Vilnius University, Clinic of Anaesthesiology and Intensive Care, Center of Anaesthesiology, Intensive Care and Pain Treatment, Vilnius 08406, Lithuania.
Vilnius University, Faculty of Medicine, Vilnius 01513, Lithuania.
Clin Nutr. 2018 Oct;37(5):1596-1601. doi: 10.1016/j.clnu.2017.08.007. Epub 2017 Aug 12.
BACKGROUND & AIMS: The aim of this study was to evaluate the incidence of malnutrition (MN) in cardiac surgery patients by implementing the new ESPEN diagnostic criteria and to determine whether these criteria are concordant with the bioelectrical impedance analysis (BIA) provided phase angle (PA) in predicting early stages of malnutrition.
A prospective study was conducted in a tertiary hospital. The nutritional state of the cardiac surgery patients was evaluated one day prior to cardiac surgery using the malnutrition screening tools NRS-2002, MUST and SF-MNA, and bioelectrical impedance analysis. Patients at risk of malnutrition were further studied in accordance with the ESPEN malnutrition diagnostic criteria. A BIA provided PA value of less than the 15th percentile of the age and gender group was set as a theoretical marker of early malnutrition. ROC AUC (receiver operating characteristic area under curve) analysis and other parameters were calculated to determine the concordance between the new ESPEN malnutrition diagnostic criteria and a low PA.
The study comprised 549 enrolled cardiac surgery patients. MN or risk of MN in accordance with at least one nutritional status assessment tool was diagnosed in 372 (67.75%) patients. MN, according to the new ESPEN malnutrition diagnostic criteria, was only diagnosed in 31 (5.6%) patients. Low PA was detected in 124 patients (22.6%), providing a higher MN rate. The ROC analysis and other concordance parameters showed that the new ESPEN diagnostic criteria (AUC 0.560, p = 0.042) were not concordant with a low PA.
Fewer patients are classified as malnourished by the new ESPEN definition as those identified by the BIA provided PA. Incorporation of the BIA provided PA into the new ESPEN definition may aid to diagnose the early stages of MN in the field of cardiac surgery.
本研究旨在通过实施新的 ESPEN 诊断标准评估心脏手术患者营养不良（MN）的发生率，并确定这些标准是否与生物电阻抗分析（BIA）提供的相位角（PA）一致，以预测营养不良的早期阶段。
在一家三级医院进行了一项前瞻性研究。在心脏手术前一天，使用营养不良筛查工具 NRS-2002、MUST 和 SF-MNA 以及生物电阻抗分析评估心脏手术患者的营养状况。根据 ESPEN 营养不良诊断标准，对有营养不良风险的患者进行进一步研究。将 BIA 提供的 PA 值小于年龄和性别组第 15 百分位的值设定为早期营养不良的理论标志物。计算 ROC AUC（接收者操作特征曲线下面积）分析和其他参数，以确定新的 ESPEN 营养不良诊断标准与低 PA 值之间的一致性。
该研究共纳入 549 例心脏手术患者。根据至少一种营养状况评估工具，诊断出 372 例（67.75%）患者存在 MN 或 MN 风险。根据新的 ESPEN 营养不良诊断标准，仅诊断出 31 例（5.6%）患者存在 MN。124 例患者（22.6%）检测到低 PA，MN 发生率较高。ROC 分析和其他一致性参数表明，新的 ESPEN 诊断标准（AUC 0.560，p=0.042）与低 PA 不一致。
与 BIA 提供的 PA 相比，新的 ESPEN 定义将更少的患者归类为营养不良。将 BIA 提供的 PA 纳入新的 ESPEN 定义可能有助于诊断心脏外科领域 MN 的早期阶段。
