[1]刘 敏,李小婉,王逸峰,等.COUNT评分对于特发性肺纤维化病人肺移植早期预后的预测价值[J].肠外与肠内营养杂志,2024,(03):135-142.[doi:DOI : 10.16151/j.1007-810x.2024.03.002]
　LIU Min,LI Xiao-wan,WANG Yi-feng,et al.The predictive value of controlling the nutritional status score for theearly prognosis of lung transplantation in patients with idiopathicpulmonary fibrosis[J].PARENTERAL & ENTERAL NUTRITION,2024,(03):135-142.[doi:DOI : 10.16151/j.1007-810x.2024.03.002]
点击复制

COUNT评分对于特发性肺纤维化病人肺移植早期预后的预测价值()
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2024年03期
页码:
135-142
栏目:
论著
出版日期:
2024-06-10

文章信息/Info

Title:
The predictive value of controlling the nutritional status score for theearly prognosis of lung transplantation in patients with idiopathicpulmonary fibrosis
作者:
刘 敏; 李小婉; 王逸峰; 孙 玥; 田 静; 董 妍; 王 宋; 许红阳
南京医科大学附属无锡人民医院重症医学科，江苏无锡 214023
Author(s):
LIU Min;  LI Xiao-wan;  WANG Yi-feng;  SUN Yue;  TIAN Jing;  DONG Yan;  WANG Song;  XUHong-yang
Department of Critical Care Medicine, the Affiliated Wuxi People’s Hospital of Nanjing MedicalUniversity, Wuxi People’s Hospital,214023,Jiangsu,China
关键词:
控制营养状态评分 ; 肺移植 ; 特发性肺纤维化 ; 危险因素
Keywords:
Controlling nutritional status score;  COUNT score;  Lung transplantation;  Risk factor
分类号:
R459.3，R563.1
DOI:
DOI : 10.16151/j.1007-810x.2024.03.002
文献标志码:
A
摘要:
目的：研究控制营养状态（COUNT）评分对于特发性肺纤维化（IPF）病人肺移植早期预后的预测价值。 方法：回顾性收集在无锡市人民医院行肺移植术的154名IPF病人，收集术前资料包括人口统计学资料、术前合并症以及最后一次的实验室检查结果，术中以及术后并发症情况。使用ROC曲线评估COUNT评分及其他营养评估工具预测30 d生存情况的能力，使用Kaplan-Meier法绘制低COUNT组和高COUNT组生存曲线，Log-rank比较两组生存率差异。并使用COX回归分析IPF病人术后30 d预后不良的独立危险因素。 结果：根据COUNT评分划分，IPF病人术前合并营养不良的有101例（65.6%）。COUNT评分对于IPF肺移植病人早期30 d预后不佳的预测能力要高于BMI、Alb、PNI指数。使用ROC确定的cutoff值为2.5划分高低COUNT组，高COUNT组30 d、90 d生存率低于低COUNT组（P < 0.05）。并且高COUNT组入ICU前24 h APACHEⅡ评分更高，术后AKI发生率更高，术后机械通气时间延长、ECMO转流时间延长(P < 0.05)。多因素COX回归分析提示高COUNT评分及肥胖是IPF病人肺移植术后30 d预后不佳的独立危险因素。 结论：COUNT评分是肺移植早期预后不佳的预测因素，在IPF病人肺移植术前进行营养评估至关重要。
Abstract:
Objective: To investigate the predictive value of the controlling nutritional status (COUNT) score forthe early prognosis of lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: Retrospectivecollection of 154 patients with IPF who underwent lung transplantation at Wuxi People’s Hospital, preoperative dataincluding demographics, preoperative comorbidities, and last laboratory findings, intraoperative as well as postoperativecomplications were collected. The ability of COUNT score and other nutritional assessment tools to predict 30-daysurvival was assessed using ROC curves, survival curves for the low and high COUNT score groups were plotted usingthe Kaplan-Meier method, and log-rank compared the difference in survival between the two groups. COX regressionwas also used to analyze independent risk factors for poor 30-day postoperative prognosis in IPF patients. Results:According to the division of COUNT score, there were 101 cases (65.6%) of preoperative combined malnutrition in IPFpatients. COUNT score was more predictive of poor early 30-day prognosis in IPF lung transplant patients than BMI, Alb, and PNI indices. Using a cutoff value of 2.5 determined by ROC to divide the high group and low COUNT group,the 30-d and 90-d survival rates of the high COUNT group were lower than those of the low COUNT group (P < 0.05).And the high COUNT group had a higher APACHE II score 24h before ICU admission, a higher incidence ofpostoperative AKI, a longer duration of postoperative mechanical ventilation, and a longer duration of ECMO diversion(P < 0.05). The multivariate COX regression analysis suggested that low COUNT score and obesity were independentrisk factors for poor prognosis in IPF patients 30 days after lung transplantation. Conclusion: COUNT score is apredictor of poor prognosis in early lung transplantation, and nutritional assessment is essential before lungtransplantation in patients with IPF.

