ABSTRACT
Objective:
To investigate the clinical value of nutritional indexes including
body mass index (BMI),
albumin (ALB),
nutrition risk screening 2002 (NRS 2002) and the
nutrition risk in
critically ill score (NUTRIC) in 28-day
prognosis of
patients with
sepsis related
acute kidney injury (AKI).
Methods:
A prospective
cohort study was conducted.
Patients with
sepsis treated in the
emergency intensive care unit (EICU) of
China Rehabilitation Research Center from December 1, 2018 to December 1, 2020 were observed for 7 days.
Patients with
sepsis related AKI were enrolled in this study. The
gender, age, BMI, basic
diseases,
shock, number of affected organs, length of
hospital stay, ALB,
mechanical ventilation (MV) and vasoactive
drug use, sequential
organ failure score (SOFA), rapid sequential
organ failure score (qSOFA) and
acute physiology and chronic health evaluationⅡ(
APACHEⅡ) were recorded. The NRS 2002 score and NUTRIC score were calculated. Cox regression model was used to analyze the
risk factors of 28-day
mortality in
patients with
sepsis related AKI. The receiver operator characteristic curves (
ROC curves) were drawn and the areas under the
ROC curves (
AUC) were calculated, and the value of BMI, ALB, NRS 2002 score and NUTRIC score was analyzed to predict 28-day
mortality in
patients with
sepsis related AKI.
Kaplan Meier survival curves were used to analyze the effects of NRS 2002 score and NUTRIC score stratification on the 28 day
prognosis of
patients with
sepsis related AKI.
Results:
A total of 140
patients with
sepsis related AKI were enrolled, including 73
survival patients and 67 died
patients within 28 days. The 28-day
mortality was 47.9% (67/140). BMI in the
survival group was significantly higher than that in the
death group [kg/m 2 22.0 (19.5, 25.6) vs. 20.7 (17.3, 23.9), P < 0.05], and NRS 2002 score and NUTRIC score were significantly lower than those in the
death group [NRS 2002 score 5 (4, 6) vs. 7 (6, 7), NUTRIC score 6 (5, 7) vs. 7 (6, 9), both P < 0.05]. The ALB of the
survival group was slightly higher than that of the
death group, but the difference was not statistically significant. Cox
regression analysis showed that NRS 2002 score and NUTRIC score were independent
risk factors for 28-day
death in
patients with
sepsis related AKI.
ROC curve analysis showed that NUTRIC score had the strongest predictive
ability for 28-day
death [
AUC = 0.785, 95%
confidence interval (95% CI) was 0.708-0.850], followed by NRS 2002 score (
AUC = 0.728, 95% CI was 0.647-0.800), but there was no significant difference between them. Compared with NRS 2002 score, the predictive
ability of BMI and ALB was poor. Kaplan-Meier curve
analysis showed that the
prognosis of
patients with NRS 2002 score≥5 was significantly worse than that of
patients with NRS 2002 score < 5 (28-day
cumulative survival rate 42.1% vs. 75.6%, Log-Rank test 2 = 11.884, P = 0.001), and the
prognosis of
patients with NUTRIC score≥6 was significantly worse than that of
patients with NUTRIC score < 6 (28-day
cumulative survival rate 40.4% vs. 86.1%, Log-Rank test 2 = 19.026, P = 0.000).
Conclusions:
Patients with
sepsis related AKI have high nutritional
risk. Both NRS 2002 score and NUTRIC score have good predictive value for the
prognosis of
patients with
sepsis related AKI, while BMI and ALB have low predictive value. Due to the complex calculation of NUTRIC score, NRS 2002 score may be more suitable for
emergency department.