摘要
目的分析脓毒症患者改良危重症营养风险(mNUTRIC)评分与入住ICU后28 d内病死风险的关系。方法选取重症监护医学信息市场Ⅳ(MIMIC-Ⅳ)数据库中2009—2022年首次入住ICU且符合脓毒症诊断标准的ICU住院患者1051例,根据患者入住ICU后28 d内病死情况分为生存组862例、病死组189例。提取数据库中既往提示与脓毒症死亡风险相关的协变量,包括人口统计学变量、合并症、疾病评分、治疗干预和实验室检查结果,测算两组患者的mNUTRIC评分。以单因素分析结果中有统计学差异的变量作为混杂因素纳入模型,调整混杂因素后,采用多因素Logistic回归模型分析脓毒症患者mNUTRIC评分与入住ICU后28 d内病死的相关性。采用限制性立方样条(RCS)模型分析脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险的关系,采用分段Logistic回归模型进行断点分析以确定其风险阈值,分析mNUTRIC评分与入住ICU后28 d内病死风险的阈值效应。结果生存组患者mNUTRIC评分为(3.91±1.96)分,病死组患者mNUTRIC评分为(5.01±1.85)分,两组相比,P<0.05。病死组患者年龄、序贯器官衰竭评估评分、急性生理学Ⅲ评分、急性生理学与慢性健康状况评价Ⅱ评分、白细胞计数、中性粒细胞计数、阴离子间隙、乳酸、天冬氨酸氨基转移酶、肌酐、血尿素氮及合并高血压病、心肌梗死比例均高于生存组(P均<0.05),而白蛋白、淋巴细胞计数、总胆固醇、血红蛋白、红细胞计数及合并恶性肿瘤、慢性支气管炎、冠心病、慢性阻塞性肺疾病比例均低于生存组(P均<0.05)。脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险呈正相关关系[OR(95%CI)=1.26(1.13~1.39),P<0.05]。脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险呈现“S”型非线性关系(P<0.05)。脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险的风险阈值为5.86分。当mNUTRIC评分≤5.86分时,mNUTRIC评分每升高1分,脓毒症患者入住ICU后28 d内病死风险增加40%;当mNUTRIC评分>5.86分时,mNUTRIC评分每升高1分,脓毒症患者入住ICU后28 d内病死风险增加4%。结论脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险呈正相关和“S”型非线性关系。脓毒症患者mNUTRIC评分与入住ICU后28 d内病死风险的风险阈值为5.86分。当mNUTRIC评分≤5.86分时,患者病死风险呈陡峭上升趋势;当mNUTRIC评分>5.86分时,患者病死风险增幅比较平缓。
Objective To analyze the relationship between the modified Nutrition Risk in the Critically Ill(mNU⁃TRIC)score and the risk of 28-day mortality after ICU admission in patients with sepsis.Methods A total of 1,051 ICU patients with a diagnosis of sepsis from the Medical Information Mart for Intensive Care IV(MIMIC-Ⅳ)database(2009-2022)were selected.These patients were admitted to the ICU for the first time and were divided into the survival group(n=862)and non-survival group(n=189)based on 28-day mortality.Covariates previously indicated to be associated with sep⁃sis mortality were extracted,including demographic variables,comorbidities,disease severity scores,therapeutic inter⁃ventions,and laboratory results.The mNUTRIC score was calculated for both groups.Variables showing statistically significant differences in univariate analysis were treated as confounders and included in a multivariate Logistic regression model to analyze the association between the mNUTRIC score and 28-day mortality after adjusting for these confounders.A restricted cubic splines(RCS)model was used to analyze the relationship between the mNUTRIC score and the risk of 28-day mortality.A piecewise Logistic regression model was employed for breakpoint analysis to identify the risk threshold,examining the threshold effect of the mNUTRIC score on 28-day mortality risk.Results The mNUTRIC score was signifi⁃cantly higher in the non-survival group(5.01±1.85)than in the survival group(3.91±1.96)(P<0.05).The non-sur⁃vival group had significantly higher age,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology ScoreⅢ(APSⅢ),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,white blood cell count,neutrophil count,anion gap,lactate,aspartate aminotransferase,creatinine,blood urea nitrogen,and proportions of hypertension and myocardial infarction(all P<0.05).Conversely,albumin level,lymphocyte count,total cholesterol,hemoglobin,red blood cell count,and proportions of malignancies,chronic bronchitis,coronary heart disease,and chronic obstructive pulmonary disease were significantly lower in the non-survival group(all P<0.05).The mNUTRIC score showed a positive correlation with the risk of 28-day mortality after ICU admission[OR(95%CI)=1.26(1.13-1.39),P<0.05].The re⁃lationship between the mNUTRIC score and the risk of 28-day mortality exhibited an S-shaped nonlinear pattern(P<0.05).The risk threshold for the mNUTRIC score regarding 28-day mortality risk was 5.86.When the mNUTRIC score was≤5.86,each 1-point increase in the score was associated with a 40%increase in the risk of 28-day mortality.When the mNUTRIC score was>5.86,each 1-point increase was associated with a 4%increase in the risk of 28-day mortality.Conclusions The mNUTRIC score is positively and nonlinearly associated with the risk of 28-day mortality after ICU ad⁃mission in patients with sepsis,demonstrating an S-shaped curve.The risk threshold for the mNUTRIC score is 5.86.The mortality risk increases steeply when the score is below or equal to this threshold,while the increase in mortality risk is more gradual when the score exceeds it.
作者
郑俊青
韩梦晨
田锁臣
曹东明
ZHENG Junqing;HAN Mengchen;TIAN Suochen;CAO Dongming(Clinical Medical College,Shandong Second Medical University,Weifang 261053,China;不详)
出处
《山东医药》
2026年第1期104-108,共5页
Shandong Medical Journal
基金
山东省医药卫生科技项目(2024030201084)。
关键词
脓毒症
营养不良
改良危重症营养风险评分
风险阈值
sepsis
malnutrition
modified Nutrition Risk in the Critically Ill score
risk threshold
