Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China.
J Hum Nutr Diet. 2021 Dec;34(6):926-934. doi: 10.1111/jhn.12899. Epub 2021 May 25.
Malnutrition is highly prevalent in critically ill patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score has been introduced to evaluate the nutritional risk of patients in an intensive care unit (ICU). The mNUTRIC score is a predictive factor of mortality for patients in a medical or mixed ICU, whereas the relationship between mNUTRIC and prognosis of patients in a cardiothoracic surgery recovery unit (CSRU) is unclear and related researches are limited.
We conducted this retrospective cohort study to explore the value of mNUTRIC score in CSRU patients. We identified totally 4059 patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database.
The optimal cut-off value of mNUTRIC score was 4 and a total of 1498 (36.9%) patients were considered to be at high nutritional risk (mNUTRIC ≥ 4). A multivariate logistic regression model indicated that patients at high nutritional risk have higher hospital mortality compared to those at low nutritional risk (odds ratio = 2.49, 95% confidence interval (CI) = 1.32-4.70, p = 0.005]. Furthermore, a Cox regression model was established adjusted for age, white blood cell and body mass index. The Kaplan-Meier curve indicated that patients at high nutritional risk have poorer 365-days [hazard ratio (HR) = 1.76, 95% CI = 1.30-2.37, p < 0.001] and 1000-days (HR = 2.30, 95% CI = 1.87-2.83, p < 0.001) overall survival.
The mNUTRIC score could not only predict hospital mortality, but also be an independent prognostic factor for long-term survival in CSRU patients. More well-designed clinical trials are needed to verify and update our findings.
危重症患者普遍存在营养不良。改良营养风险在重症患者（mNUTRIC）评分用于评估重症监护病房（ICU）患者的营养风险。mNUTRIC 评分是 ICU 内科或混合患者死亡的预测因素，而 mNUTRIC 与心胸外科恢复单元（CSRU）患者预后的关系尚不清楚，相关研究也有限。
我们进行了这项回顾性队列研究，以探讨 mNUTRIC 评分在 CSRU 患者中的价值。我们从 Multiparameter Intelligent Monitoring in Intensive Care III（MIMIC III）数据库中确定了总共 4059 名患者。
mNUTRIC 评分的最佳截断值为 4，共有 1498 名（36.9%）患者被认为存在高营养风险（mNUTRIC≥4）。多变量逻辑回归模型表明，高营养风险患者的住院死亡率高于低营养风险患者（比值比=2.49，95%置信区间（CI）=1.32-4.70，p=0.005）。此外，建立了一个 Cox 回归模型，调整了年龄、白细胞和体重指数。Kaplan-Meier 曲线表明，高营养风险患者的 365 天（危险比（HR）=1.76，95%CI=1.30-2.37，p<0.001）和 1000 天（HR=2.30，95%CI=1.87-2.83，p<0.001）总生存率较差。
mNUTRIC 评分不仅可以预测住院死亡率，而且是 CSRU 患者长期生存的独立预后因素。需要更多设计良好的临床试验来验证和更新我们的发现。
