摘要
目的探讨预后营养指数(prognostic nutritional index PNI)在急危重症患者全因死亡中的预测价值。方法选取2021年3~7月首都医科大学附属北京朝阳医院急诊抢救室收治的急危重症患者为研究对象,收集其进入急诊抢救室24h内的相关临床资料并进行描述性分析。以患者28天内全因死亡为终点绘制PNI的受试者工作特征(receiver operating characteristic,ROC)曲线,根据最佳截断值分为高PNI组和低PNI组,比较两组的临床特征。根据患者28天内是否死亡分为存活组和死亡组,比较两组的临床特征,并运用单因素和多因素Logistic回归分析评价急危重症患者28天内全因死亡的危险因素。结果共纳入603例患者,PNI最佳截断值为43.825,据此将所有患者分为高PNI组(n=334)和低PNI组(n=269),发现低PNI组28天内全因死亡的患者比例明显高于高PNI组(P<0.05)。所有患者入急诊抢救室28天内死亡127例,死亡组营养不良患者的比例明显高于存活组(P<0.05)。Logistic回归分析结果显示,由PNI筛选出的入急诊抢救室时营养不良是急危重症患者28天内全因死亡的独立危险因素(OR=1.805,95%CI:1.157~2.817,P=0.009),且高龄、低体重指数、低血红蛋白水平也是28天内全因死亡的独立危险因素。结论急危重症患者存在较高的营养不良风险,由PNI筛选出的入急诊抢救室时营养不良、高龄、低体重指数、低血红蛋白水平是28天内全因死亡的独立危险因素。
Objective To investigate the predictive value of the prognostic nutritional index(PNI)in all-cause mortality in patients with acute and critical illness.Methods Acute and critically ill patients admitted to the Department of Emergency,Beijing Chao-yang Hospital,Capital Medical University,from March to July 2021 were selected as study subjects,and the relevant clinical data within 24h of their admission to the emergency department were collected and analyzed descriptively.The receiver operating characteristic(ROC)curve of PNI was drawn with all-cause mortality of patients within 28days as the endpoint,and the patients were divided into high PNI and low PNI groups according to the optimal cut-off value,and the clinical characteristics of the two groups were compared.Patients were divided into survival and death groups according to whether they died within 28days,and the clinical characteristics of the two groups were compared,and univariate and multivariate Logistic regression analysis was used to explore the risk factors for all-cause mortality within 28days in patients with acute and critical illness.Results A total of 603 patients were included,and the optimal cut-off value of PNI was 43.825,according to which all patients were divided into the high PNI group(n=334)and low PNI group(n=269),and it was found that the proportion of patients who all-cause mortality within 28days was significantly higher in the low PNI group than in the PNI group(P<0.05).All patients died within 28days of admission to the emergency department in 127 cases,and the proportion of malnourished patients was significantly higher in the death group than that in the survival group(P<0.05).Logistic regression analysis showed that malnutrition at admission to the emergency department screened by PNI was an independent risk factor for all-cause mortality within 28days in patients with acute and critical illness(OR=1.805,95%CI:1.157-2.817,P=0.009),and advanced age,low body mass index,and low hemoglobin levels were also independent risk factors for all-cause mortality within 28days.Conclusion Patients with acute and critical illness are at high risk of malnutrition,and malnutrition at admission to the emergency department,advanced age,low body mass index,and low hemoglobin levels screened by PNI are independent risk factors for all-cause mortality within 28days.
作者
叶圣明
郭树彬
商娜
YE Shengming;GUO Shubin;SHANG Na(Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《医学研究杂志》
2024年第6期99-103,共5页
Journal of Medical Research
基金
心肺脑复苏北京市重点实验室2020年开放课题项目(2020XFN-KFKT-02)。
关键词
急危重症患者
预后营养指数
营养风险评估
预后
Acute and critical illness patients
Prognostic nutritional index
Nutritional risk assessment
Prognosis
