当院入院患者におけるNST 紹介の時期と退院時転帰との関連

　Objective: It has been widely accepted that malnutrition is a prognostic factor for a
disease. The patients with malnutrition should be referred to nutrition support team（NST）as soon
as possible. However, few reports about the relationship of the timing of NST referral and disease
outcome have been published. Here, we retrospectively examined the association between the timing of
NST referral and disease outcome.
Methods: One hundred and thirty-nine patients aged 20 and more, referred to NST at Shimane
University Hospital between 2012 and 2014 were included in this study. The study population was
divided into 2 groups, survived（n＝105）and deceased（n＝34）. The disease background, laboratory
data, and the factors regarding hospitalization and NST were compared between the 2 groups.
Results: Although the duration of hospitalization did not show any statistical difference between
the 2 groups, the duration from admission to NST referral was significantly shorter in survived group.
Serum albumin level was gradually decreased in deceased group, which was significantly recovered in
survived group. Simple regression analysis demonstrated that the change of serum albumin level was
inversely associated with the change of serum C-reactive protein after NST referral. The patients who
were referred to NST within 10-30 days of admission, or the serum albumin level was 2.5 g/dL or
greater at referral showed better outcome.
Conclusion: Our results suggest that the timing of referral to NST along with the nutritional status
of the patients during referral is associated with the disease outcome. We propose that regular check-up
of nutritional status by co-medical staff may lead to early NST referral and better outcome in patients
with malnutrition.

目的：低栄養が予後不良因子であることは広く認知され、低栄養患者はできるだけ早
期に栄養サポートチーム（NST）へ紹介することが勧められている。しかし、NST紹介の時期が
患者の転帰と関連するという報告は少ない。そこでわれわれは、NST紹介時期と転帰との関連に
ついて後方視的に分析した。
方法：2012 ～2014 年度のNST紹介患者のうち、満20 歳以上の139 症例を軽快退院群105 例、死
亡退院群34 例に分け、患者背景、臨床検査値、入退院およびNSTに関する項目を比較した。
結果：両群間において、入院日数には有意差を認めなかったが、入院からNST紹介までの日数
は軽快退院群で有意に短かった。血清アルブミン値は死亡退院群で経時的に低下したのに対し、軽快退院群ではNST紹介後有意に改善した。単相関では、紹介後の血清アルブミン値の変化量は
C-reactive proteinの変化量と負の相関を示した。入院から紹介までの日数が10 日～30 日以内また
は紹介時の血清アルブミン値が2.5g/dL 以上では退院時転帰が比較的良好であった。
結論：NST紹介時期および紹介時とその後の患者の栄養状態は、退院時転帰と相関することが
示された。多職種による定期的な栄養評価により、低栄養患者の早期からのNST紹介や良好な転
帰に繋がることが望まれる。