Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Information, Data Collection, and Definitions
2.2. Laboratory Investigations
2.3. Nutrition Risk Assessment and Disease Severity Scores
2.4. Statistical Analysis
3. Results
mNUTRIC Score and Outcomes
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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All (n = 131) | 6-Week Mortality (n = 25) | 6-Week Survival (n = 106) | p-value | |
---|---|---|---|---|
Age | 54.45 ± 14.20 | 53.88 ± 13.66 | 54.58 ± 14.39 | NS (0.842) |
Sex (male/female) | 109/22 | 20/5 | 89/17 | NS (0.634) |
Etiology (alcohol/virus/mixed type/others) | 51/67/12/1 | 13/10/2/0 | 38/57/10/1 | NS (0.550) |
mNUTRIC score | 3.88 ± 2.22 | 6.27 ± 1.39 | 3.32 ± 2.01 | <0.001 |
High mNUTRIC score | 50/131 (38.2) | 23/25 (92.0) | 27/106 (25.5) | <0.001 |
BMI | 24.12 ± 4.24 | 24.41 ± 5.01 | 24.05 ± 4.06 | NS (0.729) |
Child–Pugh score | 9.65 ± 2.34 | 12.48 ± 1.74 | 8.98 ± 1.93 | <0.001 |
Child A/B/C | 12/51/68 | 0/1/24 | 12/50/44 | <0.001 |
SOFA score | 7.57 ± 3.55 | 9.84 ± 3.83 | 6.65 ± 2.98 | <0.001 |
APACHE II | 20.57 ± 8.34 | 29.68 ± 8.76 | 18.42 ± 6.64 | <0.001 |
MELD | 18.92 ± 10.23 | 31.88 ± 11.48 | 15.86 ± 7.07 | <0.001 |
CRP (mg/L) | 37.30 ± 38.00 | 60.41 ± 52.82 | 32.00 ± 31.84 | 0.003 |
Albumin (g/dL) | 2.59 ± 0.55 | 2.42 ± 0.61 | 2.63 ± 0.52 | NS (0.080) |
Bilirubin (mg/dL) | 5.28 ± 7.62 | 13.49 ± 13.08 | 3.35 ± 3.61 | <0.001 |
INR | 1.81 ± 1.18 | 2.90 ± 2.15 | 1.55 ± 0.38 | <0.001 |
Serum creatinine (mg/dL) | 1.68 ± 1.49 | 2.82 ± 1.83 | 1.41 ± 1.27 | <0.001 |
Hemoglobulin (g/dL) | 8.43 ± 1.55 | 8.58 ± 1.96 | 8.41 ± 1.48 | NS (0.673) |
Platelet (×109/L) | 65.02 ± 35.49 | 56.08 ± 32.66 | 67.15 ± 35.95 | NS (0.162) |
Leukocytes (×109/L) | 9.43 ± 6.08 | 12.25 ± 9.01 | 8.75 ± 4.96 | 0.009 |
Blood transfusion (unit) | 4.56 ± 4.01 | 8.75 ± 5.04 | 3.65 ± 3.13 | <0.001 |
Mean arterial pressure (mmHg) | 73.91 ± 12.87 | 64.22 ± 11.12 | 76.31 ± 12.17 | 0.003 |
Shock (%) | 59/131 (45.0) | 22/25 (88.0) | 37/106 (34.9) | <0.001 |
Ascites (%) | 83/131 (63.4) | 24/25 (96.0) | 59/106 (55.7) | 0.001 |
Hepatic encephalopathy (%) | 73/131 (55.7) | 20/25 (80.0) | 53/106 (50.0) | 0.007 |
Hepatocellular carcinoma (%) | 33/131 (25.2) | 9/25 (36.0) | 24/106 (22.6) | NS (0.166) |
Bacterial infection at inclusion (%) | 42/131 (32.1) | 19/25 (76.0) | 23/106 (21.7) | <0.001 |
Treatment failure (%) | 38/131 (29.0) | 20/25 (80.0%) | 18/106 (17.0%) | <0.001 |
