老年脑卒中患者营养风险指数对30天非计划再入院的预测价值  

Correlation between nutritional risk index and 30-day unplanned readmission in elderly stroke patients

作　　者：陈志朋 刘雪梅 周晓花 王淑芳 Chen Zhipeng;Liu Xuemei;Zhou Xiaohua;Wang Shufang(Department of Neurology,Yancheng Third People's Hospital,Yancheng School of Clinical Medicine of Nanjing Medical University,Yancheng 224001,China)

机构地区：[1]南京医科大学盐城临床医学院、盐城市第三人民医院神经内科,224001

出　　处：《神经疾病与精神卫生》2023年第11期780-786,共7页Journal of Neuroscience and Mental Health

摘　　要：目的探讨老年营养风险指数(GNRI)与老年脑卒中患者非计划再入院(再入院)的关系。方法回顾性分析2019年6月至2022年5月江苏省盐城市第三人民医院收治的307例老年脑卒中患者的临床资料。根据所有患者的GNRI中位数,将患者分为GNRI正常组(GNRI≥92)和低GNRI组(GNRI<92)。使用倾向性评分匹配法(PSM)得到年龄、入院时白蛋白等13个变量均衡的两组样本,采用Logistic回归分析PSM前后GNRI对再入院的影响,采用受试者工作特征(ROC)曲线下面积(AUC)评价单独及校正其他协变量后GNRI对再入院的预测价值。结果307例老年脑卒中患者的GNRI为(92.62±25.30),GNRI正常患者133例,占43.32%。PSM后,共126对匹配成功,两组患者的年龄、体重指数、合并糖尿病、住院时间、手术治疗比例、白蛋白等临床资料比较,差异无统计学意义(P>0.05)。PSM后,低GNRI组的再入院率为28.57%(36/126)高于GNRI正常组的11.90%(15/126),差异有统计学意义(χ^(2)=10.841,P=0.001)。PSM后的Logistic回归分析显示,仅纳入GNRI的模型1中,低GNRI患者的再入院风险较GNRI正常者增加2.232倍(OR=3.232,95%CI:1.701~6.138,P=0.001);在校正了年龄、性别后的模型2中,低GNRI患者的再入院风险较GNRI正常者增加2.206倍(OR=3.206,95%CI:1.674~6.138,P=0.001);在校正了年龄、性别等所有变量后的模型3中,低GNRI患者的再入院风险较GNRI正常者分别增加2.052倍(OR=3.052,95%CI:1.469~6.339,P=0.003)。ROC曲线分析显示,模型1预测患者再入院的AUC为0.821(95%CI:0.755~0.886),采用模型2、3校正协变量后预测再入院的AUC分别为0.828(95%CI:0.770~0.886)、0.847(95%CI:0.797~0.898),模型3的AUC高于模型1、2,差异有统计学意义(Z=3.036、2.457;P=0.002、0.014)。结论GNRI可有效预测老年脑卒中患者再入院的发生,具有重要的预警作用,可能指导医护人员对老年脑卒中患者进行营养管理。Objective To explore the correlation between the geriatric nutritional risk index(GNRI)and unplanned readmission(readmission)in elderly stroke patients.Methods The clinical data of 307 elderly stroke patients admitted to the Yancheng Third People's Hospital,Jiangsu Province from June 2019 to May 2022 were retrospectively analyzed.According to the median GNRI of all patients,they were divided into a normal GNRI group(GNRI≥92)and a low GNRI group(GNRI<92).The propensity score matching(PSM)was used to obtain two sets of samples with 13 variables balanced,such as age and albumin at admission.Logistic regression was used to analyze the impact of GNRI on readmission before and after PSM.The predictive value of GNRI on readmission was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC)alone and after adjusting for other covariates.Results Among 307 elderly stroke patients,the GNRI was(92.62±25.30),and 43.32%(133/307)patients had normal GNRI.After PSM,a total of 126 pairs were successfully matched.There was no statistical difference between the two groups in age,body mass index,diabetes,hospital stay,surgical treatment ratio,albumin and other clinical data(P>0.05).After PSM,the readmission rate of the low GNRI group was 28.57%(36/126),which was higher than the 11.90%(15/126)of the normal GNRI group,and the difference was statistically significant(χ^(2)=10.841,P=0.001).Logistic regression analysis after PSM showed that in Model 1,which only included GNRI,the readmission risk of patients with low GNRI increased by 2.232 times compared to those with normal GNRI,and the difference was statistically significant[OR=3.232,95%CI(1.701,6.138),P=0.001].In Model 2,after adjusting for age and gender,the readmission risk of patients with low GNRI increased by 2.206 times compared to those with normal GNRI,and the difference was statistically significant[OR=3.206,95%CI(1.674,6.138),P=0.001].In Model 3,after adjusting for all variables such as age and gender,the readmission risk of patients with low

关 键 词：卒中 老年人 再入院 营养风险指数 倾向性评分匹配法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]