改良的重症患者营养风险评分在创伤患者营养风险分层中的应用：一项多中心观察性研究。
Application of the modified Nutrition Risk in Critically Ill score to nutritional risk stratification of trauma victims: A multicenter observational study.
机构信息
From the Department of Surgery (C.I.), University of Mississippi, Jackson, Mississippi; Department of Surgery (G.E.O.), Harborview Medical Center, University of Washington, Seattle, Washington; Clinical Evaluation Research Unit, Kingston Health Sciences Centre (A.G.D., X.J.); and Department of Critical Care Medicine (D.K.H.), Queen's University, Kingston, Ontario, Canada.
出版信息
J Trauma Acute Care Surg. 2020 Dec;89(6):1143-1148. doi: 10.1097/TA.0000000000002937.
BACKGROUND
The modified Nutrition Risk in Critically Ill (mNUTRIC) score was developed to identify patients most likely to benefit from nutritional therapies and to stratify or select study subjects for clinical trials. The score is not validated in trauma victims in whom adequate nutritional support is important and difficult to achieve. We sought to determine whether a higher mNUTRIC score was associated with worse outcomes and whether caloric and protein intake improved outcome more in patients classified as high risk relative to those classified as low risk.
METHODS
We analyzed a prospectively collected database of patients from intensive care units globally. The primary outcome was 60-day hospital mortality, and the secondary outcome was time to discharge alive. We compared outcomes between high and low mNUTRIC score groups and also tested whether the association between outcome and nutrition intake was modified by the mNUTRIC score.
RESULTS
A total of 771 trauma patients were included. Most (585; 76%) had a low-risk mNUTRIC (0-4) score, and 186 (24%) had a high-risk (5-9) mNUTRIC score. The overall 60-day mortality was 13%. Patients in the high mNUTRIC group had a higher risk of death than those in the low mNUTRIC group (adjusted odds ratio, 2.6; 95% confidence interval, 1.7-4.2). Overall, there was no relationship between caloric or protein intake and clinical outcomes. However, patients in the high mNUTRIC group fared better with increasing caloric and protein intake, whereas subjects in the low mNUTRIC score group did not (p values for interaction with the mNUTRIC score for time to discharge alive was p = 0.014 for calories and was p = 0.004 for protein).
CONCLUSION
A high mNUTRIC score identifies trauma patients at higher risk for poor outcomes and those who may benefit from higher caloric and protein intake.
LEVEL OF EVIDENCE
Epidemiological/Prognostic, level III.
背景
改良营养风险在危重症患者（mNUTRIC）评分旨在确定最有可能受益于营养治疗的患者，并对临床试验进行分层或选择研究对象。该评分在创伤患者中尚未得到验证，而在创伤患者中，充分的营养支持很重要且难以实现。我们试图确定更高的 mNUTRIC 评分是否与更差的结局相关，以及在分类为高风险的患者中，热量和蛋白质摄入是否比分类为低风险的患者更能改善结局。
方法
我们分析了全球重症监护病房前瞻性收集的患者数据库。主要结局是 60 天住院死亡率，次要结局是存活出院时间。我们比较了高和低 mNUTRIC 评分组之间的结局，还测试了结局与营养摄入之间的关系是否受 mNUTRIC 评分的影响。
结果
共纳入 771 例创伤患者。大多数（585 例；76%）的 mNUTRIC（0-4）评分较低，186 例（24%）的 mNUTRIC 评分较高（5-9）。总体 60 天死亡率为 13%。高 mNUTRIC 组患者的死亡风险高于低 mNUTRIC 组（调整后的优势比，2.6；95%置信区间，1.7-4.2）。总体而言，热量或蛋白质摄入与临床结局之间没有关系。然而，高 mNUTRIC 组患者随着热量和蛋白质摄入的增加，预后更好，而低 mNUTRIC 评分组患者则没有（与 mNUTRIC 评分的交互作用的 p 值为热量为 0.014，蛋白质为 0.004）。
结论
高 mNUTRIC 评分可识别出创伤患者预后不良的风险较高，并且这些患者可能受益于更高的热量和蛋白质摄入。
证据水平
流行病学/预后，III 级。
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