Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung 833, Taiwan.
Department of nutritional Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Nutrients. 2019 Feb 10;11(2):367. doi: 10.3390/nu11020367.
Immune dysfunction is seen both in sepsis patients and in those with malnutrition. This study aimed to determine whether insufficient nutrition and immune dysfunction have a synergistic effect on mortality in critically ill septic patients. We conducted a prospective observational study from adult sepsis patients admitted to intensive care units (ICUs) between August 2013 and June 2016. Baseline characteristics including age, gender, body mass index, NUTRIC, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were recorded. Immune dysfunction, defined by human leukocyte antigen DR (HLA-DR) expression, was tested at days 1, 3, and 7 of ICU admission. The study included 151 patients with sepsis who were admitted to the ICU. The 28-day survivors had higher day 7 caloric intakes (89% vs 73%, = 0.042) and higher day 1-HLA-DR expression (88.4 vs. 79.1, = 0.045). The cut-off points of day 7 caloric intake and day 1-HLA-DR determined by operating characteristic curves were 65.1% and 87.2%, respectively. Immune dysfunction was defined as patients with day 1-HLA-DR < 87.2%. Insufficient nutrition had no influence on survival outcomes in patients with immune dysfunction. However, patients with insufficient nutrition had poor prognosis when they were immune competent. Insufficient nutrition and immune dysfunction did not have a synergistic effect on mortality in critically ill septic patients.
免疫功能障碍既可见于脓毒症患者，也可见于营养不良患者。本研究旨在确定营养不足和免疫功能障碍对重症脓毒症患者死亡率是否有协同作用。我们进行了一项前瞻性观察性研究，纳入了 2013 年 8 月至 2016 年 6 月期间入住重症监护病房（ICU）的成年脓毒症患者。记录了包括年龄、性别、体重指数、NUTRIC、急性生理学和慢性健康评估（APACHE）Ⅱ评分和序贯器官衰竭评估（SOFA）评分在内的基线特征。免疫功能障碍通过人类白细胞抗原 DR（HLA-DR）表达来检测，在 ICU 入院第 1、3 和 7 天进行检测。该研究纳入了 151 例入住 ICU 的脓毒症患者。28 天幸存者的第 7 天热量摄入更高（89% vs 73%，= 0.042），第 1 天 HLA-DR 表达更高（88.4 vs. 79.1，= 0.045）。通过受试者工作特征曲线确定的第 7 天热量摄入和第 1 天 HLA-DR 的截断值分别为 65.1%和 87.2%。免疫功能障碍定义为第 1 天 HLA-DR < 87.2%的患者。免疫功能障碍患者中，营养不足对生存结局无影响。然而，免疫功能正常的患者存在营养不足时，预后较差。营养不足和免疫功能障碍对重症脓毒症患者的死亡率没有协同作用。
