目的 探讨骨骼肌质量指数(Skeletal muscle mass index,SMI)、肌少症指数(Sarcope-nia index,SI)与呼吸危重症患者营养状态及预后的关系.方法 选取2021年9月至2023年8月南通市第一人民医院收治的呼吸危重患者132例.采用改良危重症营养风险评分表(The modi-fied nutrition risk in critically ill,mNUTRIC)评估患者营养状况,根据评分结果分为低风险患者(n=83)、高风险患者(n=49),比较低风险患者与高风险患者的SMI、SI.以离开ICU为时间终点评估预后,分为死亡组(n=37)和存活组(n=95),比较死亡组与存活组患者的一般资料,采用多因素Logistic回归模型分析影响呼吸危重症患者死亡的因素,受试者工作特征(Receiver operator characteristic,ROC)曲线分析SMI、SI预测呼吸危重症患者死亡的风险价值.结果 与低风险患者相比,高风险患者的SMI、SI降低(P＜0.05).以离开重症监护室(Intensive care unit,ICU)为评估时间终点,与存活组相比,死亡组年龄、入院24 h内的急性生理评分、年龄评分及慢性健康评分(Acute physiology and chronic health evaluation scoring system,APACHE Ⅱ)评分及降钙素原(Procalcitonin,PCT)水平较高,白蛋白(Albumin,ALB)、SI 和 SMI 则较低(P＜0.05).多因素Logistic回归模型显示,高APACHE Ⅱ评分及低SMI、SI值是影响呼吸危重症死亡的独立危险因素.ROC曲线显示,SMI、SI单独预测呼吸危重症患者死亡的曲线下面积(Area under curve,AUC)为 0.784(0.720～0.839)、0.726(0.657～0.788),采用 SMI、SI 联合预测 AUC 为 0.890(0.835～0.938),联合预测效能较单独预测效能更好(P＜0.05).结论 SMI、SI与呼吸危重症患者营养状态关系密切,两者联合预测呼吸危重症患者死亡的临床价值高于单独预测.
Analysis of relationship between skeletal muscle mass index(SMI),sarcopenia index(SI)and nutritional status and prognosis of patients with respiratory critical illness
Objective To investigate the relationship between skeletal muscle mass index(SMI),sarcope-nia index(SI)and nutritional status and prognosis of the patients with respiratory critical illness.Methods 132 critically ill respiratory patients admitted to the hospital from September 2021 to August 2023 were select-ed.The nutritional status of the patients were assessed according to the modified nutrition risk in critically ill(mNUTRIC),which could be divided into low-risk group(n=83)and high-risk group(n=49),and SMI and SI of low risk group and high risk group were compared.The prognosis was evaluated by leaving ICU and was divided into death group(n=37)and survival group(n=95).The general data of death group and survival group were compared.Logistic regression model was used to analyze the factors affect-ing the death of the patients with respiratory critical illness.Receiver operator characteristic curve(ROC)curve analysis of SMI and SI to predicted the risk value of death in patients with respiratory critical illness.Results Compared with low-risk group,SMI and SI were lower in high-risk group(P＜0.05).Using leaving ICU as the end point of evaluation,compared with survival group,age of the death group,acute physiology and chronic health evaluation scoring system(APACHE Ⅱ)scores and procalcitonin(PCT)levels were higher,albumin(ALB),SI and SMI levels were lower(P＜0.05).Multivariate Logistic re-gression model showed that high APACHE Ⅱ score and low SMI and SI values were independent risk fac-tors for death from respiratory critical illness.ROC curve showed that the area under curve(AUC)of SMI and SI alone in predicting death of respiratory critically ill patients was 0.784(0.720～0.839)and 0.726(0.657～0.788),and the AUC of SMI and SI combined prediction was 0.890(0.835～0.938),and the combined prediction efficiency was better than that of single prediction(P＜0.05).Conclusion SMI and SI were closely related to the nutritional status of respiratory critical patients.The clinical value of SMI and SI in predicting the mortality of respiratory critical patients were higher than that of the single.
respiratory critical illnessskeletal muscle mass index(SMI)sarcopenia index(SI)nutritional status
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