Simpson Fiona, Doig Gordon S
Northern Clinical School Intensive Care Research Unit, University of Sydney, NSW, Australia.
Northern Clinical School Intensive Care Research Unit, University of Sydney, NSW, Australia
JPEN J Parenter Enteral Nutr. 2015 Mar;39(3):313-21. doi: 10.1177/0148607113515526. Epub 2013 Dec 13.
BACKGROUND: Accurate assessment of nutrition status is essential in identifying subpopulations of critically ill patients who are malnourished and at higher mortality risk. The aim of this analytic observational study was to assess the performance of physical assessment and anthropometric measures commonly used in clinical research. METHODS: A prospective study was undertaken in 31 intensive care units (ICUs) with a focus on patients with short-term contraindications to enteral nutrition. Within 24 hours of admission to the ICU, the following measures were collected: the Subjective Global Assessment components measuring subcutaneous fat loss and muscle wasting, height, weight, mid-upper-arm circumference, and triceps skinfold thickness (TSF). Mid-arm muscle circumference and body mass index (BMI) were calculated. BMI was assessed as a continuous variable and categorized according to the World Health Organization (WHO) categories. The primary outcome was hospital discharge mortality. RESULTS: In total, 1363 patients were enrolled. BMI, analyzed according to WHO categories (P = .09), and TSF (P = .32) failed to demonstrate statistically significant predictive ability. TSF failed to demonstrate statistically significant clinical utility (area under the receiver operating characteristic curve, 0.52; 95% confidence interval, 0.48-0.56). All other individual measures demonstrated statistically significant predictive ability and statistically significant clinical utility. CONCLUSIONS: On the basis of the results of our ICU cohort, we recommend caution when using BMI categorized according to WHO definitions. We cannot recommend collection of TSF. More research is required to understand reliability, performance, and use before our results are able to be generalized to other ICU populations.
背景:准确评估营养状况对于识别营养不良且死亡风险较高的危重症患者亚群至关重要。本分析性观察研究的目的是评估临床研究中常用的体格检查和人体测量指标的性能。 方法:在31个重症监护病房(ICU)进行了一项前瞻性研究,重点关注有肠内营养短期禁忌证的患者。在入住ICU的24小时内,收集以下指标:主观全面评定法中测量皮下脂肪减少和肌肉消耗的指标、身高、体重、上臂中部周长和肱三头肌皮褶厚度(TSF)。计算上臂中部肌肉周长和体重指数(BMI)。将BMI作为连续变量进行分析,并根据世界卫生组织(WHO)的分类进行分类。主要结局是出院时的死亡率。 结果:共纳入1363例患者。根据WHO分类分析的BMI(P = 0.09)和TSF(P = 0.32)未显示出统计学上显著的预测能力。TSF未显示出统计学上显著的临床实用性(受试者工作特征曲线下面积为0.52;95%置信区间为0.48 - 0.56)。所有其他单项指标均显示出统计学上显著的预测能力和临床实用性。 结论:基于我们ICU队列的研究结果,我们建议在使用根据WHO定义分类的BMI时要谨慎。我们不建议收集TSF。在我们的结果能够推广到其他ICU人群之前,需要更多的研究来了解其可靠性、性能和用途。
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