改良危重症营养风险评分与急诊重症监护室脓毒症患者住院病死率的相关性分析  

Correlation Analysis of Modified Nutritional Risk in Critically Ill Score with In-hospital Fatality in Sepsis Patients in the Emergency Intensive Care Unit

作　　者：李水仙 唐俊鹏 杨正飞[1] 刘婉弟[1] 王鹏飞[1] LI Shuixian;TANG Junpeng;YANG Zhengfei;LIU Wandi;WANG Pengfei(Emergency Intensive Care Unit,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院急诊重症监护室,广东广州510120

出　　处：《中山大学学报(医学科学版)》2025年第2期328-334,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(82372207)。

摘　　要：【目的】为了明确营养评分在脓毒症患者中的应用价值,探讨改良危重症营养风险(mNUTRIC)评分对急诊重症监护室脓毒症患者住院病死率的影响。【方法】回顾性分析2021年1月至2024年5月在中山大学孙逸仙纪念医院急诊重症监护室治疗的436例脓毒症患者的临床资料和实验室检查数据。根据在院治疗期间是否死亡将患者分为存活组(298例)和死亡组(138例)。比较2组患者临床和实验室检查资料,采用多因素Logistic回归分析患者住院期间死亡的危险因素。采用ROC曲线评价各个危险因素对脓毒症患者预后的评估价值。【结果】死亡组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、营养风险筛查2002(NRS2002)评分、mNUTRIC评分、序贯器官衰竭评估(SOFA)评分、padua静脉血栓风险评分、慢性肾衰竭比例、肺炎比例、C反应蛋白、乳酸浓度、中性粒细胞均高于存活组,预后营养指数、胆碱酯酶、胆碱酯酶白蛋白比值、淋巴细胞均低于存活组,差异均具有统计学意义(P<0.05)。Logistic回归分析结果显示:mNUTRIC评分[OR=1.254,95%CI(1.109,1.417)]、C反应蛋白[OR=1.004,95%CI(1,1.007)]、肺炎[OR=1.82,95%CI(1.017,3.257)]是脓毒症患者住院期间死亡的独立危险因素。ROC曲线分析结果显示:mNUTRIC评分预测脓毒症患者住院期间死亡的曲线下面积(AUC)为0.683,95%CI(0.623,0.742),mNUTRIC评分敏感度为83%,特异度为49.3%,C反应蛋白的AUC为0.602,95%CI(0.533,0.671),肺炎的AUC为0.582,95%CI(0.516,0.647)。【结论】mNUTRIC评分是急诊重症监护室脓毒症患者住院期间死亡的独立预测指标。【Objective】To clarify the application value of nutritional scoring in patients with sepsis and explore the impact of the modified Nutritional Risk in Critically Ill(mNUTRIC)score on the in-hospital fatality of sepsis patients in the emergency intensive care unit(EICU).【Methods】A retrospective analysis was conducted on the clinical data and laboratory examination results of 436 sepsis patients treated in the EICU of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2021 to May 2024.The patients were divided into survival group(298 cases)and death group(138 cases)according to whether they died or not during hospital treatment,and then compared the two groups’data.Logistic multi-factor regression analysis was used to analyze the risk factors for in-hospital death and the ROC curve to evaluate the predictive value of each risk factor for the prognosis of sepsis patients.【Results】The death group exhibited higher Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Nutritional Risk Screening 2002(NRS 2002)score,mNUTRIC score,Sequential Organ Failure Assessment(SOFA)score,Padua Prediction Score for Venous Thromboembolism,the proportions of chronic kidney failure and pneumonia patients,C-reactive protein(CRP)level,lactate concentration and neutrophil count,but lower prognostic nutritional index,cholinesterase level,cholinesterase albumin ratio and lymphocyte count than the survival group,with statistical significance(all P<0.05).Logistic regression analysis revealed that the mNUTRIC score[OR=1.254,95%CI(1.109,1.417)],CRP[OR=1.004,95%CI(1,1.007)],and pneumonia[OR=1.82,95%CI(1.017,3.257)]were independent risk factors for in-hospital death in sepsis patients.ROC curve analysis showed that the area under the curve(AUC)of the mNUTRIC score for predicting in-hospital death in sepsis patients was 0.683[95%CI(0.623,0.742)],with a sensitivity of 83%and a specificity of 49.3%.The AUC for CRP and pneumonia were 0.602[95%CI(0.533,0.671)],and 0.582[95%CI(0.516,0.647)].【Conclusion】The

关 键 词：mNUTRIC评分 脓毒症 危险因素 营养 预后 

分 类 号：R459.7[医药卫生—急诊医学]