Abstract: The correlation between nutritional risk and clinical prognosis in severe patients with enteral nutrition        LIU Yang*，LIN Jia-jia，GAO Kun,  et al.*Affiliated Jinling Hospital, Medical School of Southeast University，Nanjing210002，China
Corresponding author：LI Wei-qin，E-mail: liweiqindr@nju.edu.cn
Abstract    Objective    To investigate the correlation between nutritional risk and prognosis in critically ill patients with enteral nutrition (EN) support and explore the mortality-related factors in patients with high nutritional risk. Methods    A second analysis of the data of a cross-sectional observational study on the current status of multi-center enteral nutrition in China. The patients were divided into high nutritional risk group and low nutritional risk group according to the modified NUTRIC. The difference of 28-day mortality between two groups were compared, the correlation between nutritional risk and 28-day mortality was analyzed, and mortality risk factors were analyzed in the high nutritional risk population. Results    A total of 1095 patients receiving EN support were included，of which 443 were in the high nutritional risk group, and their 28-day mortality rate was 26.3%（114/443）, which was significantly higher than the low nutritional risk group of 12.7%（84/662)（P＜0.05）. Multivariate logistic regression model indicated that high nutritional risk（OR=2.09，95% CI：1.5 - 2.93；P＜0.01）was significantly associated with 28-day mortality after adjusting for baseline characteristics and clinically related factors. In the high nutritional risk population，symptoms of feeding intolerance such as nausea/vomiting（OR=3.46，95% CI：1.76 - 6.8；P＜0.01）and diarrhea（OR=2.05，95% CI：1.04 - 4.04；P=0.038）were both risk factors for 28-day mortality. Conclusion    Among  the severe patients supported by EN, the high nutritional risk group had a higher 28-day mortality, the  nutritional risk was significantly associated with poor prognosis. In addition, the feeding intolerance symptoms in the high nutritional risk population had a high predictive value for death.

Key words: severe patient enteral nutrition, nutritional risk, feeding intolerance, mortality

摘要： 目的    探究接受肠内营养（EN）支持的重症病人中营养风险与预后的相关性，分析高营养风险病人死亡相关因素。方法    二次分析一项中国多中心EN实施现状横断面观察性研究数据，根据改良营养获益评估（mNUTRIC）划分为高低营养风险组，比较两组病人28 d病死率差异，分析营养风险与28 d病死率的相关性，并在高营养风险人群中进行死亡危险因素分析。结果    共纳入1095例接受EN支持的重症病人，其中高营养风险组为443例，其28 d病死率为26.3%（114/443），显著高于低营养风险组12.7%（84/662，P＜0.05）。经校正基线特征和临床相关因素后，多变量Logistic回归模型提示高营养风险（OR=2.09，95%CI 1.5~2.93；P＜0.01）与28 d死亡显著相关。在高营养风险人群中，喂养不耐受症状如恶心或呕吐（OR=3.46，95%CI 1.76~6.8；P＜0.01）和腹泻（OR=2.05，95%CI 1.04~4.04；P=0.038）均为28 d死亡危险因素。结论    在接受EN支持的重症病人中，高营养风险组死亡风险较低营养风险组更高，营养风险与不良预后显著相关，高营养风险人群中喂养不耐受症状对死亡有较高的预测价值。

关键词: 重症病人肠内营养, 营养风险, 喂养不耐受, 病死率