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Ashmore DL, Wilson T, Halliday V, Lee M. Malnutrition in emergency general surgery: a survey of National Emergency Laparotomy Audit Leads. J Hum Nutr Diet 2024; 37:663-672. [PMID: 38436051 DOI: 10.1111/jhn.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Patients who are malnourished and have emergency general surgery, such as a laparotomy, have worse outcomes than those who are not malnourished. It is paramount to identify these patients and minimise this risk. This study aimed to describe current practices in identifying malnutrition in patients undergoing a laparotomy, specifically focusing on screening, assessment, nutrition pathways and barriers encountered by clinicians. METHODS Following piloting and validity assessment, anaesthetic and surgical National Emergency Laparotomy Audit (NELA) Leads at hospitals across England and Wales were emailed an invitation to a survey. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional role were performed in SPSSv26. University of Sheffield ethical approval was obtained (UREC 046205). The results from the survey are reported according to the CHERRIES guidelines. RESULTS The survey was completed by 166/289 NELA Leads from 117/167 hospitals (57.4% and 70.1% response rates, respectively). Participants reported low rates of nutritional screening (42/166; 25.3%) and assessment (26/166; 15.7%) for malnutrition preoperatively. More than one third of respondents (40.1%) had no awareness of local screening tools; indeed, the Malnutrition Universal Screening Tool (MUST) was used by approximately half of respondents (56.6%). Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%; 122/166). Postoperative nutrition pathways were common (71.7%; 119/166). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support and ownership. Participants indicated nutrition risk is inadequately identified and is an important missing data item from NELA. There was no significant correlation with hospital laparotomy volume in relation to screening or assessment for malnutrition, the use of nutritional support pathways or organisational barriers. There was interprofessional agreement across a number of domains, although some differences did exist. CONCLUSIONS Wide variation exists in the current practice of identifying malnutrition risk in NELA patients. Barriers include a lack of time, knowledge and ownership. Nutrition pathways that encompass the preoperative phase and incorporation of nutrition data in NELA may support improvements in care.
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Affiliation(s)
- Daniel L Ashmore
- School of Medicine and Population Health, Faculty of Health, University of Sheffield, Sheffield, UK
- Department of General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Timothy Wilson
- Department of General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Vanessa Halliday
- School of Medicine and Population Health, Faculty of Health, University of Sheffield, Sheffield, UK
| | - Matthew Lee
- School of Medicine and Population Health, Faculty of Health, University of Sheffield, Sheffield, UK
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ApSimon M, Steel C, Johnston C, Winder B, Cohen S, Reichert H, Armstrong D. Enteral nutrition on discharge from intensive care and 30-day unplanned readmission: An exploratory, retrospective study of association. Clin Nutr ESPEN 2024; 61:15-21. [PMID: 38777427 DOI: 10.1016/j.clnesp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/31/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Individuals who survive critical illness are often malnourished with inadequate oral nutrient intake after leaving the intensive care unit (ICU). Enteral nutrition (EN) improves nutrient intake but there is limited evidence on the impact of maintaining EN after discharge from the ICU. The objective of this exploratory study was to understand the association between EN maintenance after ICU and 30-day unplanned hospital re-admission, to inform on future prospective research into the effects of post-ICU nutrition. METHODS This was a single-centre, retrospective study of ICU patients, requiring ventilation, who received EN for at least 3 days in ICU and were discharged to the ward. RESULTS 102 patients met the inclusion criteria; 45 (44.1%) maintained EN and 57 (55.9%) discontinued EN after ICU discharge; there were no significant differences in demographics or clinical measures at ICU admission. Reason for EN discontinuation was documented in 38 (66.7%) patients, with 27 (71%) discontinuing EN due to a routine ward practice of feeding tube removal. Unplanned 30-day hospital re-admission occurred in 17 (16.7%) patients overall, 5 (11.1%) in the EN group and 12 (21.1%) in the non-EN group (crude odds ratio [OR] 0.47, 95% CI 0.15, 1.45, p = 0.188). After adjusting for age, sex, BMI and length of stay, there was a persistent trend to lower re-admission rates in the EN group (OR 0.37, 95% CI 0.09, 1.57, p = 0.176). CONCLUSIONS EN maintenance after ICU discharge was associated with a trend to lower 30-day unplanned hospital re-admission rates. The clinically relevant reduction of about 50% in unplanned re-admission rates in this exploratory study warrants larger, prospective studies of post-ICU nutrition strategies based on clear discontinuation criteria to optimize nutrition and evaluate patient-centred outcomes.
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Affiliation(s)
| | - Cindy Steel
- Nestlé Health Science Canada, North York, ON, Canada.
| | | | - Barb Winder
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sarah Cohen
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - Heidi Reichert
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - David Armstrong
- Hamilton Health Sciences, Hamilton, ON, Canada; Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Gholi Z, Rezaei M, Vahdat Shariatpanahi Z, Momen R, Fallah Bagher Shaidaei M, Gholami M, Aghaee S, Eskandari Sabzi H, Rajabi MR. Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients. Front Med (Lausanne) 2024; 11:1259320. [PMID: 38799151 PMCID: PMC11116702 DOI: 10.3389/fmed.2024.1259320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aim Malnutrition among intensive care unit (ICU) patients is associated with a higher risk of mortality and prolonged hospitalization. However, the influence of malnutrition on severe outcomes of ICU patients with coronavirus disease 2019 (COVID-19) is unclear. By evaluating the effect of malnutrition on the outcomes of COVID-19 in the ICU in older adult patients, this study will contribute to new knowledge of assessing the nutritional status and recovery of these patients. Methods In the current single center prospective study, 310 critically ill COVID-19 patients with an age range of ≥65 years were recruited. Data on demographic characteristics, laboratory parameters, comorbidities, medications, and types of mechanical ventilation were collected in the first 24 h of ICU admission. Malnutrition was defined based on the two-step approach of the Global Leadership Initiative on Malnutrition (GLIM) scale at baseline. During the 45 days after the baseline, we collected data on delirium incidence, mortality, invasive mechanical ventilation (IMV) requirement, length of ICU and hospital admission, and re-hospitalization. Results In this study, the prevalence of malnutrition was 63.4% among critically ill COVID-19 patients. During the 45-day follow-up, 190 (61.3%) COVID-19 deaths were recorded among the baseline 310 patients. After controlling for potential confounders, malnutrition was associated with an increased risk of delirium so malnourished COVID-19 patients had a significantly 35% higher risk of delirium than those without malnutrition (HR: 1.35, 95% CI: 1.01-1.83). Such a significant association was not for COVID-19 mortality and IMV requirement. In addition, malnutrition was associated with a significantly 84% greater odds of prolonged ICU admission (OR: 1.84, 95% CI: 1.09-3.10). No significant association was seen between malnutrition and re-hospitalization and also prolonged hospital admission. Conclusion Malnutrition was associated with an increased risk of delirium and prolonged ICU admission among critically ill older adult COVID-19 patients. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.