ICU stay (days) | 8.05 ± 8.54 | 12.76 ± 11.04 | 6.91 ± 7.47 | 0.002 |
Parameter | Beta Coefficient | Standard Error | Odds Ratios (95%CI) | p |
---|---|---|---|---|
Univariate logistic regression | ||||
mNUTRIC score | 0.849 | 0.175 | 2.338 (1.658–3.296) | <0.001 |
High mNUTRIC score | 3.516 | 0.770 | 33.648 (7.437–152.243) | <0.001 |
Child–Pugh score | 1.007 | 0.200 | 2.738 (1.850–4.053) | <0.001 |
SOFA score | 0.586 | 0.115 | 1.796 (1.434–2.250) | <0.001 |
APACHE II | 0.176 | 0.036 | 1.192 (1.112–1.278) | <0.001 |
MELD | 0.175 | 0.033 | 1.191 (1.116–1.272) | <0.001 |
CRP (mg/L) | 0.017 | 0.006 | 1.017 (1.005–1.030) | 0.007 |
Bilirubin (mg/dL) | 0.180 | 0.044 | 1.197 (1.098–1.305) | <0.001 |
INR | 3.044 | 0.625 | 20.980 (6.157–71.481) | <0.001 |
Serum creatinine (mg/dL) | 0.528 | 0.138 | 1.695 (1.293–2.223) | <0.001 |
Leukocytes (×109/L) | 0.082 | 0.035 | 1.085 (1.014–1.162) | 0.0185 |
Blood transfusion (unit) | 0.291 | 0.079 | 1.337 (1.146–1.561) | <0.001 |
Mean arterial pressure (mmHg) | −0.096 | 0.025 | 0.908 (0.865–0.953) | <0.001 |
Shock (%) | 2.616 | 0.648 | 13.676 (3.838–48.730) | <0.001 |
Ascites (%) | 2.951 | 1.039 | 19.119 (2.494–146.557) | 0.005 |
Hepatic encephalopathy (%) | 1.386 | 0.536 | 4.000 (1.398–11.446) | 0.010 |
Bacterial infection at inclusion (%) | 2.436 | 0.524 | 11.428 (4.090–31.929) | <0.001 |
Treatment failure (%) | 2.973 | 0.563 | 19.556 (6.488–58.947) | 0.001 |
ICU stay (days) | 0.064 | 0.024 | 1.066 (1.017–1.117) | 0.007 |
Multivariate logistic regression (Model 1) | ||||
mNUTRIC score | 0.770 | 0.238 | 2.160 (1.355–3.445) | 0.001 |
Bacterial infection at inclusion | 1.980 | 0.819 | 7.240 (1.453–36.071) | 0.016 |
Child–Pugh score | 0.954 | 0.274 | 2.596 (1.518–4.439) | <0.001 |
Multivariate logistic regression (Model 2) | ||||
mNUTRIC score | 0.875 | 0.292 | 2.399 (1.353–4.256) | 0.003 |
Bacterial infection at inclusion | 3.155 | 0.948 | 23.443 (3.659–150.178) | 0.001 |
MELD score | 0.184 | 0.052 | 1.202 (1.086–1.330) | <0.001 |
All (n = 131) | High mNUTRIC (n = 50) | Low mNUTRIC (n = 81) | p-value | |
---|---|---|---|---|
Age | 54.45 ± 14.20 | 60.62 ± 13.51 | 50.64 ± 13.33 | <0.001 |
Sex (male/female) | 109/22 | 38/12 | 71/10 | NS (0.083) |
Etiology (alcohol/virus/mixed type/others) | 51/67/12/1 | 17/30/3/0 | 34/37/9/1 | NS (0.359) |
BMI | 24.12 ± 4.24 | 24.51 ± 4.21 | 23.87 ± 4.27 | NS (0.448) |
Child–Pugh score | 9.65 ± 2.34 | 11.00 ± 2.28 | 8.81 ± 1.97 | <0.001 |
Child A/B/C | 12/51/68 | 1/12/37 | 11/39/31 | <0.001 |
