Chermesh Irit, Hajos Jonathan, Mashiach Tatiana, Bozhko Masha, Shani Liran, Nir Rony-Reuven, Bolotin Gil
Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
Eur J Prev Cardiol. 2014 Apr;21(4):475-83. doi: 10.1177/2047487312452969. Epub 2012 Jun 27.
Undernourished patients treated in general surgery departments suffer from prolonged and complicated hospitalizations, and higher mortality rates compared with well nourished patients. Pivotal information regarding patients' nutritional status and its effect on clinical outcome is lacking for cardiac surgery patients. We investigated the prevalence of malnutrition risk and its association with 30-day hospital mortality and postoperative complications.
Four hundred and three patients who underwent cardiac surgery during 2008 and were screened with the Malnutrition Universal Screening Tool (MUST) on admission were enrolled. Univariate and multivariate logistic regression analyses compared the association of high and low risk for malnutrition with length of hospitalization (LOS), in-hospital and 30-day mortality, and postoperative complications. Almost 20% of the patients were found to be at high risk for malnutrition. Univariate analyses revealed higher in-hospital mortality rates (p = 0.03) and greater incidence of LOS and antibiotic treatment longer than 21 days (p = 0.002 and p = 0.04, respectively), vasopressor treatment longer than 11 days (p = 0.02), and positive blood cultures (p = 0.02) in patients belonging to the high-risk MUST group. Incorporation of the MUST in a multivariate model with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) significantly improved postoperative complications prediction, as well as in-hospital and 30-day mortality, compared with the EuroSCORE alone.
Malnutrition is prevalent in patients undergoing cardiac surgery, associated with higher postoperative mortality and morbidity. Preoperative MUST screening has emerged as highly relevant for enabling early diagnosis of patients at malnutrition risk, predicting postoperative mortality and morbidity, thus promoting well timed treatment. Prospective studies are needed to explore whether intervention can decrease malnutrition risk.
与营养状况良好的患者相比，普通外科治疗的营养不良患者住院时间延长且情况复杂，死亡率更高。心脏手术患者缺乏有关其营养状况及其对临床结局影响的关键信息。我们调查了营养不良风险的患病率及其与30天住院死亡率和术后并发症的关联。
纳入2008年接受心脏手术且入院时使用营养不良通用筛查工具（MUST）进行筛查的403例患者。单因素和多因素逻辑回归分析比较了营养不良高风险和低风险与住院时间（LOS）、住院期间和30天死亡率以及术后并发症之间的关联。发现近20%的患者存在高营养不良风险。单因素分析显示，高风险MUST组患者的住院死亡率更高（p = 0.03），LOS更长、抗生素治疗超过21天（分别为p = 0.002和p = 0.04）、血管升压药治疗超过11天（p = 0.02）以及血培养阳性（p = 0.02）的发生率更高。与单独使用欧洲心脏手术风险评估系统（EuroSCORE）相比，将MUST纳入多变量模型中可显著改善术后并发症预测以及住院期间和30天死亡率。
营养不良在心脏手术患者中普遍存在，与较高的术后死亡率和发病率相关。术前MUST筛查对于早期诊断有营养不良风险的患者、预测术后死亡率和发病率以及促进及时治疗具有高度相关性。需要进行前瞻性研究以探索干预措施是否可以降低营养不良风险。
