Occurrence and risk prediction of cholestasis in elderly patients after jejunal tube feeding

doi:10.3877/cma.j.issn.2095-7157.2023.01.008

Abstract

Abstract:

Objective

To analyze the incidence, occurrence time and risk factors of cholestasis in the elderly patients after long-term jejunal feeding, and to construct a risk prediction model for cholestasis in the elderly patients after long-term jejunal feeding.

Methods

Clinical data of 84 the elderly patients over 65 years of age who were hospitalized in the Second Medical Center of PLA General Hospital from July 2019 to July 2022 and underwent jejunal nutrition tube insertion more than 2 weeks after surgery were retrospectively collected. The patients were divided into two groups according to whether cholestasis occurred. The incidence of cholestasis was analyzed. In addition, univariate and multivariate analysis of related risk factors was carried out to construct the corresponding risk prediction model, and the prediction performance and clinical applicability of the model were further evaluated.

Results

A total of 84 patients were included in the study, of which 38 patients developed cholestasis, with an incidence rate of 45.2%. The median time of tube feeding was 556.5 days. Multivariate analysis showed that: Uric acid, endotracheal intubation, history of heart failure, history of Alzheimer′s disease and history of diabetes were independent risk factors for cholestasis in the elderly patients after long-term feeding in jejunal tubes. The concordance index of COX risk prediction model established based on the above risk factors was 0.78. The Calibration curve and decision curve analysis showed that the model had good predictive performance and clinical applicability.

Conclusion

The elderly patients are prone to cholestasis after jejunal tube feeding for a long time. Uric acid, tracheal intubation, history of heart failure, history of Alzheimer′s disease and history of diabetes are independent risk factors for cholestasis after jejunal tube feeding for a long time.

Key words: Tube feeding, Elderly, Cholestasis, Risk factors, Risk prediction model

Panpan Zhang, Mingsheng Gao, Nandi Bao, Hui Shi, Qing Chang, Yuan Gong, Wenhui Liu, Tingting Li, Shiping Xu. Occurrence and risk prediction of cholestasis in elderly patients after jejunal tube feeding[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(01): 20-26.

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Figures/Tables 6

References 29

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项目	淤胆组(n＝38)	未淤胆组(n＝46)	P值
年龄(岁)	92.4±5.4	91.5±5.9	0.469
血红蛋白(g/L)	121.0±16.8	120.4±18.0	0.861
白细胞(10⁹/L)	8.9(6.2~11.2)	9.1(7.7~11.0)	0.376
中性粒细胞(%)	0.8(0.7~0.8)	0.8(0.7~0.8)	0.993
C反应蛋白(mg/ml)	1.7(0.3~5.0)	2.1(0.6~5.3)	0.506
总胆固醇(mmol/L)	3.3(2.9~3.3)	3.5(2.8~3.8)	0.907
甘油三脂(mmol/L)	1.1(0.8~1.5)	1.0(0.8~1.4)	0.497
高密度脂蛋白胆固醇(mmol/L)	1.1(0.8~1.3)	1.1(0.9~1.4)	0.456
低密度脂蛋白胆固醇(mmol/L)	2.1(1.6~2.6)	2.1(1.6~2.5)	0.911
血糖(mmol/L)	6.0(5.3~7.5)	6.1(5.1~8.1)	0.716
白蛋白(g/L)	35.7(32.0~38.2)	35.0(31.3~38.1)	0.574
尿素(mmol/L)	8.4(5.5~11.5)	8.3(6.2~11.0)	0.801
肌酐(μmol/L)	83.0(64.0~102.8)	81.0(72.8~118.3)	0.269
尿酸(μmol/L)	308.0±121.9	283.8±133.0	0.391
总胆红素(μmol/L)	8.5(6.2~11.0)	8.5(6.5~13.5)	0.798
直接胆红素(μmol/L)	3.7(3.4~4.8)	4.1(3.1~6.1)	0.605
谷丙转氨酶(U/L)	15.1(9.9~25.3)	12.0(7.9~17.8)	0.194
谷草转氨酶(U/L)	19.1(14.6~26.3)	17.1(13.8~23.3)	0.295
乳酸脱氢酶(U/L)	163.0(138.5~216.5)	184.0(153.3~213.3)	0.345
碱性磷酸酶(U/L)	68.0(49.3~77.3)	65.0(53.0~78.0)	0.794
谷氨酰转移酶(U/L)	30.0(20.0~44.0)	24.0(16.0~39.0)	0.180
淀粉酶(U/L)	51.0(37.0~68.0)	51.0(39.3~76.3)	0.669
脂肪酶(U/L)	29.6(18.2~51.4)	29.3(18.2~49.6)	0.699
脑利钠肽(pg/ml)	756.5(457.2~1164.0)	655.1(248.0~1206.6)	0.419
随访时间(d)	556.5(257.8~1064.5)	567.5(176.5~1118.0)	0.903
气管插管术	5(13.2)	7(15.2)	0.789
肺部感染	33(86.8)	37(80.4)	0.433
高血压病史	27(75.0)	32(69.6)	0.587
心衰病史	6(15.8)	4(8.7)	0.318
心梗病史	8(21.1)	6(13.0)	0.327
冠心病史	27(75.0)	25(54.3)	0.054
脑血管疾病	19(50.0)	22(50.4)	0.691
阿尔茨海默病史	13(34.2)	21(45.7)	0.288
糖尿病史	22(57.9)	15(37.6)	0.020^a
脂肪肝	16(42.1)	16(34.8)	0.492
肾功能不全	7(18.4)	11(23.9)	0.541
高脂血症	8(21.1)	9(19.6)	0.866

