基于CD55的ICU患者肠内营养并发严重腹泻预测模型
A prediction model of enteral nutrition complicated with severe diarrhea in ICU patients based on CD55.
作者信息
Xie Yun, Tian Rui, Wang Tao, Jin Wei, Hou Yijun, Zhou Zhigang, Wang Ruilan
机构信息
Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Ann Palliat Med. 2021 Feb;10(2):1610-1619. doi: 10.21037/apm-20-1050. Epub 2020 Nov 16.
BACKGROUND
Severe diarrhea is a common complication of enteral nutrition in intensive care unit (ICU) patients. CD55 not only plays a vital role in immune but also plays a crucial role in intestinal function. We intended to build a prediction model of enteral nutrition complicated with severe diarrhea in ICU patients based on CD55.
METHODS
This was a prospective, single-center, observational study. We collected 116 patients with enteral nutrition in the ICU. We collected blood samples from patients at the time of admission, tested blood biomarkers [CD55, interleukin-10 (IL-10), diamine oxidase, D-lactic acid and endotoxin], and recorded daily defecation and enteral nutrition. Finally, through multi-factor logistic regression model, a prediction model based on multiple prediction indicators was formed, and new joint predictive factors were calculated. The prediction model of enteral nutrition complicated with severe diarrhea in ICU patients was constructed through data processing analysis.
RESULTS
A total of 116 adult patients with enteral nutrition were divided into two groups: 77 patients without severe diarrhea and 39 with severe diarrhea. Compared with patients without severe diarrhea, CD55 on granulocyte membrane surface(gCD55) of patients with severe diarrhea was significantly reduced (P<0.0001), and CD55 on erythrocyte membrane surface(eCD55) of patients with diarrhea was significantly reduced (P<0.0001), serum IL-10 in patients with diarrhea significantly decreased compared with those without diarrhea, P<0.0001.The area under the curve of receiver operating characteristic (AUCROC) was 0.919 in gCD55 predicting severe diarrhea, when cutoff value =99.95%, the optimal sensitivity was 96.2%, and specificity was 100%. The AUROC of eCD55 and IL-10 in predicting severe diarrhea was 0.658 and 0.558 respectively. Based on this, a prediction model was established. The prediction model was: In[P/(1- P)] =-24.68 gCD55 -2.26 eCD55 +0.0041 IL-10 +2,691, the goodness of fit test of the model was P=0.44, and the AUCROC of the model was 0.92.
CONCLUSIONS
gCD55 and eCD55 had certain predictive value in enteral nutrition complicated with severe diarrhea.
背景
严重腹泻是重症监护病房（ICU）患者肠内营养常见的并发症。CD55不仅在免疫中起重要作用，在肠道功能中也起着关键作用。我们旨在建立基于CD55的ICU患者肠内营养并发严重腹泻的预测模型。
方法
这是一项前瞻性、单中心、观察性研究。我们收集了116例ICU中接受肠内营养的患者。在患者入院时采集血样，检测血液生物标志物[CD55、白细胞介素-10（IL-10）、二胺氧化酶、D-乳酸和内毒素]，并记录每日排便情况和肠内营养情况。最后，通过多因素逻辑回归模型，形成基于多个预测指标的预测模型，并计算新的联合预测因子。通过数据处理分析构建ICU患者肠内营养并发严重腹泻的预测模型。
结果
116例接受肠内营养的成年患者分为两组：77例无严重腹泻患者和39例有严重腹泻患者。与无严重腹泻患者相比，严重腹泻患者粒细胞膜表面CD55（gCD55）显著降低（P<0.0001），腹泻患者红细胞膜表面CD55（eCD55）显著降低（P<0.0001），腹泻患者血清IL-10较无腹泻患者显著降低，P<0.0001。gCD55预测严重腹泻时受试者工作特征曲线下面积（AUCROC）为0.919，当截断值=99.95%时，最佳敏感度为96.2%，特异度为100%。eCD55和IL-10预测严重腹泻的AUCROC分别为0.658和0.558。基于此，建立了一个预测模型。预测模型为：In[P/（1-P）]=-24.68gCD55-2.26eCD55+0.0041IL-10+2691，模型拟合优度检验P=0.44，模型的AUCROC为0.92。
结论
gCD55和eCD55在肠内营养并发严重腹泻方面具有一定的预测价值。
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