PSM)method was introduced.Ultimately,the relationship between RFS and preoperative HALP was investigated.RESULTS The optimal cutoff value for HALP was determined to be 31.5 by X-tile analysis.HALP was significantly associated with tumor site,tumor size,mitosis,Ki67,National Institutes of Health(NIH)risk category,and adjuvant therapy(all P<0.001).Before PSM,GIST patients with an increased HALP had a significantly poor RFS(P<0.001),and low HALP was an independent risk factor for poor RFS[hazard ratio(HR):0.506,95%confidence interval(95%CI):0.291-0.879,P=0.016].In NIH high-risk GIST patients,GIST patients with low HALP had a worse RFS than patients with high HALP(P<0.05).After PSM,458 GIST patients were identified;those with an increased HALP still had significantly poor RFS after PSM(P<0.001)and low HALP was still an independent risk factor for poor RFS(HR:0.558,95%CI:0.319-0.976,P=0.041).CONCLUSION HALP was significantly correlated with postoperative pathology and postoperative treatment.Furthermore,HALP showed a strong ability to predict RFS in GIST patients who underwent radical resection.

Application of the Phase Angle in Patients with Malignant Tumors

Bioelectrical impedance analysis(BIA)is a noninvasive and reproducible technique for assessing changes in body composition and nutritional status.The phase angle(PA),a major parameter of BIA,is one of the most sensitive indicators used to detect malnutrition in patients,and is also a prognostic marker in various clinical diseases.The incidence of malnutrition in cancer patients is high,and malnutrition seriously affects the treatment process and prognosis of patients.Reasonable and effective nutritional interventions are therefore of great significance for cancer patients.Compared with traditional nutritional assessment tools,the PA has unique advantages in the nutritional assessment,efficacy monitoring and prognostic prediction of patients with malignant tumors,and it has broad application prospects in clinical practice.This article reviews the research progress on the application of the PA in patients with malignant tumors to provide clinicians with a tool to predict malnutrition,and provide a more favorable basis for the nutritional assessment,treatment and prognostic prediction of cancer patients.

基于营养风险评估下的营养支持对胸腔积液穿刺引流术后患者血清营养学指标、肺功能及免疫功能的影响

目的:探究胸腔积液穿刺引流术后患者应用基于营养风险评估下的营养支持措施的干预效果及对免疫功能、营养学指标的影响。方法:选取我科2020年3月至2023年3月期间80例胸腔积液穿刺引流术后患者,依据抽签法分组。对照组40例给予常规护理,观察组40例增加基于营养风险评估下的营养支持。4 w后,对比两组患者血清营养学指标:白蛋白(Albumin,ALB)、前白蛋白(Prealbumin,PA)、血红蛋白(Hemoglobin,Hb)、转铁蛋白(Transferrin,TRF);肺功能:第1s用力呼气量(Forced expiratory volume,FEV1)、肺活量(Vital capacity,VC)、每分钟最大通气量(Maximum ventilation per minute,MVV)、用力肺活量(Forced vital capacity,FVC);免疫功能指标:CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平。结果:术后观察组CD8^(+)水平低于对照组,TRF、ALB、Hb、VC、FEV1、FVC、CD3^(+)、MVV、CD4^(+)、PA、CD4^(+)/CD8^(+)水平高于对照组,差异有统计学意义(P<0.05)。结论:基于营养风险评估下的营养支持对胸腔积液穿刺引流术后患者干预,可有效提高患者免疫功能、营养状态,促进肺功能恢复。

基于肠内营养耐受性评估表的早期肠内营养支持对重症监护病房患者疾病治疗的价值研究

目的:探讨基于肠内营养耐受性评估表的早期肠内营养(EEN)支持对重症监护病房(ICU)患者疾病治疗的价值。方法:选取EEN支持治疗的ICU患者100例,根据数字表法随机分为对照组(50例)与观察组(50例)。对照组给予常规EEN治疗,观察组基于肠内营养耐受性评估表指导EEN治疗。比较两组喂养不耐受症状发生情况、EEN治疗后第4、7天的热卡达标率、干预前和干预7 d后营养状况指标以及预后指标。结果:观察组喂养不耐受症状总发生率低于对照组(P<0.05)。观察组第7天热卡达标率高于对照组(P<0.05)。干预7 d后,两组白蛋白、总蛋白较干预前升高,且观察组高于对照组(均P<0.05);对照组血红蛋白较干预前降低,且观察组高于对照组(均P<0.05)。观察组总住院时间短于对照组(P<0.05)。结论:基于肠内营养耐受性评估表的EEN支持治疗能够减少ICU患者喂养不耐受症状的发生,改善营养状况,减少患者住院时间,有利于患者预后。

