Objective  To explore the risk factors for malnutrition (MN) in elderly patients with long-term bed and to construct a risk prediction model for MN.

Methods  Elderly patients with long-term bed admitted to the Department of Geriatrics of the Fourth People's Hospital of Yaan from January 2016 to January 2024 were retrospectively selected, and their clinical data were collected. The elderly patients with long-term bed were randomly divided into training set and validation set, according to the ratio of 7∶3. The patients were divided into MN group and non-MN group according to whether MN occurred. In the training set, the differences in clinical data between the groups were compared by univariate analysis (t-test, chi-square test or Fisher's exact test), and the risk factors for MN in patients were analyzed by stepwise multivariate Logistic regression, and a risk prediction model was constructed. The predictive efficiency of the risk prediction model was evaluated and verified by the receiver operating characteristic curve (ROC) and ROC area under curve (AUC), calibration curve and decision curve.

Results  A total of 896 elderly patients with long-term bed were included, and the incidence of MN was 46.43%. There were 627 cases in the training set and 269 cases in the validation set. Multivariate Logistic regression analysis showed that long bed rest time [OR=1.259, 95%CI (1.197, 1.324)], stroke [OR=2.866, 95%CI (1.621, 5.067)], and anemia [OR=2.479, 95%CI (1.162, 5.288)] were risk factors for MN in elderly patients with long-term bed, and high Barthel index score [OR=0.921, 95%CI (0.905, 0.938)] was a protective factor (P<0.05). The MN risk prediction model had high predictive efficiency, with AUC (95%CI) of 0.955 (0.939, 0.970) and 0.952 (0.934, 0.971) in the training set and validation set, respectively. In the training set and the validation set, the calibration curve showed that the "predicted MN probability" and "actual MN probability" of the MN risk prediction model were highly consistent; the decision curve showed that the MN risk prediction model could bring clinical benefits within a certain risk threshold range.

Conclusion  In clinical practice, elderly patients with long-term bed who are bedridden for a long time, have stroke or anemia, and have poor daily living ability should be pay more atlentron for the MN risk. The MN risk prediction model constructed in this study can provide a certain reference for identifying the high-risk MN population in elderly patients with long-term bed.

1.李雪芹, 陈崇诚, 罗燕, 等. 慢性肾脏病住院患者营养不良的危险因素分析和预测模型构建[J]. 华西医学, 2023, 38(7): 1014-1020. [Li XQ, Chen CC, Luo Y, et al. Risk factors analysis and predictive model construction for malnutrition in hospitalized patients with chronic kidney disease[J]. West China Medical Journal, 2023, 38(7): 1014-1020.] DOI: 10.7507/1002-0179.202212048.

2.谢灵灵, 罗小珍, 吴驭, 等. 进展期非小细胞肺癌患者营养不良的现状及相关因素分析[J]. 华西医学, 2023, 38(9): 1354-1359. [Xie LL, Luo XZ, Wu Y, et al. The current status and related factors of malnutrition in patients with advanced non-small cell lung cancer[J]. West China Medical Journal, 2023, 38(9): 1354-1359.] DOI: 10.7507/1002-0179.202304059.

3.李君卓, 杨雯, 刘光维, 等. 老年重症脑卒中患者营养不良风险列线图预测模型的构建及验证[J]. 中国医药导报, 2023, 20(5): 28-32. [Li JZ, Yang W, Liu GW, et  al. Construction and verification of a prediction model for malnutrition risk in senile patients with severe cerebral apoplexy[J]. China Medical Herald , 2023, 20(5): 28-32.] DOI: 10.20047/j.issn1673-7210.2023.05.06.

4.滕蛟, 吴瑞乔. 老年胃肠道肿瘤病人术前营养支持治疗研究进展[J]. 安徽医药, 2022, 26(11): 2182-2186. [Teng J, Wu RQ. Research progress on preoperative nutritional support therapy for elderly patients with gastrointestinal tumors[J]. Anhui Medical and Pharmaceutical Journal, 2022, 26(11): 2182-2186.] DOI: 10.3969/j.issn.1009-6469.2022.11.015.

5.Shaw AC，Goldstein DR，Montgomery RR. Age-dependent dysregulation of innate immunity[J]. Nat Rev Immunol, 2013, 13(12): 875-887. DOI: 10.1038/nri3547.

6.邵春海, 冯学山, 刘景芳. 住院老年病人营养不良状况及其影响因素分析[J]. 中国老年学杂志, 2008, (22): 2260-2261. [Shao CH, Feng XS, Liu JF. Analysis of malnutrition status and influencing factors in hospitalized elderly patients[J]. Chinese Journal of Gerontology, 2008, (22): 2260-2261.] DOI: 10.3969/j.issn.1005-9202. 2008.22.032.

7.王艳, 陈慧敏, 袁芳, 等. 营养相关指标对老年患者压疮发生率的影响[J]. 护理学杂志, 2011, 26(7): 1-4.[Wang Y, Chen HM, Yuan F, et al. Effects of nutrition-related factors and indicators on incidence of pressure ulcer in elderly patients[J]. Journal of Nursing Science, 2011, 26(7): 1-4.] DOI: 10.3870/hlxzz.2011.07.001.

8.Kaegi-braun N, Baumgartner A, Gomes F, et al. "Evidence-based medical nutrition-a difficult journey, but worth the effort!"[J]. Clin Nutr, 2020, 39(10): 3014-3018.DOI: 10.1016/j.clnu.2020.01.023.