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Affiliation(s)
- Zahra Gholi
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Momen
- MSc in Critical Care nursing, Instructor, Critical Care Nursing Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Gholami
- Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Simin Aghaee
- Department of Pediatric Nursing, School of Nursing, Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hakimeh Eskandari Sabzi
- Dept. of Pediatric Nursing, School of Nursing and Midwifery, Ahvaz Jundishapour University Medical Sciences, Ahvaz, Iran, Ahvaz, Iran
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Seth I, Lim B, Cevik J, Gracias D, Chua M, Kenney PS, Rozen WM, Cuomo R. Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review. JPRAS Open 2024; 39:291-302. [PMID: 38370002 PMCID: PMC10874171 DOI: 10.1016/j.jpra.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies. Results Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications. Conclusion Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jevan Cevik
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
| | - Dylan Gracias
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
| | - Marcel Chua
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Peter Sinkjaer Kenney
- Department of Plastic Surgery, Odense University Hospital, J. B. Winsløwsvej 4, Odense 5000, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Warren M. Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria 3199, Australia
- Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena 53100, Italy
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Li P, Li S, Liu S, Li M. Modified Nutrition Risk in the Critically ill score and mortality in critically ill patients with traumatic brain injury. Nutr Clin Pract 2023; 38:1032-1044. [PMID: 37255501 DOI: 10.1002/ncp.11014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Understanding the relationship between nutrition risk at admission to the intensive care unit (ICU) and the prognosis of patients with traumatic brain injury (TBI) may aid early recognition of high-risk patients. METHODS We extracted data from the Medical Information Mart for Intensive Care III and the electronic ICU Collaborative Research Databases. Using modified Nutrition Risk in the Critically ill score (mNUTRIC) within the first 24 h of ICU admission, 5153 patients were divided into three groups: low (≤1, n = 1765), moderate (2-4, n = 2574), and high (≥5, n = 814). The primary outcome was 28-day in-hospital mortality, and the secondary outcomes were 7-day in-hospital mortality, length of ICU stay, and duration of mechanical ventilation. RESULTS During the median follow-up time of 6.69 days, 647 deaths occurred in total. After adjustment for potential confounding factors, setting the low mNUTRIC group as a reference, the risk of 28-day mortality was increased in the high and moderate mNUTRIC groups (hazard ratio [HR]high vs low [95% CI]: 4.21 [2.70-6.58] and 2.84 [1.95-4.14], respectively). Similarly, high and moderate mNUTRIC scores are linked to a higher risk of 7-day mortality (PTrend < 0.001) and a longer duration of mechanical ventilation (PTrend < 0.001). The effect of mNUTRIC on mortality varied by serum glucose level (PInteraction = 0.01). Lastly, those whose mNUTRIC scores deteriorated within the first 3 days have a 1.46 times greater risk of dying compared with patients with improved mNUTRIC scores. CONCLUSIONS Nutrition risk screening by mNUTRIC score at the time of admission to the ICU may improve mortality prediction.
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Affiliation(s)
- Ping Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Sikai Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Shanshan Liu
- Department of Critical Illness, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Man Li
- Key Laboratory of Biomedical Imaging of Guangdong Province, Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital at Sun Yat-sen University, Zhuhai, Guangdong, China
- Center for Interventional Medicine, The Fifth Affiliated Hospital at Sun Yat-Sen University, Zhuhai, Guangdong, China
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O’Connor T, MacKenzie L, Clarke RW, Bradburn M, Wilson TR, Lee MJ. Screening for malnutrition in emergency laparotomy patients: a comparison of three tools. Ann R Coll Surg Engl 2023; 105:413-421. [PMID: 36541125 PMCID: PMC10149256 DOI: 10.1308/rcsann.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population. METHODS A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L. RESULTS A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores. CONCLUSIONS Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.
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Affiliation(s)
- T O’Connor
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - L MacKenzie
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - RW Clarke
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - M Bradburn
- Clinical Trials Research Unit, University of Sheffield, UK
| | - TR Wilson
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
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Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy. Nutrients 2021; 13:nu13093176. [PMID: 34579053 PMCID: PMC8465593 DOI: 10.3390/nu13093176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07-0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.
