【原】NUTRIC與NRS2002評分預測重癥患者的蛋白質與熱量缺乏

SIBCS 2020-11-25

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　　重癥監(jiān)護病房（ICU）重癥患者的營養(yǎng)狀況與臨床結局密切相關,，目前常用的營養(yǎng)狀況評估工具有營養(yǎng)風險篩查表2002（NRS2002）和重癥營養(yǎng)風險（NUTRIC）評分,。為了比較兩者對ICU患者蛋白和熱量缺乏程度的評估適用性，加利福尼亞大學歐文分校、麻省總醫(yī)院（馬薩諸塞綜合醫(yī)院）,、塔夫茨大學醫(yī)學院,、哈佛醫(yī)學院對312例ICU患者進行了回顧性分析，發(fā)現NUTRIC評分與ICU患者蛋白和熱量缺乏程度顯著相關,，而NRS2002適用于普通住院患者營養(yǎng)不良的風險預測（編者按：NRS2002用于篩查與臨床結局相關的營養(yǎng)風險,，并非用于預測營養(yǎng)不良的風險），卻不適用于ICU患者,。參照NUTRIC評分進行早期營養(yǎng)干預是否能改善臨床預后,，尚需進一步研究。

JPEN J Parenter Enteral Nutr. 2016;40(4):120-121.

Nutrition Risk in Critically Ill (NUTRIC) and Nutrition Risk Screening 2002 (NRS 2002) Scores as Predictors of Protein and Caloric Deficit in Critically Ill Patients.

Canales C, McCarthy CM, Yeh DD, Chokengarmwong N, Belcher D, Nakayama A, Quraishi SA.

University of California-Irvine, Irvine, CA, USA; Massachusetts General Hospital, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

PURPOSE: Nutrition status is strongly associated with clinical outcomes in critically ill patients. Nonetheless, patients in the intensive care unit (ICU) are typically undernourished and consequently are at risk for becoming malnourished during their hospitalization. Although several screening tools are available to assess nutrition status during the course of acute care (eg, Nutrition Risk Screening 2002 [NRS 2002]), their use in the ICU setting has not been rigorously studied. Recently, the Nutrition Risk in Critically Ill (NUTRIC) score was developed and validated for use in ICU patients; however, it is unclear whether the NUTRIC score is superior to existing screening tools to predict nutrition deficits in critically ill patients. Therefore, our goal was to compare NUTRIC vs NRS 2002 scores in terms of their association with protein as well as caloric deficit in ICU patients.

METHODS: We performed a retrospective analysis of data from a prospective observational cohort study of nutrition in critically ill adults. Only patients who had both a calculated NUTRIC score and a NRS 2002 score were included in the study. Protein and caloric deficit over the course of ICU admission was determined by subtracting actual nutrient delivery from the estimated nutrient requirements (based on the American Society for Parenteral and Enteral Nutrition guidelines). To investigate the association of NUTRIC/NRS2002 scores with protein/caloric deficit, we first performed linear regression analyses, while controlling for age, sex, race, body mass index, and ICU length of stay. We then dichotomized the nutrition risk scores as low vs high risk for malnutrition (NUTRIC: ≤4 vs >4; NRS 2002: <3 vs ≥3). We also dichotomized nutrient deficit as low vs high risk for suboptimal outcomes (protein deficit: <300 g vs ≥300 g; caloric deficit: <6000 kcal vs ≥6000 kcal). Using the dichotomized nutrition risk scores and nutrient-deficit thresholds, we performed logistic regression analyses, while controlling for age, sex, race, body mass index, and ICU length of stay.

RESULTS: A total of 312 adult ICU patients composed the analytic cohort. Linear regression modeling demonstrated that for each increment in NUTRIC score, the protein deficit was likely to increase by 49 g (β = 48.70, 95% CI = 29.23-68.17; P < .001), and the caloric deficit was likely to increase by 752 kcal (β = 751.95, 95% CI = 447.80-1056.09; P < .001). Logistic regression modeling demonstrated that patients with NUTRIC scores >4 were more than twice as likely to develop a protein deficit ≥300 g (adjusted OR = 2.35, 95% CI = 1.43-3.85; P < .001) as compared with patients with NUTRIC scores ≤4. Similarly, patients with NUTRIC scores >4 were almost 3 times as likely to develop a caloric deficit ≥6000 kcal (adjusted OR = 2.73, 95% CI = 1.66-4.50; P < .001) as compared with patients with NUTRIC scores ≤4. Neither linear regression modeling nor logistic regression modeling demonstrated an association between NRS 2002 scores and nutrient deficit. Further adjusting for APACHE II (Acute Physiology and Chronic Health Evaluation) scores in these models did not materially affect the association of NRS 2002 scores and nutrient deficit in the ICU.

CONCLUSIONS: Our data suggest that NUTRIC scores are strongly associated with both protein and caloric deficits in critically ill patients. While the NRS 2002 is commonly used in the clinical setting to predict risk of malnutrition in hospitalized patients, it may not be appropriate for ICU patients. Future studies are needed to determine whether early nutrition intervention in the ICU, based on NUTRIC scores, can improve patient outcomes.