Volume 22 Issue 3
Mar.  2024
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Article Navigation >  Chinese Journal of General Practice  > 2024  >  22(3): 384-388
YANG Ling, ZHANG Li, PENG Hu, GU Xin, YU Xiangyou. Development of a prediction model for enteral feeding intolerance in patients with sepsis[J]. Chinese Journal of General Practice, 2024, 22(3): 384-388. doi: 10.16766/j.cnki.issn.1674-4152.003408
Citation: YANG Ling, ZHANG Li, PENG Hu, GU Xin, YU Xiangyou. Development of a prediction model for enteral feeding intolerance in patients with sepsis[J]. Chinese Journal of General Practice, 2024, 22(3): 384-388. doi: 10.16766/j.cnki.issn.1674-4152.003408
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Development of a prediction model for enteral feeding intolerance in patients with sepsis

doi: 10.16766/j.cnki.issn.1674-4152.003408
  • 1.

    School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830054, China

Funds:

 82160360

 320.6750.2023-02-3

  • Received Date: 2023-11-28
    Available Online: 2024-05-27
    Abstract
  •   Objective  To explore the risk factors of enteral feeding intolerance (EFI) in sepsis patients and to understand the occurrence of EFI in sepsis patients. To construct a risk prediction model for the occurrence of EFI in sepsis patients to facilitate the screening of high-risk groups to prevent and control the occurrence of EFI.  Methods  Convenience sampling method was used to select sepsis patients admitted to the Department of Critical Care Medicine of a tertiary-level hospital in Xinjiang who underwent enteral nutrition therapy from January 2022 to June 2023 as study subjects and were divided into the feeding tolerance group and feeding intolerance group by whether or not EFI occurred in the patients, and a one-way analysis was carried out on the patients ' general, clinical, and feeding intolerance-related data, and LASSO regression was applied to solve the covariance problem among variables, then the variables in the results of LASSO regression analysis were included in logistic regression analysis to derive the risk factors for EFI in patients with sepsis, on the basis of which we constructed a prediction model for the risk of EFI in patients with sepsis, and plotted a Nomogram, ROC curve, decision curve analysis, and calibration curve to evaluate and validate the diagnostic efficacy of the prediction model.  Results  A total of 199 sepsis patients with enteral nutrition therapy were included, including 93 cases in the intolerant group and 106 cases in the tolerant group, and the incidence rate of EFI was 46.7%. Multifactorial analysis showed that sequential organ failure assessment (SOFA) score, nutritional risk screening (NRS-2002) score, analgesics, and ICU length of stay were independent risk factors for the occurrence of EFI in patients with sepsis. The area under the ROC curve was 0.885 (95% CI: 0.833-0.933), and the maximal Youden index was 0.689, with a sensitivity of 0.849, and a specificity of 0.839.  Conclusion  SOFA score, NRS-2002 score, analgesics, and ICU length of stay are risk factors for EFI in septic patients. The risk prediction model constructed in this study based on this was validated and found to be a more accurate predictor of the risk of EFI in patients with sepsis, which can help clinical healthcare professionals provide scientific and individualized enteral nutrition therapy to patients.

     

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    • References(21)
  • [1]
    SINGER M, DEUTSCHMAN C S, SEYMOUR C W, et al. The third international consensus definitions for sepsis and septic shock(Sepsis-3)[J]. JAMA, 2016, 315(8): 801-810. doi: 10.1001/jama.2016.0287
    [2]
    MUKHOPADHYAY A, TAN Z Y, CHEONG S H L, et al. Differential effects of early energy and protein inadequacies on the outcome of critically ill patients[J]. Nutr Clin Pract, 2021, 36(2): 456-463. doi: 10.1002/ncp.10543
    [3]
    ABUGROUN A, NAYYAR A, ABDEL-RAHMAN M, et al. Impact of malnutrition on hospitalization outcomes for older adults admitted for sepsis[J]. Am J Med, 2021, 134(2): 221-226. e1. doi: 10.1016/j.amjmed.2020.06.044
    [4]
    MCLAUGHLIN J, CHOWDHURY N, DJURKOVIC S, et al. Clinical outcomes and financial impacts of malnutrition in sepsis[J]. Nutr Health, 2020, 26(3): 175-178. doi: 10.1177/0260106020930145
    [5]
    华美芳, 陈莉. 鼻肠管用于神经外科重症机械通气患者的效果研究[J]. 现代医药卫生, 2019, 35(22): 3512-3514. doi: 10.3969/j.issn.1009-5519.2019.22.033

    HUA M F, CHEN L. Study of the effect of nasointestinal tubes in neurosurgical intensive mechanical ventilation patients[J]. J Mod Med Health, 2019, 35(22): 3512-3514. doi: 10.3969/j.issn.1009-5519.2019.22.033
    [6]
    亚洲急危重症协会中国腹腔重症协作组. 重症病人胃肠功能障碍肠内营养专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20(11): 1123-1136. doi: 10.3760/cma.j.cn115610-20211012-00497

    Chinese Abdominal Intensive Care Association, Asia Society for Emergency and Critical Care Medicine. Expert consensus on enteral nutrition for gastrointestinal dysfunction in critically ill patients (2021 edition)[J]. Chin J Dig Surg, 2021, 20(11): 1123-1136. doi: 10.3760/cma.j.cn115610-20211012-00497
    [7]
    张丽华, 张莉, 张丽萍, 等. 脓毒症患者肠内营养喂养不耐受现况及影响因素研究[J]. 华南预防医学, 2023, 49(2): 174-178. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202302011.htm

