中国学者在国际期刊发表全国多中心大样本患者出入院营养前瞻调查研究
2017年7月，《美国营养学院杂志》正式发表北、北京协和医院、北京大学第一医院代表全国营养调查协作组（名单详见中华外科杂志：不同疾病患者住院期间营养状态变化的调查研究）起草的研究报告，对中国住院患者入院和出院时的营养风险和状况及其与临床结局的相关性进行了评定。
该全国多中心前瞻研究于2014年6～9月在中国18个城市34个大医院入组6638例年龄≥18岁、住院7～30天的患者（男女比例1.39∶1，平均年龄59.72 ± 15.40岁），在入院和出院的24小时内进行人体测量、实验室指标检测、营养风险筛查 2002（NRS 2002）、主观全面评定（SGA），并收集住院期间的临床资料。
结果发现，入院、出院时：
根据 NRS 2002 有营养风险的患者比例分别为 40.12%、42.82%
根据 SGA 有中重度营养不良的患者比例分别为 26.45%、30.57%
体重指数 < 18.5kg/m²的患者比例分别为 8.92%、8.91%
年龄 ≥ 65 岁与 < 65 岁的患者相比，上述指标值均较高。
入院时有、无营养风险的患者相比：
住院时间较长（14.02 ± 6.422、13.09 ± 5.703 天，P < 0.0001）
住ICU时间较长（3.93 ± 4.221、2.61 ± 2.929 天，P < 0.0001）
总并发症率较高（6.90%、1.52%，P < 0.0001）
感染发生率较高（3.15%、1.75%，P < 0.0001）
总医疗费用较高（人民币 339 ± 750、300 ± 338 万元，P = 0.005）
出院时有、无营养风险的患者相比：
住院时间较长（13.95 ± 6.427、13.05 ± 5.631 天，P < 0.0001）
住ICU时间较长（3.93 ± 3.535、2.40 ± 2.791 天，P = 0.002）
总并发症率较高（3.99%、0.87%，P < 0.0001）
感染发生率较高（3.18%、1.59%，P < 0.0001）
总医疗费用较高（人民币 333 ± 728、302 ± 360 万元，P = 0.018）
住院期间接受营养支持的患者总比例为31.39%，其中：
肠外营养：17.82%
肠内营养：4.11%
肠外营养＋肠内营养：9.46%
住院期间死亡率为0.23%，其中：
入院时无营养风险患者死亡率：0.08%
入院时有营养风险患者死亡率：0.45%
综上所述，患者出院与入院时相比，存在营养风险、营养不良（包括中度至重度营养不良）的比例增加；有营养风险的患者，临床结局不良。
编者微评
该研究有几个数字值得注意，住院期间接受营养支持的患者总比例为31.39%，低于根据NRS2002有营养风险的患者比例（入院时40.12%、出院时42.82%），高于根据SGA有中重度营养不良的患者比例（入院时26.45%、出院时30.57%），远远高于体重指数<18.5kg/m²的患者比例（入院时8.92%、出院时8.91%）。那么，如果根据NRS2002进行营养支持，是否更多有营养风险的患者获益？如果根据SGA或体重指数进行营养支持，是否更多有营养风险的患者临床结局不良？由于该样本量足够，故有必要对不同NRS2002、SGA、体重指数的患者接受营养支持后能否改善结局进行深入分析。
相关阅读
J Am Coll Nutr. 2017 Jul;36(5):357-363.
Nutritional Risk and Nutritional Status at Admission and Discharge among Chinese Hospitalized Patients: A Prospective, Nationwide, Multicenter Study.
Zhu M, Wei J, Chen W, Yang X, Cui H, Zhu S; Ad hoc Working Group.
Beijing Hospital, Beijing, China; Peking Union Medical College Hospital, Beijing, China; Peking University First Hospital, Beijing, China.
OBJECTIVE: The objective of this study was to assess nutritional risk and status of Chinese hospitalized patients at admission and discharge and relations with clinical outcomes.
METHODS: A prospective, nationwide, multicenter study was conducted from June to September 2014 in 34 large hospitals in 18 cities in China. Patients ≥ 18 years with a hospital stay of 7-30 days were recruited. Anthropometric and laboratory indicators, nutritional risk screening, and assessment by Nutritional Risk Screening 2002 (NRS 2002) and subjective global assessment (SGA) were performed within 24 hours of admission and discharge. Clinical data during hospitalization were collected.
RESULTS: A total of 6,638 patients met the criteria with a male: female ratio of 1.39:1 and an average age of 59.72 ± 15.40 years. At admission, the proportion of patients with nutritional risk, body mass index (BMI) < 18.5 kg/m², and moderate to severe malnutrition was 40.12%, 8.92%, and 26.45%, respectively, whereas at discharge, these percentages were 42.82%, 8.91%, and 30.57%, respectively. The values of all of these indicators were higher in patients 65 years of age and older. Patients with nutritional risk at admission had a longer average hospital stay (14.022 ± 6.42 vs 13.09 ± 5.703 days), higher incidence of total complications (6.90% vs 1.52%), and greater total medical expenses (3.39 ± 7.50 vs 3.00 ± 3.38 million RMB; all p < 0.01) than patients without nutritional risk. Similar results were obtained for the patients with nutritional risk at discharge.
CONCLUSION: The prevalence of nutritional risk and malnutrition, including moderate to severe malnutrition, at discharge is higher than that observed at admission; the clinical outcome of patients with nutritional risk is poor.
KEYWORDS: Chinese hospitalized patients; Nutritional risk screening; clinical outcomes; nutrition survey; nutritional status; subjective global assessment
PMID: 28548607
DOI: 10.1080/07315724.2017.1304293