persmedРоссийский журнал персонализированной медициныRussian Journal for Personalized Medicine2782-38062782-3814ФОНД АЛМАЗОВА10.18705/2782-3806-2022-2-5-38-49persmed-85Research ArticleАНЕСТЕЗИОЛОГИЯ И РЕАНИМАТОЛОГИЯANESTHESIOLOGY AND INTENSIVE CARE MEDICINEМаркеры нутритивной недостаточности как предикторы летального исхода у пациентов многопрофильного отделения реанимации и интенсивной терапииMalnutrition markers as negative clinical outcome predictors in patients of mixed intensive care unitСивковА. О.SivkovA. O.

врач отделения анестезиологии и реанимации

physician of anesthesiology and intensive care unit

herous2@yandex.ruЛейдерманИ. Н.LeydermanI. N.

д.м.н., профессор кафедры анестезиологии и реаниматологии

MD, PhD, professor at department and anesthesiology department

СивковО. Г.SivkovO. G.

к.м.н., руководитель анестезиолого-реанимационной службы

candidate of medical sciences, chief of anesthesiology and intensive care service

Акционерное общество «Медико-санитарная часть «Нефтяник»РоссияJSC Neftyanik HospitalRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian FederationТюменский кардиологический научный центр — филиал Федерального государственного бюджетного научного учреждения «Томский национальный исследовательский медицинский центр Российской академии наук»РоссияTyumen Cardiology Research CenterRussian Federation202228112022253849Copyright © Сивков А.О., Лейдерман И.Н., Сивков О.Г., 20222022Сивков А.О., Лейдерман И.Н., Сивков О.Г.Sivkov A.O., Leyderman I.N., Sivkov O.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://persmed.elpub.ru/jour/article/view/85

Актуальность. Выявление пациентов с высоким риском развития летального исхода на ранних этапах интенсивной терапии критических состояний дает возможность своевременно скорректировать лечение. Для этого используют шкалы оценки тяжести состояния, не включающие в себя параметры белково-энергетического обмена и нутритивной недостаточности (НН). Цель. Оценить прогностическую значимость маркеров НН в отношении риска развития летального исхода у пациентов отделений реанимации и интенсивной терапии (ОРИТ) хирургического (ХП) и терапевтического профиля (ТП). Материалы и методы. В период с 2012 по 2017 годы на базе многопрофильного ОРИТ выполнено одноцентровое проспективное когортное исследование. Тяжесть состояния пациента определяли с помощью шкал Acute Physiology and Chronic Health Evaluation II (APACHE II) и Sequential Organ Failure Assessment (SOFA). Выполнялся расчет нутритивных индексов (Nutritional Risk Index (NRI), Maastricht Index (MI), The Prognostic Nutritional Index (PNI)) и шкал риска развития НН Nutritional Risk Screening 2002 (NRS-2002), Modified Nutrition Risk in the Critically Ill (mNUTRIC), а также производился расчет индекса массы тела (ИМТ). Результаты. Наилучшими показателями, прогнозирующими риск развития летального исхода в ХП, являются индекс NRI, шкалы mNUTRIC, NRS-2002, возраст пациентов, в ТП — шкалы NRS-2002 и mNUTRIC. Заключение. mNUTRIC и NRS-2002, NRI, наряду с системами APACHE II и SOFA, могут применяться в клинической практике многопрофильного ОРИТ для прогнозирования летального исхода.

Background. Identification of patients with a high risk of poor clinical outcome at early stages of intensive care of critical illness makes it possible to adjust the diagnostic and treatment process. Integral severity scoring systems are used for this purpose, which do not include either energy-protein metabolism or malnutrition (MN) parameters. The aim of this study was to determine the predictive value of MN markers for the risk of a poor clinical outcome in surgical (SG) and therapeutic (TG) group of intensive care units (ICU). Material and methods. During the period of 2012 to 2017, a single-center prospective cohort study based on mixed ICU was organized The patient’s critical illness severity was established by Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Nutritional indices: Nutritional Risk Index (NRI), Maastricht Index(MI), The Prognostic Nutritional Index (PNI)), and ND risk score: Nutritional Risk Screening 2002 (NRS-2002), Modified Nutrition Risk in the Critically Ill (mNUTRIC)), body mass index (BMI) were also calculated. Results. The best markers to predict the negative clinical outcome risk in the SG are NRI, mNUTRIC and NRS-2002, as well as patient’s age, while in the TG these are - NRS-2002 and mNUTRIC. Conclusion. NRI, mNUTRIC and NRS-2002 can be applied, as well as the traditional APACHE II and SOFA, in the clinical practice of a mixed ICU to predict a poor clinical outcome.

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The authors declare that there are no conflicts of interest present.