参考文献/References:


[1] Richeldi L, Collard HR, Jones MG. Idiopathic pulmonaryfibrosis. Lancet, 2017, 389(10082): 1941-1952.
[2] Allen RJ, Oldham JM, Jenkins DA, et al. Longitudinal lungfunction and gas transfer in individuals with idiopathicpulmonary fibrosis: a genome-wide association study. LancetRespir Med, 2023, 11(1): 65-73.
[3] Chambers DC, Perch M, Zuckermann A, et al. The InternationalThoracic Organ Transplant Registry of the International Societyfor Heart and Lung Transplantation: Thirty-eighth adult lungtransplantation report - 2021; Focus on recipient characteristics. JHeart Lung Transplant, 2021, 40(10): 1060-1072.
[4] Fayyaz A, Raja M, Natori Y. Prevention and Management ofInfections in Lung Transplant Recipients. J Clin Med, 2023,13(1)：11.
[5] Dupont R, Longue M, Galinier A, et al. Impact of micronutrientdeficiency & malnutrition in systemic sclerosis: Cohort study andliterature review. Autoimmun Rev, 2018, 17(11): 1081-1089.
[6] Singer JP, Calfee CS, Delucchi K, et al. Subphenotypes of frailtyin lung transplant candidates. Am J Transplant, 2023, 23(4):531-539.
[7] Ignacio de Ulíbarri J, González-Madro?o A, de Villar NG, et al.CONUT: a tool for controlling nutritional status. First validationin a hospital population. Nutr Hosp, 2005, 20(1): 38-45.
[8] Di Vincenzo O, D’Elia L, Ballarin G, et al. ControllingNutritional Status (CONUT) score and the risk of mortality orimpaired physical function in stroke patients: A systematic reviewand meta-analysis. Nutr Metab Cardiovasc Dis, 2023, 33(8):1501-1510.
[9] Li C, Chen HX, Lai YH. Comparison of different preoperativeobjective nutritional indices for evaluating 30-d mortality andcomplications after liver transplantati on. World J GastrointestSurg, 16(1): 143-154.
[10] Studer SM, Levy RD, McNeil K, et al. Lung transplant outcomes:a review of survival, graft function, physio logy, health-relatedquality of life and cost-effectiveness. Eur Respir J, 24(4):674-685.
[11] Faverio P, Bocchino M, Caminati A, et al. Nutrition in Patientswith Idiopathic Pulmonary Fibrosis: Critical Issues Analysis andFuture Research Directions. Nutrients, 2020, 12(4)：1131.
[12] Cala?as-Continente A, Gutiérrez-Botella J, García-Currás J, et al.Global Leadership Initiative on Malnutrition-DiagnosedMalnutrition in Lung Transplant Candidates. Nutrients, 2024, 16(3)：376.
[13] Boura S, Severac F, Alali O, et al. Optimization of nutritionalmanagement of patients awaiting lung trans plant at theStrasbourg University Hospitals. Clinical Nutrition Experimental,2019，27: 9-20.
[14] 张佳悦, 许红阳. 肺移植术后营养支持的研究进展. 肠外与肠内营养, 2021, 28(4): 236-241.
[15] Clausen ES, Frankel C, Palmer SM, et al. Pre-transplant weightloss and clinical outcomes after lung transplant ation. The Journalof heart and lung transplantation : the official publicati on of theInternational Society for Heart Transplantation, 37(12): 1443-1447.
[16] Ding Q, Chen W, Chen C, et al. Evaluation of nutritional status inlung transplant recipients and its correlation with post-transplantshort-term prognosis: a retrospectiv e study. Ann Transl Med, 10(14): 793.
[17] Lu K, Li H, Chen Y, et al. Can the preoperative nutritional riskscore be a predictor of the outcomes in critically ill patients oflung transplantation: a retrospective study. Ann Transl Med, 2020,8(3): 40.
[18] Zhu XY, Yang DD, Zhang K J, et al. Comparative analysis of fournutritional scores predicting the incidence of MACE in olderadults with acute coronary syndromes after PCI . Sci Rep, 2023,13(1): 20333.
[19] Zhu M, Zha Y, Cui L, et al. Assessment of Nutritional RiskScores (the Nutritional Risk Screening 2002 and ModifiedNutrition Risk in Critically Ill Scores) as Predictors of Mortalityin Critically Ill Patients on Extracorporeal MembraneOxygenation . Asaio j, 2024：70(6):510-516.
[20] 刘胜炎,李路豪,李素新,等. 控制营养状况评分对布-加综合征患者行经颈静脉肝内门腔内支架分流术后发生显性肝性脑病的预测价值.中华消化外科杂志,2023，22(2) : 260-267.
[21] Li C, Chen HX, Lai YH. Comparison of different preoperativeobjective nutritional indices for evaluating 30-d mortality andcomplications after liver transplantation. World J GastrointestSurg, 2024, 16(1): 143-154.
[22] Smith SH. Using albumin and prealbumin to assess nutritionalstatus. Nursing, 47(4): 65-66.
[23] Gradel KO. Interpretations of the Role of Plasma Albumin inPrognostic Indices: A Literature Review. JCM, 2023,12(19): 6132.
[24] Fock RA, Blatt SL, Beutler B, et al. Study of lymphocytesubpopulations in bone marrow in a model of protein-energymalnutrition. Nutrition, 2010, 26(10): 1021-1028.
[25] Wenger U, Cottini S R, Noll G, et al. Pretransplant dyslipidaemiadetermines outcome in lung transplant reci pients. Lipids HealthDis, 2013,12: 53.
[26] Kamath SK, Lawler M, Smith AE, et al. Hospital malnutrition: a33-hospital screening study. J Am Diet Assoc, 1986, 86(2):203-206.
[27] Kato T, Yaku H, Morimoto T, et al. Association with ControllingNutritional Status (CONUT) Score and In-hospital Mortality andInfection in Acute Heart Failure. Sci Rep, 2020, 10(1): 3320.
[28] Takagi K, Takahashi H, Miura T, et al. Prognostic Value of theControlling Nutritional Status (CONUT) Score in Patients atDialysis Initiation. Nutrients, 2022, 14(11)：2317.
[29] 轩晨昊, 许红阳, 王大鹏, 等. 探讨术前预后营养指数在肺移植术后病人早期预后中的预测价值 . 肠外与肠内营养, 2023, 30(2): 85-90.
[30] Madill J, Gutierrez C, Grossman J, et al. Nutritional assessmentof the lung transplant patient: body mass index as a predictor of90-day mortality following transplantation. J Heart LungTransplant. 2001,20(3): 288-296.
[31] 王大鹏, 李小杉, 徐忠平, 等. 受者体质量指数对肺移植术后早期预后的影响. 器官移植, 2023, 14(5): 669-675.
[32] Abdulqawi R, Saleh RA, Devol E, et al. Lung transplantationoutcomes in underweight recipients: A single center experience.Heliyon, 2023, 9(4): e15080.
[33] Diamond JM, Anderson MR, Cantu E, et al. Development andvalidation of primary graft dysfunction predictive algorithm forlung transplant candidates. J Heart Lung Transplant, 2023,43(4):633-641.
[34] Phillips T, Mughrabi A, Garcia L J, et al. Association of BodyMass Index with Multiple Organ Failure in Hospitalized Patientswith COVID-19: A Multicenter Retrospective Cohort Study. JIntensive Care Med, 2024: 8850666241232362.
[35] Sze S, Pellicori P, Kazmi S, et al. Prevalence and PrognosticSignificance of Malnutrition Using 3 Scoring Systems AmongOutpatients With Heart Failure: A Comparison With Body MassIndex. JACC Heart Fail, 2018, 6(6): 476-486.

