Analysis Of Risk Factors Of Pulmonary Infection In Patients With Severe Stroke From Nutritional Perspectives

Objective:To identify the risk factors of pulmonary infection in hospitalized patients with severe stroke from the perspective of nutrition,so as to provide reference for the prevention and control of pulmonary infection in severe stroke patients.Methods:In this study,122 patients with severe stroke admitted to the Neuro-intensive Care Unit(NICU)of the First Affiliated Hospital of Chongqing Medical University from August 2019 to February 2020 were selected as the research object.Collect the general information,clinical data and nutrition-related data of patients,including acute physiology and chronic health evaluation(APACHE)II score,glasgow coma scale(GCS)and sequential organ failure assessment(SOFA)score within 48 hours after admission;nutritional risk screening(NRS)2002,nutrition risk in the critically ill(NUTRIC)score,anthropometric parameters,serum nutritional parameters and inflammatory immune parameters within 48 hours of admission;some serum nutritional parameters and inflammatory immune parameters at the time of pulmonary infection,and whether nasogastric tube and endotracheal intubation were used before pulmonary infection.Patients with severe stroke were divided into two groups,case group and control group according to whether they had pulmonary infection during hospitalization in NICU.Logistic regression was used to identify nutrition-related risk factors for pulmonary infection in patients with severe stroke.T test was used to compare the levels of serum nutritional parameters and inflammatory immune parameters before and after pulmonary infection in 25 patients.Results:1.In this study,the incidence of pulmonary infection in NICU patients with severe stroke during hospitalization was 20.5%(25/122).According to the results of NRS2002 risk screening,in the control group,9.28%(9/97)of the patients had no nutritional risk(NRS2002 < 3),81.44%(79/97)had low nutritional risk(3 < NRS2002 < 5)and 9.28%(9/97)had high nutritional risk(NRS2002 ≥ 5)at admission;in the case group,4.00%(1/25)had no nutritional risk,72.00%(18/25)had low nutritional risk,and24.00%(6/25)had high nutritional risk at admission.According to the results of NUTRIC score,95.88%(93/97)of the patients in the control group had low nutritional risk(NUTRIC < 5)and 4.12%(4/97)had high nutritional risk(NUTRIC ≥ 5)at admission;in the case group,72.00%(18/25)had low nutritional risk and 28.00%(7/25)had high nutritional risk at admission.2.Univariate analysis showed that the difference of chronic obstructive pulmonary disease,APACHE II score,SOFA score,GCS score,endotracheal intubation,nasogastric tube use,NUTRIC ≥ 5 points and creatinine levels between the two groups were statistically significant(P<0.05 or 0.001).3.Multivariate Logistic regression analysis showed that NUTRIC≥5(OR= 12.202,95%CI: 2.342~63.568)and nasogastric tube use(OR=16.990,95%CI:5.343~54.024)were independent risk factors of pulmonary infection in patients with severe stroke(P<0.05 or 0.001).4.In the case group,the levels of albumin was 40.68±4.44 g/L and total protein was 70.68±7.84 g/L of 25 patients with severe stroke before pulmonary infection(at admission);the levels of albumin was 35.29±3.76g/L and total protein was 63.95±5.20 g/L after the onset of pulmonary infection(the day of diagnosis of pulmonary infection),the differences were statistically significant(P < 0.001).Conclusion:1.High nutritional risk(NUTRIC ≥ 5 points)and nasogastric tube use were independent risk factors of pulmonary infection in patients with severe stroke.It can provide reference for clinical development of prevention and control measures of pulmonary infection.2.Severe stroke patients with high nutritional risk have a high incidence of pulmonary infection.We suggest using NUTRIC score for early nutritional risk assessment in patients with severe stroke,find the potential nutritional risk in patients with severe stroke,strengthen nutritional management,in order to reduce the incidence of pulmonary infection.For patients with nasogastric tube,we should standardize the nursing operation process and implement special management,which can also help to reduce the risk of pulmonary infection.3.The Levels of serum nutritional parameters and immune inflammatory parameters before and after pulmonary infection in 25 patients were compared,and it was found that the levels of serum nutritional parameters decreased significantly after pulmonary infection,and although the albumin level of some severe stroke patients was still within the normal range,they also had the risk of pulmonary infection.It is suggested that it is lagged and incomplete to evaluate the nutritional status of patients with severe stroke only by paying attention to the changes of serum nutritional parameters.We suggest that NUTRIC ≥5 points should be used for the early detection of the risk of lung infection due to nutrition-related factors in patients with severe stroke,so as to better predict the occurrence of lung infection from the perspective of nutrition.