The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. RFS Risk Screening and Assessment
2.3. RFS Definition and Data Collection
2.4. Nutrition Management
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Differences between the RFS and Non-RFS Groups
3.3. Validation and Comparison of Four Screening Tools for Predicting RFS
3.4. Prediction Models of RFS
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | RFS (n = 84) | Non-RFS (n = 394) | p |
---|---|---|---|
Age, years, median (IQR) | 65 (51–73) | 58 (47–67) | 0.003 |
Female, n (%) | 19 (22.9%) | 119 (30.1%) | 0.164 |
BMI, kg/m2, median (IQR) | 22.9 (19.6–25.5) | 23.2 (21.2–25.4) | 0.433 |
Duration from the onset of diseases to our NCU, days, median (IQR) | 2 (0–7) | 3 (0–12) | 0.181 |
History of alcoholism, n (%) | 8 (9.5%) | 59 (15.0%) | 0.191 |
Hypertension, n (%) | 52 (62.7%) | 196 (49.6%) | 0.023 |
Diabetes mellitus, n (%) | 19 (22.9%) | 77 (19.5%) | 0.523 |
Heart disease, n (%) | 16 (19.3%) | 43 (10.9%) | 0.040 |
Mechanical ventilation at admission, n (%) | 10 (12.0%) | 53 (13.4%) | 0.737 |
APACHE II, median (IQR) | 17 (13–22) | 15 (11–19) | <0.001 |
GCS, median (IQR) | 8 (6–11) | 10 (7–12) | 0.007 |
SOFA, median (IQR) | 4 (3–7) | 4 (2–6) | 0.006 |
NUTRIC, median (IQR) | 4 (3–5) | 3 (2–4) | 0.001 |
MUST, median (IQR) | 2 (2–2) | 2 (2–2) | 0.107 |
NRS 2002, median (IQR) | 4 (3–4) | 4(3–4) | 0.094 |
SNAQ, median (IQR) | 1 (0–1) | 1 (0–1) | 0.631 |
GLIM, median (IQR) | 1 (1–1) | 1 (1–1) | 0.1224 |
mMICE, median (IQR) | 2 (1–3) | 2 (1–3) | 0.035 |
ASPEN, median (IQR) | 1 (0–2) | 0 (0–1) | 0.001 |
Baseline serum electrolytes | |||
Phosphorous, mmol/L, median (IQR) | 0.98 (0.86–1.14) | 1.05 (0.92–1.21) | 0.015 |
Potassium, mmol/L, median (IQR) | 3.91 (3.53–4.24) | 3.90 (3.63–4.20) | 0.953 |
Sodium, mmol/L, median (IQR) | 140 (135–144) | 140 (137–143) | 0.490 |
Magnesium, mmol/L, median (IQR) | 0.84 (0.79–0.89) | 0.86 (0.79–0.94) | 0.039 |
Caloric intakes within the first 72 h | |||
Day 1, Kcal/kg, median (IQR) | 8.22 (7.11–10) | 8.45 (7.24–11) | 0.21644 |
Day 2, Kcal/kg, median (IQR) | 14.54 (11.93–18.11) | 16.08 (12.85–20) | 0.018 |
Day 3, Kcal/kg, median (IQR) | 20.36 (15.71–25.08) | 21.80 (16.97–25.8) | 0.144 |
Mechanical ventilation in-hospital, n (%) | 46 (55.4%) | 163 (41.3%) | 0.018 |
Length of hospital stay, days, median (IQR) | 20 (11–33) | 18 (12–29) | 0.848 |
Length of NCU stay, days, median (IQR) | 11 (6–18) | 8 (5–14) | 0.021 |
30-day mortality, n (%) | 27 (32.5%) | 66 (16.7%) | 0.001 |
6-month mortality, n (%) | 33 (39.8%) | 77 (19.5%) | <0.001 |
6-month poor outcome (mRS > 3), n (%) | 62 (73.8%) | 207 (52.5%) | <0.001 |
SNAQ (95%CI) | GLIM (95%CI) | mNICE (95%CI) | ASPEN (95%CI) | mASPEN (95%CI) | |
---|---|---|---|---|---|
Sensitivity | 20.2 (12.6–30.7) | 20.2 (12.6–30.7) | 48.8 (37.8–59.9) | 53.6 (42.4–64.4) | 63.1 (51.8–73.2) |
Specificity | 84.8 (80.8–88.1) | 86.0 (82.1–89.2) | 65 (60.0–69.6) | 64.7 (59.8–69.4) | 0.64 (58.9–68.7) |
PPV | 22.1 (13.7–33.2) | 23.6 (14.7–35.3) | 22.9 (17.1–29.9) | 24.5 (18.6–31.4) | 27.2 (21.2–34.1) |
NPV | 83.3 (79.2–86.7) | 83.5 (79.4–87.0) | 85.6 (81.0–89.3) | 86.7 (82.2–90.3) | 89 (76.8–92.3) |
Accuracy | 73 | 75 | 62 | 63 | 64 |
к | 5.2 | 6.7 | 9.5 | 12.5 | 17.8 |
AUCs | 0.516 (0.470–0.561) | 0.533 (0.487–0.579) | 0.568 (0.522–0.613) | 0.597 (0.551–0.641) | 0.664 * (0.620–0.706) |
Parameter | Univariable Analysis | Multivariable Analysis | ||
---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | |
Hypertension | 1.745 (1.074–2.834) | 0.025 | - | - |
Heart disease | 1.921 (1.023–3.606) | 0.042 | - | - |
Day2 (Kcal/kg) | 0.957 (0.919–0.996) | 0.033 | - | - |
GCS | 0.913 (0.852–0.979) | 0.010 | 0.910 (0.848–0.978) | 0.010 |
Age | 1.025 (1.008–1.042) | 0.004 | 1.027 (1.010–1.044) | 0.002 |
ASPEN | 1.573 (1.184–2.089) | 0.002 | 1.597 (1.194–2.136) | 0.002 |
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Liu, N.; Zhao, X.-L.; Xiong, R.-Q.; Chen, Q.-F.; Wu, Y.-M.; Lin, Z.-Z.; Wang, S.-N.; Wu, T.; Pan, S.-Y.; Huang, K.-B. The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome. Nutrients 2022, 14, 4032. https://doi.org/10.3390/nu14194032
Liu N, Zhao X-L, Xiong R-Q, Chen Q-F, Wu Y-M, Lin Z-Z, Wang S-N, Wu T, Pan S-Y, Huang K-B. The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome. Nutrients. 2022; 14(19):4032. https://doi.org/10.3390/nu14194032
Chicago/Turabian StyleLiu, Na, Xiao-Lin Zhao, Rui-Qi Xiong, Quan-Feng Chen, Yong-Ming Wu, Zhen-Zhou Lin, Sheng-Nan Wang, Tong Wu, Su-Yue Pan, and Kai-Bin Huang. 2022. "The Performances of SNAQ, GLIM, mNICE, and ASPEN for Identification of Neurocritically Ill Patients at High Risk of Developing Refeeding Syndrome" Nutrients 14, no. 19: 4032. https://doi.org/10.3390/nu14194032