1 Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia.
2 Dietetic and Nutrition Department, Jurong Health Services, Singapore.
JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):744-758. doi: 10.1177/0148607115625638. Epub 2016 Feb 2.
Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.
营养不良与住院患者的临床结局不良有关。然而，将营养不良与重症监护病房（ICU）的临床结局不良联系起来的研究结果往往存在矛盾，部分原因是营养不良的诊断不当。我们主要旨在确定通过 Subjective Global Assessment（SGA）或 Mini Nutritional Assessment（MNA）等经过验证的营养评估工具诊断的营养不良是否与 ICU 中的临床结局较差独立相关，以及营养筛查工具的使用是否具有类似的关联。我们系统地在 PubMed、CINAHL、Scopus 和 Cochrane Library 中搜索了合格的研究。搜索词包括营养不良、营养状况、筛查、评估和重症监护病房的同义词。合格的研究是病例对照或队列研究，招募 ICU 中的成年人；在 ICU 入院前或入院后 48 小时内进行 SGA、MNA 或使用营养筛查工具；并报告营养不良的患病率和相关临床结局，包括死亡率、住院时间（LOS）和感染发生率（IOI）。在 1168 项研究中，有 20 项符合条件。营养不良的患病率从 38%到 78%不等。营养评估诊断的营养不良与 ICU LOS、ICU 再入院、IOI 和医院死亡率增加独立相关。SGA 明显比 MNA 具有更好的预测有效性。营养筛查确定的营养不良风险之间的关联则不太一致。营养不良与 ICU 中的临床结局不良独立相关。与营养评估工具相比，营养筛查工具的预测有效性不太一致。
