Malnutrīcijas saistība ar slimības iznākumu sepses pacientiem, retrospektīvs petījums
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Stresa katabolisma stāvoklis rada lielu malnutrīcijas risku kritiski slimiem pacientiem. Tās kopā ar novēlotu vai nepietiekamo uztura nodrošināšanu, vēl vairāk pasliktinās pacienta uztures stāvokli. Malnutrīcija ir plaši izplatīta kritiski slimo pacientu vidū, tas prevalence ir variabla, un pēc literatūras datiem sastāda apmēram 20 – 50% no visiem pacientiem (Rojer et al., 2016). Savlaicīga malnutrīcijas vai tās riska atklāšana ar sekojošu un atbilstošu uztura terapiju ievērojami, var uzlabot pacienta slimības prognozi (Abugroun et al., 2021).
Noteikt malnutrīcijas riska izplatību intensīvas terapijas nodaļā sepses pacientiem, kuriem intensīvas terapijas nodaļā (ITN) tika veikta nepārtraukta nieru aizstājterapija (NNAT), un izvērtēt, tās saistību ar hospitalizācijas ilgumu, un slimības iznākumu. Šis ir kvantitatīvs šķērsgriezuma retrospektīvs pētījums. Pētījumā tika iekļauti pacienti, kuri ārstējas laika perioda no 2014. gada 1. janvāra līdz 2019. gadam 31. decembrim SIA RAKUS stacionāra “Gaiļezers” Toksikoloģijas un sepses klīnikā. Malnutrīcijas riska noteikšanai tika izmantota modificēta uztura riska skala kritiski slimiem pacientiem (mNUTRIC (Rahman et al., 2016)). Augsts malnutrīcijas risks tika uzskatīts pie mNUTRIC ≥ 5 punktiem, toties zems < 5 punktiem. Pielietotas aprakstošas statistikas metodes, kvalitatīvo datu salīdzināšanai izmantots Pīrsona hī kvadrāta (χ2) tests, kvantitatīviem datiem - Manna–Vitnija tests.
Pētījumā kopā tika iekļauti 159 pacienti, vecumā no 23 līdz 96 gadiem (Mdn – 68 gadi, IQR= 58 – 76), no tiem 53 % vīrieši (n=84) un 47 % sievietes (n=75). Pacientu malnutrīcijas riska novērtējums tika veikts dienā, kad ITN tika uzsākta NNAT, jeb pirmajā – otrajā dienā pēc iestāšanas ITN. Pamatojoties uz mNUTRIC rādītāju, augsts malnutrīcijas risks ( ≥ 5 punkti) tika novērots 91 % (145/159) sepses pacientu, savukārt zems risks ( < 5 punkti) 9 %. Sieviešu un vīriešu vidū augsts malnutrīcijas riska rādītājs bija līdzīgi izplatīts, 88 % un 94% attiecīgi. Augsta malnutrīcijas riska grupā pacientu vidējais pavadītājs laiks ITN bija sešas dienas (IQR 2 – 12) un piecas dienas (IQR 3 – 9) zema riska grupā (p=0,920). Kopējais hospitalizācijas ilgums augsta malnutrīcijas riska grupā bija 12 dienas (IQR- 3 – 22) savukārt, zemā riska grupā 15 dienas (IQR- 9 – 18; p=0,553). ITN mirstība augsta malnutrīcijas riska grupā bija 56 %, bet zema riska grupā 28 % (p=0,045). Mirušo pacientu grupā vērojams augstāks (Mdn=7; IQR 6 – 7) mNUTRIC vidējais punktu skaits, salīdzinājumā ar izdzīvojušiem (Mdn= 6; IQR 5 – 7; p=0,028).
Lielākai daļai sepses pacientu, kuriem ITN tika veikta NNAT, bija augsts malnutrīcijas risks. Pacientiem ar augstu malnutrīcijas risku, bija ievērojami augstāka mirstība ITN un slimnīcā, nekā pacientiem ar zemu malnutrīcijas risku. Saistība starp augstu malnutrīcijas risku un ilgāku ITN/slimnīcā pavadīto laiku neapstiprinājās.
