改良 NUTRIC 评分预测短期及长期急性机械通气患者死亡率的能力：一项回顾性队列研究。
Ability of the modified NUTRIC score to predict mortality in patients requiring short-term prolonged acute mechanical ventilation: a retrospective cohort study.
机构信息
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
出版信息
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241232263. doi: 10.1177/17534666241232263.
BACKGROUND
The modified NUTRIC (nutritional risk in the critically ill) score has been reported to predict clinical outcomes in critically ill patients. However, the applicability of this score may differ between patients undergoing short-term mechanical ventilation (STMV, < 96 h) and those undergoing prolonged acute mechanical ventilation (PAMV, ⩾96 h), as PAMV patients typically experience significantly higher morbidity and mortality.
OBJECTIVE
This study aimed to investigate the predictive ability of modified NUTRIC score for predicting 28-day mortality in patients receiving STMV and PAMV.
DESIGN
Retrospective single-center cohort study.
METHODS
We enrolled patients who received mechanical ventilation (MV) on the day of admission to the intensive care unit (ICU) from 1 December 2015 to 30 November 2020. Modified NUTRIC scores were calculated based on the clinical data of each patient at ICU admission.
RESULTS
The study population comprised 464 patients, including 319 (68.8%) men with a mean age of 69.7 years. Among these patients, 132 (28.4%) received STMV and 332 (71.6%) received PAMV. The overall 28-day mortality rate was 26.7%, which was significantly higher in STMV patients than in PAMV patients (37.9% 22.3%, < 0.001). Evaluation of the predictive performance of the modified NUTRIC score for 28-day mortality revealed areas under the receiver operating characteristic curves of 0.672 [95% confidence interval (CI): 0.627-0.714] for total patients, 0.819 (95% CI, 0.742-0.880) for STMV patients, and 0.595 (95% CI, 0.540-0.648) for PAMV patients. The best overall cutoff value was 5 in total, STMV, and PAMV patients. This cutoff value was a significant predictor of 28-day mortality based on the Cox proportional hazard model for total [hazards ratio (HR): 2.681; 95% CI: 1.683-4.269] and STMV (HR: 5.725; 95% CI: 2.057-15.931) patients, but not for PAMV patients.
CONCLUSION
The modified NUTRIC score is more effective in predicting 28-day mortality in patients undergoing STMV than in those undergoing PAMV.
背景
改良 NUTRIC（危重症患者营养风险）评分已被报道可预测危重症患者的临床结局。然而，该评分在接受短期机械通气（STMV，<96 小时）和接受延长急性机械通气（PAMV，⩾96 小时）的患者中的适用性可能不同，因为 PAMV 患者通常经历更高的发病率和死亡率。
目的
本研究旨在探讨改良 NUTRIC 评分对接受 STMV 和 PAMV 的患者预测 28 天死亡率的预测能力。
设计
回顾性单中心队列研究。
方法
我们纳入了 2015 年 12 月 1 日至 2020 年 11 月 30 日入住重症监护病房（ICU）当天接受机械通气（MV）的患者。根据每位患者 ICU 入院时的临床数据计算改良 NUTRIC 评分。
结果
研究人群包括 464 例患者，其中 319 例（68.8%）为男性，平均年龄为 69.7 岁。这些患者中，132 例（28.4%）接受 STMV，332 例（71.6%）接受 PAMV。总的 28 天死亡率为 26.7%，STMV 患者明显高于 PAMV 患者（37.9% 22.3%，<0.001）。评估改良 NUTRIC 评分对 28 天死亡率的预测性能显示，总患者的受试者工作特征曲线下面积为 0.672[95%置信区间（CI）：0.627-0.714]，STMV 患者为 0.819（95%CI，0.742-0.880），PAMV 患者为 0.595（95%CI，0.540-0.648）。总患者、STMV 患者和 PAMV 患者的最佳截断值均为 5。基于 Cox 比例风险模型，该截断值是总患者[风险比（HR）：2.681；95%CI：1.683-4.269]和 STMV 患者（HR：5.725；95%CI：2.057-15.931）28 天死亡率的显著预测因子，但不是 PAMV 患者的预测因子。
结论
改良 NUTRIC 评分在预测 STMV 患者 28 天死亡率方面比 PAMV 患者更有效。
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