Nazari S, Comincioli V, Dionigi R, Comodi I, Dionigi P, Capelo A, Bonoldi A P, Bonacasa R, Cozzi M
JPEN J Parenter Enteral Nutr. 1981 Jul-Aug;5(4):307-16. doi: 10.1177/0148607181005004307.
In spite of the many anthropometric, biohumoral, and immunologic parameters employed in the nutritional assessment of hospitalized patients, it is difficult in clinical practice to evaluate accurately the degree and type of malnutrition and to assess the prognostic significance of this determination. The purpose of this study is to evaluate nutritional status of surgical patients by means of cluster analysis in orderr to identify different nutritional patterns and to evaluate their clinical and prognostic significance. Nutritional assessment of 71 surgical patients was carried out at admission, and the sets of data were evaluated by means of cluster analysis. Four clusters with different nutritional patterns were identified. The incidence of clinical variables (type of disease, postoperative sepsis, palliative procedures, mortality at 6 months, etc.) in each cluster was determined in order to evaluate their clinical and prognostic significance. Cluster 1 showed minor variations of the indicators, including most of the controls presented the lowest incidence of sepsis, palliative procedures, and mortality at 6 months. It was then considered as a reference group representative of the normal nutritional condition at our institution. The other three clusters showed major variations of nutritional indicators and represent poorer risk clinical conditions. Sepsis, palliative procedures and mortality rate were significantly more frequent in these clusters (p less than 0.05, p less than 0.001, p less than 0.05). A different distribution in the clusters was recorded in gastrointestinal tract cancers and other neoplasms. Only the incidence of gastrointestinal tract cancers increases progressively in the clusters with poorer prognosis, suggesting that this type of neoplasia is more frequently associated with major changes of nutritional status.
尽管在评估住院患者营养状况时采用了许多人体测量、生物体液和免疫学参数，但在临床实践中，准确评估营养不良的程度和类型以及评估这种判定的预后意义仍然很困难。本研究的目的是通过聚类分析评估外科手术患者的营养状况，以便识别不同的营养模式并评估其临床和预后意义。在71例外科手术患者入院时进行了营养评估，并通过聚类分析对数据集进行了评估。确定了四种具有不同营养模式的聚类。确定每个聚类中临床变量（疾病类型、术后脓毒症、姑息性手术、6个月时的死亡率等）的发生率，以评估其临床和预后意义。聚类1显示指标变化较小，包括大多数对照组的脓毒症、姑息性手术和6个月时的死亡率发生率最低。然后将其视为代表我们机构正常营养状况的参考组。其他三个聚类显示营养指标变化较大，代表临床风险较差的情况。这些聚类中的脓毒症、姑息性手术和死亡率明显更高（p<0.05，p<0.001，p<0.05）。胃肠道癌症和其他肿瘤在聚类中的分布不同。只有胃肠道癌症的发生率在预后较差的聚类中逐渐增加，这表明这种类型的肿瘤更常与营养状况的重大变化相关。