鱼胶原低聚肽对急诊复杂手外伤手术患者预后的影响

目的探讨早期肠内营养添加鱼胶原低聚肽对急诊复杂手外伤手术患者预后的影响。方法回顾性分析急诊收治的122例接受手术治疗的复杂开放性手外伤患者资料,所有患者术后均早期应用肠内营养制剂,根据配方不同分为2组。对照组60例,肠内营养配方为口服均衡营养素联合乳清蛋白;试验组62例,肠内营养配方为对照组配方加用鱼胶原低聚肽。比较2组患者临床基线资料,治疗前后血红蛋白(Hb)、淋巴细胞计数(Lym)、中性粒细胞与淋巴细胞比值(NLR)、白蛋白(ALB)、前白蛋白(PA)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、肌酐(Cr)、甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)等水平变化;比较2组患者住院时间和术后感染性并发症发生率。结果与治疗前比较,对照组和试验组营养治疗后Hb、ALB、肝肾功能及脂质代谢指标无显著变化,PA、Lym显著提高,NLR显著降低;治疗后与对照组相比,试验组NLR下降更明显(P<0.01)。试验组感染性并发症发生率低于对照组,住院时间缩短(P<0.05)。结论急诊复杂手外伤术后早期肠内营养添加鱼胶原低聚肽可促进PA合成,降低炎症反应及伤口感染发生率,缩短住院时间。

超早期肠内营养干预对ICU重型颅脑损伤患者营养状况、并发症及临床预后的影响

目的:探讨超早期肠内营养干预对重型颅脑损伤(SHI)患者营养状况、并发症及临床预后的影响。方法:将96例SHI患者按照不同的干预方式分为对照组与试验组,每组各48例。对照组术后予以常规肠内营养干预(术后24 h内进行);试验组予以超早期肠内营养支持(术后6 h内进行)。记录两组患者干预前和干预7 d后营养指标[血清总蛋白(TP)、前白蛋白(PA)、白蛋白(ALB)和血红蛋白(Hb)];记录目标热卡达标率和并发症发生情况,并统计两组ICU入住时间、总住院时间和死亡率。结果:干预7 d后,试验组TP、Hb、ALB、PA水平均高于对照组(P<0.05);试验组5 d目标热卡达标率为61.22%,高于对照组的39.58%(P<0.05);两组患者胃肠道并发症发生率无统计学差异(P>0.05);试验组感染发生率低于对照组(P<0.05);试验组ICU入住时间和总住院时间均缩短(P<0.05),住院期内死亡率降低(P<0.05)。结论:对于SHI患者,超早期肠内营养干预能够改善其营养状况,减少院内感染的发生,促进康复,降低死亡率。

肺结核患者营养管理护理实践专家共识

肺结核住院患者营养风险若未及时纠正,易出现营养相关性疾病,如营养不良、药物性肝损伤、免疫功能低下、肺部感染等,从而增加抗结核治疗失败的风险。营养管理是治疗肺结核非常重要的辅助方法之一,但仍存在护理人员营养知识缺乏、营养评估标准不明确和管理流程不健全等相关问题,因此,规范结核病营养护理具有重要意义。基于此,中国防痨协会护理专业分会、同济大学附属上海市肺科医院联合组织专家,针对住院成人肺结核患者的营养管理护理问题,以临床实践为基础,运用文献分析法,结合结核病领域专家的工作经验,共同拟定《肺结核患者营养管理护理实践专家共识》,旨在为临床护理工作者实施营养管理提供指导依据,规范我国住院成人肺结核患者营养管理护理实践。

An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy

status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay （LOS） and the in-patient cost were also compared between these two groups. Results： At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin （ALB）, transferrin, and ALB parameters （P = 0.001, 0.000, and 0.000, respectively）. The complication incidences, including bone marrow suppression （20% vs. 48%, P = 0.037） and complications related infections （ 12% vs. 44%, P = 0.012）, in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy （96% vs. 76%, P - 0.103）. Furthemlore, the average LOS was decreased by 4.5 days （P = 0.001 ） and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times （P 〉 0.05） in the NST group. Conelusions： A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.

