Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama-City 700-8558, Okayama, Japan.
Biostatistics Center, Kurume University, 67 Asahi-Machi, Kurume-City 830-0011, Fukuoka, Japan.
Nutrients. 2022 Aug 27;14(17):3541. doi: 10.3390/nu14173541.
The majority of inpatients requiring parenteral nutrition (PN) do not receive adequate amino acid, which may negatively impact clinical outcomes. We investigated the influence of amino acid doses on clinical outcomes in medical adult inpatients fasting >10 days and receiving only PN, using Japanese medical claims database. The primary endpoint was in-hospital mortality, and the secondary endpoints included deterioration of activities of daily living (ADL), intravenous catheter infection, hospital readmission, hospital length of stay (LOS), and total medical costs. Patients were divided into four groups according to their mean prescribed daily amino acid doses from Days 4 to 10 of fasting: Adequate (≥0.8 g/kg/day), Moderate (≥0.6−<0.8 g/kg/day), Low (≥0.4−<0.6 g/kg/day), and Very low (<0.4 g/kg/day). Multivariate logistic or multiple regression analyses were performed with adjustments for patient characteristics (total n = 86,702). The Adequate group was used as the reference in all analyses. For the Moderate, Low, and Very low groups, adjusted ORs (95% CI) of in-hospital mortality were 1.20 (1.14−1.26), 1.43 (1.36−1.51), and 1.72 (1.62−1.82), respectively, and for deterioration of ADL were 1.21 (1.11−1.32), 1.34 (1.22−1.47), and 1.22 (1.09−1.37), respectively. Adjusted regression coefficients (95% CI) of hospital LOS were 1.2 (0.4−2.1), 1.5 (0.6−2.4), and 2.9 (1.8−4.1), respectively. Lower prescribed doses of amino acids were associated with worse clinical outcomes including higher in-hospital mortality.
大多数需要肠外营养 (PN) 的住院患者没有得到足够的氨基酸，这可能会对临床结果产生负面影响。我们使用日本医疗索赔数据库，调查了禁食 >10 天且仅接受 PN 的成年住院患者的氨基酸剂量对临床结果的影响。主要终点是住院期间死亡率，次要终点包括日常生活活动 (ADL) 恶化、静脉导管感染、医院再入院、住院时间 (LOS) 和总医疗费用。根据患者禁食第 4 至 10 天的平均规定每日氨基酸剂量，将患者分为四组：充足（≥0.8 g/kg/天）、适度（≥0.6-<0.8 g/kg/天）、低（≥0.4-<0.6 g/kg/天）和极低（<0.4 g/kg/天）。使用患者特征（总 n = 86702）进行多变量逻辑或多元回归分析。所有分析均以充足组为参考。对于中度、低度和极低度组，住院死亡率的调整后比值比 (95%CI) 分别为 1.20 (1.14-1.26)、1.43 (1.36-1.51) 和 1.72 (1.62-1.82)，ADL 恶化的调整后比值比 (95%CI) 分别为 1.21 (1.11-1.32)、1.34 (1.22-1.47) 和 1.22 (1.09-1.37)。住院 LOS 的调整回归系数 (95%CI) 分别为 1.2 (0.4-2.1)、1.5 (0.6-2.4) 和 2.9 (1.8-4.1)。较低的氨基酸规定剂量与较差的临床结果相关，包括较高的住院死亡率。