SOFA score | 7.57 ± 3.55 | 10.40 ± 3.42 | 5.83 ± 2.29 | <0.001 |
APACHE II | 20.57 ± 8.34 | 27.90 ± 7.47 | 16.05 ± 4.95 | <0.001 |
MELD | 18.92 ± 10.23 | 26.22 ± 11.04 | 14.41 ± 6.44 | <0.001 |
CRP (mg/L) | 37.30 ± 38.00 | 53.97 ± 43.46 | 26.09 ± 29.21 | <0.001 |
Albumin (g/dL) | 2.59 ± 0.55 | 2.49 ± 0.53 | 2.65 ± 0.55 | NS (0.091) |
Bilirubin (mg/dl) | 5.28 ± 7.62 | 7.69 ± 9.88 | 3.80 ± 5.37 | 0.004 |
INR | 1.81 ± 1.18 | 2.24 ± 1.67 | 1.54 ± 0.38 | <0.001 |
Serum creatinine (mg/dL) | 1.68 ± 1.49 | 2.68 ± 1.84 | 1.06 ± 0.72 | <0.001 |
Hemoglobulin (g/dL) | 8.43 ± 1.55 | 8.45 ± 1.51 | 8.42 ± 1.59 | NS (0.924) |
Platelet (x109/L) | 65.02 ± 35.49 | 63.53 ± 33.08 | 65.92 ± 37.04 | NS (0.711) |
Leukocytes (x109/L) | 9.43 ± 6.08 | 11.57 ± 7.76 | 8.12 ± 4.32 | 0.002 |
Blood transfusion (unit) | 4.56 ± 4.01 | 5.17 ± 4.71 | 4.15 ± 3.44 | NS (0.243) |
Mean arterial pressure (mmHg) | 73.91 ± 12.87 | 68.24 ± 11.82 | 77.41 ± 12.30 | <0.001 |
Shock (%) | 59/131 (45.0) | 28/50 (56.0) | 31/81 (38.3) | 0.048 |
Ascites (%) | 83/131 (63.4) | 39/50 (78.0) | 44/81 (54.3) | 0.006 |
Hepatic encephalopathy (%) | 73/131 (55.7) | 33/50 (66.0) | 40/81 (49.4) | NS (0.063) |
Hepatocellular carcinoma (%) | 33/131 (25.2) | 21/60 (42.0) | 12/81 (14.8) | <0.001 |
Bacterial infection at inclusion (%) | 42/131 (32.1) | 23/50 (46.0) | 19/81 (23.5) | 0.007 |
Outcome | ||||
Treatment failure (%) | 38/131 (29.0) | 24/50 (48.0) | 14/62 (17.3) | <0.001 |
ICU stay (days) | 8.05 ± 8.54 | 11.20 ± 10.56 | 6.05 ± 6.26 | 0.001 |
ICU mortality (%) | 26/131 19.8) | 23/50 (46.0) | 3/81 (3.7) | <0.001 |
28-day mortality (%) | 23/131 (17.6) | 21/50 (42.0) | 2/81 (2.5) | <0.001 |
6-week mortality (%) | 25/131 (19.1) | 23/50 (46.0) | 2/81 (2.5) | <0.001 |
All (n = 131) | Treatment Failure (n = 38) | Treatment Success (n = 93) | p-value | |
---|---|---|---|---|
Age | 54.45 ± 14.20 | 52.18 ± 11.54 | 55.38 ± 15.12 | NS (0.245) |
Sex (male/female) | 109/22 | 34/4 | 75/18 | NS (0.220) |
Etiology (Alcohol/virus/mixed type/others) | 51/67/12/1 | 20/14/3/1 | 31/53/9/0 | NS (0.090) |
mNUTRIC score | 3.88 ± 2.22 | 4.82 ± 2.48 | 3.49 ± 2.00 | 0.002 |
High mNUTRIC score | 50/131 (38.2) | 24/38 (63.2) | 26/93 (28.0) | <0.001 |
BMI | 24.12 ± 4.24 | 25.01 ± 4.29 | 23.72 ± 4.18 | NS (0.147) |
Child–Pugh score | 9.65 ± 2.34 | 10.87 ± 2.27 | 9.15 ± 2.19 | <0.001 |
Child A/B/C | 12/51/68 | 0/12/26 | 12/39/42 | <0.001 |
SOFA score | 7.57 ± 3.55 | 10.40 ± 3.42 | 5.83 ± 2.29 | <0.001 |