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Palmer M, Hill J, Hosking B, Naumann F, Stoney R, Ross L, Woodward T, Josephson C. Quality of nutritional care provided to patients who develop hospital acquired malnutrition: A study across five Australian public hospitals. J Hum Nutr Diet 2021; 34:695-704. [PMID: 33855787 DOI: 10.1111/jhn.12876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about the nutritional care provided to patients who develop hospital acquired malnutrition (HAM). The present study aimed to describe the quality of nutritional care provided to patients who developed HAM and determine whether this differed by length of stay (LOS). METHODS A retrospective medical records audit was conducted on adults with LOS > 14 days across five Australian public hospitals from July 2015 to January 2019 who were clinically assessed to have HAM. Descriptors and nutrition-related care data were sourced. Descriptive statistics were conducted. Chi-squared and t-tests were used to compare patient data by LOS ≤ or > 50 days. RESULTS Eligible patients (n = 208) were 64% male, with median (range) LOS of 51 (15-354) days, body mass index = 26.8 ± 6.2 kg m-2 and mean ± SD age of 65 ± 17 years. Malnutrition screening was first completed a median (range) of 0 (0-31) days after admission, with weekly screening conducted on 29% of patients. Mean (range) time to initial dietitian assessment was 9 (0-87) days and 27 (2-173) days until malnutrition diagnosis. Thirty-seven percent of patients were weighed within 24 h of a dietitian requesting it, and 51% had fluid retention that may have masked further weight loss. Most (91%) patients consumed < 80% of nutrition requirements for > 2 weeks. However, 54% did not receive additional nutrition support (e.g., enteral nutrition), which was not considered by the dietitian in 28% (n = 31/112) of these patients. Only 40% consumed adequate intake prior to discharge. Those with LOS > 50 days (50%, n = 104/208) took 24 days longer to be diagnosed with malnutrition and lost 2.4 kg more body weight during admission (p < 0.010). CONCLUSIONS Opportunities exist to optimise nutritional care to facilitate the prevention and management of hospital acquired malnutrition in long-stay patients.
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Affiliation(s)
- Michelle Palmer
- Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD, Australia
| | - Jan Hill
- Nutrition & Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Breanne Hosking
- Nutrition & Dietetics, Redland Hospital, Cleveland, QLD, Australia
| | - Fiona Naumann
- Nutrition & Dietetics, Beaudesert Hospital, Beaudesert, QLD, Australia
| | - Rachel Stoney
- Nutrition & Dietetics, Redland Hospital, Cleveland, QLD, Australia
| | - Lynda Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Talia Woodward
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
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Ashmore D, Lee M. Parenteral nutrition in emergency surgery: A multicentre cross-sectional study. J Hum Nutr Diet 2021; 35:5-13. [PMID: 33829582 DOI: 10.1111/jhn.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emergency general surgical patients are inherently at high risk of malnutrition. Early decision-making with implementation is fundamental to patient recovery. For many patients, parenteral nutrition (PN) is the only feeding option available. The present study assessed the timing and outcomes of this decision-making process. METHODS A sample of at least 10 consecutive adult patients admitted as a general surgical emergency to eight UK hospitals over 1 year who had received PN was identified. Patient demographics, basic descriptors and nutritional data were captured. Process measures regarding dates decisions were made or activities completed were extracted from records, as were outcome measures including PN complications. Six time frames examining the process of PN delivery were analysed. Associations between categorical and binary variables were investigated with a chi-squared test with significance determined as p < 0.05. RESULTS In total, 125 patients were included. Intestinal obstruction was the most common diagnosis with 59% of all patients deemed high risk on nutritional assessment at admission. Median time to decision for PN was 5 days following admission (n = 122, interquartile range = 7). Patients received PN for a mean of 11 days. Eighty-five percent of patients developed a complication, with a phosphate abnormality being the most commonly reported (54%). Only altered blood glucose levels appeared to correlate with a delay in starting PN (p < 0.01). CONCLUSIONS The present study shows there are delays in the decision to use PN in the acutely ill surgical patient. Once initiated, the pathway is relatively short. There are high rates of electrolyte abnormalities in this population.
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Affiliation(s)
- Daniel Ashmore
- Department of General Surgery, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Matthew Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
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Zheng C, Xie K, Li XK, Wang GM, Luo J, Zhang C, Jiang ZS, Wang YL, Luo C, Qiang Y, Hu LW, Wang YQ, Shen Y. The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study. J Hum Nutr Diet 2021; 34:926-934. [PMID: 33788349 DOI: 10.1111/jhn.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Malnutrition is highly prevalent in critically ill patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score has been introduced to evaluate the nutritional risk of patients in an intensive care unit (ICU). The mNUTRIC score is a predictive factor of mortality for patients in a medical or mixed ICU, whereas the relationship between mNUTRIC and prognosis of patients in a cardiothoracic surgery recovery unit (CSRU) is unclear and related researches are limited. METHODS We conducted this retrospective cohort study to explore the value of mNUTRIC score in CSRU patients. We identified totally 4059 patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database. RESULTS The optimal cut-off value of mNUTRIC score was 4 and a total of 1498 (36.9%) patients were considered to be at high nutritional risk (mNUTRIC ≥ 4). A multivariate logistic regression model indicated that patients at high nutritional risk have higher hospital mortality compared to those at low nutritional risk (odds ratio = 2.49, 95% confidence interval (CI) = 1.32-4.70, p = 0.005]. Furthermore, a Cox regression model was established adjusted for age, white blood cell and body mass index. The Kaplan-Meier curve indicated that patients at high nutritional risk have poorer 365-days [hazard ratio (HR) = 1.76, 95% CI = 1.30-2.37, p < 0.001] and 1000-days (HR = 2.30, 95% CI = 1.87-2.83, p < 0.001) overall survival. CONCLUSIONS The mNUTRIC score could not only predict hospital mortality, but also be an independent prognostic factor for long-term survival in CSRU patients. More well-designed clinical trials are needed to verify and update our findings.
