Tripathy Swagata, Mishra J C
Department of Trauma and Emergency Medicine (Critical Care), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Department of Anaesthesia, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2015 Sep;19(9):518-22. doi: 10.4103/0972-5229.164798.
Few malnutrition screening tests are validated in the elderly Intensive Care Unit (ICU) patient.
Having previously established malnutrition as a cause of higher mortality in this population, we compared two screening tools in elderly patients.
For this prospective study, 111 consecutive patients admitted to the ICU and > 65 years underwent the Malnutrition Universal Screening Tool (MUST), and the Geriatric Nutrition Risk Index (GNRI) screening tests.
Standard definition of malnutrition risk was taken as the gold standard to evaluate the sensitivity, specificity and predictive values of the tools. The k statistic was calculated to measure the agreement between the tools. The Shrout classification was used to interpret its values.
The mean age of the patients screened was 74.7 ± 8.4 (65-97 years). The standard definition, MUST and GNRI identified 52.2%, 65.4%, and 64.9% to be malnourished, respectively. The sensitivity and specificity of the tests were 96.5% computed tomography (CI) (87.9-99.5%) and 72.3% CI (57.5-84.5%) for MUST and 89.5% CI (75.2-96.7%) and 55.0% CI (75.2-96.9%) for GNRI, respectively. Screening was not possible by GNRI and MUST tool in 31% versus 4% of patients, respectively. The agreement between the tools was moderate for Standard-MUST k = 0.65 and MUST-GNRI k = 0.60 and fair for Standard-GNRI k = 0.43.
The risk of malnutrition is high among our patients as identified by all the tools. Both GNRI and MUST showed a high sensitivity with MUST showing a higher specificity and greater applicability.
很少有营养不良筛查测试在老年重症监护病房（ICU）患者中得到验证。
鉴于此前已确定营养不良是该人群死亡率较高的一个原因，我们对老年患者的两种筛查工具进行了比较。
在这项前瞻性研究中，111例连续入住ICU且年龄大于65岁的患者接受了营养不良通用筛查工具（MUST）和老年营养风险指数（GNRI）筛查测试。
以营养不良风险的标准定义作为评估工具敏感性、特异性和预测值的金标准。计算k统计量以衡量工具之间的一致性。采用Shrout分类法解释其值。
接受筛查患者的平均年龄为74.7±8.4岁（65 - 97岁）。标准定义、MUST和GNRI分别将52.2%、65.4%和64.9%的患者判定为营养不良。MUST测试的敏感性和特异性分别为96.5%置信区间（CI）（87.9 - 99.5%）和72.3% CI（57.5 - 84.5%），GNRI测试的敏感性和特异性分别为89.5% CI（75.2 - 96.7%）和55.0% CI（75.2 - 96.9%）。GNRI和MUST工具分别无法对31%和4%的患者进行筛查。工具之间的一致性：标准 - MUST为中等（k = 0.65），MUST - GNRI为中等（k = 0.60），标准 - GNRI为一般（k = 0.43）。
所有工具均显示我们的患者中营养不良风险很高。GNRI和MUST均显示出较高的敏感性，其中MUST具有更高的特异性和更强的适用性。
