Qiao Jun-Ying, Guo Fei-Fei, Li Fan, Chen Li-Xia, Luan Bin
Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2019 Jun;21(6):528-533. doi: 10.7499/j.issn.1008-8830.2019.06.006.
To investigate the nutritional status of critically ill hospitalized children and to explore the value of nutritional risk screening tools in the nutritional risk assessment.
The clinical data of 211 critically ill children who were admitted to the pediatric intensive care unit from November 2017 to April 2018 were collected to evaluate their nutritional status on admission and at discharge. Two nutritional risk screening tools, STRONGkids and PYMS, were used for nutritional risk screening in the 211 children.
Among the 211 patients, 68 (32.2%) were found to have malnutrition on admission, with 34 cases each of moderate and severe malnutrition. Moderate or high nutritional risk was found in 154 cases (73.0%) with STRONGkids and 165 cases (78.2%) with PYMS. Using weight-for-age Z-score as the gold standard to evaluate the efficacy of the two nutritional risk screening tools, the areas under the receiver operating characteristic curves of STRONGkids and PYMS were 0.822 and 0.759 respectively. Both tools had a significant clinical value in screening for malnutrition (P<0.05), but there was no significant difference in clinical efficacy between them (P>0.05). With the optimal cut-off value of 3 points, the sensitivities of STRONGkids and PYMS for screening of malnutrition were 92.1% and 76.2% respectively. The children with moderate or high nutritional risk on admission had a significantly poorer prognosis than those with low nutritional risk (P=0.014 and 0.001 respectively). The children with severe malnutrition had a significantly poorer prognosis than those with normal nutrition (P=0.0009).
The detection rates of malnutrition and nutritional risk are high in critically ill children. Malnutrition/high nutritional risk is related to a poor prognosis. Both STRONGkids and PYMS have a clinical value for nutritional risk screening in critically ill children, and they have similar clinical efficacy; however, STRONGkids is more sensitive.
调查住院重症患儿的营养状况，并探讨营养风险筛查工具在营养风险评估中的价值。
收集2017年11月至2018年4月入住儿科重症监护病房的211例重症患儿的临床资料，评估其入院时及出院时的营养状况。采用两种营养风险筛查工具STRONGkids和PYMS对这211例患儿进行营养风险筛查。
211例患者中，入院时发现68例（32.2%）存在营养不良，其中中度和重度营养不良各34例。STRONGkids筛查出154例（73.0%）存在中度或高度营养风险，PYMS筛查出165例（78.2%）存在中度或高度营养风险。以年龄别体重Z评分作为评估两种营养风险筛查工具效能的金标准，STRONGkids和PYMS的受试者工作特征曲线下面积分别为0.822和0.759。两种工具在筛查营养不良方面均具有显著的临床价值（P<0.05），但它们的临床效能无显著差异（P>0.05）。以最佳截断值3分为标准，STRONGkids和PYMS筛查营养不良的灵敏度分别为92.1%和76.2%。入院时存在中度或高度营养风险的患儿预后明显差于低营养风险患儿（分别为P=0.014和0.001）。重度营养不良患儿的预后明显差于营养正常患儿（P=0.0009）。
重症患儿营养不良和营养风险的检出率较高。营养不良/高营养风险与预后不良有关。STRONGkids和PYMS在重症患儿营养风险筛查中均具有临床价值，且临床效能相似；然而，STRONGkids更敏感。
