营养状况对老年肝硬化住院患者临床结局的影响
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摘要
目的探讨营养状况对老年肝硬化住院患者临床结局的影响。方法收集2012年11月至2018年7月重庆市第五人民医院消化内科收治的肝硬化患者465例,其中老年肝硬化患者236例,采用营养风险筛查2002(NRS2002)评估老年肝硬化住院患者的营养风险,并按照预后分为存活组和死亡组,比较两组患者的临床资料,采用logistic回归模型分析影响其预后的危险因素。结果存在营养风险老年肝硬化住院患者死亡率明显高于无营养风险者,两者比较差异有统计学意义(P<0.05)。死亡组终末期肝病模型(MELD)评分、NRS2002评分、血清白蛋白、血清钠和Child Pugh分级与存活组比较差异均有统计学意义(P<0.05)。多因素分析表明,MELD评分、凝血酶原时间、血清钠、Child Pugh分级及消化道出血是存在营养风险的老年肝硬化住院患者死亡的独立危险因素。结论老年肝硬化患者营养风险发生率高,相应地其住院期间死亡风险高,MELD评分、凝血酶原时间、血清钠、Child Pugh分级及消化道出血是存在营养风险的老年肝硬化住院患者死亡的独立危险因素,因此,应重视老年肝硬化患者的营养评估及营养治疗。
Objective To explore the effect of nutritional status on clinical outcomes in elderly patients with hepatic cirrhosis.Methods A total of 465 patients with liver cirrhosis was collected from November 2012 to July 2018, including 236 elderly patients with hepatic cirrhosis. Nutritional risk screening 2002(NRS2002) was used to evaluate the nutritional risk of elderly inpatients with liver cirrhosis, and the patients were divided into the survival group and the death group according to the prognosis, logistic regression model analysis was used to evaluate the risk factors influencing the prognosis of patients.Results The mortality rate of elderly inpatients with hepatic cirrhosis suffering nutritional risk was significantly higher than that of those without nutritional risk(P<0.05). Compared with the survival group, MELD score, NRS2002 score, serum albumin, serum sodium and Child Pugh grading in the death group was significantly different(P<0.05). Multivariate analysis showed that end-stage liver disease model(MELD) score, prothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding were independent risk factors for death in elderly hospitalized patients with hepatic cirrhosis suffering nutritional risk. Conclusion The elderly patients with hepatic cirrhosis have a high incidence of nutritional risk and death during hospitalization. MELD score, aprothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding are independent risk factors for death of elderly patients with hepatic cirrhosis suffering nutritional risk. Therefore, nutritional assessment and treatment in elderly patients with hepatic cirrhosis should be paid attention.
Objective To explore the effect of nutritional status on clinical outcomes in elderly patients with hepatic cirrhosis.Methods A total of 465 patients with liver cirrhosis was collected from November 2012 to July 2018, including 236 elderly patients with hepatic cirrhosis. Nutritional risk screening 2002(NRS2002) was used to evaluate the nutritional risk of elderly inpatients with liver cirrhosis, and the patients were divided into the survival group and the death group according to the prognosis, logistic regression model analysis was used to evaluate the risk factors influencing the prognosis of patients.Results The mortality rate of elderly inpatients with hepatic cirrhosis suffering nutritional risk was significantly higher than that of those without nutritional risk(P<0.05). Compared with the survival group, MELD score, NRS2002 score, serum albumin, serum sodium and Child Pugh grading in the death group was significantly different(P<0.05). Multivariate analysis showed that end-stage liver disease model(MELD) score, prothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding were independent risk factors for death in elderly hospitalized patients with hepatic cirrhosis suffering nutritional risk. Conclusion The elderly patients with hepatic cirrhosis have a high incidence of nutritional risk and death during hospitalization. MELD score, aprothrombin time, serum sodium, Child Pugh grading and gastrointestinal bleeding are independent risk factors for death of elderly patients with hepatic cirrhosis suffering nutritional risk. Therefore, nutritional assessment and treatment in elderly patients with hepatic cirrhosis should be paid attention.
引文
[1] Eghtesad S, Poustchi H, Malekzadeh R. Malnutrition in liver cirrhosis: the influence of protein and sodium[J]. Middle East J Dig Dis, 2013, 5(2): 65-75.
[2] Maharshi S, Sharma BC, Srivastava S. Malnutrition in cirrhosis increases morbidity and mortality [J]. J Gastroenterol Hepatol, 2015, 30(10):1507-1513.
[3] Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies [J]. Clin Gastroenterol Hepatol, 2012, 10(2): 117-125.
[4] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J].Clin Nutr, 2003, 22(3): 321-336.
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[6] Fialla AD, Israelsen M, Hamberg O, et al. Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis [J]. Liver Int, 2015, 35(9): 2072-2078.
[7] Schuppan D, Afdhal NH. Liver cirrhosis[J].Lancet, 2008, 371(9615): 838-851.
[8] Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology, 2000, 31(4):864-871.
[9] Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics[J] Hepatology, 1987, 7(4):660-664.
