早期肠内营养充足可降低中性粒细胞与淋巴细胞比值，改善重症外科患者的临床结局。
Early Enteral Nutrition Adequacy Mitigates the Neutrophil-Lymphocyte Ratio Improving Clinical Outcomes in Critically Ill Surgical Patients.
机构信息
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
出版信息
Nutr Clin Pract. 2019 Feb;34(1):148-155. doi: 10.1002/ncp.10177. Epub 2018 Sep 10.
BACKGROUND
Neutrophil-lymphocyte ratio (NLR) is a measure of host inflammatory response; a higher NLR is associated with worse clinical outcomes. Enteral nutrition (EN) may mitigate inflammation through interaction with gut-associated lymphoid tissue. We hypothesized that early EN adequacy in critically ill surgical patients is associated with lower NLR and better clinical outcomes.
METHODS
In this retrospective study, we analyzed data from adult surgical intensive care unit (ICU) patients receiving EN. NLR at baseline ICU admission (NLR-B), NLR after 3-5 days of EN (F-NLR), nutrition adequacy, caloric deficit (CD), protein deficit (PD), hospital length of stay (LOS), ICU LOS, 28-day ventilator-free days (28-VFD), and in-hospital mortality were collected. Tertiles groups were created for NLR, F-NLR, CD, and PD; the highest (H) and lowest (L) tertiles were compared. Regression analyses were performed to control for effect of age, gender, APACHE II, and NLR.
RESULTS
Subjects in the L-CD group had lower median F-NLR (7 [range, 5-11] vs 10 [7-22], P = 0.005) and shorter ICU LOS (9 [6-16]) vs 16 [9-32] days; P = 0.006). The L-NLR group had shorter hospital LOS (18 [10-31] vs 22 [15-38] days, P = 0.023), greater 28-VFD (23 [18-25] vs 19 [11-22] days, P = 0.005), and lower in-hospital mortality (13% vs 41%, P = 0.002).
CONCLUSION
In critically ill surgical patients, early enteral caloric adequacy is associated with less inflammation and improved clinical outcomes.
背景
中性粒细胞与淋巴细胞比值（NLR）是宿主炎症反应的衡量指标；更高的 NLR 与更差的临床结局相关。肠内营养（EN）通过与肠相关淋巴组织的相互作用可能减轻炎症。我们假设危重症外科患者的早期 EN 充足与较低的 NLR 和更好的临床结局相关。
方法
在这项回顾性研究中，我们分析了接受 EN 的成人外科重症监护病房（ICU）患者的数据。收集了 ICU 入院时的 NLR（NLR-B）、EN 后 3-5 天的 NLR（F-NLR）、营养充足性、热量不足（CD）、蛋白质不足（PD）、住院时间（LOS）、ICU LOS、28 天无呼吸机天数（28-VFD）和住院死亡率。为 NLR、F-NLR、CD 和 PD 创建了三分位数组；比较了最高（H）和最低（L）三分位组。进行回归分析以控制年龄、性别、APACHE II 和 NLR 的影响。
结果
L-CD 组的 F-NLR 中位数较低（7 [范围 5-11] 比 10 [7-22]，P=0.005），ICU LOS 较短（9 [6-16] 比 16 [9-32] 天；P=0.006）。L-NLR 组的住院 LOS 较短（18 [10-31] 比 22 [15-38] 天，P=0.023），28-VFD 更大（23 [18-25] 比 19 [11-22] 天，P=0.005），住院死亡率更低（13% 比 41%，P=0.002）。
结论
在危重症外科患者中，早期肠内热量充足与炎症减轻和临床结局改善相关。
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