集中治療室（ICU）に収容されたCOVID-19に罹患した重症患者におけるmodified nutrition risk in the critically ill（mNUTRIC）スコアの有効性の評価

Evaluation of the effectiveness of the modified nutrition risk in the critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU).

抄録

背景:

COVID-19は非常に有害なパンデミックであり、その回復過程は栄養状態に大きく影響されるが、これらの患者に対する適切な栄養尺度はまだ提案されていない。そこで本研究では、集中治療室（ICU）に入院したCOVID-19に罹患した重症患者を対象に、modified Nutrition Risk in the Critically ill（mNUTRIC）スコアの有効性を評価することを目的とした。

BACKGROUND: COVID-19 is a very harmful pandemic, and its recovery process is highly influenced by nutritional status; however, an appropriate nutritional scale has not yet been proposed for these patients. Therefore, the purpose of this study was to evaluate the effectiveness of the modified Nutrition Risk in the Critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU).

材料と方法:

ICU病棟に入院したCOVID-19に罹患した重症患者204名を対象に行った横断的研究である。評価指標は、mNUTRICスコア、人口統計学的指標、生化学的指標を含む。

MATERIAL AND METHODS: This was a cross-sectional study performed on 204 critically ill patients affected by COVID-19 admitted to the ICU wards. Evaluated indicators include the mNUTRIC Score as well as demographic, and biochemical indicators.

結果:

COVID-19患者の67.2％は重症であった。入院期間、ICU滞在期間（p>0.001）、PH（p>0.001）は非生存者で生存者より有意に低かった。mNUTRICスコア（p>0.001）、PCO2（p=0.003）、CRPレベル（p=0.021）は非生存者が生存者より有意に高かった。mNUTRICスコアは，年齢（p>0.001），AST（p=0.000），LDH（p=0.026），CRP（p=0.014）と直接相関し，入院期間（p=0.031），アルブミン（p=0.003），PH（p<0.001）と逆相関していた．さらに，mNUTRICスコアと死亡確率には有意ではない相関が認められた（OR=1.085，95%CI [0.83，1.42]，p=0.552）．一方、より重度のCOVID-19疾患（OR=8.057、95%CI [1.33, 48.64], p=0.023）と高いPCO2（OR=1.042、95%CI [1.01, 1.08], p=0.023）レベルの患者には死亡の確率が高いことが示されました。

RESULTS: A high percentage of COVID-19 patients (67.2%) had severe disease. Hospital and ICU stay (p > 0.001) and PH (p > 0.001) values were significantly lower in non-survivors than in survivors. mNUTRIC score (p > 0.001), PCO2 (p = 0.003), and CRP levels (p = 0.021) were significantly higher in non-survivors than survivors. mNUTRIC score had a direct correlation with age (p > 0.001), AST (p = 0.000), LDH (p = 0.026), and CRP (p = 0.014) and an inverse correlation with hospital duration (p = 0.031), albumin (p = 0.003) and PH (p < 0.001). Furthermore, there was a non-significant correlation between the mNUTRIC score and mortality chance (OR = 1.085, 95%CI [0.83, 1.42], p = 0.552). While, patients with more severe COVID-19 disease (OR = 8.057, 95%CI [1.33, 48.64], p = 0.023) and higher PCO2 (OR = 1.042, 95%CI [1.01, 1.08], p = 0.023) levels had higher odds of mortality.

結論:

COVID-19患者において，CRP値が高く，PH値が低いほど死亡率が高く，栄養状態も悪いことが明らかになった．さらに，mNUTRICスコアと死亡率の確率には有意な関連は認められなかった．

CONCLUSIONS: Our findings revealed that COVID-19 patients with higher CRP levels and lower PH had higher mortality and poor nutritional condition. Moreover, there was a non-significant association between the mNUTRIC score and mortality chance.