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Affiliation(s)
- Chao Zheng
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chi Zhang
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhi-Sheng Jiang
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-Lin Wang
- St. Robert Catholic High School, Thornhill, Canada
| | - Chao Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Li-Wen Hu
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yan-Qing Wang
- Department of Cardiology, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
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Association between disease-related malnutrition and innate immunity gene expression in critically ill patients at intensive care unit admission. Cent Eur J Immunol 2021; 45:414-424. [PMID: 33658890 PMCID: PMC7882404 DOI: 10.5114/ceji.2020.103393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to analyse the relationship between nutritional disorders and the expression of innate antibacterial response genes in patients admitted to the intensive care unit (ICU). In 46 patients with severe malnutrition and life-threatening surgical complications, nutritional status tests were performed on the basis of the NRS 2002 (Nutritional Risk Screening) scale, cytokine, albumin, C-reactive protein concentrations, anthropometric tests, and body composition analysis. Concurrently, the expression of Toll-like receptor 2, NOD1, TRAF6, and HMGB1 genes was determined in peripheral blood leukocytes at the mRNA level using real-time polymerase chain reaction. It was found that both the nutritional status and the gene expression changed depending on the group of patients studied (including the group of survivors vs. non-survivors). Significant correlations were found between the results of routine tests used in the diagnostics of malnutrition (including NRS 2002, resistance, reactance, phase angle, excess of extracellular water) and the expression of the studied genes. Moreover, the expression of TRAF6 and HMGB1 genes correlated with the Acute Physiology and Chronic Health Evaluation II scale and the age of the patients. The results of the research suggest that the expression of innate antibacterial response genes may be a new diagnostic tool complementing the assessment of nutritional disorders in surgical patients admitted to the ICU. These tests may be helpful in providing more accurate diagnostics of the genetic effects of malnutrition and in the monitoring of patients for whom nutritional treatment is planned to support the functions of the immune system, thereby increasing the effectiveness of this type of treatment in the ICU.
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Abahuje E, Niyongombwa I, Karenzi D, Bisimwa JDA, Tuyishime E, Ntirenganya F, Rickard J. Malnutrition in Acute Care Surgery Patients in Rwanda. World J Surg 2020; 44:1361-1367. [PMID: 31897691 DOI: 10.1007/s00268-019-05355-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Malnutrition is prevalent in hospitalized surgical patients and has been shown to significantly alter outcomes including length of hospital stay, complications, and mortality. Different tools for nutrition assessment were developed and are being used. The aim of this study was to characterize the nutritional status of acute care surgery patients, determine risk factors for malnutrition, and describe outcomes in patients with malnutrition. METHODS This was a prospective, descriptive study of malnutrition in acute care surgery patients at CHUK. Over a 6-month time period, we collected data on demographics, diagnosis, operation, and patient outcomes. We assessed the incidence of malnutrition using the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines and Subjective Global Assessment (SGA). We reported frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. RESULTS We analyzed data for 279 acute care surgery patients. Most (n = 209, 73%) patients were male. The median duration of symptoms was 5 days (IQR 2, 14). The most common diagnoses were trauma (n = 83, 30%), intestinal obstruction (n = 76, 27%), and peritonitis (n = 49, 18%). Most (n = 210, 73%) patients underwent operation. The median length of hospital stay was 6 days (IQR 4, 11). Using ASPEN guidelines, 99 (35%) patients had evidence of malnutrition on hospital admission and 76 (27%) had evidence of malnutrition using SGA. After 1 week of hospital stay, 48 (41%) patients had evidence of malnutrition. Overall mortality was 3%, with higher mortality seen in patients with malnutrition (8% vs. 0.6%, p = 0.001). The length of hospital stay was longer in patients with malnutrition on hospital admission (6 days vs. 5 days, p = 0.044). CONCLUSIONS Acute care surgical patients present to the hospital at high-risk for malnutrition. Efforts are needed to ensure that surgical patients receive adequate nutrition support to improve patient outcomes and minimize complications.
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Affiliation(s)
- Egide Abahuje
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
- Kigali University Teaching Hospital, Kigali, Rwanda.
| | - Irenee Niyongombwa
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - David Karenzi
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Eugene Tuyishime
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Faustin Ntirenganya
- University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
- Kigali University Teaching Hospital, Kigali, Rwanda
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Acehan S, Gulen M, Satar S, Kuvvetli A, Isikber C, Yesiloglu O, Toptas Firat B, Sonmez A, Segmen MS, Ince C. Evaluation of Nutrition Risk in Patients Over 65 Years of Age With Nontraumatic Acute Abdominal Syndrome. Nutr Clin Pract 2020; 35:1070-1079. [PMID: 32935880 DOI: 10.1002/ncp.10575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the power of CRP/Albumin ratio, NRS-2002, mNUTRIC scores to predict nutritional needs and mortality in patients over 65 years of age diagnosed with acute abdominal syndrome in the emergency department and then transferred to the surgical intensive care unit. MATERIAL AND METHOD CRP/Albumin ratio, APACHE II, SOFA, NRS-2002 and mNUTRIC scores were calculated. The analysis of the data was conducted in IBM SPSS Statistics Base 22.0 package program. RESULTS In the analytical evaluation made for nutritional needs, AUC value for mNUTRIC was found to be: 0,683, 95% CI 0,611-0,755, p < 0.001. It was found out that mortality of patients had a statistically significant and moderate correlation with mNUTRIC score (r = 0.537; p < 0.001). In the analytical evaluation made for mortality, mNUTRIC's AUC value (AUC: 0.808, 95% CI 0.736-0.880, p < 0.001) was found to be the highest. When the cut-off value determined to predict mortality was taken as 3.5 for mNUTRIC score, sensitivity was 75.9% and specificity was 69.4%. CONCLUSION The evaluation of the risk of malnutrition through nutritional risk tools in intensive care patients over 65 years of age with acute abdominal syndrome can also predict nutritional needs in the early period besides mortality. Based on our data, the fact that mNUTRIC score cut-off value in older patients hospitalized in intensive care is 3.5 and higher may be a predictor for ICU mortality.
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Affiliation(s)
- Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Onder Yesiloglu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Basak Toptas Firat
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ahmet Sonmez
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Mustafa Sencer Segmen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Cagdas Ince
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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14
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Wang WN, Wang CY, Hsu CY, Fu PK. Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk. Nutrients 2020; 12:E2009. [PMID: 32640749 PMCID: PMC7400848 DOI: 10.3390/nu12072009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022] Open
Abstract
Nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h for patients at high nutritional risk. However, whether small bowel enteral nutrition (SBEN) should be routinely used instead of NGEN to improve hospital mortality remains unclear. We retrospectively analyzed 113 critically ill patients with modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5 and feeding volume < 750 mL/day in the first week of their stay in the intensive care unit (ICU). Age, sex, mNUTRIC score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched in the SBEN (n = 48) and NGEN (n = 65) groups. Through a univariate analysis, factors associated with hospital mortality were SBEN group (hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.31-1.00), Simplified Organ Failure Assessment (SOFA) score on day 7 (HR, 1.12; 95% CI, 1.03-1.22), and energy intake achievement rate < 65% (HR, 2.53; 95% CI, 1.25-5.11). A multivariate analysis indicated that energy intake achievement rate < 65% on the third follow-up day (HR, 2.29; 95% CI, 1.12-4.69) was the only factor independently associated with mortality. We suggest initiation of SBEN on the seventh ICU day before parenteral nutrition initiation for critically ill patients at high nutrition risk.
