Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Department of Anesthesia, Rabin Medical Center, Petah Tikva, Israel.
Clin Nutr. 2020 Nov;39(11):3419-3425. doi: 10.1016/j.clnu.2020.02.035. Epub 2020 Mar 6.
While various nutritional assessment tools have been proposed, consensus is lacking with respect to the most effective tool to identify severe malnutrition in critically ill patients.
We conducted a retrospective study in an adult general intensive care unit (ICU) comparing four nutritional assessment tools: Nutrition Risk Screening (NRS), Nutrition Risk in Critically Ill (NUTRIC), and malnutrition criteria proposed by European Society of Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN). These criteria were tested for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in diagnosis of severe malnutrition, defined as Subjective Global Assessment (SGA) C.
Hospitalization records for 120 critically ill patients were analyzed. 60 (50%), 17 (14.2%) and 43 (35.8%) patients were classified as SGA A, B, and C, respectively. The sensitivity in diagnosis of severe malnutrition was 79.1%, 58.1%, 65.1%, and 65.1%, and specificity was 94.8%, 74.0%, 94.8%, and 98.7% for NRS, NUTRIC, ESPEN, and ASPEN, respectively. NRS, ESPEN, and ASPEN had higher PPV (89.5%, 87.5%, and 87.5%, respectively) and NPV (89%, 83%, and 83.5%, respectively) than NUTRIC (PPV 55.6% and NPV 76%). NUTRIC showed the highest correlation with mortality, but none of the tools retained their correlation with mortality after adjustment for potential confounding factors.
NRS showed the highest sensitivity and high specificity, PPV, and NPV. NUTRIC had least effective overall performance in diagnosis of severe malnutrition in an ICU setting. A larger population may be required to explore the association between mortality and these nutritional assessment tools.
虽然已经提出了各种营养评估工具，但对于在危重症患者中识别严重营养不良的最有效工具仍缺乏共识。
我们在成人综合重症监护病房（ICU）进行了一项回顾性研究，比较了四种营养评估工具：营养风险筛查（NRS）、危重症患者营养风险（NUTRIC）、欧洲临床营养与代谢学会（ESPEN）和美国肠外与肠内营养学会（ASPEN）提出的营养不良标准。这些标准在诊断严重营养不良（主观全面评估（SGA）C 级）方面的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）进行了测试。
共分析了 120 例危重症患者的住院记录。60 例（50%）、17 例（14.2%）和 43 例（35.8%）患者分别被归类为 SGA A、B 和 C。严重营养不良诊断的敏感性分别为 79.1%、58.1%、65.1%和 65.1%，特异性分别为 94.8%、74.0%、94.8%和 98.7%，NRS、NUTRIC、ESPEN 和 ASPEN 分别为。NRS、ESPEN 和 ASPEN 的阳性预测值（89.5%、87.5%和 87.5%）和阴性预测值（89%、83%和 83.5%）均高于 NUTRIC（PPV 55.6%和 NPV 76%）。NUTRIC 与死亡率相关性最高，但在调整潜在混杂因素后，这些工具与死亡率的相关性均不保留。
NRS 显示出最高的敏感性和高特异性、PPV 和 NPV。NUTRIC 在 ICU 环境中诊断严重营养不良的整体性能最差。可能需要更大的人群来探讨这些营养评估工具与死亡率之间的关系。
