摘要
目的 探讨营养控制状况(CONUT)评分与创伤患者发生感染性并发症的相关性。方法 回顾性分析自2021年12月至2022年12月东部战区总医院重症监护室(ICU)收治的141例创伤患者临床资料,按是否发生感染性并发症分为A组(未发生感染性并发症,n=82)与B组(发生感染性并发症,n=59)。收集可能导致患者发生感染性并发症的相关因素,包括基本资料、治疗措施及实验室检查指标等。采用Logistic回归分析发生感染性并发症的危险因素,采用Spearman相关性分析对CONUT评分与营养风险筛查2002(NRS 2002)、血清白蛋白(ALB)的相关性进行分析。采用受试者工作特征(ROC)曲线评价CONUT评分对创伤患者发生感染性并发症的预测价值,并用DeLong非参数检验对比各指标预测感染性并发症发生的ROC曲线下面积(AUC)。结果 Spearman相关性分析结果显示,CONUT评分与NRS 2002呈正相关性(r=0.921,P<0.001);CONUT评分与ALB呈负相关(r=-0.827,P<0.001)。多因素Logistic回归分析结果显示,机械通气时间、损伤严重度评分(ISS)、CONUT评分、手术时长、ICU住院时间是创伤患者发生感染性并发症的独立危险因素(P<0.05)。ROC曲线结果显示,CONUT评分、NRS 2002、ALB预测创伤患者发生感染性并发症的AUC分别为0.796(95%可信区间:0.722~0.869)、0.748(95%可信区间:0.672~0.824)、0.732(95%可信区间:0.646~0.818),Youden指数最大值为0.511、0.478、0.431,截断值分别为5分、3分、35.4 g/L。DeLong非参数检验结果显示,CONUT评分预测创伤患者发生感染性并发症的AUC高于NRS 2002(Z=2.072)、ALB(Z=2.198),差异有统计学意义(P<0.05)。结论 机械通气时间、ISS、CONUT评分、手术时长、ICU住院时间是创伤患者发生感染性并发症的独立危险因素。CONUT评分较NRS 2002和ALB预测感染性并发症的效果更好,当CONUT评分≥5分时,创伤患者的营养状况更差,感染性并发症发生风险升高。
Objective To explore the correlation between controlling nutritional status(CONUT)score and infectious complications in trauma patients.Methods The clinical data of 141 trauma patients admitted to Intensive Care Unit(ICU)of the General Hospital of Eastern Theater Command from December 2021 to December 2022 were retrospectively analyzed.According to the presence or absence of infectious complications,they were divided into group A(without infectious complications,n=82)and group B(with infectious complications,n=59).The related factors that may lead to infectious complications of patients were collected,including basic data,treatment measures and laboratory examination indicators.Logistic regression was used to analyze the risk factors of infectious complications.Spearman correlation analysis was used to analyze the correlation between CONUT score and nutritional risk screening 2002(NRS 2002)and serum albumin(ALB).Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of CONUT score for infectious complications in trauma patients,and DeLong non-parametric test was used to compare the area under the ROC curve(AUC)of each index for predicting infectious complications.Results Spearman correlation analysis showed that the CONUT score was positively correlated with NRS 2002(r=0.921,P<0.001),and CONUT score was negatively correlated with ALB(r=-0.827,P<0.001).Multivariate Logistic regression analysis showed that mechanical ventilation time,injury severity scores(ISS),CONUT score,operation duration,and ICU length of stay were independent risk factors for infectious complications in trauma patients(P<0.05).ROC curve results showed that the AUC of CONUT score,NRS 2002,and ALB for predicting infectious complications in trauma patients were 0.796[95%credibility interval(CI):0.722-0.869],0.748(95%CI:0.672-0.824),and 0.732(95%CI:0.646-0.818),respectively.The maximum Youden index value of CONUT score,NRS 2002,and ALB for predicting infectious complications in trauma patients were 0.511,0.478,0.431
作者
徐瑶
叶向红
李嘉琪
左俊焘
XU Yao;YE Xiang-hong;LI Jia-qi;ZUO Jun-tao(Graduate School,Bengbu Medical College,Bengbu 233000,China)
出处
《创伤与急危重病医学》
2024年第1期35-40,共6页
Trauma and Critical Care Medicine
基金
军事医学创新工程项目(18CXZ040)
蚌埠医学院研究生科研创新计划项目(Byycxz22043)。
关键词
创伤
营养控制状况评分
感染性并发症
Trauma
Controlling nutritional status score
Infectious complication
