Sezer Mehmet Tugrul, Demir Murat, Gungor Gokhan, Yavuz Lutfi
Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey.
J Ren Nutr. 2008 May;18(3):288-93. doi: 10.1053/j.jrn.2007.11.009.
Nutritional support and the route of nutrition are important conditions for patients with acute renal failure (ARF) in intensive care units (ICUs). Enteral nutrition (EN) is the primary route of nutrition in these patients because of a lower rate of complications. A lack of enteral feeding was reported to increase intercellular adhesion molecule-1 (ICAM-1) in experimental models. Serum soluble ICAM-1 (sICAM-1) level is an independent predictor of mortality in predialysis patients. However, the effect of nutritional route on serum ICAM-1 level is unknown in ARF patients. The aim of this study was to investigate the relationship between route of nutrition and serum ICAM-1 level and its prognostic implications in ICU ARF patients.
In total, 64 ICU patients with ARF were assessed according to their clinical features, route of nutrition, laboratory parameters, serum sICAM-1 levels, presence of infection, Acute Physiology and Chronic Health Evaluation (APACHE) III scores, and outcomes on their first nephrology consultation day.
Thirty-two patients died during the follow-up period. The mortality rate and infection rate were higher in the parenteral nutrition (PN) group compared with the EN group (64% vs 42%, P = .05, and 84% vs 64%, P = .05, respectively). The route of nutrition influenced the serum sICAM-1 level. Parenteral nutrition was associated with a higher serum sICAM-1 level compared to EN (434 ng/mL [range 255 to 1,240] vs 217 ng/mL [range 123 to 296], respectively, P = .0004). The APACHE III score was found to be an independent prognostic factor among the parameters of nutritional route, presence of infection, serum albumin level, and serum sICAM-1 level.
Patients with ARF as supported by PN had a lower serum albumin level, and a higher APACHE III score, sICAM-1 level, and mortality and infection rate. Serum sICAM-1 levels did not independently predict mortality in the present set of ARF patients.
营养支持及营养途径是重症监护病房（ICU）中急性肾衰竭（ARF）患者的重要条件。肠内营养（EN）是这些患者的主要营养途径，因为其并发症发生率较低。据报道，在实验模型中，缺乏肠内喂养会增加细胞间黏附分子-1（ICAM-1）的水平。血清可溶性ICAM-1（sICAM-1）水平是透析前患者死亡率的独立预测指标。然而，营养途径对ARF患者血清ICAM-1水平的影响尚不清楚。本研究的目的是探讨营养途径与血清ICAM-1水平之间的关系及其对ICU中ARF患者的预后意义。
总共64例ICU中的ARF患者在首次肾病会诊日，根据其临床特征、营养途径、实验室参数、血清sICAM-1水平、感染情况、急性生理与慢性健康状况评估（APACHE）III评分及预后进行评估。
32例患者在随访期间死亡。肠外营养（PN）组的死亡率和感染率高于EN组（分别为64%对42%，P = 0.05；84%对64%，P = 0.05）。营养途径影响血清sICAM-1水平。与EN相比，PN与更高的血清sICAM-1水平相关（分别为434 ng/mL[范围255至1240]对217 ng/mL[范围123至296]，P = 0.0004）。在营养途径、感染情况、血清白蛋白水平和血清sICAM-1水平等参数中，APACHE III评分是一个独立的预后因素。
接受PN支持的ARF患者血清白蛋白水平较低，但APACHE III评分、sICAM-1水平、死亡率和感染率较高。在本组ARF患者中，血清sICAM-1水平不能独立预测死亡率。
