Application Of PG-SGA Scale In Nutritional Assessment Of Critically Ill Patients

Objective(s):Through the use of the PG-SGA scale for nutritional assessment of critically ill patients in the Department of Intensive Care Medicine of the Second People’s Hospital of Yunnan Province,the applicability of PG-SGA in critically ill patients was explored,and the PG-SGA score and clinical prognosis of critically ill patients were analyzed.In particular,the relationship between’lung infections provides reference and basis for medical staff to better implement early nutritional support treatment.Methods:This study is a prospective cohort study design.In 2018,the American Association for Enteral and Parenteral Nutrition recommended that adult nutrition management be divided into three steps,namely nutritional risk screening-nutritional assessment-nutritional support.Therefore,this study is used within 24 hours for patients admitted to the ICU from June 2020 to December 2020 NRS2002 and mNutric first carried out nutritional risk screening,compared the positive rates of the two scales,and compared whether the results were different and whether they were applicable.Secondly,for 95 patients with nutritional risk(NRS2002≥3 points),the PG-SGA scale was used to evaluate the nutritional status,and the patients were divided into groups according to the final results of the evaluation,namely the well-nourished group and the undernourished group.All laboratory indicators(albumin,serum prealbumin,procalcitonin,etc.)and clinical prognostic indicators(mortality,duration of mechanical ventilation,etc.)of patients in the group were statistically compared and analyzed.At the same time,because the occurrence of pulmonary infection has a great impact on the recovery and clinical prognosis of critically ill patients,this study is based on the clinical diagnosis of patients when they leave the ICU,and divided the enrolled patients into pulmonary infection group and non-pulmonary infection group.The data of PG-SGA scores,mechanical ventilation time and other data of the two groups of patients were analyzed by multiple factors to determine the independent risk factors for pulmonary infection in ICU patients,and timely intervention was carried out to reduce the incidence of pulmonary infection and promote the recovery of patients.Use SPSS 22.0 for data entry and statistical analysis of data.Measurement data selection(χ±S)is used for statistical description,and count data is used for selection rate description.Perform statistical descriptions.The ROC curve is used to analyze the sensitivity and specificity of NRS2002 and mNutric in ICU patients,the χ2 test is used to determine whether the test results of the two scales are different,and the Kappa test is used to analyze the consistency and consistency of the screening results of the two scales degree.Various laboratory indicators(serum prealbumin,albumin,procalcitonin,APACHE II score,SOFA score,etc.)and clinical prognostic indicators(mortality,length of mechanical ventilation,length of stay in ICU)between the well-nourished group and the undernourished group,Total length of hospital stay,etc.)were compared using t-test and non-parametric test.Logistic regression was used to analyze the factors affecting ICU patients with pulmonary infection,and the relationship between PG-SGA score and the incidence of pulmonary infection was determined.Results:1.Changes in nutritional status of critically ill patientsThe changes in serum prealbumin(PA)of 114 patients on the first and third days of admission to the ICU showed that the PA value of the patients on the third day was significantly lower than that on the first day,and the change in the PA value was statistically significant(P<0.01).2.Application analysis of NRS2002 and mNutric in nutritional risk screening of critically ill patientsThe screening results of NRS2002 showed that there were 95 patients with nutritional risk,accounting for 83.33%,and the mNutric screening results showed that there were 85 patients with nutritional risk,accounting for 74.56%.ROC curve analysis results show that the sensitivity of NRS2002 is 92.3%,the specificity is 87%,the sensitivity of mNutric is 88%,and the specificity is 89.9%.The consistency test results of the two methods show that the χ2 value is 1.169,P=0.175(P>0.05),K=0.227,P=0.015(P<0.05),indicating that the screening results of the two methods are consistent,but the degree of consistency is poor.3.The difference in indicators between the well-nourished group and the undernourished groupIn this study,patients with PG-SGA≥ 4 points were considered malnourished,and patients with PG-SGA<4 were considered well-nourished.After two independent sample t-tests,the BMI between the two groups(t=2.574,P=0.012,P<0.05),PA(t=2.383,P=0.019,P<0.05),APACHEII score(t=-2.373,P=0.02,P<0.05),SOFA(t=-2.719,P=0.008,P<0.05),Total length of hospital stay(LOS)(t=-2.257,P=0.026,P<0.05)there are significant differences between groups,and the differences are statistically significant.ALB(t=-0.167,P=0.868,P>0.05),age distribution(t=-0.143,P=0.886,P>0.05)there was no significant difference between the groups.After non-parametric test,there are significant differences between the two groups in PCT(Z=-5.64,P=0.00,P<0.01),mechanical ventilation time(Z=-2.208,P=0.027,P<0.05).There is statistical significance.There was no significant difference in serum creatinine(Z=-0.286,P=0.789,P>0.05)and ICU hospital stay(Z=-1.861,P=0.063,P>0.05)between the two groups,and there was no statistical significance.4.The relationship between PG-SGA score and clinical outcomeIn this study,patients with a PG-SGA≥4 were classified as the malnourished group,and those with a PG-SGA score less than 4 were classified as the well-nourished group.The different clinical outcomes of the two groups of patients were compared and analyzed.The results showed that the mortality and lung infections of the two groups.The differences in incidence,duration of mechanical ventilation,and total length of hospital stay(LOS)were statistically significant(P<0.05),but there was no statistically significant difference in the length of ICU hospitalization between patients in different groups(P>0.05).5.The relationship between PG-SGA score and lung infectionAfter the t test of two independent samples,the BMI(t=1.957,P=0.053,P>0.05),PG-SGA(t=-3.129,P=0.02,P<0.05)between the lung infection group and the non-pulmonary infection group),APACHE Ⅱ score(t=-2.471,P=0.015,P<0.05),SOFA(t=-3.027,P=0.003,P<0.05),total hospital stay(LOS)(t=-1.995,P=0.049,P<0.05)there are significant differences between groups,and the differences are statistically significant.ALB(t=0.072,P=0.943,P>0.05),age distribution(t=1.83,P=0.07,P>0.05),PA(t=1.14,P=0.257,P>0.05)between patients in different groups)There was no statistically significant difference between the groups.After non-parametric test(Mann-Whitney U test),PCT(Z=-2.390,P=0.017,P<0.01)and mechanical ventilation time(Z=-1.978,P=0.048,P<0.05)between the two groups of patients There are significant differences between groups.There was no significant difference between the two groups of serum creatinine(Z=-1.129,P=0.259,P>0.05),ICU length of stay(Z=-1.148,P=0.251,P>0.05).The statistically significant single-factor APACHE Ⅱ score,SOFA score,PG-SGA score,PCT,mechanical ventilation time were used as independent variables,and lung infection was used as the dependent variable.They were included in the binary Logistics regression analysis.The results showed:PG-SGA score,the duration of mechanical ventilation during ICU is an independent risk factor for pulmonary infection in critically ill patients(P<0.05).Conclusion(s):1.Both NRS2002 and mNutric scores can be used for nutritional risk screening of critically ill patients,and there is no difference in screening results.The two scales are consistent in nutritional risk screening,and the degree of consistency is poor.2.PG-SGA is suitable for nutritional assessment of critically ill patients.3.The PG-SGA score is closely related to the time of mechanical ventilation,the length of ICU hospitalization,and the total length of hospitalization in critically ill patients.4.PG-SGA score is an independent risk factor for pulmonary infection in critically ill patients.The higher the score,the greater the chance of pulmonary infection in critically ill patients.