股骨粗隆间骨折高龄患者经PFNA内固定术治疗后肠内营养状态评分及其预后预测价值研究

目的探究股骨粗隆间骨折高龄(≥80岁)患者经股骨近端钉抗扭转系统(PFNA)内固定术治疗后肠内营养状态评分及其预后预测价值。方法选取2020~2022年首都医科大学附属北京友谊医院收治的86例股骨粗隆间骨折老年PFNA内固定术患者。回顾性收集所有患者临床相关资料,对患者进行营养风险和营养不足、综合评价患者手术最近1周的进食量是否下降及其感染性并发症评估。统计老年高龄患者的不良预后,对死亡组与生存组进行单因素分析,并且进行危险因素分析,对营养风险筛查工具(numerical rating scale 2002,NRS 2002)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)的预测价值进行评价。结果60~69岁、70~79岁和≥80岁3个年龄组中有营养风险的患者分别为8、16、39例,其中,≥80岁组中有营养风险患者人数占比最多,达到了90.70%(3943)。较高的营养风险等级与感染性并发症的发生以及延长的住院时间密切相关(P<0.05)。43例老年高龄患者预后死亡9例,占20.93%,单因素结果显示,死亡组患者年龄、APACHEⅡ评分、NRS 2002评分、MLR和冠心病比例明显高于生存组(P<0.05)。NRS 2002评分、MLR对高龄患者不良预后的曲线下面积(AUC)分别为0.801和0.816,而两者联合对不良预后的AUC值达0.915。结论股骨粗隆间骨折高龄患者经PFNA内固定术治疗后普遍存在营养不良。年龄、疾病严重程度、营养风险和炎症反应与不良预后存在密切关联。临床应充分考虑患者的年龄、健康状况和营养状况,采取个性化的治疗和康复措施,以提高预后和生存质量。同时,NRS 2002评分和MLR在预测接受PFNA内固定术治疗的高龄股骨粗隆间骨折患者术后死亡方面具有较好的预测价值,联合应用这两个指标可以更准确地评估患者的预后风险。

胆管癌病人临床营养评价方法的研究进展

采用准确、可靠的临床营养评价方法,对胆管癌病人进行精准化营养评估,并进行合理的营养支持,有望降低病人死亡风险,减少并发症,并改善预后。因此,根据可靠的营养指标评估胆管癌病人对于促进制定最合适的诊疗策略非常重要。该文查阅国内外文献,整理归纳胆管癌病人的临床营养评价方法,阐述了各营养评价指标对该类病人营养状况评估的适用性、有效性以及对临床结局的预测性,明确切实可行的营养评价方法,以更准确地评判胆管癌病人的营养状况。

老年营养风险指数在老年慢性阻塞性肺疾病病情判断中的价值

目的:探讨常用的营养评价指标在老年慢性阻塞性肺疾病(COPD)病人病情判断中的价值。方法:回顾性分析2018年1月至2020年8月在黄山首康医院老年科住院的94例老年COPD病人的临床资料,按转归分为好转组(n=83)和转ICU组(n=11)。评估营养状况和肺功能,收集第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1/预计值%)等信息,分析病人入院时的身体质量指数(BMI)、白蛋白、前白蛋白、视黄醇结合蛋白、淋巴细胞计数和老年营养风险指数(GNRI)等营养评价指标与肺功能的相关性,以及上述指标预测病人转入ICU的判断价值。结果:94例病人中男性60例,女性34例,中位年龄78(72, 83)岁。FEV1/预计值%与BMI、白蛋白、前白蛋白、视黄醇结合蛋白、淋巴细胞计数和GNRI等营养评价指标的相关系数分别是0.535(P <0.001)、0.726 (P <0.001)、0.351(P=0.001)、0.498 (P <0.001)、0.572 (P <0.001)和0.940(P <0.001)。上述指标预测病人转入ICU的受试者操作特征曲线的曲线下面积分别是0.744(95%CI:0.544~0.944, P <0.001)、0.834(95%CI:0.669~1.000, P <0.001)、0.658(95%CI:0.468~0.823,P<0.001)、0.602(95%CI:0.408~0.811,P<0.001)、0.649(95%CI:0.428~0.856, P <0.001)、0.875(95%CI:0.751~0.999, P <0.001)。结论:营养评价指标与老年COPD病人肺功能有一定的相关性,可协助判断COPD病人预后,其中GNRI的预测效果最佳。

预后营养指数在急危重症患者全因死亡中的预测价值

目的探讨预后营养指数(prognostic nutritional index PNI)在急危重症患者全因死亡中的预测价值。方法选取2021年3~7月首都医科大学附属北京朝阳医院急诊抢救室收治的急危重症患者为研究对象,收集其进入急诊抢救室24h内的相关临床资料并进行描述性分析。以患者28天内全因死亡为终点绘制PNI的受试者工作特征(receiver operating characteristic,ROC)曲线,根据最佳截断值分为高PNI组和低PNI组,比较两组的临床特征。根据患者28天内是否死亡分为存活组和死亡组,比较两组的临床特征,并运用单因素和多因素Logistic回归分析评价急危重症患者28天内全因死亡的危险因素。结果共纳入603例患者,PNI最佳截断值为43.825,据此将所有患者分为高PNI组(n=334)和低PNI组(n=269),发现低PNI组28天内全因死亡的患者比例明显高于高PNI组(P<0.05)。所有患者入急诊抢救室28天内死亡127例,死亡组营养不良患者的比例明显高于存活组(P<0.05)。Logistic回归分析结果显示,由PNI筛选出的入急诊抢救室时营养不良是急危重症患者28天内全因死亡的独立危险因素(OR=1.805,95%CI:1.157~2.817,P=0.009),且高龄、低体重指数、低血红蛋白水平也是28天内全因死亡的独立危险因素。结论急危重症患者存在较高的营养不良风险,由PNI筛选出的入急诊抢救室时营养不良、高龄、低体重指数、低血红蛋白水平是28天内全因死亡的独立危险因素。