The state of catabolic response to stress causes a high risk of malnutrition in critically ill patients. Together with delayed or insufficient nutrition, it impairs the patient's state of nutrition even more. The malnutrition is widespread among critically ill patients, its prevalence is variable and according to literature composes approximately 20-50% of all patients (Rojer et al., 2016). Timely detection of malnutrition or its risk with subsequent and appropriate nutritional therapy may significantly improve the patient's disease forecast (Abugroun et al., 2021). To determine the risk of malnutrition prevalence in the intensive care unit (ICU) for sepsis patients undergoing continuous renal replacement therapy (CRRT) in the ICU and to assess its relationship with the hospitalisation duration and the outcome of the disease. This is a quantitative cross-section retrospective research. The research includes patients treated during the period starting from 1 January 2014 until 31 December 2019 in the Clinic of Toxicology and Sepsis of SIA RAKUS hospital "Gaiļezers". A modified dietary risk scale for critically ill patients (mNUTRIC (Rahman et al., 2016) is used to determine the risk of malnutrition. A high risk of malnutrition is considered at mNUTRIC ≥ 5 points, while it is considered low, when it is < 5 points. Descriptive statistical methods have been applied, the comparison of qualitative data is based on the Pearson chi-squared (χ 2) test, for quantitative data - the Mann-Whitney U test. The research includes 159 patients aged 23 to 96 years (Mdn= 68 years, IQR 58 – 76), of whom 53% are men (n=84) and 47% are women (n=75). The risk assessment of patient malnutrition is performed on the day on which the CRRT is initiated in the ICU, or on the first and second day after admission to the ICU. Based on mNUTRIC, a high risk of malnutrition (≥ 5 points) is observed in 91% (145/159) of sepsis patients, while a low risk (< 5 points) in 9%. Among women and men, high malnutrition risk rates are similarly common, 88% and 94%, respectively. In the high malnutrition risk group, the average time for the patient spent in the ICU is six days (IQR 2 - 12) and five days (IQR 3 - 9) in the low-risk group (p=0.920). The total duration of hospitalisation in the high-risk group is 12 days (IQR 3 - 22), while in the low-risk group - 15 days (IQR 9 – 18; p=0.553). In the ICU, the mortality in high-malnutrition risk group is 56%, while in the low-risk group - 28% (p=0.045). In the deceased patient’s group, the average points of mNUTRIC is higher (Mdn=7; IQR 6 – 7) compared to survived patients (Mdn=6; IQR 5 – 7; p=0.028). The majority of sepsis patients that undergo CRRT in the ICU have a high risk of malnutrition. Patients with high risk of malnutrition have significantly higher mortality in the ICU/hospital than patients with a low risk of malnutrition. The relationship between high risk of malnutrition and time spent longer in the ICU/hospital was not confirmed.
The state of catabolic response to stress causes a high risk of malnutrition in critically ill patients. Together with delayed or insufficient nutrition, it impairs the patient's state of nutrition even more. The malnutrition is widespread among critically ill patients, its prevalence is variable and according to literature composes approximately 20-50% of all patients (Rojer et al., 2016). Timely detection of malnutrition or its risk with subsequent and appropriate nutritional therapy may significantly improve the patient's disease forecast (Abugroun et al., 2021). To determine the risk of malnutrition prevalence in the intensive care unit (ICU) for sepsis patients undergoing continuous renal replacement therapy (CRRT) in the ICU and to assess its relationship with the hospitalisation duration and the outcome of the disease. This is a quantitative cross-section retrospective research. The research includes patients treated during the period starting from 1 January 2014 until 31 December 2019 in the Clinic of Toxicology and Sepsis of SIA RAKUS hospital "Gaiļezers". A modified dietary risk scale for critically ill patients (mNUTRIC (Rahman et al., 2016) is used to determine the risk of malnutrition. A high risk of malnutrition is considered at mNUTRIC ≥ 5 points, while it is considered low, when it is < 5 points. Descriptive statistical methods have been applied, the comparison of qualitative data is based on the Pearson chi-squared (χ 2) test, for quantitative data - the Mann-Whitney U test. The research includes 159 patients aged 23 to 96 years (Mdn= 68 years, IQR 58 – 76), of whom 53% are men (n=84) and 47% are women (n=75). The risk assessment of patient malnutrition is performed on the day on which the CRRT is initiated in the ICU, or on the first and second day after admission to the ICU. Based on mNUTRIC, a high risk of malnutrition (≥ 5 points) is observed in 91% (145/159) of sepsis patients, while a low risk (< 5 points) in 9%. Among women and men, high malnutrition risk rates are similarly common, 88% and 94%, respectively. In the high malnutrition risk group, the average time for the patient spent in the ICU is six days (IQR 2 - 12) and five days (IQR 3 - 9) in the low-risk group (p=0.920). The total duration of hospitalisation in the high-risk group is 12 days (IQR 3 - 22), while in the low-risk group - 15 days (IQR 9 – 18; p=0.553). In the ICU, the mortality in high-malnutrition risk group is 56%, while in the low-risk group - 28% (p=0.045). In the deceased patient’s group, the average points of mNUTRIC is higher (Mdn=7; IQR 6 – 7) compared to survived patients (Mdn=6; IQR 5 – 7; p=0.028). The majority of sepsis patients that undergo CRRT in the ICU have a high risk of malnutrition. Patients with high risk of malnutrition have significantly higher mortality in the ICU/hospital than patients with a low risk of malnutrition. The relationship between high risk of malnutrition and time spent longer in the ICU/hospital was not confirmed.
Description
Uzturs
Nutrition
Veselības aprūpe
Health Care
Nutrition
Veselības aprūpe
Health Care
Keywords
mNUTRIC, malnutrīcijas risks, sepse, kritiski slimie pacienti, ITN, mNUTRIC, risk of malnutrition, sepsis, critically ill patients, ICU