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Affiliation(s)
- Wei-Ning Wang
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Nursing, Hungkuang University, Taichung 43302, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- College of Human Science and Social Innovation, Hungkuang University, Taichung 43302, Taiwan
- Department of Computer Science, Tunghai University, Taichung 40705, Taiwan
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Epidemiological Study on the Status of Nutrition-Support Therapies by Emergency Physicians in China. Emerg Med Int 2019; 2019:7657436. [PMID: 31885927 PMCID: PMC6915028 DOI: 10.1155/2019/7657436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/12/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This study aimed to investigate the current status of nutrition-support therapies by emergency physicians in China and to provide an evidence-based case to improve the regulation of enteral and parenteral nutrition-support therapies. Methods Physicians from the Emergency Branch of the China Geriatrics Society were enrolled in the present survey. A questionnaire related to nutrition-support therapy, including the time, location, ways, indications, complications, and nutrition-support training for physicians was answered. Results 527 questionnaires were collected from over 300 hospitals in 25 provinces of China. The time to initiation of emergency nutrition support was often delayed. Furthermore, the treatment intensity and standardized training of physicians are weaknesses concerning nutrition support. Treatment standardization has been significantly improved, including blood glucose monitoring, precaution and management of complications, and the use of immunomodulators. Conclusions Emergency physicians should pay attention to early identifying and providing nutrition support to those patients who need it. Finally, standardized training should be developed for emergency nutrition-support therapy.
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16
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Muscle loss: The new malnutrition challenge in clinical practice. Clin Nutr 2019; 38:2113-2120. [DOI: 10.1016/j.clnu.2018.11.021] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/16/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022]
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Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: A Literature Review. J Clin Med 2019; 8:jcm8091395. [PMID: 31500087 PMCID: PMC6780491 DOI: 10.3390/jcm8091395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Medical nutrition therapy in critically ill patients remains challenging, not only because of the pronounced stress response with a higher risk for complications, but also due to their heterogeneity evolving from different phases of illness. The present review aims to address current knowledge and guidelines in order to summarize how they can be best implemented into daily clinical practice. Further studies are urgently needed to answer such important questions as best timing, route, dose, and composition of medical nutrition therapy for critically ill patients and to determine how to assess and to adapt to patients’ individual needs.
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18
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Lee MJ, Sayers AE, Drake TM, Singh P, Bradburn M, Wilson TR, Murugananthan A, Walsh CJ, Fearnhead NS. Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit. BMJ Open 2019; 9:e029235. [PMID: 31352419 PMCID: PMC6661661 DOI: 10.1136/bmjopen-2019-029235] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes. DESIGN Prospective cohort study. SETTING 131 UK hospitals with acute surgical services. PARTICIPANTS 2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium. RESULTS Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition. CONCLUSIONS Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO.
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Affiliation(s)
- Matthew James Lee
- Department of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, South Yorkshire, UK
| | - Adele E Sayers
- General Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Thomas M Drake
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Pritam Singh
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Timothy R Wilson
- General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Ciaran J Walsh
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Nicola S Fearnhead
- Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
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19
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Osooli F, Abbas S, Farsaei S, Adibi P. Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital. Adv Pharm Bull 2019; 9:314-320. [PMID: 31380259 PMCID: PMC6664107 DOI: 10.15171/apb.2019.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/10/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose: Malnutrition is highly prevalent in critically ill patients and is associated with the increased healthcare-related cost and poor patient outcomes. Identifying the factors associated with undernutrition may assist nutritional care. Therefore, this study was designed to identify factors associated with malnutrition and inadequate energy intake to improve nutritional support in intensive care unit (ICU).
Methods: This prospective study was conducted on 285 random samples of ICU patients. We reported time to initiate the enteral nutrition, percent of the adequately received nutrition, and development of malnutrition during the follow-up period. Moreover, variables and clinical outcomes associated with calories underfeeding and malnutrition were reported.
Results: In 28.6% of samples, enteral feeding was initiated greater than 48 hours after ICU admission. During follow-up, 87.4% and 83.3% of patients failed to receive at least 80% of protein and energy target, and malnutrition developed in 84% of study population. Moreover, surgical and medical patients compared to trauma patients were associated with underfeeding. However, only nutrition risk in the critically ill score (NUTRIC) score ≥5 could predict malnutrition development in our study. Finally, underfeeding contributed significantly to a more mortality rate both in ICU and hospital.
Conclusion: Our findings revealed that the majority of nutritionally high-risk patients failed to receive adequate calories and subsequently developed malnutrition. The present study added valuable information to the small body of literature about the factors affecting nutritional decline and malnutrition during the ICU stay.
