肺炎住院学龄儿童营养情况与再入院风险的关系研究

Study on the relationship between nutritional status and readmission risk among children of school age hospitalized with pneumonia

摘要:

目的探讨肺炎住院学龄儿童营养情况对出院后再入院风险的影响程度。 方法按纳入排除标准，通过本院电子病案系统获取上海市儿童医院2017—2024年社区获得性肺炎首次住院的8 817例6~18岁学龄儿童的数据、住院身高、体质量体检数据以及出院后再入院的情况数据。经Excel编制WS/T 456、WS/T 586营养筛查模板，基于体质量指数(body mass index, BMI)对学龄儿童的营养情况进行分级，使用SPSS对营养筛查结果的分布进行描述和分层分析，建立多因素COX回归对营养情况与轻症、重症肺炎出院后1年内和30 d内累积再入院率的关联及强度进行分析，控制性别、年龄、地区等混杂，计算调整RR值。分析学龄儿童的消瘦、超重肥胖等营养情况、出院后再入院事件发生情况及距前次出院间隔的时间，建立营养情况与肺炎出院后再入院率的关系。 结果肺炎首次住院学龄儿童平均年龄(8.47±2.02)岁，营养正常者占61.4%、消瘦者占16.7%、超重肥胖者占21.9%，轻症肺炎者占83.6%、重症肺炎者占16.4%。在首次住院为重症肺炎的学龄儿童中，消瘦、超重肥胖组出院后1年内再入院率分别为9.6%、10.1%，高于营养正常组的5.4%；超重肥胖组的30 d内再入院率为5.1%，高于营养正常组的2.6%。控制性别、年龄、居住地区的COX回归结果显示，相对于营养正常组，消瘦、超重肥胖导致1年内再入院风险的调整RR值分别为1.777、1.966，超重肥胖导致30 d内再入院风险的RR值为2.052，差异均有统计学意义(P<0.05)。 结论相对于营养正常学龄儿童，消瘦、超重肥胖与重症肺炎住院学龄儿童出院后再入院率的升高有关，建议加强学龄儿童营养筛查，普及肺炎住院学龄儿童营养筛查，重点关注消瘦、超重肥胖学龄儿童，改善膳食模式和生活行为方式，加强营养干预，鼓励接种流感疫苗。

Abstract:

ObjectiveTo explore the impact of nutritional status on the risk of readmission among hospitalized children with pneumonia after discharge and to propose countermeasures and recommendations. MethodsA total of 8 817 children aged 6-18 years who were first hospitalized for community-acquired pneumonia from 2017 to 2024 at Shanghai Childrens Hospital were enrolled according to the inclusion and exclusion criteria in this study. Data on pneumonia hospitalizations, height, weight, and readmission status after discharge were retrieved from the hospitals electronic medical record system. Nutritional status was classified based on body mass index(BMI) using the WS/T 456 and WS/T 586 nutritional screening templates compiled in Excel. The SPSS was used to describe and stratify the distribution of nutritional screening results. A multivariate COX regression model was employed to analyze the association and strength between nutritional status and cumulative readmission rates within one year or 30 days after discharge for both mild and severe pneumonia, controlling for confounding factors such as gender, age, and region. ResultsThe average age of children first hospitalized for pneumonia was (8.47±2.02) years. The nutritional status distribution was as follows: 61.4% normal, 16.7% wasted, and 21.9% overweight or obese. Mild pneumonia accounted for 83.6% of cases, while severe pneumonia accounted for 16.4%. Among children hospitalized for severe pneumonia for the first time, the one-year readmission rates was 9.6% and 10.1% in the wasting and overweight/obesity groups respectively, significantly higher than the 5.4% in the normal nutrition group. The 30-day readmission rate in the overweight/obesity group(5.1%) was also notably higher than the 2.6% observed in the normal nutrition group. After controlled for gender, age and residential area, the COX regression analysis revealed that the adjusted risk ratios(RR) for one-year readmission were 1.777 for wasting and 1.966 for overweight/obesity children when compared to that in the normal nutrition group. The RR for 30-day readmission in the overweight/obesity group was 2.052. All these differences demonstrated statistical significance(all P<0.05). ConclusionCompared to children with normal nutrition, wasting and overweight/obesity are associated with an increased readmission rate after pneumonia discharge. It is recommended to strengthen nutritional screening for children, promote nutritional screening for hospitalized pneumonia children, enhance nutritional interventions, encourage influenza vaccination, and focus on improving dietary patterns and lifestyle behaviors, particularly for wasted and overweight/obese children.