[The evaluation value of mNUTRIC and NRS-2002 scores in assessing nutritional status and clinical outcomes in patients with end-stage liver disease].

Q3 Medicine
J Y Yang, X R Mao, Z H Yang, X J Zhou, X Gou, J F Li
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The mNUTRIC score, NRS-2002 score, sequential organ failure (SOFA) score, model for end-stage liver disease (MELD) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Child-Pugh grade, and clinical outcomes at 28 and 90 days at 24 h post-ICU admission were collected. The differences in clinical indicators between the mNUTRIC high group (≥5 points) and the low group, and the NRS-2002 high group (≥3 points) and the low group were compared. Spearman correlation analysis was used to explore the correlation between the mNUTRIC score and NRS-2002 score, clinical indicators, and 28 and 90-day mortality rates. Multivariate logistic regression analysis was used to determine the risk factors associated with 28-day and 90-day mortality in patients. The value of mNUTRIC score and NRS-2002 score in assessing the clinical outcomes of patients with end-stage liver disease was explored by receiver operating characteristic (ROC) curve. <b>Results:</b> The clinical indicators related to nutritional status of patients were worse in the high-mNUTRIC group than those in the low-mNUTRIC group, and the 28-day and 90-day mortality rates were significantly higher than those in the low-mNUTRIC group [89.0%(65/73) vs. 29.2%(12/41), 97.2%(71/73) vs. 39.0%(16/41), <i>P</i><0.001]. There was no statistically significant difference in the incidence rate of hepatic encephalopathy, esophageal variceal bleeding, and ascites between the high and low mNUTRIC group. The clinical indicators related to nutritional status were worse in the high-NRS-2002 group than those in the low-NRS-2002 group of patients, and the 28-day and 90-day mortality rates were significantly higher than those in the low-group [73.0%(73/100) vs. 4/14, 81.0%(81/100) vs. 6/14, <i>P</i>=0.008, 0.004]. The NRS-2002 high-score group did not differ significantly from the low-score group in terms of hepatic encephalopathy, esophagogastric variceal bleeding, or ascites prevalence. Patient's age, white blood cell count (WBC), urea nitrogen (BUN), creatinine (UREA), uric acid (UA), total cholesterol (TG), Child-Pugh, MELD, SOFA, APACHE Ⅱscores were significantly positively correlated with the mNUTRIC score. Conversely, albumin (Alb) and Glasgow Coma Scale (GCS) were significantly negatively correlated. 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The AUC of NRS-2002 for predicting patient death at 90 days was 0.715 (95%<i>CI</i>: 0.599-0.832). The AUC of the two indicators combined for predicting patient death at 90 days was 0.922 (95%<i>CI</i>: 0.871-0.972). <b>Conclusion:</b> mNUTRIC score and NRS-2002 score can better evaluate the nutritional status in patients with end-stage liver disease. 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引用次数: 0

Abstract

Objective: Comparative analysis of the mNUTRIC and NRS-2002 scores for evaluating nutritional risk and predicting clinical outcomes in end stage liver disease patients. Method: A retrospective cohort study method was used to screen 114 cases with end-stage liver disease admitted to the intensive care unit (ICU) of the First Hospital of Lanzhou University from December 1, 2016 to March 31, 2021 according to the inclusion and exclusion criteria. The patient's demographic data, blood routine, blood biochemical indexes, coagulation function indexes, arterial blood gas analysis and imaging examination data were collected. The mNUTRIC score, NRS-2002 score, sequential organ failure (SOFA) score, model for end-stage liver disease (MELD) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Child-Pugh grade, and clinical outcomes at 28 and 90 days at 24 h post-ICU admission were collected. The differences in clinical indicators between the mNUTRIC high group (≥5 points) and the low group, and the NRS-2002 high group (≥3 points) and the low group were compared. Spearman correlation analysis was used to explore the correlation between the mNUTRIC score and NRS-2002 score, clinical indicators, and 28 and 90-day mortality rates. Multivariate logistic regression analysis was used to determine the risk factors associated with 28-day and 90-day mortality in patients. The value of mNUTRIC score and NRS-2002 score in assessing the clinical outcomes of patients with end-stage liver disease was explored by receiver operating characteristic (ROC) curve. Results: The clinical indicators related to nutritional status of patients were worse in the high-mNUTRIC group than those in the low-mNUTRIC group, and the 28-day and 90-day mortality rates were significantly higher than those in the low-mNUTRIC group [89.0%(65/73) vs. 29.2%(12/41), 97.2%(71/73) vs. 39.0%(16/41), P<0.001]. There was no statistically significant difference in the incidence rate of hepatic encephalopathy, esophageal variceal bleeding, and ascites between the high and low mNUTRIC group. The clinical indicators related to nutritional status were worse in the high-NRS-2002 group than those in the low-NRS-2002 group of patients, and the 28-day and 90-day mortality rates were significantly higher than those in the low-group [73.0%(73/100) vs. 4/14, 81.0%(81/100) vs. 6/14, P=0.008, 0.004]. The NRS-2002 high-score group did not differ significantly from the low-score group in terms of hepatic encephalopathy, esophagogastric variceal bleeding, or ascites prevalence. Patient's age, white blood cell count (WBC), urea nitrogen (BUN), creatinine (UREA), uric acid (UA), total cholesterol (TG), Child-Pugh, MELD, SOFA, APACHE Ⅱscores were significantly positively correlated with the mNUTRIC score. Conversely, albumin (Alb) and Glasgow Coma Scale (GCS) were significantly negatively correlated. Patient's age, WBC, CREA, BUN, UREA, UA, Child-Pugh, MELD, SOFA, APACHE Ⅱwere significantly positively correlated with the NRS-2002 score.Conversely, albumin (Alb) and Glasgow Coma Scale (GCS) were significantly negatively correlated (P<0.05). The 28-day and 90-day mortality rates of patients increased with the increase in the mNUTRIC scores. The mNUTRIC score was an independent predictor of death within 28 and 90 days in patients with end-stage liver disease. The area under the curve (AUC) of mNUTRIC for predicting patient death at 28 days was 0.864 (95%CI: 0.794-0.934). The AUC of NRS-2002 for predicting patient death at 28 days was 0.683 (95%CI: 0.573-0.792). The AUC of the two indicators combined for predicting patient death at 28 days was 0.868 (95%CI: 0.799-0.936). The AUC of mNUTRIC for predicting patient death at 90 days was 0.915 (95%CI: 0.861-0.969). The AUC of NRS-2002 for predicting patient death at 90 days was 0.715 (95%CI: 0.599-0.832). The AUC of the two indicators combined for predicting patient death at 90 days was 0.922 (95%CI: 0.871-0.972). Conclusion: mNUTRIC score and NRS-2002 score can better evaluate the nutritional status in patients with end-stage liver disease. The mNUTRIC score is a good predictor of 28-day and 90-day mortality in patients with end-stage liver disease, and its application value efficacy is enhanced when combined with NRS-2002.