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Affiliation(s)
- Fatemeh Osooli
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbas
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Farsaei
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Xing J, Zhang Z, Ke L, Zhou J, Qin B, Liang H, Chen X, Liu W, Liu Z, Ai Y, Wang D, Wang Q, Zhou Q, Zhang F, Qian K, Jiang D, Zang B, Li Y, Huang X, Qu Y, Xie Y, Xu D, Zou Z, Zheng X, Liu J, Guo F, Liang Y, Sun Q, Gao H, Liu Y, Chang P, Ceng A, Yang R, Yao G, Sun Y, Wang X, Zhang Y, Wen Y, Yu J, Sun R, Li Z, Yuan S, Song Y, Gao P, Liu H, Zhang Z, Wu Y, Ma B, Guo Q, Shan F, Yang M, Li H, Li Y, Lu W, Wang L, Qian C, Wang Z, Lin J, Zhang R, Wan P, Peng Z, Gong Y, Huang L, Wu G, Sun J, Deng Y, Shi D, Zhou L, Zhou F, Shi Q, Guo X, Liu X, Wu W, Meng X, Li L, Chen W, Li S, Wan X, Chao Z, Zhang A, Gu L, Chen W, Wu J, Zhou L, Zhang Z, Weng Y, Feng Y, Yang C, Feng Y, Zhao S, Tong F, Hao D, Han H, Fu B, Gong C, Li Z, Hu K, Kou Q, Zhang H, Liu J, Fan C, Zhou X, Chen X, Sun J, Zhou X, Song B, Sun C, Zhao L, Dong X, Zhang L, Tong D, Pan Z, Cai C, Wang D, Dong Y, Gong Y, Wu Z, Meng X, Wang P, Li W. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care 2018; 22:229. [PMID: 30244686 PMCID: PMC6151932 DOI: 10.1186/s13054-018-2159-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/10/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. METHODS This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. RESULTS A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). CONCLUSIONS The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
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Affiliation(s)
- Juan Xing
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Ke
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Jing Zhou
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
| | - Bingyu Qin
- Henan Provincial People’s Hospital, Zhengzhou, China
| | | | | | - Wenming Liu
- Changzhou No.2 People’s Hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Zhongmin Liu
- Jilin University First Hospital, Changchun, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Difeng Wang
- Guizhou Medical University affiliated hospital, Guiyang, China
| | | | | | | | - Kejian Qian
- First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongpo Jiang
- Third Military Medical University Daping Hospital, Chongqing, China
| | - Bin Zang
- China Medical University Second Affiliated Hospital, Shenyang, China
| | - Yimin Li
- Guangzhou Medical University First Affiliated Hospital, Guangzhou, China
| | - Xiaobo Huang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | | | - Donglin Xu
- Guangzhou First Municipal People’s Hospital, Guangzhou, China
| | - Zhiqiang Zou
- Xiehe Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Jianbo Liu
- Inner Mongolia People’s Hospital, Huhehaote, China
| | - Feng Guo
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Qingdao, China
| | - Qiang Sun
- Tianjing People’s Hospital, Tianjin, China
| | - Hongmei Gao
- Tianjing First Central Hospital, Tianjin, China
| | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Aibin Ceng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | | | - Gaiqi Yao
- Peking University Third Hospital, Beijing, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Xiaorong Wang
- Wenzhou Medical University First Affiliated Hospital, Wenzhou, China
| | - Yi Zhang
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Yichao Wen
- Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Jian Yu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rongqing Sun
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Zhiwei Li
- First People’s Hospital of Kunming, Kunming, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huanzhong University of Science and Technology, Wuhan, China
| | - Yunlin Song
- Xinjiang Medical University Affiliated First Hospital, Wulumuqi, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Haiyan Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Yunfu Wu
- Suzhou Municipal Hospital, Suzhou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Mingshi Yang
- Central South University Third Xiangya Hospital, Changsha, China
| | - Hailing Li
- 401 Military Hospital of China, Qindao, China
| | - Yuanfei Li
- Changsha Central Hospital, Changsha, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Chuangyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Zhiyong Wang
- Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Peng Wan
- First People’s Hospital of Yichang, Yichang, China
| | - Zhiyong Peng
- Wuhan University Zhongnan Hospital, Wuhan, China
| | - Yuqiang Gong
- Wenzhou Medical University Second Affiliated Hospital, Wenzhou, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Guobao Wu
- Zhongnan University Xiangya Second Hospital, Changsha, China
| | - Jie Sun
- Yunnan Second People’s Hospital, Kunming, China
| | - Yijun Deng
- Yancheng First People’s Hospital, Yancheng, China
| | - Dongwu Shi
- Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Lixin Zhou
- First People’s Hospital of Foshan, Foshan, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Qindong Shi
- Xi’an Jiao Tong University First Affiliated Hospital, Xi’an, China
| | | | - Xueyan Liu
- Shenzhen People’s Hospital, Shenzhen, China
| | - Weidong Wu
- Shanxi Dayi Hospital of Shanxi Academy of Medical Science, Taiyuan, China
| | | | - Liandi Li
- Qingdao University Affiliated Hospital, Qingdao, China
| | - Weiwei Chen
- Linhai First People’s Hospital, Linhai, China
| | - Shusheng Li
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xianyao Wan
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - An Zhang
- Chongqing Medical University Second Affiliated Hospital, Chongqing, China
| | - Liming Gu
- People’s Hospital of Yuxi City, Yuxi, China
| | - Wei Chen
- Shijitan Hospital of Capital Medical University, Beijing, China
| | - Jinglan Wu
- Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | | | - Yongshun Feng
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Chunli Yang
- Jiangxi Provincial People’s Hospital, Nanchang, China
| | - Yongjian Feng
- Jinan University First Affiliated Hospital, Jinan, China
| | - Sumin Zhao
- General Hospital of Rocket Army, Beijing, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | - Dong Hao
- Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Hui Han
- Chinese PLA General Hospital, Beijing, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Chuanyong Gong
- Tianjing Hospital of ITCWM Nankai Hospital, Tianjing, China
| | - Zhiping Li
- Hunan Provincial People’s Hospital, Changsha, China
| | - Kunlin Hu
- People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuye Kou
- Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Han Zhang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Jie Liu
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Chuming Fan
- First People’s Hospital of Yunnan, Kunming, China
| | - Xin Zhou
- Xinjiang Military General Hospital, Wulumuqi, China
| | | | - Junli Sun
- Luoyang Central Hospital, Luoyang, China
| | - Xuejun Zhou
- Huairou First Hospital of Beijing, Beijing, China
| | - Bin Song
- Military General Hospital of Beijing PLA, Beijing, China
| | - Cheng Sun
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Liyun Zhao
- Guangdong Second TCM Hospital, Guangzhou, China
| | | | | | - Dafei Tong
- Shenyang First People’s Hospital, Shenyang, China
| | - Zhiguo Pan
- Guangzhou Military General Hospital, Guangzhou, China
| | - Chuangjie Cai
- Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | | | | | - Yuanqi Gong
- Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Zhisong Wu
- Beijing University of Chinese Medicine Affiliated Dongfang Hospital, Beijing, China
| | - Xinke Meng
- Shenzhen Second People’s Hospital, Shenzhen, China
| | - Ping Wang
- Chendu Fifth People’s Hospital, Chendu, China
| | - Weiqin Li
- Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002 China
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21
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Teigen LM, Kuchnia AJ, Nagel EM, Price KL, Hurt RT, Earthman CP. Diagnosing clinical malnutrition: Perspectives from the past and implications for the future. Clin Nutr ESPEN 2018; 26:13-20. [PMID: 29908677 DOI: 10.1016/j.clnesp.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
This review, intended for both researchers and clinicians, provides a history of the definition of clinical malnutrition. Despite global efforts, we remain without one clear, objective, internationally accepted definition; clarity in this regard will ultimately improve our evaluation and monitoring of nutritional status to achieve optimal patient outcomes. In this review we explore the development of the term malnutrition and its diagnosis and application in the setting of acute and chronic disease. We begin in the second century A.D. with the work of the Greek physician Galen who is credited as the first to apply the term marasmus to characterize three categories of malnutrition, which are surprisingly similar to components of current international definitions. We then highlight significant developments over the next 2000 years culminating in our current application of the clinical diagnosis of malnutrition. A perspective on historical practices may inform current efforts toward a global definition and diagnosis of malnutrition.
