Clinical Nutrition Laboratory, Department of Food and Nutrition, Faculty of Home Economics, Tokyo Kasei University, 1-18-1 Kaga, Itabashi-ku, Tokyo, 173-8602, Japan.
Medical Nutrition Laboratory, Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka-shi, Osaka, 558-8585, Japan.
Eur J Clin Nutr. 2022 Dec;76(12):1727-1732. doi: 10.1038/s41430-022-01168-5. Epub 2022 Jun 2.
The study aimed to explore the risk factors for the outcome of nutrition support teams (NSTs) for elderly patients. Previously identified risk factors lack general versatility owing to slightly subjective judgment standards; this study aimed to explore an objective and simple index of NST outcome and identify the risk factors for NST outcome.
This retrospective observational study analyzed, 372 elderly patients enrolled in the NST between January 2014 and July 2018. We identified that the energy fill rate to total energy expenditure (%TEE) at the time of NST termination (post-%TEE) < 75.0% was the most valid index for the outcome in our previous study. The cutoff values of continuous variables at the time of NST enrollment (pre-) were set for post-%TEE < 75.0% using receiver operating characteristic curve analysis, and hazard ratios (HRs) were calculated.
From the multivariable Cox proportional hazard analysis, pre-%TEE < 62.6% (HR: 1.96; 95% confidence interval [95% CI]: 1.29-2.99; p = 0.002), presence of pressure ulcers (HR: 1.74; 95% CI: 1.02-2.98; p = 0.042), pre-prognostic nutritional index (PNI) < 32.7 (HR: 1.78; 95% CI: 1.13-2.82; p = 0.014), and presence of pre-peripheral parenteral nutrition (PPN) (HR: 1.74; 95% CI: 1.19-2.56; p = 0.005) were identified as independent risk factors for post-%TEE < 75.0%.
Post-%TEE < 75.0% was the objective and simple index for NST outcomes. Patients with low pre-%TEE, pressure ulcers, low pre-PNI, or pre-PPN require early nutritional intervention.
本研究旨在探讨营养支持团队（NST）治疗老年患者结局的影响因素。既往确定的风险因素由于判断标准稍显主观而缺乏普遍适用性；本研究旨在探索一种 NST 结局的客观且简单的指标，并确定 NST 结局的影响因素。
本回顾性观察性研究分析了 2014 年 1 月至 2018 年 7 月期间纳入 NST 的 372 例老年患者。我们之前的研究发现，NST 终止时（NST 后）能量供给率与总能量消耗（%TEE）之比（后-%TEE）<75.0%是结局最有效的指标。采用受试者工作特征曲线分析，为 NST 纳入时（NST 前）的连续变量设置后-%TEE<75.0%的截断值，并计算风险比（HR）。
多变量 Cox 比例风险分析显示，NST 前-%TEE<62.6%（HR：1.96；95%置信区间[95%CI]：1.29-2.99；p=0.002）、存在压疮（HR：1.74；95%CI：1.02-2.98；p=0.042）、NST 前预后营养指数（PNI）<32.7（HR：1.78；95%CI：1.13-2.82；p=0.014）和存在 NST 前外周肠外营养（PPN）（HR：1.74；95%CI：1.19-2.56；p=0.005）是后-%TEE<75.0%的独立危险因素。
后-%TEE<75.0%是 NST 结局的客观且简单的指标。NST 前-%TEE 低、存在压疮、NST 前 PNI 低或存在 NST 前 PPN 的患者需要早期营养干预。