APACHE II | 20.57 ± 8.34 | 24.39 ± 9.88 | 19.01 ± 7.10 | 0.001 |
MELD | 18.92 ± 10.23 | 24.58 ± 13.03 | 16.60 ± 7.80 | <0.001 |
CRP (mg/L) | 37.30 ± 38.00 | 49.57 ± 50.26 | 31.94 ± 30.08 | 0.030 |
Albumin (g/dL) | 2.59 ± 0.55 | 2.43 ± 0.58 | 2.65 ± 0.52 | 0.035 |
Bilirubin (mg/dL) | 5.28 ± 7.62 | 7.71 ± 10.62 | 4.29 ± 5.78 | 0.019 |
INR | 1.81 ± 1.18 | 2.38 ± 1.87 | 1.57 ± 0.41 | <0.001 |
Serum creatinine (mg/dL) | 1.68 ± 1.49 | 2.25 ± 1.87 | 1.44 ± 1.25 | <0.005 |
Hemoglobulin (g/dL) | 8.43 ± 1.55 | 8.24 ± 1.73 | 8.50 ± 1.49 | NS (0.423) |
Platelet (x109/L) | 65.02 ± 35.49 | 57.09 ± 32.71 | 68.30 ± 36.24 | NS (0.101) |
Leukocytes (x109/L) | 9.43 ± 6.08 | 9.72 ± 5.87 | 9.31 ± 6.19 | NS (0.728) |
Blood transfusion (unit) | 4.56 ± 4.01 | 7.84 ± 4.76 | 3.28 ± 2.81 | <0.001 |
Mean arterial pressure (mmHg) | 73.91 ± 12.87 | 68.56 ± 12.87 | 76.06 ± 12.30 | 0.003 |
Shock (%) | 59/131 (45.0) | 31/38 (81.6) | 28/93 (30.1) | <0.001 |
Ascites (%) | 83/131 (63.4) | 32/38 (84.2.0) | 51/93 (54.8) | 0.002 |
Hepatic encephalopathy (%) | 73/131 (55.7) | 24/38 (63.2) | 49/93 (52.7) | NS (0.274) |
Hepatocellular carcinoma (%) | 33/131 (25.2) | 13/38 (34.2) | 20/93 (21.5) | NS (0.128) |
Bacterial infection at inclusion (%) | 42/131 (32.1) | 21/38 (55.3) | 21/93 (22.6) | <0.001 |
Outcome | ||||
ICU stay (days) | 8.05 ± 8.54 | 10.11 ± 10.21 | 7.22 ± 7.67 | NS (0.082) |
ICU mortality (%) | 26/131 (19.8) | 19/38 (50.0) | 7/93 (7.5) | <0.001 |
28-day mortality (%) | 23/131 (17.6) | 18/38 (47.4) | 5/93 (5.4) | <0.001 |
6-week mortality (%) | 25/131 (19.1) | 20/38 (52.6) | 5/93 (5.4) | <0.001 |
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Tsai, M.-H.; Huang, H.-C.; Peng, Y.-S.; Chen, Y.-C.; Tian, Y.-C.; Yang, C.-W.; Lien, J.-M.; Fang, J.-T.; Hou, M.-C.; Shen, C.-H.; et al. Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value. Nutrients 2019, 11, 2152. https://doi.org/10.3390/nu11092152
Tsai M-H, Huang H-C, Peng Y-S, Chen Y-C, Tian Y-C, Yang C-W, Lien J-M, Fang J-T, Hou M-C, Shen C-H, et al. Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value. Nutrients. 2019; 11(9):2152. https://doi.org/10.3390/nu11092152
Chicago/Turabian StyleTsai, Ming-Hung, Hui-Chun Huang, Yun-Shing Peng, Yung-Chang Chen, Ya-Chung Tian, Chih-Wei Yang, Jau-Min Lien, Ji-Tseng Fang, Ming-Chih Hou, Chien-Heng Shen, and et al. 2019. "Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value" Nutrients 11, no. 9: 2152. https://doi.org/10.3390/nu11092152