Zhou Hai-Jiang, Zuo Dong-Jing, Zhang Da, He Xin-Hua, Guo Shu-Bin
Nutrition School of Education College of Chinese Emergency Medicine, Beijing Key Laboratory of Cardio-pulmonary Cerebral Resuscitation, Emergency Medicine Clinical Research Center, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
World J Emerg Med. 2023;14(1):17-24. doi: 10.5847/wjem.j.1920-8642.2023.005.
Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes. Despite its large population, few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units (EDOUs).
Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled. Demographic information, laboratory parameters, nutritional support therapies, and 28-day mortality were recorded. Risk factors for mortality were examined using multi-variate-adjusted logistic regression analysis. Receiver operating characteristic (ROC) curves for each predictor of mortality were plotted, and the area under the ROC (AUROC) curves was compared.
A total of 2,005 eligible patients were finally enrolled. At the 28-day follow-up, 1,911 patients survived, and 94 died. The group with a Nutritional Risk Screening 2002 (NRS 2002) score of 3-4 points was the largest (52.01%). The number of patients receiving oral nutritional supplements, enteral nutrition (EN), parenteral nutrition (PN), and the combination of EN and PN was 425, 314, 853, and 413, respectively. Among the total, 77.55% of patients had nutritional risk (NRS 2002 ≥3). The proportion of patients with high nutritional risk (NRS2002≥5) in the age group >80 years was significantly higher than that in the age group 66-80 years (29.00% vs. 23.93%, P=0.032), but not significantly higher than that in the age group 18-65 years (29.00% vs. 26.54%, P=0.449). Logistic regression analysis revealed that heart failure (odds ratio [OR] 1.856, 95% confidence interval [CI] 1.087-3.167, P=0.023), consciousness (OR 2.967, 95% CI 1.894-4.648, P<0.001), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.037, 95% CI 1.017-1.058, P<0.001), NRS 2002 score (OR 1.286, 95% CI 1.115-1.483, P=0.001), and Mini Nutritional Assessment-Short Form score (OR 0.946, 95% CI 0.898-0.997, P=0.039) were all independent risk factors for 28-day mortality. APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC.
Nutritional risk is prevalent among older patients in EDOUs in China. APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU. Timely and appropriate nutritional screening and support measures are critical to reduce patients' length of hospital stay and mortality.
营养风险在急诊科收治的患者中很常见，且与不良临床结局相关。尽管中国人口众多，但针对急诊科观察病房（EDOU）患者营养状况的综合研究较少。
纳入2020年6月至2020年12月期间中国90家三级医院EDOU收治的患者。记录人口统计学信息、实验室参数、营养支持治疗及28天死亡率。采用多变量调整逻辑回归分析检验死亡风险因素。绘制各死亡预测指标的受试者工作特征（ROC）曲线，并比较ROC曲线下面积（AUROC）。
最终共纳入2005例符合条件的患者。在28天随访时，1911例患者存活，94例死亡。营养风险筛查2002（NRS 2002）评分为3 - 4分的组人数最多（52.01%）。接受口服营养补充剂、肠内营养（EN）、肠外营养（PN）以及EN和PN联合治疗的患者人数分别为425例、314例、853例和413例。总体中，77.55%的患者存在营养风险（NRS 2002≥3）。年龄>80岁组中高营养风险（NRS2002≥5）患者的比例显著高于66 - 80岁组（29.00%对23.93%，P = 0.032），但不显著高于18 - 65岁组（29.00%对26.54%，P = 0.449）。逻辑回归分析显示，心力衰竭（比值比[OR] 1.856，95%置信区间[CI] 1.087 - 3.167，P = 0.023）、意识（OR 2.967，95% CI 1.894 - 4.648，P<0.001）、急性生理与慢性健康状况评价II（APACHE II）评分（OR 1.037，95% CI 1.017 - 1.058，P<0.001）、NRS 2002评分（OR 1.286，95% CI 1.115 - 1.483，P = 0.001）以及微型营养评定简表评分（OR 0.946，95% CI 0.898 - 0.997，P = 0.039）均为28天死亡的独立风险因素。根据AUROC比较，APACHE II和NRS 2002评分优于其他预测指标。
中国EDOU老年患者中营养风险普遍存在。APACHE II和NRS 2002评分是EDOU收治患者死亡的重要风险因素。及时且适当的营养筛查和支持措施对于缩短患者住院时间和降低死亡率至关重要。
