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作 者:牛晓璇 许雅鑫 李宏宾 高键 NIU Xiaoxuan;XU Yaxin;LI Hongbin;GAO Jian(Department of Nutrition,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Intensive Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China;Department of General Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
机构地区:[1]复旦大学附属中山医院营养科,上海200032 [2]郑州大学附属第一医院重症医学科,郑州450000 [3]复旦大学附属中山医院全科医学科,上海200032
出 处:《中国临床医学》2024年第6期925-931,共7页Chinese Journal of Clinical Medicine
摘 要:目的探讨基于前白蛋白水平和T淋巴细胞计数构建的营养免疫评分(nutritional and immunity score,NIS)与危重症患者预后的相关性。方法回顾性纳入2020年9月至2021年8月入住郑州大学第一附属医院重症监护病房的患者,收集患者基本信息、入院24 h内急性生理学与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)及相关生化指标,并以入住重症监护病房28 d内全因死亡为终点。通过X-tile软件确定与死亡风险相关的前白蛋白水平和T淋巴细胞计数的最佳截断值。根据截断值和正常参考范围进行分层,并计算NIS评分。采用单因素和多因素Cox回归,分析NIS与死亡结局的相关性。结果前白蛋白的最佳截断值为110 mg/L,T淋巴细胞计数为455个/μL,NIS得分0~4分。校正混杂因素后,多因素Cox回归分析显示,NIS评分2分(HR=1.87,95%CI 1.19~2.94,P=0.023)、3分(HR=2.04,95%CI 1.20~3.19,P=0.007)和4分(HR=1.68,95%CI 1.24~3.96,P=0.005)的患者死亡风险增加。结论NIS≥2分与危重症患者死亡风险增加相关;NIS可作为危重症早期风险分层和预后评估的有效工具。Objective To explore the correlation between the nutritional and immunity score(NIS)based on prealbumin and T lymphocyte count and the prognosis of critically ill patients.Methods A retrospective study was conducted involving patients from the intensive care unit of the First Affiliated Hospital of Zhengzhou University from September 2020 to August 2021.Patients’basic information,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores within 24 hours of admission,and relevant biochemical indicators were collected.The primary endpoint was all-cause mortality within 28 days.The optimal cut-off values for prealbumin and T lymphocyte count related to mortality risk were determined using X-tile software.Patients were stratified according to these cut-off values and normal reference ranges,and the NIS was calculated.Univariate and multivariate Cox regression analyses were conducted to evaluate the relationship between NIS and mortality.Results The optimal cut-off value for prealbumin was 110 mg/L,and for T lymphocyte count,it was 455/μL,with NIS scores ranging from 0 to 4.After adjusting for confounding factors,patients with NIS scores of 2(HR=1.87,95%CI 1.19-2.94,P=0.023),3(HR=2.04,95%CI 1.20-3.19,P=0.007),and 4(HR=1.68,95%CI 1.24-3.96,P=0.005)showed a significantly increased risk of mortality.Conclusions NIS≥2 is associated with an increased risk of death in critically ill patients.NIS can serve as an effective tool for early risk stratification and prognostic assessment in critically ill patients.
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