Ong Chengsi, Han Wee Meng, Wong Judith Ju-Ming, Lee Jan Hau
Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore.
Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore.
Clin Nutr. 2014 Apr;33(2):191-7. doi: 10.1016/j.clnu.2013.12.010. Epub 2014 Jan 2.
BACKGROUND & AIMS: Malnutrition can significantly affect clinical outcomes in critically ill children. In view of the limitations of anthropometry, nutrition-related serum biomarkers have been used to assess the degree of malnutrition in the pediatric intensive care unit. The aim of this review is to critically appraise the use of nutrition-related serum biomarkers in predicting clinical outcomes in critically ill children.
We searched major databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) using MeSH terms and key words related to "biomarkers", "nutrition" and "critically ill children". All studies that explored the relationship between any nutrition-related serum biomarker and clinical outcomes in critically ill children (1 day-18 years) were included. The clinical outcomes of interest were duration of intensive care unit or hospital stay, duration of mechanical ventilation and mortality.
We found one randomized controlled trial and 15 observational studies involving 2068 children. In these 16 studies, 16 different nutritional biomarkers and two nutrition indices were examined. Albumin (n = 7), magnesium (n = 4), transferrin, prealbumin and calcium (n = 3 respectively) were the most commonly studied biomarkers. Seven biomarkers (25-hydroxyvitamin D, albumin, calcium, magnesium, total protein, transferrin, triglycerides) and two indices (modified nutritional index and Onodera's prognostic nutritional index) had positive associations with clinical outcomes. However, no biomarkers or nutrition indices consistently predicted clinical outcomes.
Current medical literature does not provide convincing data to demonstrate any association between nutrition-related serum biomarkers and clinical outcomes in critically ill children. Further research is required to identify novel and clinically robust nutrition-related biomarkers.
营养不良会显著影响危重症儿童的临床结局。鉴于人体测量学的局限性，营养相关血清生物标志物已被用于评估儿科重症监护病房中营养不良的程度。本综述的目的是严格评估营养相关血清生物标志物在预测危重症儿童临床结局中的应用。
我们使用与“生物标志物”、“营养”和“危重症儿童”相关的医学主题词和关键词搜索了主要数据库（MEDLINE、EMBASE、CINAHL、Cochrane图书馆）。纳入所有探讨任何营养相关血清生物标志物与危重症儿童（1天至18岁）临床结局之间关系的研究。感兴趣的临床结局包括重症监护病房或住院时间、机械通气时间和死亡率。
我们发现了一项随机对照试验和15项观察性研究，涉及2068名儿童。在这16项研究中，检测了16种不同的营养生物标志物和两种营养指数。白蛋白（7项研究）、镁（4项研究）、转铁蛋白、前白蛋白和钙（各3项研究）是研究最频繁的生物标志物。七种生物标志物（25-羟维生素D、白蛋白、钙、镁、总蛋白、转铁蛋白、甘油三酯）和两种指数（改良营养指数和小野寺预后营养指数）与临床结局呈正相关。然而，没有生物标志物或营养指数能始终如一地预测临床结局。
当前医学文献未提供令人信服的数据来证明营养相关血清生物标志物与危重症儿童临床结局之间存在任何关联。需要进一步研究以确定新的、临床稳健的营养相关生物标志物。
