Intensive Care Unit, First Hospital of Jilin University, Changchun, China.
Clin Nutr. 2021 Jan;40(1):217-221. doi: 10.1016/j.clnu.2020.05.011. Epub 2020 May 18.
BACKGROUND & AIMS: The impact of nutrition support on patients with acute gastrointestinal injury (AGI) has not been fully determined. This study aimed to 1) investigate the relationship between nutrition support and AGI, as well as nutrition support and prognosis in critically ill AGI patients and 2) evaluate the prognostic benefits of nutrition support in different severity categories of AGI patients.
This prospective study included 379 patients in whom AGI occurred in the first 72 h after admission from 12 teaching hospitals in China. Clinical characteristics including demographics, APACHE II score, modified NUTRIC score, SOFA score, calories of nutrition, and 7 and 28-day mortality were recorded. Multiple logistic regression analysis was applied to identify the risk factors for mortality. The survival benefit of nutrition support as reflected by calories of nutrition in 72 h was evaluated for patients categorized according to their APACHE II, modified NUTRIC, and SOFA scores.
Patients were classified into Grades I (n = 141), II (n = 173), III (n = 48), and IV (n = 17). Significant differences were observed among different AGI grade cohorts (I-IV) in terms of APACHE II, SOFA, and modified NUTRIC scores and calories of enteral nutrition (EN), parenteral nutrition (PN), and EN + PN. Ordinal logistic regression analysis showed that only SOFA score was an independent risk factor for AGI grades (P < 0.001). APACHE II score, mechanical ventilation (MV), AGI grades, and calories of EN + PN intake were independent risk factors for 28-d mortality. Increased nutritional intake was associated with reduced mortality in severely ill patients with APACHE II scores ≥15 (P = 0.007).
AGI grade affected the intake of calories and was one of the risk factors for 28-d mortality. The nutrition intake of patients with AGI grade III to IV was almost only PN. The positive association between nutrition support and prognosis was more apparent in AGI patients with higher APACHE II scores.
营养支持对急性胃肠损伤（AGI）患者的影响尚未完全确定。本研究旨在：1）探讨营养支持与 AGI 以及危重症 AGI 患者营养支持与预后的关系；2）评估不同严重程度 AGI 患者营养支持的预后获益。
本前瞻性研究纳入了中国 12 家教学医院入院后 72 小时内发生 AGI 的 379 例患者。记录了临床特征，包括人口统计学、急性生理与慢性健康状况评分 II（APACHE II）、改良营养风险指数（NUTRIC）评分、序贯器官衰竭评分（SOFA）、热量摄入以及 7 天和 28 天死亡率。采用多因素逻辑回归分析确定死亡率的危险因素。根据患者的 APACHE II、改良 NUTRIC 和 SOFA 评分，评估营养支持在 72 小时内提供的热量对不同严重程度 AGI 患者的生存获益。
患者分为 I 级（n=141）、II 级（n=173）、III 级（n=48）和 IV 级（n=17）。不同 AGI 分级（I-IV）队列在 APACHE II、SOFA 和改良 NUTRIC 评分以及肠内营养（EN）、肠外营养（PN）和 EN+PN 热量摄入方面存在显著差异。有序逻辑回归分析显示，只有 SOFA 评分是 AGI 分级的独立危险因素（P<0.001）。APACHE II 评分、机械通气（MV）、AGI 分级和 EN+PN 热量摄入是 28 天死亡率的独立危险因素。对于 APACHE II 评分≥15 的重症患者，增加营养摄入与死亡率降低相关（P=0.007）。
AGI 分级影响热量摄入，是 28 天死亡率的危险因素之一。AGI 分级 III 至 IV 级患者的营养摄入几乎仅为 PN。在 APACHE II 评分较高的 AGI 患者中，营养支持与预后之间的正相关更为明显。