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Affiliation(s)
- Levi M Teigen
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA; Department of Clinical Dietetics, Mayo Clinic, Rochester, MN, USA.
| | - Adam J Kuchnia
- Department of Nutritional Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily M Nagel
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Kathleen L Price
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Ryan T Hurt
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carrie P Earthman
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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22
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Havens JM, Seshadri AJ, Salim A, Christopher KB. Red cell distribution width predicts out of hospital outcomes in critically ill emergency general surgery patients. Trauma Surg Acute Care Open 2018; 3:e000147. [PMID: 29766132 PMCID: PMC5931307 DOI: 10.1136/tsaco-2017-000147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/06/2018] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Red cell distribution width (RDW) is associated with mortality and bloodstream infection risk in critically ill patients. We hypothesized that an increase in RDW at hospital discharge in critically ill patients who received emergency general surgery (EGS) would be associated with increased mortality after hospital discharge. Methods We performed a two-center observational study of patients treated in medical and surgical intensive care units. We studied 1567 patients, who received critical care between 1998 and 2012 who underwent EGS and survived hospitalization. The exposure of interest was RDW within 24 hours of hospital discharge and categorized a priori in quintiles as ≤13.3%, 13.3% to 14.0%, 14.0% to 14.7%, 14.7% to 15.8%, 15.8% to 17.0% and >17.0%. The primary outcome was 90-day all-cause mortality. Adjusted ORs were estimated by multivariable logistic regression models with inclusion of covariate terms for age, race, gender, Deyo-Charlson Index, sepsis and number of organs with acute failure. Results The cohort patients were 51.4% male and 23.2% non-white. 23.9% had sepsis and the mean age was 58 years. 90-day postdischarge mortality was 6.8%. Patients with a discharge RDW 15.8% to 17.0% or RDW >17.0% have an adjusted OR of 90-day postdischarge mortality of 3.64 (95% CI 1.04 to 12.68; p=0.043) or 4.58 (95% CI 1.32 to 15.93; p=0.02), respectively, relative to patients with a discharge RDW ≤13.3%. Further, patients with a discharge RDW ≥15.8 have an adjusted OR of 30-day hospital readmission of 2.12 (95% CI 1.17 to 3.83; p=0.013) relative to patients with a discharge RDW ≤13.3%. Conclusions In EGS patients requiring critical care who survive hospitalization, an elevated RDW at the time of discharge is a robust predictor of all-cause patient mortality and hospital readmission after discharge. Level of evidence Level II, prognostic retrospective study.
