Relationship between the nutritional risk assessment indicators and 1-year prognosis in the patients with severe neurological rehabilitation

Yin Yanyan; Liu Aixian

doi:10.3969/j.issn.1002-1949.2024.10.011

Abstract：Objective To explore the relationship between the nutritional risk assessment indicators and the 1-year prognosis of patients in the neurological intensive rehabilitation ward during hospitalization.Methods It's a retrospective study.The clinical data of patients in the neurological intensive rehabilitation ward of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from December 2020 to August 2022 were analyzed.The following variables were collected at admission:gender,age,primary diagnosis,Glasgow coma scale(GCS),hemoglobin,serum albumin,nutrition risk screening 2002(NRS2002);the lowest blood phosphorus,the lowest prealbumin,the highest procalcitonin(PCT),the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score within 24 h on the day of serious illness(or the worst APACHE Ⅱ score during ICU),sequential organ failure assessment(SOFA)score,the modified nutrition risk in critically ill(m-NUTRIC)score and the length of ICU stay were recorded during ICU stay.The total length of stay was recorded at discharge,and the follow-up was 1 year.The patients were divided into survival group(n=220)and death group(n=56)according to whether the patients died or not at the endpoint of 1-year follow-up.Multivariate Logistic regression analysis was used to evaluate the risk factors for 1-year mortality in the patients with severe neurological rehabilitation.The receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC)and its 95％confidence interval(95％CI)were calculated with the purpose of evaluating the value of nutritional risk predictors and the lowest blood phosphorus combined with the lowest prealbumin and the highest PCT during hospitalization in predicting the death of patients in neurological intensive rehabilitation ward within a year.Results There were statistical differences in age,disease structure,hemoglobin and NRS2002 at admission,the lowest prealbumin,the lowest blood phosphorus,the highest PCT,the worst APACHE Ⅱ,the SOFA,the m-NUTRIC and the total hospital stay between the survival group and the death group(P＜0.05).Multiple Logistic regression analysis with the above variables as independent variables and 1-year death as dependent variables showed that when the equation contained the above 6 variables,the P value was 0.358＞0.200,which was a good fit to the original data.After adjusting age,major diagnosis and hemoglobin,the above indicators were independent risk factors for 1-year death in the patients recovering in neurological intensive rehabilitation ward.The area under ROC curves(95％CI)of the combined forecast containing the lowest blood phosphorus,the lowest prealbumin and the highest PCT,NRS2002 and m-NUTRIC predicting 1-year prognosis of severe neurological rehabilitation patients were 0.887(0.844-0.922),0.679(0.595-0.763)and 0.689(0.631-0.743),the best cutoff values were combined forecast＞0.252,NRS2002＞4 and blood m-NUTRIC＞3,and the Jorden index was 0.658,0.321 and 0.326.Conclusions The lowest blood phosphorus combined with the lowest prealbumin and the highest PCT during ICU stay can better predict the 1-year prognosis of patients recovering in a neurological intensive rehabilitation ward.