The Application Of Nutritional Risk Screening In The Diagnosis And Treatment Of TB And Its Association With The Outcome Of Anti-TB Treatment

Objective:Nutritional risk refers to the risk of adverse impact on clinical outcomes caused by nutritional factors.Nutritional risk is different from malnutrition and the risk of malnutrition.Nutritional risk screening,malnutrition assessment and nutritional support for patients can improve their clinical outcomes.In recent years,nutritional risk screening has been widely used in the diagnosis and treatment of various diseases,such as digestive diseases,malignant tumors,and respiratory diseases.However,it has not been included or standardized applied in the diagnosis and treatment of tuberculosis(TB).TB is a chronic infectious disease associated with malnutrition.Malnutrition can exacerbate TB and result in adverse clinical outcomes.The purpose of this study was to carry out nutritional risk screening in TB patients and evaluate the effect of high risk on treatment or clinical outcome.This study also aimed to provide reference for the standardized application of nutritional risk screening in the diagnosis and treatment of TB patients.Methods:In this study,804 inpatients with pulmonary tuberculosis(PTB)were enrolled in a chest hospital in Shandong Province from January 2019 to June 2021.The NRS 2002 was used for nutritional risk screening.The NRS 2002 score of three and more points was defined as high nutritional risk and less than three points was defined as low nutritional risk.Basic information,clinical characteristics and dietary intakes of subjects were collected to analyze the association of nutritional risk with clinical symptoms and dietary intakes.484 PTB patients were followed up for two months.They were divided into low-risk group and high-risk group.Clinical symptoms,imaging information,gastrointestinal adverse reaction and psychological status of subjects were collected before treatment,after one-month treatment and after two-months treatment.Height and weight were measured to calculate BMI.Serum glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,alkaline phosphatase,gamma glutamyl transferase and total bilirubin were determined to evaluate the liver function.Follow-up analysis was performed on high-risk patients before anti-tuberculosis treatment to evaluate treatment outcomes or clinical outcomes during intensive therapy,such as TB score,symptoms and signs,imaging manifestations,gastrointestinal adverse reactions,liver dysfunction,and psychological status.Results:Among the 804 PTB patients,59.1% were with high nutritional risk.The elderly(aged 65 and above)accounted for 17.7% and were 9.5% higher than the patients with low nutritional risk.The correlation analysis between clinical symptoms and nutritional risk score showed that the number of lung segments with lesion(r = 0.185,P < 0.001)and TB score(r = 0.397,P < 0.001)were positively correlated with nutritional risk score.Nutritional risk score was closely related to dietary nutritional status.The intake of cereals and potatoes,poultry and livestock meat,fish,shrimp and aquatic products,vegetables and fruits were negatively correlated with nutritional risk score(P < 0.05).The two-month follow-up of 484 TB patients showed that the average TB score of patients in the high-risk group before treatment,after one-month treatment and twomonths treatment were 2.93,1.77,1.53,respectively,higher than that in the low-risk group(P < 0.001).The average number of lung segments with lesion in the patients of high-risk group before treatment,after one-month treatment and two-months treatment were 3.47,3.48,and 3.38,respectively,higher than that in patients of low-risk group(P =0.019).The risk of increased TB score and increased number of lung segments with lesion in the high-risk group were 2.128 times(95% CI: 1.700-2.665)and 1.703 times(95% CI:1.090-2.661)higher than that in the low-risk group.The incidence of gastrointestinal adverse reactions and adverse psychological status in high-risk group were significantly higher than that in low-risk group,and the OR(95% CI)values were 1.588(1.126,2.241)and 1.505(1.126,2.011),respectively.There was no statistical difference in the risk of liver abnormalities between the high-risk group and the low-risk group,while the highrisk group had 66.2 times higher risk of alkaline phosphatase elevation than the low-risk group(P = 0.041).Conclusion:More than 50% of PTB patients were found to have high nutritional risk through the NRS 2002 nutritional risk screening.During intensive treatment,the risks of increased TB score,imaging lesion,gastrointestinal adverse reactions and adverse psychological conditions were higher in the high-risk group than the low-risk group.It is recommended that the nutritional risk screening should be included in tuberculosis diagnosis,treatment and health management as soon as possible.Nutritional risk screening for tuberculosis patients before treatment can quickly identify patients with nutritional risk,and effectively improve the clinical treatment outcome and promote the recovery of patients through personalized nutritional support or comprehensive intervention.