    ZHANG L H, ZHANG L, ZHANG L P, et al. Enteral nutrition feeding intolerance and its influencing factors in patients with sepsis[J]. South China J Prev Med, 2023, 49(2): 174-178. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202302011.htm
    [8]
    向艳, 金静芬, 王丽竹, 等. 脓毒症患者肠内营养不耐受现状及影响因素分析[J]. 护理与康复, 2022, 21(7): 12-16, 22. doi: 10.3969/j.issn.1671-9875.2022.07.003

    XIANG Y, JIN J F, WANG L Z, et al. Present status on enteral nutrition intolerance for septic patients and analysis on influencing factor[J]. Nursing and Rehabilitation Journal, 2022, 21(7): 12-16, 22. doi: 10.3969/j.issn.1671-9875.2022.07.003
    [9]
    HU K L, DENG X L, HAN L, et al. Development and validation of a predictive model for feeding intolerance in intensive care unit patients with sepsis[J]. Saudi J Gastroenterol, 2021, 28(1): 32-38.
    [10]
    周田田. 老年脓毒症患者肠内营养喂养不耐受的相关因素分析及护理对策[D]. 镇江: 江苏大学, 2018.

    ZHOU T T. The nursing countermeasures and analysis of related factors with enteral feeding intolerance in elderly septic patients[D]. Zhenjiang: Jiangsu University, 2018.
    [11]
    郭林彬, 高薇薇, 高万朋, 等. 脓毒症急性胃肠损伤治疗研究进展[J]. 中国临床研究, 2023, 36(10): 1504-1508. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202310013.htm

    GUO L B, GAO W W, GAO W P, et al. Progress in the treatment of acute gastrointestinal injury in sepsis[J]. Chinese Journal of Clinical Research, 2023, 36(10): 1504-1508. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202310013.htm
    [12]
    JENKINS B, CALDER P C, MARINO L V. A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults[J]. Clin Nutr ESPEN, 2022, 49: 92-102. doi: 10.1016/j.clnesp.2022.04.014
    [13]
    YU K R, GUO N, ZHANG D D, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study[J]. Chin Med J(Engl), 2022, 135(15): 1814-1820.
    [14]
    伏添, 王彩凤, 张谞丰, 等. SAP患者早期肠内营养过程FI的预测评估[J]. 昆明医科大学学报, 2019, 40(12): 108-113. doi: 10.3969/j.issn.1003-4706.2019.12.022

    FU T, WANG C F, ZHANG X F, et al. The predictive assessment of feeding intolerance during early enteral nutrition in patients with severe acute pancreatitis[J]. Journal of Kunming Medical University, 2019, 40(12): 108-113. doi: 10.3969/j.issn.1003-4706.2019.12.022
    [15]
    刘炳炜, 徐燕平, 席绍松, 等. SOFA评分联合PCT检测对脓毒症患者病情及其预后的临床评估价值[J]. 中华全科医学, 2021, 19(3): 391-393. doi: 10.16766/j.cnki.issn.1674-4152.001818

    LIU B W, XU Y P, XI S S, et al. Clinical value of SOFA combined with procalcitonin test in assessing the condition and prognosis of patients with sepsis[J]. Chinese Journal of General Practice, 2021, 19(3): 391-393. doi: 10.16766/j.cnki.issn.1674-4152.001818
    [16]
    LI J B, WANG L J, ZHANG H, et al. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis[J]. J Intensive Care, 2023, 11(1): 29. doi: 10.1186/s40560-023-00674-3
    [17]
    苏小平, 徐静娟, 赵亚东, 等. 危重患者早期肠内营养喂养不耐受风险预测模型的构建[J]. 护理学报, 2022, 29(17): 47-51. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202217009.htm

    SU X P, XU J J, ZHAO Y D, et al. Construction of a prediction model for the risk of intolerance to early enteral nutrition feeding in critically ill patients[J]. Journal of Nursing, 2022, 29(17): 47-51. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202217009.htm
    [18]
    XIAO Y J, XU L. Prevalence and risk factors of enteral feeding intolerance in critically ill patients and the effectiveness of preventive treatments: a prospective study[J]. Saudi J Med Med Sci, 2023, 11(2): 135-142. doi: 10.4103/sjmms.sjmms_384_22
    [19]
    DICKERSON R N, FARRAR J E, BYERLY S, et al. Enteral feeding tolerance during pharmacologic neuromuscular blockade[J]. Nutr Clin Pract, 2023, 38(6): 1236-1246. doi: 10.1002/ncp.11045
    [20]
    范小宁, 孙盼盼, 靳玉萍, 等. 护士主导的肠内营养喂养策略在神经重症患者中的应用[J]. 中华全科医学, 2022, 20(12): 2151-2155. doi: 10.16766/j.cnki.issn.1674-4152.002791

    FAN X N, SUN P P, JIN Y P, et al. Application of nurse-led enteral nutritional feeding strategies in neurological intensive care unit patients[J]. Chinese Journal of General Practice, 2022, 20(12): 2151-2155. doi: 10.16766/j.cnki.issn.1674-4152.002791
    [21]
    HEYLAND D K, ORTIZ A, STOPPE C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database[J]. Crit Care Med, 2021, 49(1): 49-59.
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