目的 探讨与血流感染(bloodstream infection,BSI)疾病负担密切相关的营养筛查手段,为BSI患者的营养干预提供建议.方法 采用前瞻性横断面调查方法,纳入2021年1月1日～2023年10月31日在首都医科大学附属北京积水潭医院就诊的、符合纳入与排除标准的BSI确诊病例.收集变量包括年龄、性别、身高、体重等人口学信息,入院时体重指数(body mass index,BMI)、入院时营养风险筛查2002(nutrition risk screening 2002,NRS 2002)评分、入院时日常生活活动能力(Barthel index,BI)评分、血清白蛋白以及基础疾病、入院48h内序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、ICU住院天数、总住院天数、住院费用、健康结局等并进行分析.结果 350例BSI患者纳入分析,平均年龄为65.86±17.21岁,男性204例(58.29％),有基础疾病者279例(79.71％).感染来源为血管内导管的占8.57％(n=30),非导管相关的首位感染类型为肺炎(66.57％,n=233).血培养细菌类型为杆菌181例(51.71％)、球菌130例(37.14％)、真菌20例(5.71％)及混合感染19例(5.43％).350例患者入院时低BMI占6.86％(n=24)、NRS2002评分提示严重营养风险者占3.7％(n=13)、低白蛋白者占93.43％(n=327);入院时BI评分提示中重度依赖者占53.43％(n=187).入院48h SOFA评分为3(1,6)分;收住ICU 136例(38.86％),ICU住院天数为10.50(5.00,24.50)天;机械通气占9.43％(n=33),平均时长220(84,360)h;治疗结局治愈259例(74.00％),感染复发或放弃治疗28例(8.00％),死亡63例(18.00％);住院期间总治疗费用为54736.00(28721.22,98639.50)万元.多因素Logistic回归分析结果显示,与SOFA评分独立相关的变量为恶性肿瘤病史与BI评分,与健康结局独立相关的变量为入院时NRS2002评分,与医疗费用独立相关的为住院天数(P＜0.05).结论 BSI多见于有基础疾病的老年人,入住ICU比例高.入院时进行NRS 2002评分及BI评分可以较好地评估BSI的疾病预后及疾病严重程度.进一步,临床医师需要根据上述评分进行分级干预,以降低该类患者的疾病负担.
Investigation of Nutritional Status and Disease Burden of Patients with Bloodstream Infection
Objective To explore the nutritional screening methods closely related to the burden of bloodstream infection(BSI)and provide recommendations for nutritional intervention in BSI patients.Methods A prospective cross-sectional survey was conducted to include confirmed cases of BSI who met the inclusion and exclusion criteria and were treated at Beijing Jishuitan Hospital,Capital Medical University from January 1,2021 to October 31,2023.The collected variables include demographic information such as age,gender,height,and weight,admission body mass index(BMI),admission nutrition risk screening 2002(NRS 2002)score,admission Barthel index(BI)score,serum albumin,as well as baseline disease,sequential organ failure assessment(SOFA)score within 48 hours of ad-mission,ICU hospitalization days,total hospitalization days,hospitalization costs,and health outcomes for analysis.Results A total of 350 patients were included in the analysis,with an average age of 65.86±17.21 years.There were 204males(58.29％)and 279(79.71％)with underlying diseases.The source of infection was intravascular catheters,accounting for 8.57％(30 cases),and the first non-catheter related infection type was pneumonia,accounting for 66.57％(233 cases).The types of bacteria in blood culture were ba-cillus 181 cases(51.71％),staphylococcus 130 cases(37.14％),fungi 20 cases(5.71％),and mixed infections 19 cases(5.43％).Among the 350 patients,6.86％(24 cases)had low BMI at admission,NRS 2002scores indicated that 3.7％(13 cases)had severe nu-tritional risk,and 93.43％(327 cases)had low albumin level.At admission,the BI score showed that 53.43％(187 cases)had moder-ate to severe dependence.The SOFA score within 48hours of admission was 3(1,6)points;136 cases(38.86％)were admitted to the ICU,with the hospitalization time of 10.50(5.00,24.50)days.Mechanical ventilation accounted for 9.43％(33 cases),with an aver-age duration of 220(84,360)hours.The treatment outcome was 259 cases(74.00％)cured,28 cases(8.00％)had infection recur-rence or abandoned treatment,and 63 cases(18.00％)died.The total treatment cost during hospitalization was 547.36million yuan(287.21 million yuan,986.40million yuan).Multivariate logistic regression analysis showed that the variables independently correlated with SOFA scores were the history of malignant tumors and BI score at admission,the variables independently correlated with health out-comes were the NRS 2002score at admission,and the variables independently correlated with medical expenses were hospitalization days(P＜0.05).Conclusion BSI is more common in the elderly people with underlying diseases and has a high proportion of ICU admis-sions.NRS 2002score and BI score at admission can effectively evaluate the prognosis and severity of BSI.Furthermore,clinicians need to conduct graded interventions based on the above scores to reduce the disease burden of these patients.
万方数据
维普
