摘要
目的探讨改良版危重症营养风险(mNUTRIC)评分对脓毒症病人发生持续炎症-免疫抑制-分解代谢综合征(PICS)的预测价值。方法纳入2021年1月至2022年8月在海南医学院第二附属医院重症监护病房(ICU)接受治疗的285例脓毒症病人为研究对象。收集病人入ICU时的年龄、查尔森合并症指数评分、急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分、mNUTRIC评分以及实验室指标和器官功能支持治疗情况。根据是否发生PICS将病人分为PICS组(n=102)与非PICS组(n=183),比较两组间各指标的差异。应用二分类logistic回归模型和受试者操作特征(ROC)曲线分析mNUTRIC评分与脓毒症病人发生PICS的关系。结果脓毒症病人PICS发生率为35.79%。PICS组年龄、查尔森合并症指数评分、APACHEⅡ评分、SOFA评分、mNUTRIC评分、应用血管活性药物时间≥72 h占比、机械通气时间≥72 h占比、连续肾脏替代治疗(CRRT)时间≥72 h占比以及血清C-反应蛋白、乳酸水平分别为(73.49±8.64)岁、[2.00(1.00,3.00)]分、(21.67±6.62)分、(8.69±2.63)分、[5.00(5.00,6.00)]分、53.92%、71.57%、48.04%、[32.85(20.83,74.98)]mg/L、[3.33(2.30,4.78)]mmol/L,均高于非PICS组的(67.72±8.63)岁、[1.00(0.00,2.00)]分、(17.83±6.05)分、(7.45±2.43)分、[3.00(2.00,4.00)]分、29.51%、41.53%、23.50%、[27.00(18.50,38.30)]mg/L、[2.60(2.02,4.00)]mmol/L,差异有统计学意义(P<0.05)。PICS组的血清白蛋白水平为(37.17±2.92)g/L,低于非PICS组的(38.22±2.88)g/L,差异有统计学意义(P<0.05)。mNUTRIC评分≥5分的脓毒症病人PICS发生率为73.64%,高于mNUTRIC评分<5分的12.00%(χ^(2)=111.66,P<0.001)。logistic回归分析结果显示,mNUTRIC评分值升高[OR=2.61,95%CI:(1.73,3.94),P<0.001],机械通气时间≥72 h[OR=3.24,95%CI:(1.60,6.56),P=0.001]、CRRT时间≥72 h[OR=3.45,95%CI:(1.68,7.08),P=0.001]是脓毒症病人发生PICS的独立危险因素。mNUTRIC评分预测脓毒症病人发生PICS的ROC曲线下面积为0.85,95%CI:(0.81,0.89),最佳截断值为4分时,预测脓毒症病人发生PICS的灵敏度为79.41%、特异度为84.15%和约登指数为0.64。结论发生PICS的脓毒症病人入ICU时mNUTRIC评分明显高于非PICS病人,同时mNUTRIC评分是脓毒症病人发生PICS的独立预测因子,并且mNUTRIC评分在预测脓毒症病人PICS方面具有更好的区分能力。
Objective To investigate the predictive value of modified NUTrition Risk in the Critically ill(mNUTRIC)score for persis⁃tent inflammation,immunosuppression and catabolism syndrome(PICS)in patients with sepsis.Methods Two hundred and eightyfive patients with sepsis who were treated in the intensive care unit(ICU)of the Second Affiliated Hospital of Hainan Medical Universiand chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,mNUTRIC score,laboratory indexes at ICU admission,and organ function supportive treatment were collected.Patients were assigned into the PICS group(n=102)and the non-PICS group(n=183)according to the presence or absence of PICS,and the differences of each index between the two groups were compared.Binary logistic regression model and receiver operating characteristic(ROC)curve were used to analyze the rela⁃tionship between mNUTRIC score and the occurrence of PICS in patients with sepsis.Results In this study,the incidence of PICS in patients with sepsis was 35.79%.The age,chalson comorbidity index score,SOFA score,APACHEⅡscore,mNUTRIC score,the pro⁃portion of duration of vasoactive drug use more than 72 hours,the proportion of duration of mechanical ventilation more than 72 hours,the proportion of duration of continuous renal replacement therapy(CRRT)more than 72 hours,and the serum levels of C-reactive pro⁃tein and lactate in the PICS group were(73.49±8.64)years,[2.00(1.00,3.00)]points,(21.67±6.62)points,(8.69±2.63)points,[5.00(5.00,6.00)]points,53.92%,71.57%,48.04%,[32.85(20.83,74.98)]mg/L and[3.33(2.30,4.78)]mmol/L,respectively,which were higher than those in the non-PICS group{(67.72±8.63)years,[1.00(0.00,2.00)]points,(17.83±6.05)points,(7.45±2.43)points,[3.00(2.00,4.00)]points,29.51%,41.53%,23.50%,[27.00(18.50,38.30)]mg/L and[2.60(2.02,4.00)]mmol/L}(all P<0.05).The serum al⁃bumin level in the PICS group was(37.17±2.92)g/L,which was lower than that in the non-PICS group[(38.22±2.88)mmol/L](P<0.05).The incidence of PICS in patients with sepsis with mNUTRIC score≥5 points was 73.64%,which was higher than that in patients with sepsis with mNUTRIC score<5 points(12.00%)(χ2=111.66,P<0.001).Logistic regression analysis showed that the elevated value of mNUTRIC score[OR=2.61,95%CI:(1.73,3.94),P<0.001],duration of mechanical ventilation more than 72 hours[OR=3.24,95%CI:(1.60,6.56),P=0.001],duration of CRRT more than 72 hours[OR=3.45,95%CI:(1.68,7.08),P=0.001]were the independent risk fac⁃tors for PICS in patients with sepsis.The area under the ROC curve of mNUTRIC score in predicting PICS in patients with sepsis was 0.85,95%CI:(0.81,0.89),and the best cut-off value was 4 points to predict PICS in patients with sepsis,with a sensitivity of 79.41%,a specificity of 84.15%and a Youden index of 0.64.Conclusions The mNUTRIC score of patients with sepsis with PICS is significantly higher than that of patients without PICS at ICU admission.At the same time,the mNUTRIC score is an independent predictor of PICS in patients with sepsis,and the mNUTRIC score has a better discriminatory ability for PICS prediction in patients with sepsis.
作者
洪巧
李云婷
李芬
HONG Qiao;LI Yunting;LI Fen(Department of Emergency,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China)
出处
《安徽医药》
CAS
2024年第5期943-948,共6页
Anhui Medical and Pharmaceutical Journal
