Study On Applicability Of Different Nutritional Assessment In Critically Ill Patients

ObjectiveTo understand the nutritional status of critically ill patients,compare the application effects of three assessment tools,evaluate the predictive value of different nutritional assessment tools on the outcome of critically ill patients,and identify new combined predictor to assist the medical staff to objectively assess the mortality risk of critically ill patients by applying Nutritional Risk Screening 2002(NRS2002),Subjective Global Assessment(SGA)and Nutrition Risk in Critically ill Score(NUTRIC).MethodsA cross-sectional survey was conducted to select 546 patients admitted to the comprehensive ICU of Qingdao municipal hospital affiliated to Qingdao university from October 2018 to September 2019.Basic information of patients was collected by general information questionnaire.NRS2002,SGA and NUTRIC were used to assess the nutritional status of the patients.Body measurement indexes of the patients including height,weight,body mass index(BMI),triceps skinfold(TSF),middle arm circumference(MAC),calf circumference(CC),arm muscle circumference(AMC)were also measured,and laboratory indexes including total protein(TP),albumin(ALB),prealbumin(PA),serum creatinine(SCr),blood urea nitrogen(BUN),total cholesterol(TC),triglyceride(TG),total lymphocyte count(LYM),hemoglobin(Hb),c-reactive protein(CRP)were detected.The results of traditional single nutrition evaluation index,NRS2002,SGA and NUTRIC were compared for critically ill patients.Spearman rank correlation was used to analyze the correlation between the three nutritional assessment tools and other objective nutritional indexes,and the three tools are compared and analyzed.At the same time,the prognostic indicators of enrolled patients were prospectively observed and divided into two groups according to the clinical outcome of 28 days,and the differences between the death group and the survival group were compared.Binary Logistic regression was used to screen the risk factors affecting the clinical outcome of patients at 28 days,and a prediction model of death risk was constructed to determine the new combined predictor.Results1.The detection rates of malnutrition assessed by traditional single index were: BMI(16.30%),TSF(78.75%),AMC(41.58%),ALB(76.56%),PA(65.38%)and Hb(50.73%),respectively.The evaluation results of the three assessment tools for critically ill patients: According to the risk screening of NRS2002,the nutritional risk composition ratio of critically ill patients was 98.17%;According to SGA assessment results,the composition ratio of malnutrition in critically ill patients was 55.49%.According to the NUTRIC score,the composition of the high nutritional risk group of critically ill patients was 57.33%.2.Among the three assessment tools,NRS2002 and SGA had a good correlation with the body measurement index and laboratory test index of the assessment of nutritional status,while NUTRIC had a slight difference.There were correlations among the three assessment tools,and the cross-classification results showed that NRS2002 and SGA,NRS2002 and NUTRIC had poor consistency,while SGA and NUTRIC had medium height consistency,and the detection rates of malnutrition were different with different methods.3.APACHE II score(X1),length of hospital stay before admission to ICU(X2),length of mechanical ventilation in ICU(X3),SGA(X4)and NUTRIC(X5)were independent risk factors for 28-day death in ICU patients,and a prediction model of death risk:(10)(10)(10)(10)(10)-(28)XXXXPit5166.04369.03096.02X096.01058.0738.4)(log.The AUC of the combined predictor was 0.762,the optimal cut-off point of the predictor was 0.343,the sensitivity was 68.64%,the specificity was 72.15%,and the diagnostic accuracy was 71.06%.ConclusionThe nutritional status of critically ill patients is not optimistic.The nutritional status of critically ill patients is evaluated by NRS2002,SGA and NUTRIC,which is simple and easy to operate.The NRS2002 positive screening rate is the highest,but its predictive validity is inconsistent,which is suitable for patients with mild disease.SGA is the most valuable tool to assess the nutritional status of the population,and can best reflect the nutritional status of the critically ill patients.NUTRIC is objective and easy to obtain and is suitable for critically ill and unconscious patients.SGA and NUTRIC are more valuable than NRS2002 in predicting the clinical prognosis of critically ill patients.In this study,a 28-day risk of death prediction model was established for severe patients,and the performance of the combined predictor constructed by Logistic regression model is superior to any single indicator in predicting 28-day death events.