Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy

지속적 신대체요법을 받은 중환자에서 영양공급이 임상결과와 영양상태에 미치는 영향

  • Kim, Ju Yeun (Department of Clinical Nutrition, The Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Kim, Ji-Myung (Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University) ;
  • Kim, Yuri (Department of Clinical Nutrition, The Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 김주연 (이화여자대학교 임상보건과학대학원) ;
  • 김지명 (신한대학교 식품조리과학부 식품영양전공) ;
  • 김유리 (이화여자대학교 임상보건과학대학원)
  • Received : 2015.02.23
  • Accepted : 2015.06.01
  • Published : 2015.06.30
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Abstract

Purpose: This study was designed to investigate whether nutritional supply influences biochemical markers and clinical outcomes in patients who received continuous renal replacement therapy (CRRT) by evaluating adequacy of nutritional supply for patients. Methods: From January 2012 to December 2013, 239 adult patients who received CRRT in the intensive care unit for more than 3 days were included. General information from electronic medical records and nutritional status related biochemical data and clinical outcomes on the first day of CRRT and 2 weeks after CRRT were collected. Results: The rate of delivered energy and protein was 68.06% and 43.13% which was much lower than energy and protein supply based on their requirement. When the patients were divided into two groups according to 70% of energy received rate and 50% of protein received rate, the group with more than 70% of energy received rate showed significant decrease of length of hospital stay (p = 0.007), length of stay in intensive care unit (ICU) (p = 0.008), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) compared to less than 70% of energy received rate after adjusting for age. In addition, the group with more than 50% of protein received rate showed decreased mortality (p = 0.031), length of hospital stay (p = 0.008), length of ICU stay (p = 0.035), duration of CRRT (p < 0.001), and APACHE II score (p < 0.001) after adjusting for age. We found that the level of hematocrit (p = 0.006) was significantly improved in the group with more than 70% of energy received rate, and the level of TLC (p = 0.049), hematocrit (p = 0.041) was significantly improved in the group with more than 50% of protein received rate. We also found that energy delivery was negatively correlated with length of stay in ICU (p = 0.049) and positively correlated with level of calcium (p = 0.037). In addition, protein delivery was correlated with the levels of serum total protein (p = 0.021), serum albumin (p = 0.048), hematocrit (p = 0.009), and total cholesterol (p = 0.021) when dead patients were included, but was correlated with the levels of hematocrit (p = 0.034) and calcium (p = 0.024) when dead patients were excluded. Conclusion: Proper nutritional delivery may help patients' clinical outcomes for patients receiving CRRT. However, their actual intakes of energy and protein were not adequate for their requirements. Identification of patients with malnutrition is necessary and a multidisciplinary approach for systemic management is also required.

본 연구는 지속적 신대체요법을 받은 급성 신손상 환자 239명을 대상으로 영양공급 충족률이 환자의 임상적인 결과에 미치는 영향을 알아보고자 수행하였으며 대상자의 영양요구량 및 실제공급량을 조사하여 영양공급 충족률에 따른 임상결과를 비교하였다. 대상자의 평균 에너지 충족률이 68.06%, 평균 단백질 충족률이 43.13%로 나타났고 체중 당 에너지 공급량은 16.62 kcal/kg/일, 단백질 공급량은 0.63 g/kg/일로 지침에서 권장하는 요구량에 미치지 못하는 수준이었다. 에너지 충족률 70%, 단백질 충족률 50% 기준으로 두 군간 임상결과의 차이를 관찰한 결과 에너지 충족률이 높은 군에서 총 재원일수, 중환자실 재원일수와 지속적 신대체요법 적용일수, APACHE II score가 유의하게 감소하는 것으로 분석되었고 단백질 충족률이 높은 군에서는 총 재원일수, 중환자실 재원일수, 지속적 신대체요법 적용일수, APACHE II score 이외에 사망률도 유의하게 감소한 것으로 분석되었다. 생화학적 검사 결과의 경우 에너지 충족률 70% 이상 충족군에서는 헤마토크릿 수치가, 단백질 충족률 50% 이상 충족군에서는 총 임파구수, 헤마토크릿 수치가 유의하게 개선된 것으로 나타났다. 사망환자를 제외하고 영양공급량과 임상결과를 나타내는 항목의 상관관계를 분석한 결과 에너지 공급량과 중환자실 재원일수가 의미 있는 음의 상관관계를 가지는 것으로 나타났으며 영양공급량과 생화학적 검사 결과의 상관관계를 파악한 결과 에너지 공급량에 따라서는 유의한 상관계수가 도출되지 않았고 단백질 공급량과는 따라서는 헤마토크릿과 칼슘이 유의한 양의 상관관계를 가지는 것으로 나타났다. 본 연구 결과 영양공급 충족률이 높은 군에서 임상적인 결과 및 영양상태와 관련한 생화학적 검사결과가 개선되는 것으로 나타나 요구량에 적정한 영양공급이 환자의 치료에 긍정적인 영향을 준다는 것을 확인할 수 있었다. 이를 위해서 의료진의 타당한 영양처방이 중요하겠으며 영양지원의 체계적인 관리를 위해 다학제적인 접근과 함께 영양공급의 적정성을 지속적으로 모니터링하는 것이 중요하겠다.

Keywords

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