[1]王世杰,章 黎,周品闻,等.老年营养风险指数对外科重症病人术后急性呼吸衰竭的预测价值：一项基于MIMIC-IV数据库的研究[J].肠外与肠内营养杂志,2023,(06):321-327.[doi:10.16151/j.1007-810x.2023.06.001]
　WANG Shi-jie,ZHANG Li,ZHOU Pin-wen,et al.Predictive value of the geriatric nutrition risk index for postoperative acute respiratory failure in critically ill surgical patients: a study based on the MIMIC-IV database[J].PARENTERAL & ENTERAL NUTRITION,2023,(06):321-327.[doi:10.16151/j.1007-810x.2023.06.001]
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老年营养风险指数对外科重症病人术后急性呼吸衰竭的预测价值：一项基于MIMIC-IV数据库的研究()
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2023年06期
页码:
321-327
栏目:
论著
出版日期:
2023-12-10

文章信息/Info

Title:
Predictive value of the geriatric nutrition risk index for postoperative acute respiratory failure in critically ill surgical patients: a study based on the MIMIC-IV database
作者:
王世杰; 章 黎; 周品闻; 张玉鹏; 肖亚琴; 解廷斌; 王新颖
南京大学医学院附属金陵医院/东部战区总医院 普通外科，江苏南京 210002
Author(s):
WANG Shi-jie;  ZHANG Li;  ZHOU Pin-wen;  ZHANG Yu-peng;  XIAO Ya-qin;  XIE Ting-bin;  WANG Xin-ying
Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, Jiangsu, China
关键词:
老年营养风险指数 ; 急性呼吸衰竭 ; 预测价值
Keywords:
Geriatric nutrition risk index;  Acute respiratory failure;  Predictive value
分类号:
R459.3，R592
DOI:
10.16151/j.1007-810x.2023.06.001
文献标志码:
A
摘要:
目的：评估老年营养风险指数(GNRI)对外科重症病人术后急性呼吸衰竭(ARF)的预测价值。 方法：回顾性收集美国重症监护医学信息（MIMIC-IV）数据库中收录的2008~2019年之间老年外科重症病人的临床资料。单因素和多因素Logistic回归确定术后ARF的危险因素，限制性立方样条(RCS)描绘术前GNRI与术后ARF的关系。受试者工作特征（ROC）曲线、净重分类改进（NRI）与综合判别改进（IDI）比较术前GNRI纳入预测模型后预测效能的改变。 结果：共纳入6 032例病人，其中术后ARF为794（13.2%）例，术后ARF组的术前GNRI明显低于无ARF组(中位数：94 vs 107，P < 0.001)。多因素Logistic回归分析显示，术前GNRI判定存在营养风险是术后ARF发生的独立危险因素（低风险，P = 0.018；中风险，P < 0.001；高风险，P < 0.001）。RCS分析显示术前GNRI与术后ARF呈非线性相关。ROC曲线、NRI与IDI均显示，将GNRI纳入术后ARF预测模型中可显著提高其预测能力（均P < 0.001）。 结论：术前GNRI判定存在营养风险是外科重症病人术后ARF发生的独立危险因素，将GNRI纳入术后ARF预测模型中可显著提高其预测能力。
Abstract:
Objective: To evaluate the predictive value of geriatric nutritional risk Index (GNRI) for postoperative acute respiratory failure (ARF) in critically ill surgical patients. Methods: Clinical data of critically ill elderly surgical patients included in the medical information mart for intensive care (MIMIC-IV) from 2008 to 2019 were retrospectively collected. Univariate and multivariate logistic regression were used to determine the risk factors for postoperative ARF, the relationship between preoperative GNRI and incidence of postoperative ARF was described by restricted cubic spline(RCS). The predictive performance of incorporating preoperative GNRI into prediction models was evaluated by receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: A total of 6 032 patients were included, of whom 794 (13.2%) developed ARF. Patients with ARF had significantly lower GNRI scores than patients without ARF (median 94 vs 107, P < 0.001). Multivariate logistic regression analysis showed that nutritional risk diagnosed by preoperative GNRI was an independent risk factor for postoperative ARF (low risk, P = 0.018; moderate risk, P < 0.001; severe risk, P < 0.001). RCS analysis showed a nonlinear correlation between preoperative GNRI and postoperative ARF.The ROC curves, NRI and IDI showed that the incorporation of GNRI into postoperative ARF prediction model could improve the predictive accuracy (all: P < 0.001). Conclusion: Nutritional risk diagnosed by preoperative GNRI is an independent risk factor for postoperative ARF in critically ill surgical patients. The incorporation of GNRI into postoperative ARF prediction model could improve the predictive accuracy.

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备注/Memo

备注/Memo:
基金项目 ：江苏省科技计划社会发展—临床前沿技术项目（BE2022822）作者简介 ：王世杰，医学博士研究生，从事普通外科临床营养专业。E-mail：wsj199411@sina.com通讯作者 ：王新颖，E-mail：wangxinying@nju.edu.cn
更新日期/Last Update: 1900-01-01