危重症患者的氮平衡与预后：一项系统评价和荟萃分析。
Nitrogen balance and outcomes in critically ill patients: A systematic review and meta-analysis.
作者信息
Zhu Yi-Bing, Yao Yan, Xu Yuan, Huang Hui-Bin
机构信息
Department of Emergency, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
出版信息
Front Nutr. 2022 Aug 22;9:961207. doi: 10.3389/fnut.2022.961207. eCollection 2022.
OBJECTIVE
Nitrogen balance (NB) is a commonly used nutrition indicator in clinical practice, while its relation to the interpretation of protein malnutrition and outcomes in critically ill patients remains unclear. This study aimed to evaluate the impact of NB on prognosis in such a patient population.
METHODS
We searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to May 10, 2022. Meta-analyses were performed to evaluate the relationship between NB (initial, final, or absolute change of NB levels) and prognosis and important clinical outcomes in critically ill patients. Pooled odds ratios (ORs) and mean differences (MDs) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity.
RESULTS
Eight studies with 1,409 patients were eligible. These studies were moderate to high quality. When pooled, the initial NB was comparable between the survival and non-survival groups (five studies, MD 1.20, 95% CI, -0.70 to 3.11, = 77%; = 0.22), while a significantly higher final NB in the survival group than that in the death group (two studies, MD 3.69, 95% CI, 1.92-5.46, = 55%; < 0.0001). Two studies provided the absolute change of NB over time and suggested survival patients had more increased NB (MD 4.16 g/day, 95% CI, 3.70-4.61, = 0%; < 0.00001). Similarly, for studies utilizing multivariate logistic regression, we found an improved NB (four studies, OR 0.85, 95% CI, 0.73-0.99, = 61%; = 0.04) but not an initial NB (two studies, OR 0.92, 95% CI 0.78-1.08, = 55%; = 0.31) was significantly associated the risk of all-cause mortality. These results were further confirmed in subgroup analyses. In addition, patients with improved NB had more protein and calorie intake and a similar length of stay in hospital than those without.
CONCLUSIONS
Our results suggested that an improved NB but not the initial NB level was associated with all-cause mortality in critically ill patients. This highlights the requirement for dynamic monitoring of NB during nutrition treatment. Further randomized clinical trials examining the impact of NB-guided protein intake on clinical outcomes in critically ill patients are warranted.
SYSTEMATIC REVIEW REGISTRATION
INPLASY202250134, https://doi.org/10.37766/inplasy2022.5.0134.
目的
氮平衡（NB）是临床实践中常用的营养指标，但其与危重症患者蛋白质营养不良的解读及预后的关系仍不明确。本研究旨在评估NB对这类患者群体预后的影响。
方法
我们检索了截至2022年5月10日的PubMed、EMBASE和Cochrane数据库中的相关研究。进行荟萃分析以评估NB（初始、最终或NB水平的绝对变化）与危重症患者的预后及重要临床结局之间的关系。计算合并比值比（OR）和平均差（MD）及其95%置信区间（CI）。我们还进行了亚组分析以探索异质性来源。
结果
八项研究共纳入1409例患者，这些研究质量为中等至高。汇总分析时，生存组和非生存组的初始NB相当（五项研究，MD 1.20，95%CI，-0.70至3.11，I² = 77%；P = 0.22），而生存组的最终NB显著高于死亡组（两项研究，MD 3.69，95%CI，1.92 - 5.46，I² = 55%；P < 0.0001）。两项研究提供了NB随时间的绝对变化，表明生存患者的NB增加更多（MD 4.16 g/天，95%CI，3.70 - 4.61，I² = 0%；P < 0.00001）。同样，对于采用多因素逻辑回归的研究，我们发现NB改善（四项研究，OR 0.85，95%CI，0.73 - 0.99，I² = 61%；P = 0.04）而非初始NB（两项研究，OR 0.92，95%CI 0.78 - 1.08，I² = 55%；P = 0.31）与全因死亡风险显著相关。这些结果在亚组分析中得到进一步证实。此外，NB改善的患者比未改善的患者摄入更多蛋白质和热量，住院时间相似。
结论
我们的结果表明，NB改善而非初始NB水平与危重症患者的全因死亡相关。这凸显了在营养治疗期间对NB进行动态监测的必要性。有必要进一步开展随机临床试验，研究NB指导的蛋白质摄入量对危重症患者临床结局的影响。
系统评价注册
INPLASY202250134，https://doi.org/10.37766/inplasy202。 5.0134
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