Chittawatanarat Kaweesak, Chaiwat Onuma, Morakul Sunthiti, Kongsayreepong Suneerat
J Med Assoc Thai. 2016 Sep;99 Suppl 6:S163-S169.
The objective of this study was to compare the differences of nutrition status, nutrition delivery, and the outcomes between the metropolis (MUH) and regional university based hospitals (RUH) in Thailand.
The nutrition data were retrieved from the THAI-SICU database. A total of 1,686 patients (MUH 927 patients vs. RUH 759 patients) with completion of nutrition status and nutrition delivery data were included in this analysis. The enrolled patients from study centers located in Bangkok were defined as MUH, and the patients from Chiang Mai were defined as RUH. Patient characteristics, nutrition status using the subjective global assessment (SGA) and nutrition risk screening (NRS), nutrition delivery, and outcomes of treatment were recorded. The outcome associations were analyzed by a multivariable regression model.
At admission, there were significant differences of age, gender, body mass index, disease severity, albumin level, and diagnosis. RUH had significantly poorer nutritional status than MUH (RUH vs. MUH: SGA class B and C, 57.7% vs. 37.1%, p<0.001; NRS at risk, 56.3% vs. 38.4%, p<0.001). The tendency of total calories and enteral nutrition delivery per day of RUH was significantly lower than MUH especially in the first three weeks of hospitalization. Carbohydrates were the main resource for parenteral nutrition. Although there was no difference of protein delivery, MUH had a significantly higher prescription of fat emulsion especially in the 1st-2nd weeks. Even though there were higher occurrences of intensive care unit (ICU) mortality, 28-day mortality, sepsis occurrence, ICU length of stay (LOS), and hospital LOS in RUH, the multivariable analysis did not demonstrate the statistical value of these outcomes.
RUH had a poorer nutritional status. MUH had more total caloric intake and enteral nutrition delivery per day especially during the first three weeks. However, the treatment outcomes showed no differences in multivariable analysis.
本研究旨在比较泰国大城市医院（MUH）和地区性大学附属医院（RUH）在营养状况、营养供给及治疗结果方面的差异。
营养数据取自THAI-SICU数据库。本分析纳入了1686例完成营养状况及营养供给数据的患者（MUH 927例患者 vs. RUH 759例患者）。来自曼谷研究中心的登记患者被定义为MUH组，来自清迈的患者被定义为RUH组。记录患者特征、采用主观全面评定法（SGA）和营养风险筛查（NRS）评估的营养状况、营养供给及治疗结果。通过多变量回归模型分析结果相关性。
入院时，两组患者在年龄、性别、体重指数、疾病严重程度、白蛋白水平及诊断方面存在显著差异。RUH组的营养状况明显差于MUH组（RUH组 vs. MUH组：SGA B级和C级，57.7% vs. 37.1%，p<0.001；NRS有风险，56.3% vs. 38.4%，p<0.001）。RUH组每日总热量及肠内营养供给量的趋势显著低于MUH组，尤其是在住院的前三周。碳水化合物是肠外营养的主要来源。尽管蛋白质供给量无差异，但MUH组脂肪乳剂的处方量显著更高，尤其是在第1 - 2周。尽管RUH组重症监护病房（ICU）死亡率、28天死亡率、脓毒症发生率、ICU住院时间（LOS）及住院LOS的发生率更高，但多变量分析未显示这些结果具有统计学意义。
RUH组营养状况较差。MUH组每日总热量摄入及肠内营养供给更多，尤其是在前三周。然而，多变量分析显示治疗结果无差异。
