Tsai Yi-Hsuan, Lin Chiung-Yu, Chen Yu-Mu, Chang Yu-Ping, Hung Kai-Yin, Chang Ya-Chun, Chen Hung-Cheng, Huang Kuo-Tung, Chen Yung-Che, Wang Yi-Hsi, Wang Chin-Chou, Lin Meng-Chih, Fang Wen-Feng
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan.
Nutrients. 2021 May 30;13(6):1873. doi: 10.3390/nu13061873.
Nutritional status affects the survival of patients with sepsis. This retrospective study analyzed the impact of body mass index (BMI) and modified nutrition risk in critically ill (mNUTRIC) scores on survival of these patients. Data of 1291 patients with sepsis admitted to the intensive care unit (ICU) were extracted. The outcomes were mortality, duration of stay, ICU stay, and survival curve for 90-day mortality. Logistic regression analysis was performed to examine the risk factors for mortality. Cytokine and biomarker levels were analyzed in 165 patients. The 90-day survival of underweight patients with low mNUTRIC scores was significantly better than that of normal-weight patients with low mNUTRIC scores (70.8% vs. 58.3%, respectively; = 0.048). Regression model analysis revealed that underweight patients with low mNUTRIC scores had a lower risk of mortality (odds ratio = 0.557; = 0.082). Moreover, normal-weight patients with low mNUTRIC scores had the lowest human leukocyte antigen DR (HLA-DR) level on days 1 (underweight vs. normal weight vs. overweight: 94.3 vs. 82.1 vs. 94.3, respectively; = 0.007) and 3 (91.8 vs. 91.0 vs. 93.2, respectively; = 0.047). Thus, being underweight may not always be harmful if patients have optimal clinical nutritional status. Additionally, HLA-DR levels were the lowest in patients with low survival.
营养状况影响脓毒症患者的生存。这项回顾性研究分析了体重指数（BMI）和危重症患者改良营养风险（mNUTRIC）评分对这些患者生存的影响。提取了1291例入住重症监护病房（ICU）的脓毒症患者的数据。观察指标为死亡率、住院时间、ICU住院时间以及90天死亡率的生存曲线。进行逻辑回归分析以检查死亡的危险因素。对165例患者的细胞因子和生物标志物水平进行了分析。mNUTRIC评分低的体重过轻患者的90天生存率显著高于mNUTRIC评分低的正常体重患者（分别为70.8%和58.3%；P = 0.048）。回归模型分析显示，mNUTRIC评分低的体重过轻患者的死亡风险较低（比值比 = 0.557；P = 0.082）。此外，mNUTRIC评分低的正常体重患者在第1天（体重过轻组vs.正常体重组vs.超重组：分别为94.3 vs. 82.1 vs. 94.3；P = 0.007）和第3天（分别为91.8 vs. 91.0 vs. 93.2；P = 0.047）的人类白细胞抗原DR（HLA-DR）水平最低。因此，如果患者具有最佳的临床营养状况，体重过轻不一定总是有害的。此外，生存率低的患者的HLA-DR水平最低。
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