Okyar Baş Arzu, Mermer Meltem, Eşme Mert
Hacettepe University, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey.
Department of Nutrition and Dietetics, Toros University, Mersin, Turkey.
Nutrition. 2025 Mar;131:112672. doi: 10.1016/j.nut.2024.112672. Epub 2024 Dec 15.
Malnutrition is strongly related to mortality in intensive care unit (ICU) patients. The Patient- and Nutrition-Derived Outcome Risk Assessment Score (PANDORA) is a novel mortality prediction tool encompassing nutritional assessment. Since there is limited evidence regarding the power of PANDORA in predicting mortality in critically ill patients, we aimed to evaluate the benefit of adding PANDORA to the Global Leadership Initiative on Malnutrition (GLIM) for mortality prediction in the ICU setting by comparing it with the other valid mortality predictors.
A total of 251 ICU patients were enrolled in the study. Malnutrition evaluation tools (i.e., GLIM criteria, The nutritional risk screening 2002, The modified Nutrition Risk in Critically Ill score), and mortality/disease severity tools (PANDORA, The Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment) were performed. Scores ≥43 were defined as high PANDORA score.
The median age (IQR) of participants was 67 (52-78) years, and 47.0% (n = 118) were female. Patients were evaluated according to 30th, 60th, 90th, and 180th-day mortalities. In all groups, patients were older, had a lower body mass index and longer hospitalization time, and were more likely to have malnutrition and higher PANDORA, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores. In the Cox regression analyses, even if adjusted for various confounders, malnutrition according to GLIM criteria and a high PANDORA score had the highest hazard ratio (HR) for mortality (HR: 3.62; 95% confidence interval [CI]: 1.49-8.77; P = 0.004, HR: 3.71; 95% CI: 1.69-8.12; P = 0.001, HR: 3.46; 95% CI: 1.69-7.06; P = 0.001 and HR: 4.00; 95% CI: 1.98-8.09; P = 0.004 for 30th, 60th, 90th, and 180th days, respectively).
PANDORA is a valid tool for predicting mortality in ICU patients. Furthermore, to our knowledge this is the first study to reveal that integrating GLIM criteria into PANDORA may enhance its power in this setting.
营养不良与重症监护病房（ICU）患者的死亡率密切相关。患者及营养衍生结局风险评估评分（PANDORA）是一种包含营养评估的新型死亡率预测工具。由于关于PANDORA预测危重症患者死亡率能力的证据有限，我们旨在通过将其与其他有效的死亡率预测指标进行比较，评估在ICU环境中，将PANDORA纳入全球营养不良领导倡议（GLIM）用于死亡率预测的益处。
本研究共纳入251例ICU患者。采用了营养不良评估工具（即GLIM标准、营养风险筛查2002、改良的危重症营养风险评分）以及死亡率/疾病严重程度工具（PANDORA、急性生理与慢性健康状况评估II评分、序贯器官衰竭评估）。PANDORA评分≥43被定义为高PANDORA评分。
参与者的年龄中位数（四分位间距）为67（52 - 78）岁，女性占47.0%（n = 118）。根据第30、60、90和180天的死亡率对患者进行评估。在所有组中，患者年龄更大、体重指数更低、住院时间更长，且更有可能存在营养不良，PANDORA、急性生理与慢性健康状况评估II以及序贯器官衰竭评估评分更高。在Cox回归分析中，即使对各种混杂因素进行了调整，根据GLIM标准判定的营养不良和高PANDORA评分在死亡率方面具有最高的风险比（HR）（第30、60、90和180天的HR分别为：3.62；95%置信区间[CI]：1.49 - 8.77；P = 0.004，HR：3.71；95% CI：1.69 - 8.12；P = 0.001，HR：3.46；95% CI：1.69 - 7.06；P = 0.001以及HR：4.00；95% CI：1.98 - 8.09；P = 0.004）。
PANDORA是预测ICU患者死亡率的有效工具。此外，据我们所知，这是第一项揭示将GLIM标准纳入PANDORA可能会增强其在该环境中预测能力的研究。
