中文摘要：

目的了解院内急性肾损伤（AKI）患者营养不良的情况；探讨主观综合性营养评估（SGA）分级与AKI患者预后的关系。方法前瞻性观察在复旦大学附属华山医院住院期间发生的AKI患者。在诊断AKI的24h内进行营养评估，包括SGA评分、人体学测量和血清学营养指标。主要终点事件为90d全因死亡。使用Cox回归模型校正混杂因素，分析SGA分级与AKI患者90d全因死亡率的关系，并用Kaplan—Meier曲线和log—rank检验进行90d生存分析。结果共170例AKI患者入选。院内AKI患者中，营养正常（SGA评分A级）、中度营养不良（SGA评分B级）和重度营养不良（SGA评分C级）患者的比例分别为25．3％、51-8％和22．9％。3组的90d全因死亡率分别为9．8％、34．9％和56．8％。经Cox回归模型校正混杂因素后，SGA评分差（B级和C级）患者的90d全因死亡的风险比（HR）为SGA评分A级的4．0倍（95％CI1．42～11．22，P=0．008）。Kaplan-Meier生存曲线显示SGA分级越差，累积生存率越低（log—rank检验，P〈0．01）。结论SGA评分是AKI患者全因死亡的独立危险因素。对AKI患者及时进行SGA营养评估有重要意义。

英文摘要：

Objective To elucidate the malnutrition in patients with hospital-acquired acute kidney injury （AKI）, and to examine the association between subjective global assessment （SGA） and prognosis. Methods Adult patients with hospital-acquired AKI were prospectively enrolled in this cohort study. Nutritional evaluations, including SGA, anthropometrie and serum nutritional markers were conducted at enrollment. Overall survival at 90 days among different SGA scores was analyzed using Kaplan-Meier methods, and differences were tested using the log-rank test. The Cox model was used to analyze the relationship between SGA scores and all-cause mortality after adjusting for confounders. Results A total of 170 patients were enrolled. The prevalence of moderate malnutrition （SGA B） and severe malnutrition （SGA C） was 51.8% and 22.9% respectively, while patients with normal nutrition （SGA A） accounted for 25.3%. After 90 days follow-up, all-cause mortality was 9.8% in SGA A group, 34.9% in SGA B group and 56.8% in SGA C group respectively. After adjusting for age, sex, dialysis, ventilation, hemoglobin, platelets and bilirubin,the hazard ratio （HR） of 90 days all-cause mortality was 4.0 （95% CI 1.42-11.22, P=O.O08） in malnutrition group （SGA B group and SGA C group） compared with SGA A group. The Kaplan-Meier curve also revealed that the worse the SGA score was, the lower the cumulative survival became （P〈0.01）. Conclusion SGA score is an independent risk factor for all-cause mortality within 90 days in patients with hospital-acquired acute kidney injury.