Kritik hastalarda modifiye beslenme riski puanı ile klinik sonuçların değerlendirilmesi

Abstract

Amaç Bu çalışmada amacımız Yoğun Bakım Üniteleri’ne (YBÜ) yatırılan hastalarda klinik sonuçları ve mortaliteyi tahmin etmede Modifiye Beslenme Risk Skoru (mNUTRIC) skorunun etkinliğini değerlendirmektir. Yöntem Bu çalışma prospektif gözlemsel kohort çalışması olarak tasarlanmıştır. Pamukkale Üniversitesi Hastanesi Anesteziyoloji ve Reanimasyon YBÜ’lerine yatırılan hastalarda yürütülmüştür. Bu çalışmanın birincil sonuç ölçütü, sağ kalanlar ve sağ kalamayanlar arasında 2., 7. ve 12. günlerdeki mNUTRIC skorlarının karşılaştırılmasıdır. İkincil sonuç ölçütleri arasında invaziv mekanik ventilasyon (IMV), hemodiyaliz ve vazopressör veya inotropik destek gerekliliğini tahmin etme etkinliği yer almıştır. Ayrıca çalışmada beslenme yeterliliğinin (hipokalorik veya hiperkalorik olarak kategorize edilmiş) ve protein alım düzeylerinin (düşük veya yüksek olarak sınıflandırılmış) hastalarda mortalite üzerindeki etkisi incelenmiştir. Sürekli değişkenleri içeren karşılaştırmalarda Student t-testi veya Mann-Whitney U testi, kategorik değişkenlerde ise Ki-Kare testi kullanıldı. Bulgular Çalışmaya katılan 176 hastanın mNUTRIC skorları titizlikle değerlendirildi. Bu bağlamda, tüm hasta kohortunun (n=176) ikinci gün mNUTRIC skorları hesaplandı, yedinci gün 91 hasta ve on ikinci gün 46 hasta için APACHE II, SOFA ve mNUTRIC skorları, hastalıklarına yenik düşen hastalarda anlamlı derecede yüksek değerler gösterdi (22,60±7,94, 6,81±3,03 ve 5,00±2,03), hayatta kalanlara göre ise anlamlı derecede yüksek değerler gösterdi (16,99±5,05, 3,94±2,26 ve 3,32±1,48, hepsi p<0,001). Yedinci günde bu skorlar ölen hastalarda (24.38±7.07, 6.82±3.52 ve 5.00±1.61) sağ kalanlara (18.06±4.70, 3.85±2.10 ve 3.50±1.58, hepsi p<0.001) göre yüksek seviyelerde seyretti. On ikinci günde APACHE II, SOFA ve mNUTRIC skorları hayatta kalmayan hastalar için 25.61±7.18, 7.00±3.57 ve 5.52±1.81 iken sağ kalanların skorları sırasıyla 18.70±5.88, 4.39±1.75 ve 3.39±2.02 idi (sırasıyla p=0.001, p=0.008, p<0.001). Sonuç APACHE II, SOFA ve mNUTRIC skorlarında hayatta kalan ve ölen hastalar arasında 2., 7. ve 12. günlerde istatistiksel olarak anlamlı farklılıklar gözlemlendi. Ancak, beslenme yeterliliği ve protein alımının yüksek mNUTRIC skorlarına sahip kritik hastalarda ölüm riskini doğrudan etkileyen belirleyiciler olmadığı gözlemlendi. Anahtar kelimeler: mNUTRIC, Yoğun Bakım Ünitesi, Ölüm, Morbidite, Puanlama Sistemi

Keywords

• mNUTRIC
• yoğun bakım ünitesi
• mortalite
• morbidite
• puanlama sistemi

Evaluation of clinical outcomes with the modified nutritional risk score in critically Ill patients

Abstract

Aims: Our aim in this study was to evaluate the effectiveness of the modified nutrition risk score (mNUTRIC) score in predicting clinical outcomes and mortality in patients admitted to intensive care units (ICUs). Methods: This study was designed as a prospective observational cohort study. It was conducted in patients admitted to the Anesthesiology and Reanimation ICUs of Pamukkale University Hospital. The primary outcome measure of this study was the comparison of mNUTRIC scores at days 2, 7, and 12 between survivors and non-survivors. Secondary outcome measures included the effectiveness of predicting the necessity for invasive mechanical ventilation (IMV), hemodialysis, and vasopressor or inotropic support. Additionally, the study examined the impact of nutritional adequacy (categorized as hypocaloric or hypercaloric) and protein intake levels (classified as low, medium and high) on mortality among patients. Student’s T test or Mann-Whitney U test was used for comparisons involving continuous variables, and the Chi-square test was used for categorical variables. Results: The mNUTRIC scores of 176 patients who participated in the study were meticulously assessed. In this context, mNUTRIC scores were computed for the entirety of the patient cohort (n=176) on the second day for 91 patients on the seventh day, and for forty-six patients on the twelfth day on the second day the APACHE II, SOFA, and mNUTRIC scores exhibited significantly elevated values in patients who succumbed to their conditions (22.60±7.94, 6.81±3.03, and 5.00±2.03) in contrast to those who survived (16.99±5.05, 3.94±2.26, and 3.32±1.48, all p<0.001). On the seventh day these scores persisted at heightened levels in deceased patients (24.38±7.07, 6.82±3.52, and 5.00±1.61) relative to survivors (18.06±4.70, 3.85±2.10, and 3.50±1.58, all p<0.001). On the twelfth day the APACHE II, SOFA, and mNUTRIC scores recorded were 25.61±7.18, 7.00±3.57, and 5.52±1.81 for patients who did not survive, whereas survivors had scores of 18.70±5.88, 4.39±1.75, and 3.39±2.02 (p=0.001, p=0.008, p<0.001, respectively). Conclusion: Statistically significant differences were observed in the APACHE II, SOFA, and mNUTRIC scores on days 2, 7, and 12 between surviving and deceased patients. However, it was observed that nutritional adequacy and protein intake were not determinants that directly affected the mortality risk in critically ill patients with high mNUTRIC scores.

Keywords

• mNUTRIC
• intensive care unit
• mortality
• morbidity
• scoring system

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