重症患者临床结局与根据复杂方法或仅根据体重预测性能量方程相关
背景：能量摄入目标制定对重症患者能量摄入非常重要，然而其临床结局与能量目标的相关性尚未被报道。
方法：该二级分析利用2007～2009年重症国际营养调查数据库改善营养方法评估死亡率或健康出院时间是否与根据复杂方法对比仅根据体重预测能量方程相关。样本量为5672例在重症监护病房（ICU）≥4天的患者及3356例在ICU≥12天的患者。在控制年龄、性别、住院类别、急性生理和慢性健康状况评价Ⅱ评分、ICU地理区域、实际能量摄入情况及肥胖等基本情况下，利用回归分析比较了组间死亡率和健康出院时间。
结果：根据复杂方法和仅根据体重预测能量方程，对死亡率的差异无统计学意义（优势比[OR]：0.90；95%可信区间[CI]：0.86～1.15），但是肥胖（OR：0.83；95% CI：0.71～0.96）及高能量摄入（OR：0.65；95% CI：0.56～0.76）的死亡率OR值较低。利用仅根据体重预测能量方程的住院≥4天患者存活出院时间较短（危害比[HR]：1.11；95% CI：1.01～1.23）且住ICU≥12天患者（HR：1.19；95% CI：1.06～1.34）能量摄入较高。
结论：以上数据表明较高能量摄入对生存和健康出院时间很重要。但是，以上分析仅限于实际能量摄入＜70%的目标。实施完整摄入目标需要明确决定能量摄入目标方法与临床结局之间的关系。
JPEN J Parenter Enteral Nutr. 2015;39(7):864-9.
Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight-Only Predictive Energy Equations.
Compher C, Nicolo M, Chittams J, Kang Y, Day AG, Heyland DK.
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada.
BACKGROUND: The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported.
METHODS: This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007-2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥ 4 days and a subset of 3356 in the ICU ≥ 12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity.
RESULTS: There was no difference in mortality between the use of complex and weight-only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86-1.15), but obesity (OR, 0.83; 95% CI, 0.71-0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56-0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight-only equations (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) in patients staying ≥ 4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06-1.34) in patients in the ICU ≥ 12 days.
CONCLUSION: These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.
KEYWORDS: ICU; energy; length of stay; mortality; predictive equation
PMID: 24803475
DOI: 10.1177/0148607114533127