Fletcher J P, Little J M, Walker P J
Aust N Z J Surg. 1986 Dec;56(12):891-5. doi: 10.1111/j.1445-2197.1986.tb01850.x.
The relationship of a number of nutritional parameters to mortality and sepsis was assessed in a group of 82 patients requiring total parenteral nutrition (TPN). Duration of TPN ranged from 9 to 105 days with a mean of 32.3 days. Parameters assessed were serum albumin, transferrin, absolute lymphocyte count (ALC), delayed hypersensitivity skin test reaction, mid-arm muscle circumference, triceps skin-fold thickness and weight. Combinations of parameters were found to be more useful than single parameters. The only single parameter of significance was ALC. The best overall predictor of death and/or sepsis was a combination of reduced serum albumin, transferrin, ALC and anergy, which was found to be related to a significantly higher mortality (P = 0.002) and incidence of septic complications (P = 0.003). This combination of parameters also had the best specificity (90%), accuracy (79%) and positive predictive value (65%) for prediction of death and/or sepsis. Increasing age was also found to be associated with a higher mortality (P less than 0.001) and increased incidence of septic complications (P = 0.01).
在一组82例需要全胃肠外营养（TPN）的患者中，评估了多个营养参数与死亡率和脓毒症之间的关系。TPN的持续时间为9至105天，平均为32.3天。评估的参数包括血清白蛋白、转铁蛋白、绝对淋巴细胞计数（ALC）、迟发型超敏皮肤试验反应、上臂中部肌肉周长、肱三头肌皮褶厚度和体重。发现参数组合比单个参数更有用。唯一具有显著意义的单个参数是ALC。死亡和/或脓毒症的最佳总体预测指标是血清白蛋白降低、转铁蛋白降低、ALC降低和无反应性的组合，发现这与显著更高的死亡率（P = 0.002）和脓毒症并发症发生率（P = 0.003）相关。这种参数组合对于死亡和/或脓毒症的预测也具有最佳的特异性（90%）、准确性（79%）和阳性预测值（65%）。还发现年龄增加与更高的死亡率（P < 0.001）和脓毒症并发症发生率增加（P = 0.01）相关。
