改良重症患者营养风险评分（mNUTRIC）与重症监护病房临床结局的相关性：一项大型前瞻性观察研究的二次分析。
Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study.
机构信息
Emergency Department of China Rehabilitation Research Center, Fengtai District, Capital Medical University, no.10 Jiaomen North Street, Beijing, 100068, China.
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing, 100069, China.
出版信息
BMC Anesthesiol. 2021 Sep 8;21(1):220. doi: 10.1186/s12871-021-01439-x.
BACKGROUND
Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores.
METHODS
This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden's index. The significance level was set at 5%.
RESULTS
Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740-0.786). According to Youden's index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality.
CONCLUSIONS
Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score.
TRIAL REGISTRATION
This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875 ). Registered on 14 December 2011.
背景
重症监护病房（ICU）患者营养不良与不良临床结局相关。改良危重患者营养风险评分（mNUTRIC）被提出作为一种适用于危重症患者的营养评估工具，但尚未得到充分验证和广泛应用。我们的研究旨在使用 mNUTRIC 评分识别 ICU 患者的营养风险，并探讨 28 天死亡率与高 mNUTRIC 评分之间的关系。
方法
这是一项二次分析研究，数据来自北京急性肾损伤试验（BAKIT）。共连续收治 9049 例患者，其中 3107 例患者临床资料完整，纳入本研究。我们将研究人群分为高营养风险（mNUTRIC 评分≥5 分）和低营养风险（mNUTRIC 评分<5 分）组。通过受试者工作特征（ROC）曲线分析评估 mNUTRIC 评分的预测能力，使用约登指数确定最佳截断值，以获得最高的敏感性和特异性。显著性水平设定为 5%。
结果
在 3107 例患者中，28 天死亡率为 17.4%（540 例死亡）。近 28.2%的 ICU 入院患者存在营养不良风险，高营养风险患者年龄较大（P<0.001），疾病严重程度评分高于低营养风险患者。多因素分析显示，mNUTRIC 评分是 28 天死亡率的独立危险因素，且死亡率随评分升高而增加（P=0.000）。mNUTRIC 评分的曲线下面积（AUC）计算值为 0.763（95%CI：0.740-0.786）。根据约登指数，我们发现 mNUTRIC 评分>4 是预测 28 天死亡率的合适截断值。
结论
入住 ICU 的患者存在较高的营养不良风险，高 mNUTRIC 评分与 ICU 住院时间延长和死亡率升高相关。需要更多的大型前瞻性研究来验证该评分的有效性。
试验注册
本研究在中国临床试验注册中心（ChiCTR-ONC-11001875）注册。注册日期为 2011 年 12 月 14 日。
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