Predictive value of BMI and serum ALB combined with mNUTRIC score for the prognosis of patients with severe pneumonia

doi:10.3877/cma.j.issn.1674-6902.2024.03.009

Abstract

Abstract:

Objective

To analyze the predictive value of Body Mass Index (BMI), serum albumin (ALB) combined with Modified Nutrition Risk in Critically Ⅲ (mNUTRIC) score for the prognosis of patients with severe pneumonia.

Methods

232 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 2017 to August 2020 were retrospectively collected. The patients were divided into observation group (182 case) and control group (50 case) according to the outcome of ICU hospitalization. General Information, BMI, serum ALB, laboratory examination, length of stay, length of mechanical ventilation, acute physiology and chronic health evaluation Ⅱ (APECHE Ⅱ), sepsis-related organ failure assessment (SOFA), pneumonia severity index (PSI) score and mNUTRIC score were compared between 2 groups. Logistic regression was used to analyze the risk factors of death of severe pneumonia. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the factors affecting the prognosis of severe pneumonia.

Results

Age of the observation group (80.0 vs. 76.5), arterial blood lactic acid(1.90 vs.1.65 mmol/L), duration of mechanical ventilation (242.0 vs. 165.5)h, SOFA score (6 vs. 5) and mNUTRIC score (5 vs. 4) were higher than control group (P<0.05); BMI of the observation group (20.10 vs. 21.50 kg/m²), ALB[(32.34±5.98) vs.(35.12±6.09)g/L] was lower than control group (P<0.05). Age, and SOFA score are risk factors for death from severe pneumonia; low serum ALB, Low BMI, mNUTRIC score were independent risk factors for death from severe pneumonia; The AUCs for age, BMI, ALB, mNUTRIC scores and SOFA scores to assess the prognosis of patients with severe pneumonia were 0.618, 0.651, 0.653, 0.660, 0.600(P<0.05). The AUC for BMI combined with ALB was 0.682; The AUC for the combination of age, BMI and ALB was 0.709; The AUC for the combination of BMI, ALB and SOFA score was 0.715; The AUC for the combination of age, BMI, ALB and SOFA score was 0.732; The AUC for the combination of BMI, ALB and mNUTRIC score was 0.735(P<0.05).

Conclusion

BMI, ALB, and mNUTRIC scores are valuable in assessing the prognosis of patients with severe pneumonia, and the combined of them can further improve the predictive value of short-term prognosis of patients with severe pneumonia.

Key words: Severe pneumonia, Prognosis, Body mass index, Serum albumin, mNUTRIC scores

Jierou Wu, Qin Wang, Jing Zhang, Gengbiao Zhou, Fang Lai, Yun Han. Predictive value of BMI and serum ALB combined with mNUTRIC score for the prognosis of patients with severe pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(03): 392-396.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2024.03.009

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2024/V17/I03/392

Figures/Tables 4

References 25

1	Wang P, Song Y, Liu Z, et al. Xuebijing injection in the treatment of severe pneumonia: study protocol for a randomized controlled trial[J]. Trials, 2016, 17(1): 142.
2	徐子惠. 急诊重症肺炎并发感染性休克的临床分析与探讨[J]. 世界最新医学信息文摘，2019, 19(18): 60-66.
3	徐佳宁，王沪旭，尹卓伟，等. 改良Nutric评分在重症患者中的应用[J]. 中国临床医生杂志，2019, 47(11): 1323-1326.
4	Lee J, Kim K, Jo YH, et al. Severe thinness is associated with mortality in patients with community-acquired pneumonia: a prospective observational study[J]. Am J Emerg Med, 2015, 33(2): 209-213.
5	刘瑞莹，李　群，杨　帅，等. ALB、CD64及BCL-2在重症肺炎中的表达及与病情严重程度、预后的关系研究[J]. 分子诊断与治疗杂志，2020, 12(12): 1708-1712.
6	瞿介明，曹　彬. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志，2016, 39(04): 253-279.
7	施　毅. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志，2018, 41(4): 255-280.
8	中国高血压防治指南修订委员会，中华医学会心血管病学分会高血压联盟中国，中国医师协会高血压专业委员会，等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志，2019, 24(1): 24-56.
9	中国老年型糖尿病防治临床指南编写组，中国老年医学学会老年内分泌代谢分会，中国老年保健医学研究会老年内分泌与代谢分会，等. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中华内科杂志，2022, 61(1): 12-50.
10	陈亚红. 2021年GOLD慢性阻塞性肺疾病诊断、治疗及预防全球策略解读[J/CD]. 中国医学前沿杂志(电子版), 2021, 13(1): 16-37.
11	上海慢性肾脏病早发现及规范化诊治与示范项目专家组，高　翔，梅长林. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志，2017, 37(1): 28-34.
12	Ferrer M, Travierso C, Cilloniz C, et al. Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients[J]. PLoS One, 2018, 13(1): e191721.
13	Cavallazzi R, Furmanek S, Arnold FW, et al. The burden of community-acquired pneumonia requiring admission to ICU in the United States[J]. Chest, 2020, 158(3): 1008-1016.
14	陈皓伦，崔志新，唐绮云，等. 早期肠内营养在重症肺炎并胃肠功能障碍患者中的应用[J]. 海南医学，2022, 33(2): 166-168.
15	Bermejo-Martin JF, Almansa R, Martin-Fernandez M, et al. Immunological profiling to assess disease severity and prognosis in community-acquired pneumonia[J]. Lancet Respir Med, 2017, 5(12): e35-e36.
16	刘英丽. 早期肠内营养支持治疗ICU重症肺炎患者的临床效果观察[J]. 医学理论与实践，2019, 32(20): 3352-3354.
17	Ata UH, Ishtiaq W, Yousaf M, et al. Modified nutrition risk in critically Ill (mNUTRIC) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study from the pakistani population[J]. Cureus, 2018, 10(12): e3786.
18	Acehan S, Gulen M, Isikber C, et al. mNUTRIC tool is capable to predict nutritional needs and mortality early in patients suffering from severe pneumonia[J]. Clin Nutr ESPEN, 2021, 45: 184-191.
19	Matsuo A, Takamori A, Kawaura F, et al. Risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients: a retrospective study in Japan[J]. J Clin Biochem Nutr, 2020, 67(3): 302-306.
20	李中士，兰　超，张文华，等. Alb PCT及NT-proBNP ARDS[J]. 西南医科大学学报，2023, 46(6): 509-512，523.
21	谢朝云，陈应强，熊　芸，等. 老年糖尿病重症肺炎患者死亡率及影响因素[J]. 中国老年学杂志，2018, 38(22): 5426-5428.
22	成军霞，梅馨方，青　刚，等. NLR与qSOFA评分对老年重症肺炎预后的临床意义[J/CD]. 中华肺部疾病杂志(电子版), 2023, 16(5): 703-705.
23	薛文娟，陈公平，林振吕，等. 重症新型冠状病毒肺炎患者预后危险因素的评估[J]. 福建医科大学学报，2021, 55(6): 525-530.
24	陈　晨，鲁厚清. 血乳酸水平联合NLR对ICU重症肺炎预后风险预测[J/CD]. 中华肺部疾病杂志(电子版), 2022, 15(4): 551-553.
25	冯　旭，丁　锋，郭宏杰. APACHE评分联合TNF-α、IL-10、IL-1β水平测定对老年重症肺炎患者预后结局的评估价值[J]. 中国老年学杂志，2020, 40(8): 1630-1633.

