Ardehali Seyed Hossein, Eslamian Ghazaleh, Malek Shirin
Department of Anesthesiology and Critical Care, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Cellular and Molecular Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acute Crit Care. 2021 Nov;36(4):361-368. doi: 10.4266/acc.2021.00178. Epub 2021 Nov 26.
Malnutrition is a serious condition in critically ill patients. The aim of this study is to evaluate the relationships between the Onodera's prognostic nutritional index (OPNI) and intestinal permeability and between OPNI and systemic inflammation in critically ill patients.
This was a cross-sectional study conducted in the general intensive care unit (ICU) of a university-affiliated hospital. A total of 162 patients admitted between May 2018 and December 2019, was included in the study. The OPNI was calculated at admission and categorized as ≤40 or >40. We assessed plasma endotoxin and zonulin concentrations as markers of intestinal permeability as well as serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as markers of systemic inflammation upon admission under stringent conditions. The relationships between these markers and OPNI were assessed after adjusting for potential confounders through estimation of a binary logistic regression model.
Median (interquartile range) hs-CRP, IL-6 zonulin, and endotoxin were significantly greater in the low OPNI subgroup than in the high OPNI subgroup (all P<0.05). Multivariate analyses showed significant association between serum IL-6 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.64-0.96), serum hs-CRP (OR, 0.77; 95% CI, 0.53-0.92), plasma endotoxin (OR, 0.81; 95% CI, 0.72-0.93), and plasma zonulin (OR, 0.83; 95% CI, 0.75-0.98) levels with OPNI in the overall population.
Our results provide evidence that higher plasma endotoxin, zonulin, IL-6, and hs-CRP levels are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU patients.
营养不良是危重症患者的一种严重状况。本研究旨在评估危重症患者小野寺预后营养指数（OPNI）与肠道通透性之间以及OPNI与全身炎症之间的关系。
这是一项在大学附属医院综合重症监护病房（ICU）进行的横断面研究。共有162例于2018年5月至2019年12月期间入院的患者纳入本研究。入院时计算OPNI，并分为≤40或>40。在严格条件下，我们评估血浆内毒素和连蛋白浓度作为肠道通透性标志物，以及血清白细胞介素-6（IL-6）和高敏C反应蛋白（hs-CRP）作为入院时全身炎症标志物。通过估计二元逻辑回归模型对潜在混杂因素进行校正后，评估这些标志物与OPNI之间的关系。
低OPNI亚组的hs-CRP、IL-6、连蛋白和内毒素中位数（四分位间距）显著高于高OPNI亚组（均P<0.05）。多变量分析显示，总体人群中血清IL-6（比值比[OR]，0.88；95%置信区间[CI]，0.64-0.96）、血清hs-CRP（OR，0.77；95%CI，0.53-0.92）、血浆内毒素（OR，0.81；95%CI，0.72-0.93）和血浆连蛋白（OR，0.83；95%CI，0.75-0.98）水平与OPNI存在显著关联。
我们的结果表明，在混合ICU人群中，尤其是外科ICU患者中，较高的血浆内毒素、连蛋白、IL-6和hs-CRP水平与逐渐降低的OPNI相关。