9.努尔比亚木·艾合提, 石芳, 许明, 等. 老年心血管疾病病人衰弱与抑郁的相关性研究进展[J]. 护理研究, 2023, 37(19): 3487-3491. [Nurbiamu Aiheti, Shi F, Xu M, et al. Research progress on correlation between frailty and depression in elderly patients with cardiovascular diseases[J]. Chinese Nursing Research, 2023, 37(19): 3487-3491.]DOI: 10.12102/j.issn.1009-6493.2023. 19.012.

10.Chen X, Yang K, Yang J, et al. Meta-analysis of efficacy of Sijunzi decoction combined with enteral nutrition for the treatment of gastric cancer[J]. Nutr Cancer, 2020, 72(5): 723-733. DOI: 10.1080/01635581.2019.1653470.

11.刘爱平, 黄鹏, 张慧敏, 等. 不同营养评估法在老年长期卧床患者预后评价中的应用[J]. 河北医药, 2024, 46(4): 578-580, 584. [Liu AP, Huang P, Zhang HM, et al. Comparison of two different nutritional assessment methods in evaluating the prognosis of elderly patients with long-term bed rest[J]. Hebei Medical Journal, 2024, 46(4): 578-580, 584.] DOI: 10.3969/j.issn.1002-7386.2024.04.022.

12.Zhang KP, Tang M, Fu ZM, et al. Global leadership initiative on malnutrition criteria as a nutrition assessment tool for patients with cancer[J]. Nutrition, 2021, 91-92: 111379. DOI: 10.1016/j.nut.2021.111379.

13.郝珂, 程宝莉. 围术期肠功能保护策略研究进展[J]. 协和医学杂志, 2023, 14(5): 1067-1071. [Hao K, Cheng BL. Research progress of perioperative intestinal function protection strategies[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(5): 1067-1071.] DOI: 10.12290/xhyxzz.2023-0113.

14.刘金枚, 张坤, 彭杨, 等. 医养结合机构老年人营养不良预测模型的构建及验证[J]. 护理研究, 2023, 37(18): 3254-3260. [Liu JM, Zhang K, Peng Y, et al. Development and verification of prediction model of malnutrition among elderly in medical-nursing combined institutions[J]. Chinese Nursing Research, 2023, 37(18): 3254-3260.] DOI: 10.12102/j.issn.1009-6493.2023.18.005.

15.刘霞, 郭丝雨, 张紫薇. 长期卧床老年病人并发肺炎的危险因素及Nomogram预测模型构建[J]. 护理研究, 2023, 37(16): 2909-2914. [Liu X, Guo SY, Zhang ZW. Risk factors and Nomogram prediction model construction for complications of pneumonia in long-term bedridden elderly patients[J]. Chinese Nursing Research, 2023, 37(16): 2909-291.] DOI: 10.12102/j.issn.1009-6493. 2023.16.009.

16.李骏然, 梁卫东, 翟婧秀, 等. 牵引床辅助直接前侧入路股骨头置换术治疗老年股骨颈骨折的疗效 [J]. 实用医学杂志, 2023, 39(24): 3222-3226. [Li JR, Liang WD, Zhai JX, et al. Efficacy and safety offemoral head replacement through the direct anterior approach assisting by the traction tablefor femoral neck fracture in the elderly[J]. The Journal of Practical Medicine, 2023, 39(24): 3222-3226.] DOI: 10.3969/j.issn.1006-5725.2023. 24.013.

17.马骁,石海燕,王湘,等. 电磁导航床旁鼻肠管置管技术在老年卧床患者中的应用[J].中华护理杂志, 2024, 59(1):70-76.[Ma X, Shi HY, Wang X, et al. Application of electromagnetic navigation bedside nasointestinal catheterization technology in elderly bedridden patients[J] Chinese Journal of Nursing, 2024, 59 (1): 70-76.] DOI: 10.3761/j.issn.0254-1769.2024.01.010.

18.Sabbouh T, Torbey MT. Malnutrition in stroke patients: risk factors, assessment, and management[J]. Neurocrit Care, 2018, 29(3): 374-384. DOI: 10.1007/s12028-017-0436-1.

19.虞妹, 沙薇, 钱丹. 时间康复干预对脑卒中后吞咽障碍患者的影响[J]. 齐鲁护理杂志, 2024, 30(3): 17-20. [Yu M, Sha W, Qian D. Efficacy evaluation of temporal rehabilitation intervention on patients with dysphagia after stroke[J]. Journal of Qilu Nursing 2024, 30(3): 17-20.] DOI: 10.3969/j.issn.1006-7256.2024.03.005.

20.Emiroglu C, Görpelioglu S, Aypak C. The relationship between nutritional status, anemia and other vitamin deficiencies in the elderly receiving home care[J]. J Nutr Health Aging, 2019, 23(7): 677-682. DOI: 10.1007/s12603-019-1215-9.

21.李花, 田苗, 许济, 等. 解郁方联合调神养心针对脑卒中后抑郁患者临床症状及脑神经功能的改善作用[J]. 中国中医基础医学杂志, 2021, 27(6): 995-998, 1007. [Li H, Tian M, Xu J, et al. Improvement of clinical symptoms and brain nerve function of patients with post-stroke depression by combining Jieyu recipe with regulating shen and nourishing heart[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2021, 27(6): 995-998,1007.] DOI: 10.19945/j.cnki.issn.1006-3250.2021.06.026.

22.袁敏, 黄雅芳, 郝立晓, 等. 北京市养老机构老年人营养状况调查及其影响因素研究[J]. 中国全科医学, 2020, 23(24): 3075-3080. [Yuan M, Huang YF, Hao LX, et al. Investigation on the nutritional status of the elderly in some nursing home and its influencing factors in Beijing[J]. Chinese General Practice, 2020, 23(24): 3075-3080.] DOI: 10.12114/j.issn.1007-9572.2020.00.118.