Development and validation of a risk prediction model for feeding intolerance in neurocritical patients with enteral nutrition.

IF 4 2区 农林科学 Q2 NUTRITION & DIETETICS Frontiers in Nutrition Pub Date : 2024-10-23 eCollection Date: 2024-01-01 DOI:10.3389/fnut.2024.1481279
Rong Yuan, Lei Liu, Jiao Mi, Xue Li, Fang Yang, Shifang Mao
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Abstract

Background: This study collects and analyzes clinical data on enteral nutrition therapy in neurocritical patients, develops and validates a feeding intolerance (FI) risk prediction model, and provides a theoretical basis for screening patients with high risk of feeding intolerance (FI) and delivering personalized care.

Methods: A convenience sampling method was employed to select 300 patients who were admitted to a tertiary hospital in China for early enteral nutrition therapy in the neurointensive care unit between April 2022 and December 2022. Independent risk factors for FI were identified using univariate and logistic regression analyses. A prediction model was established, and the goodness of fit and discriminant validity of the model were evaluated.

Results: The incidence of FI in neurocritical patients receiving enteral nutrition was 71%. Logistic regression analysis identified age, Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation, feeding via the nasogastric tube route, hyperglycemia, and low serum albumin as independent risk factors for the development of FI (p < 0.05). The predictive formula for FI risk was established as follows: Logit p = -14.737 + 1.184 × mechanical ventilation +2.309 × feeding route +1.650 × age + 1.336 × GCS tertile (6-8 points) + 1.696 × GCS tertile (3-5 points) + 1.753 × APACHE II score + 1.683 × blood glucose value +1.954 × serum albumin concentration. The Hosmer-Lemeshow test showed χ2  = 9.622, p = 0.293, and the area under the ROC curve was 0.941 (95% confidence interval: 0.912-0.970, p < 0.001). The optimal critical value was 0.767, with a sensitivity of 85.9%, a specificity of 90.8%, and a Youden index of 0.715.

Conclusion: The early enteral nutrition FI risk prediction model developed in this study demonstrated good predictive ability. This model can serve as a valuable reference for effectively assessing the risk of FI in neurocritical patients, thereby enhancing clinical outcomes.

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神经重症患者肠内营养喂养不耐受风险预测模型的开发与验证。
研究背景本研究收集并分析了神经重症患者肠内营养治疗的临床数据,建立并验证了喂养不耐受(FI)风险预测模型,为筛查喂养不耐受(FI)高风险患者并提供个性化护理提供理论依据:方法:采用方便抽样法,选取2022年4月至2022年12月期间入住中国某三级甲等医院神经重症监护病房接受早期肠内营养治疗的300名患者。通过单变量和逻辑回归分析确定了FI的独立风险因素。建立了预测模型,并对模型的拟合度和判别效度进行了评估:接受肠内营养的神经重症患者的 FI 发生率为 71%。逻辑回归分析发现,年龄、格拉斯哥昏迷量表(GCS)评分、急性生理学和慢性健康评估 II(APACHE II)评分、机械通气、鼻胃管喂养、高血糖和低血清白蛋白是发生 FI 的独立风险因素(P P = -14.737 + 1.184 × 机械通气 +2.309 × 喂食途径 +1.650 × 年龄 + 1.336 × GCS 三分层(6-8 分) + 1.696 × GCS 三分层(3-5 分) + 1.753 × APACHE II 评分 + 1.683 × 血糖值 +1.954 × 血清白蛋白浓度。Hosmer-Lemeshow检验显示χ2=9.622,P=0.293,ROC曲线下面积为0.941(95%置信区间:0.912-0.970,P 结论:早期肠内营养 FI 风险预测的准确性较高:本研究建立的早期肠内营养 FI 风险预测模型具有良好的预测能力。该模型可作为有效评估神经重症患者 FI 风险的重要参考,从而提高临床疗效。
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来源期刊
Frontiers in Nutrition
Frontiers in Nutrition Agricultural and Biological Sciences-Food Science
CiteScore
5.20
自引率
8.00%
发文量
2891
审稿时长
12 weeks
期刊介绍: No subject pertains more to human life than nutrition. The aim of Frontiers in Nutrition is to integrate major scientific disciplines in this vast field in order to address the most relevant and pertinent questions and developments. Our ambition is to create an integrated podium based on original research, clinical trials, and contemporary reviews to build a reputable knowledge forum in the domains of human health, dietary behaviors, agronomy & 21st century food science. Through the recognized open-access Frontiers platform we welcome manuscripts to our dedicated sections relating to different areas in the field of nutrition with a focus on human health. Specialty sections in Frontiers in Nutrition include, for example, Clinical Nutrition, Nutrition & Sustainable Diets, Nutrition and Food Science Technology, Nutrition Methodology, Sport & Exercise Nutrition, Food Chemistry, and Nutritional Immunology. Based on the publication of rigorous scientific research, we thrive to achieve a visible impact on the global nutrition agenda addressing the grand challenges of our time, including obesity, malnutrition, hunger, food waste, sustainability and consumer health.
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