Agarwal N, Acevedo F, Leighton L S, Cayten C G, Pitchumoni C S
Department of Surgery, Our Lady of Mercy Medical Center, New York Medical College, Bronx 10466.
Am J Clin Nutr. 1988 Nov;48(5):1173-8. doi: 10.1093/ajcn/48.5.1173.
Nutritional indices (percentage ideal body weight [IBW], serum albumin, serum transferrin, total lymphocyte count [TLC] and delayed cutaneous hypersensitivity [DH] response) were assessed in 80 consecutive patients (aged 85-100 y) within 24 h of admission to determine their predictive value for mortality. Nine patients died. Pearson correlation analysis demonstrated that death was significantly (p less than 0.05 to less than 0.01) associated with sepsis, serum albumin less than 30 g/L, TLC less than or equal to 1500 cells/mm3, and percentage IBW less than or equal to 90%. However, when serum albumin was controlled for, logit regression analyses demonstrated that the impact of other nutritional indices on death was insignificant. The effect of serum albumin remained significant (p less than 0.05 to less than 0.01) even when age and physician's diagnosis were held constant. With the logit model, serum albumin greater than or equal to 30 g/L had a sensitivity of 0.33, specificity of 0.99, and overall predictive power of 0.91. Serum albumin is thus the simplest and best single predictor of mortality and can provide early identification of elderly people at increased risk of death.
对80例连续入院的患者（年龄85 - 100岁）在入院后24小时内评估营养指标（理想体重百分比[IBW]、血清白蛋白、血清转铁蛋白、淋巴细胞总数[TLC]和迟发性皮肤超敏反应[DH]），以确定其对死亡率的预测价值。9例患者死亡。Pearson相关性分析表明，死亡与败血症、血清白蛋白低于30 g/L、TLC低于或等于1500个细胞/mm³以及IBW百分比低于或等于90%显著相关（p值小于0.05至小于0.01）。然而，当对血清白蛋白进行控制时，logit回归分析表明其他营养指标对死亡的影响不显著。即使年龄和医生诊断保持不变，血清白蛋白的影响仍然显著（p值小于0.05至小于0.01）。使用logit模型，血清白蛋白大于或等于30 g/L时，灵敏度为0.33，特异性为0.99，总体预测能力为0.91。因此，血清白蛋白是死亡率最简单且最佳的单一预测指标，可早期识别死亡风险增加的老年人。
