Diethelm Julian, Wunderle Carla, van Zanten Arthur R H, Tribolet Pascal, Stanga Zeno, Mueller Beat, Schuetz Philipp
Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.
Gelderse Vallei Hospital, Department of Intensive Care, Willy Brandtlaan 10, 6716RP Ede, the Netherlands; Division of Human Nutrition & Health of the University of Wageningen, Stippeneng 4, 6708 WE Wageningen, Netherlands.
Clin Nutr ESPEN. 2025 Jun;67:242-249. doi: 10.1016/j.clnesp.2025.03.042. Epub 2025 Mar 21.
Assessing a patient's catabolism in clinical practice is challenging but could help guide nutritional interventions. The urea-to-creatinine ratio (UCR) reflects muscle breakdown and protein metabolism and has been associated with risk for overfeeding and adverse outcomes in the critical care setting. We validated this concept in a well-characterized population of medical ward patients from a previous nutritional trial.
This secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT) examined baseline UCR and changes during follow-up in medical inpatients at risk for malnutrition. A catabolic state was defined as a high baseline UCR or an increase in UCR over 7 days. The primary endpoint was mortality at 30 days.
We included 1595 of 2028 EFFORT patients with baseline UCR measurements and 870 who also had UCR measurements on day 7. A high baseline UCR, as well as an increase in UCR over 7 days, were associated with increased mortality (adjusted HR for 30-day mortality 2.05 (1.47-2.87) p < 0.001 and 2.02 (1.34-3.06) p = 0.001). There was no difference in treatment response when stratifying patients based on baseline or follow-up UCR.
Assessment of catabolism through UCR measurement at baseline and changes during follow-up was associated with increased mortality and adverse outcomes in medical inpatients at nutritional risk. However, this stratification was not associated with response to nutritional therapy in our sample. Further studies into the dynamic changes in UCR are needed to better understand the clinical implications for medical ward patients.
Clinicaltrials.gov as NCT02517476 (registered 7 August 2015).
在临床实践中评估患者的分解代谢具有挑战性，但有助于指导营养干预。尿素肌酐比值（UCR）反映肌肉分解和蛋白质代谢，并且在重症监护环境中与过度喂养风险及不良结局相关。我们在先前一项营养试验中特征明确的内科病房患者群体中验证了这一概念。
这项对“早期营养支持对营养不良内科住院患者虚弱、功能结局及恢复的影响试验（EFFORT）”的二次分析，研究了有营养不良风险的内科住院患者的基线UCR及随访期间的变化。分解代谢状态定义为基线UCR高或UCR在7天内升高。主要终点是30天死亡率。
我们纳入了EFFORT研究中2028例有基线UCR测量值的患者中的1595例，以及870例在第7天也有UCR测量值的患者。基线UCR高以及UCR在7天内升高均与死亡率增加相关（30天死亡率的校正风险比分别为2.05（1.47 - 2.87），p < 0.001和2.02（1.34 - 3.06），p = 0.001）。根据基线或随访UCR对患者进行分层时，治疗反应无差异。
通过测量基线UCR及随访期间的变化来评估分解代谢，与有营养风险的内科住院患者死亡率增加及不良结局相关。然而，在我们的样本中，这种分层与营养治疗反应无关。需要进一步研究UCR的动态变化，以更好地理解其对内科病房患者的临床意义。
Clinicaltrials.gov，编号NCT02517476（2015年8月7日注册）
