Epidemiological Study Of Nutrition Assessment And Stress-induced Gastrointestinal Injury In Orthopaedic Trauma Patients

BackgroundFor traumatic orthopedics patients,malnutrition incidence rate was very high and the prognosis was poor.Meanwhile,due to trauma stimuli,multiorgans of the traumatic patients would suffer from a series of pathological and physiological changes caused by stress,which would be represented as stress-induced gastrointestinal injury(SGI)in digestive system.However,at present,neither nutrition assessment nor SGI has received enough emphasis both from traumatic orthopedics clinics and scientific research.Direct evidence was missing regarding epidemiological characteristics,risk factors,diagnostic standards and other aspects.It's supposed in this research to set up standardized clinical information database of traumatic orthopedics and biobank and get know of nutritional features and epidemiological features and risk factors of SGI of traumatic orthopedics patients through a series of epidemiological methods in the anticipation of figuring out optimal biomarkers and diagnostic standards for early stage diagnosis of SGI to offer basis for clinical diagnosis and treatment.Methods1.Standardize collection procedures for clinical information and samples and set up standardized clinical information database of traumatic orthopedics and biobank;2.Carry out cross-sectional study to assess nutrition and gastroenteric functions of the traumatic orthopedics patients.Take Mini Nutrition Assessment(MNA)for nutrition assessment and Intestinal fatty acid binding protein(IFABP),D-lactate and Diamine oxidase(DAO)blood parameters to assess gastroenteric functions;3.Take Logistic regression model to analyze risk factors of SGI,screen out independent risk factors of SGI and confirm contribution of each factor on disease incidence;4.Receiver operating characteristic curve(ROC)of each biomarker in diagnosing SGI will be drew through study of diagnostic test and figure out optimal biomarker and cut-off points for traumatic orthopedics SGI diagnosis.ResultsFrom 1 March 2017 to 31 November 2017,in total this research included 316 qualified patients and extracted 1580 copies of serum,1580 copies of plasma,632 copies of leukocytes and 948 copies of DNA.Clinical information database of traumatic orthopedics and biobank were set up.MNA evaluation indicated that incidence rate of malnutrition in traumatic orthopedics was 3.5%and 24.1%patients might suffer from malnutrition risk.44.3%patients suffered from SGI of different degree.We discovered through analysis of risk factors for SGI incidence that IFABP(OR 1.001,95%CI 1.001-1.001),DAO(OR 1.064,95%CI 1.039-1.090),CRP(OR 1.172,95%CI 1.086-1.264),age(OR 1.021,95%CI 1.007-1.036),over-weight or obesity(OR 3.241,95%CI 1.429-7.351)were all independent risk factors for SGI incidence.High MNA score(OR 0.832,95%CI 0.726-0.953)was protective factor of SGI.We also figured out through diagnostic test that among the indexes,the maximal area under curve of ROC achieved when taking IFABP for SGI diagnosis was 0.765 and maximal Youden index can be obtained at the diagnostic cut-off point of 1741.54 pg/ml.Conclusion1.regulated clinical information database of traumatic orthopedics and biobank2.Malnutrition of traumatic orthopedics and incidence risk of SGI was specified in this research.3.IFABP,DAO and CRP increase,age,over-weight or obesity were independent factors for SGI and high MNA score was protective factor of SGI.4.Efficacy of IFABP on SGI diagnosis was better than other gastroenteric related biomarkers,and good sensitivity and specificity can be achieved at 1741.54 pg/ml concentration.