肠内营养改善心胸外科恢复单元患者的预后和免疫营养状况：倾向评分匹配分析。
Enteral nutrition improves the prognosis and immune nutritional status of patients in the cardiothoracic surgery recovery unit: A propensity score-matched analysis.
机构信息
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.
出版信息
Clin Nutr. 2022 Dec;41(12):2699-2705. doi: 10.1016/j.clnu.2022.10.012. Epub 2022 Oct 26.
BACKGROUND
It remains unclear whether enteral nutrition (EN) has an impact on prognosis and immune nutritional status for patients in the cardiothoracic surgery recovery unit (CSRU). We hypothesized that only patients with specific characteristics would benefit from EN and aimed to distinguish that specific population by examining a large database.
METHODS
Propensity-score matching (PSM) was used to eliminate the baseline imbalances between the EN and non-EN groups. The modified nutritional risk in the critically ill (mNUTRIC) score was used to assess the severity of patients' disease as well as their nutritional risk. Kaplan-Meier curves were used to compare the differences in 28- and 1000-day overall survival in the two groups after PSM. Generalized additive mixed models (GAMMs) were used to show dynamic changes in neutrophil-to-lymphocyte ratios (NLRs) and platelet-to-lymphocyte ratios (PLRs) in the two groups. Subgroup analysis was used to identify the specific population that could benefit from EN.
RESULTS
A total of 1823 patients (EN group, n = 395; non-EN group, n = 1428) were enrolled; after PSM, 320 pairs of patients remained. EN was found to reduce the 28-day mortality rate (adjusted hazard ratio [HR] = .56; 95% CI, .35-.91; P = .019) of patients, whereas it had no effect on 1000-day survival (adjusted HR = .97; 95% CI, .75-1.25; P = .797). Subgroup analyses indicated that patients with mNUTRIC equal to or greater than 4, body mass index (BMI) 25-30 kg/m, and vasopressor support were more likely to benefit from EN. NLR and PLR in the EN group decreased progressively over time compared with the non-EN group, suggesting that EN might improve clinical outcomes by regulating immune and inflammatory responses.
CONCLUSION
EN may improve the prognosis and immune nutritional status of patients in the CSRU. Patients who might benefit should be actively treated with EN.
背景
肠内营养（EN）是否对心胸外科恢复单元（CSRU）患者的预后和免疫营养状况有影响仍不清楚。我们假设只有具有特定特征的患者才会从 EN 中受益，并旨在通过检查大型数据库来区分该特定人群。
方法
采用倾向评分匹配（PSM）消除 EN 组和非 EN 组之间的基线不平衡。使用改良危重患者营养风险指数（mNUTRIC）评分评估患者疾病的严重程度及其营养风险。PSM 后，使用 Kaplan-Meier 曲线比较两组患者 28 天和 1000 天总生存率的差异。使用广义加性混合模型（GAMM）显示两组中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）的动态变化。亚组分析用于确定可以从 EN 中受益的特定人群。
结果
共纳入 1823 例患者（EN 组，n=395；非 EN 组，n=1428）；PSM 后，仍有 320 对患者。EN 降低了 28 天死亡率（调整后的危险比 [HR] = 0.56；95%置信区间，0.35-0.91；P=0.019），但对 1000 天生存率无影响（调整后 HR = 0.97；95%置信区间，0.75-1.25；P=0.797）。亚组分析表明，mNUTRIC 评分等于或大于 4、BMI 为 25-30 kg/m2 和血管加压支持的患者更有可能从 EN 中受益。与非 EN 组相比，EN 组的 NLR 和 PLR 随时间逐渐降低，这表明 EN 可能通过调节免疫和炎症反应改善临床结局。
结论
EN 可能改善 CSRU 患者的预后和免疫营养状况。应积极为可能受益的患者提供 EN 治疗。
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