[10] 施万英, 陈会杰, 陆金鑫, 等.营养风险筛查NRS2002在肝硬化住院患者中的临床应用研究[J].中华健康管理杂志, 2017, 11(5):458-460.
[11] Nishikawa H,Osaki Y. Liver cirrhosis:evaluation,nutritional status,and prognosis[J]. Mediators Inflamm,2015,2015:872152.
[12] 杨中菊, 胡乃中.老年肝硬化患者营养状况及其与临床相关因素分析[J].安徽医学, 2011, 32(12): 1998- 2000.
[13] 张辉凯, 孟祥林, 李海雷, 等.失代偿期肝硬化住院患者营养不良情况及其与预后的关系[J].临床肝胆病杂志, 2016, 32(6):1100-1103.
[14] Higuera-dela Tijera F, Servín-Caama o A, Servìn-Abad L, et al. Malnutrition is a key prognostic factor related to high mortality-rate in patients with severe alcoholic hepatitis[J]. Nutr Hosp, 2018, 35(3):677-682.
[15] Huo TI, Lee SD, Lin HC. Selecting an optimal prognostic system for liver cirrhosis:the model for end-stage liver disease and beyond[J] Liver Int,2008,28(5):606-613.
[16] Freeman RB. Overview of the MELD/PELD system of liver allocation indications for liver transplantation in the MELD era: evidence-based patient selection [J]. Liver Transpl, 2004, 10(10 Suppl 2):S2-3.
[17] 凡小丽,文茂瑶,沈怡,等.不同评分系统对失代偿期肝硬化患者短期和中期死亡风险预测能力的比较[J].临床肝胆病杂志,2017,33(7):1284-1290.
[18] Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortalit among patients on the liver-transplant waiting list [J]. N Engl J Med, 2008, 359(10):1018-1026.
[19] Cardenas A, Gines P. Predicting mortality in cirrhosis-serum sodium helps [J].N Engl J Med, 2008, 359(10):1060-1062.
[20] Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortali-t better than MELD alone[J]. Liver Transpl, 2005, 11(3):336-343.
[2] Maharshi S, Sharma BC, Srivastava S. Malnutrition in cirrhosis increases morbidity and mortality [J]. J Gastroenterol Hepatol, 2015, 30(10):1507-1513.
[3] Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies [J]. Clin Gastroenterol Hepatol, 2012, 10(2): 117-125.
[4] Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J].Clin Nutr, 2003, 22(3): 321-336.
[5] 蒋朱明, 于康, 李海龙. 营养支持对有营养风险患者结局的影响[J].中华临床营养杂志, 2010, 18(5): 263-267.
[6] Fialla AD, Israelsen M, Hamberg O, et al. Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis [J]. Liver Int, 2015, 35(9): 2072-2078.
[7] Schuppan D, Afdhal NH. Liver cirrhosis[J].Lancet, 2008, 371(9615): 838-851.
[8] Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology, 2000, 31(4):864-871.
[9] Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics[J] Hepatology, 1987, 7(4):660-664.
[10] 施万英, 陈会杰, 陆金鑫, 等.营养风险筛查NRS2002在肝硬化住院患者中的临床应用研究[J].中华健康管理杂志, 2017, 11(5):458-460.
[11] Nishikawa H,Osaki Y. Liver cirrhosis:evaluation,nutritional status,and prognosis[J]. Mediators Inflamm,2015,2015:872152.
[12] 杨中菊, 胡乃中.老年肝硬化患者营养状况及其与临床相关因素分析[J].安徽医学, 2011, 32(12): 1998- 2000.
[13] 张辉凯, 孟祥林, 李海雷, 等.失代偿期肝硬化住院患者营养不良情况及其与预后的关系[J].临床肝胆病杂志, 2016, 32(6):1100-1103.
[14] Higuera-dela Tijera F, Servín-Caama o A, Servìn-Abad L, et al. Malnutrition is a key prognostic factor related to high mortality-rate in patients with severe alcoholic hepatitis[J]. Nutr Hosp, 2018, 35(3):677-682.
[15] Huo TI, Lee SD, Lin HC. Selecting an optimal prognostic system for liver cirrhosis:the model for end-stage liver disease and beyond[J] Liver Int,2008,28(5):606-613.
[16] Freeman RB. Overview of the MELD/PELD system of liver allocation indications for liver transplantation in the MELD era: evidence-based patient selection [J]. Liver Transpl, 2004, 10(10 Suppl 2):S2-3.
[17] 凡小丽,文茂瑶,沈怡,等.不同评分系统对失代偿期肝硬化患者短期和中期死亡风险预测能力的比较[J].临床肝胆病杂志,2017,33(7):1284-1290.
[18] Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortalit among patients on the liver-transplant waiting list [J]. N Engl J Med, 2008, 359(10):1018-1026.
[19] Cardenas A, Gines P. Predicting mortality in cirrhosis-serum sodium helps [J].N Engl J Med, 2008, 359(10):1060-1062.
[20] Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortali-t better than MELD alone[J]. Liver Transpl, 2005, 11(3):336-343.