项目	淤胆组(n＝38)	未淤胆组(n＝46)	P值
年龄(岁)	92.4±5.4	91.5±5.9	0.469
血红蛋白(g/L)	121.0±16.8	120.4±18.0	0.861
白细胞(10⁹/L)	8.9(6.2~11.2)	9.1(7.7~11.0)	0.376
中性粒细胞(%)	0.8(0.7~0.8)	0.8(0.7~0.8)	0.993
C反应蛋白(mg/ml)	1.7(0.3~5.0)	2.1(0.6~5.3)	0.506
总胆固醇(mmol/L)	3.3(2.9~3.3)	3.5(2.8~3.8)	0.907
甘油三脂(mmol/L)	1.1(0.8~1.5)	1.0(0.8~1.4)	0.497
高密度脂蛋白胆固醇(mmol/L)	1.1(0.8~1.3)	1.1(0.9~1.4)	0.456
低密度脂蛋白胆固醇(mmol/L)	2.1(1.6~2.6)	2.1(1.6~2.5)	0.911
血糖(mmol/L)	6.0(5.3~7.5)	6.1(5.1~8.1)	0.716
白蛋白(g/L)	35.7(32.0~38.2)	35.0(31.3~38.1)	0.574
尿素(mmol/L)	8.4(5.5~11.5)	8.3(6.2~11.0)	0.801
肌酐(μmol/L)	83.0(64.0~102.8)	81.0(72.8~118.3)	0.269
尿酸(μmol/L)	308.0±121.9	283.8±133.0	0.391
总胆红素(μmol/L)	8.5(6.2~11.0)	8.5(6.5~13.5)	0.798
直接胆红素(μmol/L)	3.7(3.4~4.8)	4.1(3.1~6.1)	0.605
谷丙转氨酶(U/L)	15.1(9.9~25.3)	12.0(7.9~17.8)	0.194
谷草转氨酶(U/L)	19.1(14.6~26.3)	17.1(13.8~23.3)	0.295
乳酸脱氢酶(U/L)	163.0(138.5~216.5)	184.0(153.3~213.3)	0.345
碱性磷酸酶(U/L)	68.0(49.3~77.3)	65.0(53.0~78.0)	0.794
谷氨酰转移酶(U/L)	30.0(20.0~44.0)	24.0(16.0~39.0)	0.180
淀粉酶(U/L)	51.0(37.0~68.0)	51.0(39.3~76.3)	0.669
脂肪酶(U/L)	29.6(18.2~51.4)	29.3(18.2~49.6)	0.699
脑利钠肽(pg/ml)	756.5(457.2~1164.0)	655.1(248.0~1206.6)	0.419
随访时间(d)	556.5(257.8~1064.5)	567.5(176.5~1118.0)	0.903
气管插管术	5(13.2)	7(15.2)	0.789
肺部感染	33(86.8)	37(80.4)	0.433
高血压病史	27(75.0)	32(69.6)	0.587
心衰病史	6(15.8)	4(8.7)	0.318
心梗病史	8(21.1)	6(13.0)	0.327
冠心病史	27(75.0)	25(54.3)	0.054
脑血管疾病	19(50.0)	22(50.4)	0.691
阿尔茨海默病史	13(34.2)	21(45.7)	0.288
糖尿病史	22(57.9)	15(37.6)	0.020^a
脂肪肝	16(42.1)	16(34.8)	0.492
肾功能不全	7(18.4)	11(23.9)	0.541
高脂血症	8(21.1)	9(19.6)	0.866

