Ait Hssain Ali, Farigon Nicolas, Merdji Hamid, Guelon Dominique, Bohé Julien, Cayot Sophie, Chabanne Russel, Constantin Jean-Michel, Pereira Bruno, Bouvier Damien, Andant Nicolas, Roth Hubert, Thibault Ronan, Sapin Vincent, Hasselmann Michel, Souweine Bertrand, Cano Noël, Boirie Yves, Dupuis Claire
Department of Intensive Care, Medical Intensive Care, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
Clin Nutr. 2023 Oct;42(10):2070-2079. doi: 10.1016/j.clnu.2023.09.001. Epub 2023 Sep 9.
BACKGROUND & AIMS: After a prolonged intensive care unit (ICU) stay patients experience increased mortality and morbidity. The primary aim of this study was to assess the prognostic value of nutritional status, body mass composition and muscle strength, as assessed by body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip (HG) test, and that of the biological features to predict one-year survival at the end of a prolonged ICU stay.
This was a multicenter prospective observational study. Survivor patients older than 18 years with ICU length of stay >72 h were eligible for inclusion. BIA and HG were performed at the end of the ICU stay. Malnutrition was defined by BMI and fat-free mass index (FFMI). The primary endpoint was one-year mortality. Multivariable logistic regression was performed to determine parameters associated with mortality.
572 patients were included with a median age of 63 years [53.5; 71.1], BMI of 26.6 kg/m [22.8; 31.3], SAPS II score of 43 [31; 58], and ICU length of stay of 9 days [6; 15]. Malnutrition was observed in 142 (24.9%) patients. During the 1-year follow-up after discharge, 96 (18.5%) patients died. After adjustment, a low HG test score (aOR = 1.44 [1.11; 1.89], p = 0.01) was associated with 1-year mortality. Patients with low HG score, malnutrition, and Albuminemia <30 g/L had a one-year death rate of 41.4%. Conversely, patients with none of these parameters had a 1-year death rate of 4.1%.
BIA to assess FFMI, HG and albuminemia at the end of ICU stay could be used to predict 1-year mortality. Their ability to identify patients eligible for a structured recovery program could be studied.
在重症监护病房（ICU）长期住院后，患者的死亡率和发病率会增加。本研究的主要目的是评估营养状况、身体成分和肌肉力量的预后价值，通过体重指数（BMI）、生物电阻抗分析（BIA）、握力（HG）测试以及生物学特征来预测长期ICU住院结束时的一年生存率。
这是一项多中心前瞻性观察性研究。年龄大于18岁、ICU住院时间>72小时的存活患者符合纳入标准。在ICU住院结束时进行BIA和HG测试。营养不良通过BMI和去脂体重指数（FFMI）定义。主要终点是一年死亡率。进行多变量逻辑回归以确定与死亡率相关的参数。
纳入572例患者，中位年龄63岁[53.5；71.1]，BMI为26.6kg/m²[22.8；31.3]，简化急性生理学评分（SAPS）II为43[31；58]，ICU住院时间为9天[6；15]。142例（24.9%）患者存在营养不良。出院后1年随访期间，96例（18.5%）患者死亡。调整后，低HG测试评分（调整后比值比[aOR]=1.44[1.11；1.89]，p=0.01）与1年死亡率相关。HG评分低、营养不良且白蛋白血症<30g/L的患者一年死亡率为41.4%。相反，无这些参数的患者一年死亡率为4.1%。
在ICU住院结束时通过BIA评估FFMI、HG和白蛋白血症可用于预测1年死亡率。它们识别适合结构化康复计划患者的能力有待研究。