相似文献/References:

[1]张佳悦,许红阳.肺移植术后营养支持的研究进展[J].肠外与肠内营养杂志,2021,(04):236.[doi:10.16151/j.1007-810x.2021.04.010]
　ZHANG Jia-yue,XU Hong-yang.Advances in nutrition support after lung transplantation[J].PARENTERAL & ENTERAL NUTRITION,2021,(03):236.[doi:10.16151/j.1007-810x.2021.04.010]
[2]许红阳.肺移植围术期的营养支持[J].肠外与肠内营养杂志,2021,(06):321.[doi:10.16151/j.1007-810x.2021.06.001]
[3]许田田,谢 丽,何春水,等.简化营养评分应用于老年严重肢体缺血病人的营养筛查[J].肠外与肠内营养杂志,2022,(01):7.[doi:10.16151/j.1007-810x.2022.01.002]
　XU Tian-tian,XIE Li,HE Chun-shui,et al.Application of simplified nutritional screening index in elderly patients with critical limb ischemia[J].PARENTERAL & ENTERAL NUTRITION,2022,(03):7.[doi:10.16151/j.1007-810x.2022.01.002]
[4]轩晨昊,许红阳,王大鹏,等.探讨术前预后营养指数在肺移植术后病人早期预后中的预测价值[J].肠外与肠内营养杂志,2023,(02):85.[doi:10.16151/j.1007-810x.2023.02.005]
　XUAN Chen-hao,XU Hong-yang,WANG Da-peng,et al.The value of preoperative prognostic nutritional index score in predicting short-term clinical outcomes of patients undergoing lung transplantation[J].PARENTERAL & ENTERAL NUTRITION,2023,(03):85.[doi:10.16151/j.1007-810x.2023.02.005]

备注/Memo

备注/Memo:
基金项目 ：无锡市太湖人才计划(2021THRC-TD-ZZYXK-2021)作者简介 ：刘 敏，医学硕士，主要从事肺移植术后原发性移植物失功的临床研究。E-mail：luckyminy1229@163.com通讯作者 ：许红阳：E-mail：xhy1912@ali.com
更新日期/Last Update: 1900-01-01