营养风险指数评估老年重症社区获得性肺炎患者预后的临床价值  

The Clinical Value of Geriatric Nutritional Risk Index in Evaluating Prognosis of Elderly Patients with Severe Community Acquired Pneumonia

作　　者：杨琴[1] 徐维国[1] 杨爱萍[1] 李丹[1] YANG Qin;XU Weiguo;YANG Aiping;LI Dan(Department of Respiratory and Critical Care Medicine, Mianyang Central Hospital,Mianyang 621000, China)

机构地区：[1]绵阳市中心医院呼吸与危重症医学科,四川绵阳621000

出　　处：《标记免疫分析与临床》2021年第6期988-992,共5页Labeled Immunoassays and Clinical Medicine

基　　金：绵阳市卫生计生委支持项目(编号:201648)。

摘　　要：目的分析营养风险指数(geriatric nutritional risk index,GNRI)评估重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)患者预后的临床价值。方法以2015年8月至2018年12月我院收治的126例老年SCAP患者、60例非SCAP患者和60例健康人为研究对象。比较三组入院时GNRI。记录126例老年SCAP患者入院28 d内的存活情况,分为死亡组和存活组,比较两组患者的临床资料。Pearson分析GNRI与APACHEⅡ评分的相关性;老年SCAP患者死亡预后的影响因素用Logistic多因素分析;ROC曲线分析GNRI预测死亡预后的价值。结果SCAP患者GNRI为89.00±6.65分,明显低于非SCAP患者(92.08±7.67分)和健康人(94.89±3.12分),均P<0.001。非SCAP患者GNRI也低于健康人(P=0.009)。GNRI与APACHEⅡ评分呈负相关(r=-0.289,P<0.001)。死亡组血红蛋白、总蛋白和GNRI均低于存活组,而年龄、C反应蛋白和APACHEⅡ评分均高于存活组(P<0.05)。Logistic多因素分析结果显示,年龄(OR=1.456)、血红蛋白(OR=0.678)、总蛋白(OR=0.701)、GNRI(OR=0.768)、C反应蛋白(OR=2.045)和APACHEⅡ评分(OR=3.786)是影响老年SCAP患者死亡预后的独立影响因素(P均<0.05)。GNRI预测老年SCAP患者28 d死亡预后的AUC为0.838,当GNRI取82.07分时,约登指数最大(0.625),即此时预测价值最高,灵敏度和特异性分别为89.02%和73.45%。结论GNRI与老年SCAP的病情严重程度有关,GNRI对老年SCAP患者28 d内死亡预后的早期评估有一定价值。Objective To analyze the clinical value of geriatric nutritional risk index(GNRI)in evaluating the prognosis of patients with severe community-acquired pneumonia(SCAP).Methods From August,2015 to December,2018,126 elderly patients with SCAP,60 patients with non-SCAP and 60 healthy people were selected as the research objects.GNRI was compared among the three groups at admission.126 elderly patients with SCAP were divided into the death group and survival group.The clinical data of the two groups were compared.Pearson analysis was conducted for the correlation analysis.Logistic regression model was established to analyze the factors influencing the prognosis of elderly patients with SCAP and ROC curve was drawn to analyze the value of GNRI in predicting prognosis,and area under ROC curve(AUC),sensitivity,specificity and Youden index were calculated.Results GNRI of SCAP patients was 89.00±6.65 points,which was significantly lower than that of non-SCAP patients(92.08±7.67 points,P<0.001)and healthy people(94.89±3.12 points,P<0.001).GNRI of patients with non-SCAP was also lower than that of healthy people(P=0.009).There was a negative correlation between GNRI and ApacheⅡscore(r=-0.289,P<0.001).The hemoglobin,total protein and GNRI of the death group were lower than those of the survival group,while age,C-reactive protein and ApacheⅡscores were higher than those of the survival group(P<0.05).Logistic multivariate analysis showed that age(OR=1.456),hemoglobin(OR=0.678),total protein(OR=0.701),GNRI(OR=0.768),C-reactive protein(OR=2.045)and ApacheⅡscore(OR=3.786)were the independent factors affecting the prognosis of elderly patients with SCAP(all P<0.05).The AUC of GNRI in predicting 28-day mortality of elderly patients with SCAP was 0.838.When GNRI was 82.07,the Youden index was the highest(0.625),indicating that the predictive value was the highest,with sensitivity and specificity of 89.02%and 73.45%,respectively.Conclusion GNRI is related to the severity of the disease in elderly patients with SCAP.GNRI has

关 键 词：营养风险指数 老年人 重症社区获得性肺炎 预后 

分 类 号：R563.1[医药卫生—呼吸系统] R15[医药卫生—内科学]