Analysis of nutritional risk assessment and prognosis in critically ill patients / 中华危重病急救医学

ABSTRACT

Objective To explore the prognostic role of nutritional benefit assessment (NUTRIC score), nutritional risk screening 2002 (NRS 2002), traditional nutritional laboratory indicators albumin (ALB) and prealbumin (PA) in critically ill patients. Methods A historical-prospective cohort study was conducted. The data of 427 patients admitted to Department of Critical Care Medicine of the Affiliated Hospital of Guizhou Medical University from February 2014 to October 2014 were retrospectively analyzed, and thereafter a follow-up of 275 critically ill patients from November 2014 to April 2015 prospectively enrolled was performed. 261 patients were enrolled finally. Patients were divided into death group and survival group according to 28-day and 90-day outcome, the baseline data, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, NRS 2002, NUTRIC score, ALB and PA were compared between the two groups. Logistic regression analysis was used to find risk factors for 28-day and 90-day prognosis. Results ① NRS 2002 score of all the 261 patients were greater than or equal to 3 with 100% nutritional risk. The patients in NUTRIC score 5-9 group had lower ALB and PA, higher NRS 2002 score, longer mechanical ventilation time and length of intensive care unit (ICU) stay, which indicated they were more serious. ② Twenty eight-day mortality was 20.7% (54 died from 261). Compared with survival group, the patients in death group had higher APACHE Ⅱ, SOFA, and NUTRIC scores [29.00 (22.75, 34.25) vs. 24.00 (20.00, 28.00), 10.0 (8.0, 13.0) vs. 9.0 (7.0, 11.0), 6.37±1.84 vs. 5.59±1.64, all P < 0.01], and longer days from hospital to ICU admission and mechanical ventilation time in ICU [1.5 (0, 9.2) days vs. 0 (0, 4.0) days, 6.0 (4.0, 11.0) days vs. 4.2 (2.5, 7.8) days, both P < 0.05]. It was revealed by logistic regression analysis that APACHE Ⅱ score [odds ratio (OR) = 1.089, 95% confidence interval (95%CI) = 1.039-1.141, P = 0.000] and days from hospital to ICU admission (OR = 1.042, 95%CI = 1.014-1.071, P = 0.003) were the independent risk factors for 28-day death in critically ill patients. ③ Ninety-day mortality was 42.5% (111 died from 261). Compared with the survival group, the death group patients were older with higher APACHE Ⅱ, SOFA, NRS 2002, and NUTRIC scores [age (years) 64.44±18.11 vs. 54.25±19.66, APACHE Ⅱ 27.00 (23.00, 31.00) vs. 23.00 (20.00, 27.00), SOFA 10.0 (8.0, 12.0) vs. 9.0 (7.0, 11.0), NRS 2002 5.08±1.47 vs. 4.67±1.41, NUTRIC 6.32±1.58 vs. 5.33±1.68], ALB was significantly reduced [g/L 27.70 (23.05, 32.00) vs. 30.73 (26.90, 34.20)], and mechanical ventilation time in ICU was extended obviously [days 5.7 (3.6, 11.0) vs. 3.9 (2.4, 7.0), all P < 0.05]. It was revealed by logistic regression analysis that old age (OR = 1.019, 95%CI = 1.002-1.037, P = 0.029) and NUTRIC score (OR = 1.211, 95%CI = 0.983-1.491, P = 0.072) were the independent risk factors for 90-day death probability, and ALB probability was the protect factor for 90-day death (OR = 0.954, 95%CI = 0.916-0.994, P = 0.024). Conclusion It was NUTRIC score but not NRS 2002, ALB and PA predicted 90-day mortality in critically ill patients.