目的:本研究旨在比较在COVID-19大流行期间,重症监护病房(ICU)中免疫功能低下和免疫功能正常的患者对肠内营养(EN)支持的反应不同,包括血清营养生物标志物,炎症生物标志物,胃肠道(GI)不耐受症状,和临床结果。
方法:观察性,在中国西南一家教学医院的ICU中进行了回顾性研究。我们在2022年12月至2023年2月之间招募了154名患者的便利样本。我们将免疫功能低下定义为原发性免疫缺陷疾病,活动性恶性肿瘤,接受癌症化疗,HIV感染,实体器官移植,造血干细胞移植,接受目标剂量的皮质类固醇治疗,接受生物免疫调节剂,或接受改善疾病的抗风湿药物或其他免疫抑制药物。我们进行了Mann-WhitneyU测试,χ2检验,或广义估计方程模型来探索免疫功能低下患者和免疫功能低下患者之间的差异。
结果:在154名研究参与者中,41(27%)被定义为免疫功能低下。免疫功能低下的患者比免疫功能正常的患者年轻。在血清营养生物标志物方面,两组之间没有统计学上的显着差异。炎症生物标志物,胃肠道不耐受症状的发生率,和住院死亡率。然而,免疫功能低下的患者比免疫功能正常的患者住院时间更长.
结论:我们发现免疫功能低下的患者在医院待的时间更长。这些发现可能有助于我们在EN介入研究之前更好地标准化参与者,并根据患者的免疫状况更好地个性化EN支持。
OBJECTIVE: This
study aimed to compare how immunocompromised and immunocompetent patients responded differently to enteral nutrition (EN) support in intensive care units (ICUs) during the COVID-19 pandemic, including serum nutritional biomarkers, inflammatory biomarkers, gastrointestinal (GI) intolerance symptoms, and clinical outcomes.
METHODS: An observational, retrospective
study was conducted in the ICUs of a teaching hospital in southwest China. We recruited a convenience sample of 154 patients between December 2022 and February 2023. We defined immunocompromise as primary immunodeficiency diseases, active malignancy, receiving cancer chemotherapy, HIV infection, solid organ transplantation, hematopoietic stem cell transplantation, receiving corticosteroid therapy with a target dose, receiving biological immune modulators, or receiving disease-modifying antirheumatic drugs or other immunosuppressive drugs. We conducted a Mann-Whitney U test, χ2 test, or generalized estimation equation model to explore the differences between immunocompromised and immunocompetent patients.
RESULTS: Among the 154
study participants, 41 (27%) were defined as immunocompromised. The immunocompromised patients were younger than the immunocompetent patients. There were no statistically significant differences between the two groups with respect to serum nutritional biomarkers, inflammatory biomarkers, incidence of GI intolerance symptoms, and in-hospital mortality. However, the immunocompromised patients exhibited a longer hospitalization duration than the immunocompetent patients.
CONCLUSIONS: We found that the immunocompromised patients spent more time in the hospital. These findings may help us to standardize the participants before EN interventional studies better and better individualize EN supports based on patients\' immunity status.