临床资料	OR	95%CI	P值
年龄(岁)	1.041	1.008～1.074	0.014^a
BMI(kg/m²)	0.843	0.762～0.933	0.001^a
BMI<18.5 kg/m²(是)	2.574	1.305～5.080	0.006^a
BMI>24.0 kg/m²(是)	0.116	0.027～0.497	0.004^a
ALB(g/L)	0.928	0.881～0.978	0.006^a
Lac(mmol/L)	1.088	0.998～1.186	0.051
机械通气时间(h)	1.001	1.000～1.001	0.077
总蛋白使用量(g)	1.000	1.000～1.000	0.768
氨基酸使用量(g)	1.000	0.999～1.001	0.444
SOFA评分	1.172	1.055～1.303	0.003^a
APECHE Ⅱ评分	1.009	0.983～1.036	0.509
mNUTRIC评分	1.422	1.167～1.732	0.000^a
合并ARDS	2.278	0.977～5.312	0.057^a

临床资料	OR	95%CI	P值
年龄(岁)	1.041	1.008～1.074	0.014^a
BMI(kg/m²)	0.843	0.762～0.933	0.001^a
BMI<18.5 kg/m²(是)	2.574	1.305～5.080	0.006^a
BMI>24.0 kg/m²(是)	0.116	0.027～0.497	0.004^a
ALB(g/L)	0.928	0.881～0.978	0.006^a
Lac(mmol/L)	1.088	0.998～1.186	0.051
机械通气时间(h)	1.001	1.000～1.001	0.077
总蛋白使用量(g)	1.000	1.000～1.000	0.768
氨基酸使用量(g)	1.000	0.999～1.001	0.444
SOFA评分	1.172	1.055～1.303	0.003^a
APECHE Ⅱ评分	1.009	0.983～1.036	0.509
mNUTRIC评分	1.422	1.167～1.732	0.000^a
合并ARDS	2.278	0.977～5.312	0.057^a

检测指标	B	SE	Wald	OR	95%CI	P值
BMI(kg/m²)	－0.168	0.055	9.428	0.845	0.750～0.941	0.002^a
mNUTRIC评分	0.327	0.105	9.668	1.387	1.128～1.704	0.002^a
ALB(g/L)	－0.057	0.029	3.966	0.944	0.893～0.999	0.046^a

检测指标	B	SE	Wald	OR	95%CI	P值
BMI(kg/m²)	－0.168	0.055	9.428	0.845	0.750～0.941	0.002^a
mNUTRIC评分	0.327	0.105	9.668	1.387	1.128～1.704	0.002^a
ALB(g/L)	－0.057	0.029	3.966	0.944	0.893～0.999	0.046^a

检测指标	AUC	95%CI	SE	分界值	P值	灵敏度	特异度	约登指数
年龄	0.618	0.531～0.706	0.045	79.5	0.0184	0.540	0.637	0.177
SOFA评分	0.600	0.500～0.699	0.051	23.95	0.0030	0.360	0.890	0.250
mNUTRIC评分	0.660	0.578～0.743	0.042	31.5	0.0101	0.640	0.593	0.233
BMI	0.651	0.572～0.730	0.040	4.5	0.0001	0.940	0.308	0.248
ALB	0.635	0.549～0.721	0.044	7.5	0.0397	0.600	0.670	0.270

Please choose a citation manager

Content to export