改良版危重症营养风险评分对脓毒症病人发生持续炎症-免疫抑制-分解代谢综合征的预测价值  

Predictive value of modified NUTrition risk in the critically ill score for persistent inflammation,immunosuppression and catabolism syndrome in patients with sepsis

作　　者：洪巧 李云婷[1] 李芬 HONG Qiao;LI Yunting;LI Fen(Department of Emergency,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院急诊科,海南海口570311

出　　处：《安徽医药》2024年第5期943-948,共6页Anhui Medical and Pharmaceutical Journal

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 patient

关 键 词：脓毒症 改良版危重症营养风险评分 持续炎症-免疫抑制-分解代谢综合征 预测价值 

分 类 号：R459.7[医药卫生—急诊医学]