指标	HR	95%CI	P值
年龄(岁)	1.068	1.003~1.137	0.041^ab
血红蛋白(g/L)	1.002	0.985~1.020	0.821
白细胞(10⁹/L)	0.947	0.858~1.046	0.283
中性粒细胞(%)	0.539	0.045~6.389	0.624
C反应蛋白(mg/ml)	0.948	0.867~1.037	0.243
总胆固醇(mmol/L)	0.889	0.633~1.248	0.495
甘油三脂(mmol/L)	1.919	1.283~2.870	0.001^ab
高密度脂蛋白胆固醇(mmol/L)	0.342	0.130~0.905	0.031^ab
低密度脂蛋白胆固醇(mmol/L)	0.959	0.683~1.347	0.810
血糖(mmol/L)	0.976	0.848~1.124	0.740
白蛋白(g/L)	0.984	0.942~1.027	0.458
尿素(mmol/L)	1.066	1.011~1.123	0.017^ab
肌酐(μmol/L)	1.009	1.001~1.018	0.033^ab
尿酸(μmol/L)	1.005	1.003~1.008	0.000^ab
总胆红素(μmol/L)	0.971	0.899~1.049	0.453
直接胆红素(μmol/L)	1.050	0.912~1.209	0.499
谷丙转氨酶(U/L)	0.998	0.986~1.011	0.811
谷草转氨酶(U/L)	1.008	0.990~1.026	0.393
乳酸脱氢酶(U/L)	1.000	0.995~1.005	0.961
碱性磷酸酶(U/L)	0.995	0.984~1.007	0.415
谷氨酰转移酶(U/L)	0.993	0.978~1.009	0.408
淀粉酶(U/L)	1.003	0.994~1.013	0.472
脂肪酶(U/L)	1.002	0.997~1.007	0.475
脑利钠肽(pg/ml)	1.000	1.000~1.000	0.009^ab
气管插管术	0.378	0.128~1.117	0.078^a
肺部感染	1.204	0.468~3.095	0.700
高血压病史	1.749	0.841~3.637	0.135
心衰病史	4.694	1.820~12.106	0.001^ab
心梗病史	2.233	1.012~4.925	0.047^ab
冠心病病史	1.845	0.910~3.743	0.090^a
脑血管疾病	0.997	0.522~1.902	0.992
阿尔茨海默病史	0.561	0.284~1.107	0.096^a
糖尿病病史	1.767	0.920~3.396	0.088^a
脂肪肝	0.676	0.341~1.340	0.262
肾功能不全	1.292	0.562~2.971	0.546
高脂血症	0.950	0.433~2.084	0.898

指标	HR	95%CI	P值
年龄(岁)	1.068	1.003~1.137	0.041^ab
血红蛋白(g/L)	1.002	0.985~1.020	0.821
白细胞(10⁹/L)	0.947	0.858~1.046	0.283
中性粒细胞(%)	0.539	0.045~6.389	0.624
C反应蛋白(mg/ml)	0.948	0.867~1.037	0.243
总胆固醇(mmol/L)	0.889	0.633~1.248	0.495
甘油三脂(mmol/L)	1.919	1.283~2.870	0.001^ab
高密度脂蛋白胆固醇(mmol/L)	0.342	0.130~0.905	0.031^ab
低密度脂蛋白胆固醇(mmol/L)	0.959	0.683~1.347	0.810
血糖(mmol/L)	0.976	0.848~1.124	0.740
白蛋白(g/L)	0.984	0.942~1.027	0.458
尿素(mmol/L)	1.066	1.011~1.123	0.017^ab
肌酐(μmol/L)	1.009	1.001~1.018	0.033^ab
尿酸(μmol/L)	1.005	1.003~1.008	0.000^ab
总胆红素(μmol/L)	0.971	0.899~1.049	0.453
直接胆红素(μmol/L)	1.050	0.912~1.209	0.499
谷丙转氨酶(U/L)	0.998	0.986~1.011	0.811
谷草转氨酶(U/L)	1.008	0.990~1.026	0.393
乳酸脱氢酶(U/L)	1.000	0.995~1.005	0.961
碱性磷酸酶(U/L)	0.995	0.984~1.007	0.415
谷氨酰转移酶(U/L)	0.993	0.978~1.009	0.408
淀粉酶(U/L)	1.003	0.994~1.013	0.472
脂肪酶(U/L)	1.002	0.997~1.007	0.475
脑利钠肽(pg/ml)	1.000	1.000~1.000	0.009^ab
气管插管术	0.378	0.128~1.117	0.078^a
肺部感染	1.204	0.468~3.095	0.700
高血压病史	1.749	0.841~3.637	0.135
心衰病史	4.694	1.820~12.106	0.001^ab
心梗病史	2.233	1.012~4.925	0.047^ab
冠心病病史	1.845	0.910~3.743	0.090^a
脑血管疾病	0.997	0.522~1.902	0.992
阿尔茨海默病史	0.561	0.284~1.107	0.096^a
糖尿病病史	1.767	0.920~3.396	0.088^a
脂肪肝	0.676	0.341~1.340	0.262
肾功能不全	1.292	0.562~2.971	0.546
高脂血症	0.950	0.433~2.084	0.898

指标	HR	95%CI	P值
尿酸(μmol/L)	1.007	1.003~1.010	0.000^a
气管插管术	0.153	0.041~0.565	0.005^a
心衰病史	3.391	1.222~9.407	0.019^a
阿尔茨海默病史	0.477	0.229~0.993	0.048^a
糖尿病病史	3.085	1.479~6.436	0.003^a

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