Bufarah M N B, Costa N A, Losilla M P R P, Reis N S C, Silva M Z C, Balbi A L, Ponce D
Department of Internal Medicine, Botucatu Medical School, UNESP -São Paulo State University, Botucatu, Brazil.
University of the Sacred Heart - USC, Bauru, Brazil.
Clin Nutr ESPEN. 2018 Apr;24:66-70. doi: 10.1016/j.clnesp.2018.01.012. Epub 2018 Feb 16.
Acute renal injury (AKI) interferes greatly with nutritional status, affecting the metabolism of all macronutrients and increased mortality rates in hospitalized patients. Our objective was to evaluate the association of nutritional parameters (albumin, cholesterol, caloric and protein intake and nitrogen balance (NB)) with mortality in patients with AKI.
This is a prospective observational study that evaluated 595 consecutive patients over the age of 18 years with AKI, requiring enteral or parenteral feeding. At the time of the patient's enrollment, demographic and laboratorial data, caloric and protein supply and NB were recorded on the first day of referral to the nephrologist. All patients were followed throughout the hospital stay and mortality rate was also recorded.
The medium age of patients with AKI was 64 (54-75) years, 64.5% male, 62% admitted to intensive care unit (ICU), 52% on dialysis and the majority (48%) were at stage 3 by AKIN. Length of stay and hospital mortality were 18 (10-31) days and 46%, respectively. Superior age, AKI severity, lower body weight and body mass index (BMI), higher need for dialysis, ICU admission and shorter hospital stay were associated with higher mortality. At logistic regression, caloric (OR: 0.946; CI:95%: 0.901-0.994; p:0.029) and protein intake (OR: 0.947; CI:95%: 0.988-0.992; p = 0.028) and serum albumin (OR: 0.545; CI:95%: 0.401-0741; p < 0.001) were associated with hospital mortality. Cholesterol (OR: 0.995; CI:95%: 0.991-1.000; p = 0.052) was not associated with increased mortality in the adjusted analysis. Analysis of the receiver operating characteristic (ROC) curve showed that calorie intake < 12 kcal/kg (AUC: 0.745; CI:95%: 0.684-0.765; p < 0.001) and protein intake < 0.5 g/kg (AUC: 0.726; CI:95%: 0.686-0.767; p < 0.001) were predictors of hospital mortality, as well as a negative NB < -6.47 g N/day (AUC: 0.745; CI:95%: 0.704-0.786; p < 0.001).
In conclusion, low caloric and protein intake, negative NB and low albumin value are conditions associated with higher hospital mortality in patients with AKI.
急性肾损伤（AKI）严重影响营养状况，影响所有常量营养素的代谢，并增加住院患者的死亡率。我们的目的是评估营养参数（白蛋白、胆固醇、热量和蛋白质摄入量以及氮平衡（NB））与AKI患者死亡率之间的关联。
这是一项前瞻性观察性研究，评估了595例年龄在18岁以上的连续AKI患者，这些患者需要肠内或肠外营养支持。在患者入组时，记录了转介至肾病科第一天的人口统计学和实验室数据、热量和蛋白质供应以及NB。所有患者在住院期间均接受随访，并记录死亡率。
AKI患者的中位年龄为64（54 - 75）岁，男性占64.5%，62%入住重症监护病房（ICU），52%接受透析，大多数（48%）根据AKIN标准处于3期。住院时间和医院死亡率分别为18（10 - 31）天和46%。高龄、AKI严重程度、较低的体重和体重指数（BMI）、更高的透析需求、入住ICU以及较短的住院时间与较高的死亡率相关。在逻辑回归分析中，热量摄入（OR：0.946；CI：95%：0.901 - 0.994；p：0.029）、蛋白质摄入量（OR：0.947；CI：95%：0.988 - 0.992；p = 0.028）和血清白蛋白（OR：0.545；CI：95%：0.401 - 0.741；p < 0.001）与医院死亡率相关。胆固醇（OR：0.995；CI：95%：0.991 - 1.000；p = 0.052）在调整分析中与死亡率增加无关。受试者工作特征（ROC）曲线分析表明，热量摄入<12 kcal/kg（AUC：0.745；CI：95%：0.684 - 0.765；p < 0.001）、蛋白质摄入量<0.5 g/kg（AUC：0.726；CI：95%：0.686 - 0.767；p < 0.001）以及负氮平衡< - 6.47 g N/天（AUC：0.745；CI：95%：0.704 - 0.786；p < 0.001）是医院死亡率的预测指标。
总之，低热量和蛋白质摄入、负氮平衡和低白蛋白值是与AKI患者较高医院死亡率相关的因素。