[微量营养素和NRS-2002评分在评估终末期肝病患者营养状况和临床结果中的价值]。
目的:通过比较和探讨营养风险筛查(NRS)-2002评分与危重病营养风险修正评分(mNUTRIC)的应用,评价终末期肝病患者的营养状况及临床结局。方法:采用回顾性队列研究方法,对2016年12月1日至2021年3月31日兰州大学第一医院重症监护病房(ICU)收治的114例终末期肝病患者按纳入和排除标准进行筛查。收集患者的人口学资料、血常规、血液生化指标、凝血功能指标、动脉血气分析及影像学检查资料。收集患者的mNUTRIC评分、NRS-2002评分、顺序性器官衰竭(SOFA)评分、终末期肝病模型(MELD)评分、急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分、Child-Pugh评分以及进入ICU 24小时后28天和90天的临床结果。比较mNUTRIC高组(≥5分)与低组、NRS-2002高组(≥3分)与低组临床指标的差异。采用Spearman相关分析探讨mNUTRIC评分与NRS-2002评分、临床指标与28天和90天死亡率之间的相关性。采用多因素logistic回归分析28、90天死亡相关因素。采用受试者工作特征(ROC)曲线探讨mNUTRIC评分和NRS-2002评分对终末期肝病患者临床预后的评价价值。结果:高营养组患者营养状况相关临床指标均较低营养组差,28天、90天死亡率均显著高于低营养组[89.0%(65/73)vs 29.2%(12/41), 97.2%(71/73) vs 39.0%(16/41), PP=0.008, 0.004]。高、低组肝性脑病、食管静脉曲张出血、腹水发生率比较,差异均无统计学意义。患者年龄、白细胞计数(WBC)、尿素氮(BUN)、肌酐(urea)、尿酸(UA)、总胆固醇(TG)、Child-Pugh、MELD、SOFA、APACHEⅡ评分与mNUTRIC评分呈显著正相关。相反,白蛋白(Alb)与格拉斯哥昏迷评分(GCS)呈显著负相关。患者年龄、WBC、CREA、BUN、UREA、UA、Child-Pugh、MELD、SOFA、APACHEⅡ与NRS-2002评分呈显著正相关。相反,白蛋白(Alb)与格拉斯哥昏迷量表(GCS)呈显著负相关(PCI: 0.794-0.934)。NRS-2002预测患者28天死亡的AUC为0.683 (95%CI: 0.573-0.792)。两项指标联合预测患者28天死亡的AUC为0.868 (95%CI: 0.799-0.936)。mNUTRIC预测患者90天死亡的AUC为0.915 (95%CI: 0.861-0.969)。NRS-2002预测患者90天死亡的AUC为0.715 (95%CI: 0.599-0.832)。两项指标联合预测患者90天死亡的AUC为0.922 (95%CI: 0.871-0.972)。结论:mNUTRIC评分和NRS-2002评分能更好地评价终末期肝病患者的营养状况。mNUTRIC评分是终末期肝病患者28天和90天死亡率的良好预测指标,与NRS-2002联合使用可提高其应用价值和疗效。
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来源期刊
中华肝脏病杂志
中华肝脏病杂志 Medicine-Medicine (all)
CiteScore
1.20
自引率
0.00%
发文量
7574
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