Zou Shangpu, Lin Pengcheng, Chen Xiaoyu, Xia Lijing, Liu Xiling, Su Shanshan, Zhou Ying, Li Yuping
The Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Respiratory and Critical Care Medicine, The Second Hospital of Yiwu, Yiwu, China.
Front Nutr. 2024 Nov 28;11:1501132. doi: 10.3389/fnut.2024.1501132. eCollection 2024.
Identifying nutritional risk in COVID-19 patients poses a challenge due to the unique qualities of every nutritional screening instrument. The objective was to assess the efficacy of six nutritional scores, including the Nutritional Risk Screening 2002 (NRS-2002) score, the NUTRIC (nutrition risk in the critically ill) score, the modified NUTRIC score, the prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, TCB index (TCBI), predicting prognosis of COVID-19 patients.
Clinical data were collected from COVID-19 patients admitted to the First Affiliated Hospital of Wenzhou Medical University between December 2022 and February 2023. Participants in this research were divided into two groups: all patients and those specifically from the intensive care unit (ICU). Each group was further stratified into two groups: survivors and non-survivors.
506 COVID-19 patients and 190 COVID-19 patients in intensive care unit (ICU) were evaluated. In all COVID-19 patients, we found that NRS-2002 ( < 0.001) and TCBI ( = 0.002) were statistically significant independent predictors in multivariate analyses, while APACHE II score ( = 0,048) and the mNUTRIC score ( = 0.025) were statistically significant independent predictors in multivariate analyses in ICU patients. The NRS-2002 demonstrated a higher AUC value (0.687) than other nutritional scores in all patients, with an optimum cut-off value of 3, translating into a corresponding sensitivity of 66.2% and specificity of 68.7%. With an optimum cut-off value of 4, the mNUTRIC score demonstrated a higher AUC value (0.884) in ICU patients, resulting in a sensitivity of 88.4% and a specificity of 76.9%. By using the discrimination and clinical application (DCA) curve, NRS-2002 demonstrated the greatest net benefit in all patients, while NUTRIC score and mNUTRIC score offered the more significant overall advantage than other nutritional scores in ICU patients. Kaplan-Meier analyses showed lower survival rates in patients in low nutritional risk.
Malnutrition was common in COVID-19 patients. The mNUTRIC score and NRS-2002 were, respectively, more effctive scoring systems of prognosis in all COVID-19 patients and severe or critical COVID-19 patients of the intensive care unit (ICU).
由于每种营养筛查工具都有其独特之处，识别新冠病毒感染患者的营养风险具有挑战性。目的是评估六种营养评分，包括营养风险筛查2002（NRS - 2002）评分、NUTRIC（危重症患者营养风险）评分、改良NUTRIC评分、预后营养指数（PNI）、控制营养状况（CONUT）评分、TCB指数（TCBI），对新冠病毒感染患者预后的预测效果。
收集了2022年12月至2023年2月期间入住温州医科大学附属第一医院的新冠病毒感染患者的临床资料。本研究的参与者分为两组：所有患者以及专门来自重症监护病房（ICU）的患者。每组又进一步分为两组：幸存者和非幸存者。
对506例新冠病毒感染患者和190例重症监护病房（ICU）的新冠病毒感染患者进行了评估。在所有新冠病毒感染患者中，我们发现NRS - 2002（<0.001）和TCBI（=0.002）在多因素分析中是具有统计学意义的独立预测因素，而急性生理与慢性健康状况评分系统II（APACHE II）评分（=0.048）和改良NUTRIC评分（=0.025）在ICU患者的多因素分析中是具有统计学意义的独立预测因素。在所有患者中，NRS - 2002的曲线下面积（AUC）值（0.687）高于其他营养评分，最佳截断值为3，相应的敏感性为66.2%，特异性为68.7%。改良NUTRIC评分在ICU患者中的最佳截断值为4时，AUC值较高（0.884），敏感性为88.4%，特异性为76.9%。通过使用决策曲线分析（DCA）曲线，NRS - 2002在所有患者中显示出最大的净效益，而NUTRIC评分和改良NUTRIC评分在ICU患者中比其他营养评分具有更显著的总体优势。Kaplan - Meier分析显示，营养风险低的患者生存率较低。
营养不良在新冠病毒感染患者中很常见。改良NUTRIC评分和NRS - 2002分别是所有新冠病毒感染患者以及重症监护病房（ICU）中重症或危重症新冠病毒感染患者更有效的预后评分系统。