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Affiliation(s)
- Joaquim Michael Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anupamaa J Seshadri
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ali Salim
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kenneth B Christopher
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,The Nathan E. Hellman Memorial Laboratory Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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23
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Oh TK, Lee J, Lee YJ, Hwang JW, Do SH, Jeon YT, Song IA. Association between Modified Body Mass Index and 30-Day and 1-Year Mortality after Intensive Care Unit Admission: A Retrospective Cohort Study. J Clin Med 2018; 7:jcm7040081. [PMID: 29652842 PMCID: PMC5920455 DOI: 10.3390/jcm7040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 12/26/2022] Open
Abstract
Because conventional body mass index (cBMI) does not reflect fluid accumulation, modified BMI (mBMI, serum albumin multiplied by cBMI) is a more accurate measure of malnutrition status. This study aimed to determine whether mortality after intensive care unit (ICU) admission was associated with cBMI, mBMI, and/or serum albumin levels. The medical records of patients who were admitted to a tertiary hospital ICU between 1 January 2012 and 31 July 2016 were retrospectively reviewed. In total, 6169 ICU-admitted patients were included in the analyses. Multivariate Cox regression analyses revealed that low cBMI, mBMI and albumin level were significantly associated with 30-day and 1-year mortality after ICU admission (hazard ratio < 1.0, p < 0.05). The adjusted area under the curve (AUC) of mBMI for 1-year mortality was significantly higher than that of cBMI (p < 0.001), but not significantly different from that of albumin level (p = 0.098). Low values of mBMI, cBMI and albumin were independently associated with 30-day and 1-year mortality after ICU admission. Combining cBMI and albumin (mBMI) did not increase the validity of the AUC of albumin for 1-year mortality after ICU admission. Our study showed that serum albumin alone, rather than mBMI (combining cBMI), is recommended in predicting mortality among ICU patients.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Jaebong Lee
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
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24
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ROUNDS Studies: Relation of OUtcomes with Nutrition Despite Severity-Round One: Ultrasound Muscle Measurements in Critically Ill Adult Patients. J Nutr Metab 2018; 2018:7142325. [PMID: 29805803 PMCID: PMC5901955 DOI: 10.1155/2018/7142325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/23/2018] [Accepted: 03/05/2018] [Indexed: 12/19/2022] Open
Abstract
Malnutrition (undernutrition) encompasses low intake or uptake, loss of fat mass, and muscle wasting and is associated with worse outcomes. Ultrasound has been introduced in the intensive care unit as a tool to assess muscle mass. The aim of the present study is to explore the relation between initial muscle mass and mortality in adult patients admitted to the intensive care unit. Methods. Rectus femoris and vastus intermedius thicknesses were measured by B-mode ultrasound in adult patients at admission, along with demographic characteristics, illness severity, comorbidities, biochemical variables, treatments, and in-hospital mortality as main outcomes. Analysis was made comparing survivors versus nonsurvivors and finally using binary logistic regression with mortality as dependent variable. Results. 59 patients were included in the analysis, severity measured by sequential organ failure assessment (SOFA) score was greater in nonsurvivors (17 (7) versus 24 (10) and 3 (1–5) versus 7 (3–10), resp.). Also, muscle thickness was lower in the latter group (1.44 (0.59) cm versus 0.98 (0.3) cm). Logistic regression showed severity by SOFA score as a risk factor and muscle thickness as a protective factor for mortality. Conclusion. Muscle mass showed to be a protective factor despite severity of illness; there is much more work to do regarding interventions and monitoring in order to prevent or overcome low muscle mass at admission to the intensive care unit.
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25
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De Waele E, Honoré PM, Malbrain MLNG. Between Dream and Reality in Nutritional Therapy: How to Fill the Gap. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2018 2018. [DOI: 10.1007/978-3-319-73670-9_44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Buter H, Veenstra JA, Koopmans M, Boerma CE. Phase angle is related to outcome after ICU admission; an observational study. Clin Nutr ESPEN 2017; 23:61-66. [PMID: 29460815 DOI: 10.1016/j.clnesp.2017.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/07/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Malnutrition at the time of ICU admission is associated with an increased morbidity and mortality. Malnutrition is most often assessed by a questionnaire but can also be determined with bio-impedance and measurement of phase angle. In a single-centre observational study we compared the percentage of malnutrition in patients admitted to our ICU, according to the Short Nutritional Assessment Questionnaire (SNAQ) with the phase angle measured with bio-impedance. Furthermore, we questioned whether malnutrition is related to outcome parameters. METHODS In a 15 week period consecutive patients admitted to the ICU were included. Exclusion criteria included age <18 years, anatomical and/or neurological abnormalities of the limbs and an ICU stay less than 6 h. Bio-impedance measurements were performed shortly after admission, the SNAQ was obtained from the patient or legal representative. Malnutrition is considered with a SNAQ ≥2 or a phase angle of <5° for men and <4.6° for women. The study was approved by our local ethical committee (MCL, nWMO 77, April 18, 2015). RESULTS 299 Patients were included (66% male, age 66 ± 12 year, BMI 27 ± 4 kg/m2 and APACHE II score 14 [11-17]), of which 64% elective and 36% acute admissions. Hospital mortality was 7.4%. Malnutrition was present in 16% according to the SNAQ and in 36% according to phase angle. There was a fair accordance between the SNAQ and phase angle. Phase angle was significantly higher in patients with a SNAQ score of 0-1 (5.5°±1.3) in comparison with patients with a SNAQ score ≥2 (4.4°± 1.1) (p < 0.001). Logistic regression analysis showed a significant relation between SNAQ and BMI, malignant disease and hospital length of stay and between phase angle and age, sex, BMI, malignant disease, hospital length of stay and hospital mortality. CONCLUSION Malnutrition was present in 16% according to the SNAQ and in 36% according to phase angle in our IC population. Malnutrition was associated with prolonged hospital length of stay. In this small population of mixed ICU patients, a low phase angle was found to independently predict hospital mortality. CLINICAL TRIALS. GOV NUMBER NCT02911181.
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Affiliation(s)
- Hanneke Buter
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Janny A Veenstra
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Matty Koopmans
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Christiaan E Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
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27
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Li Q, Zhang Z, Xie B, Ji X, Lu J, Jiang R, Lei S, Mao S, Ying L, Lu D, Si X, Ji M, He J, Chen M, Zheng W, Wang J, Huang J, Wang J, Ji Y, Chen G, Zhu J, Shao Y, Lin R, Zhang C, Zhang W, Luo J, Lou T, He X, Chen K, Peng W, Sun R. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study. PLoS One 2017; 12:e0182393. [PMID: 28771622 PMCID: PMC5542540 DOI: 10.1371/journal.pone.0182393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients. METHODS A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages. MAIN RESULTS A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877). CONCLUSIONS The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.
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Affiliation(s)
- Qian Li
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, P. R. China
| | - Zhongheng Zhang
- Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Xie
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Xiaowei Ji
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Jiahong Lu
- Department of Critical Care Medicine, Huzhou Central Hospital, Zhejiang, China
| | - Ronglin Jiang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Shu Lei
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Shihao Mao
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of TCM, Zhejiang, China
| | - Lijun Ying
- Department of Critical Care Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Di Lu
- Department of Critical Care Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Xiaoshui Si
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Mingxia Ji
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jianxing He
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Mengyan Chen
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Wenjuan Zheng
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jiao Wang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Jing Huang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Junfeng Wang
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Yaling Ji
- Department of Critical Care Medicine, YiWu Central Hospital, Zhejiang, P. R. China
| | - Guodong Chen
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Jianhua Zhu
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Yadi Shao
- Department of Critical Care Medicine, NingBo First Hospital, Zhejiang, China
| | - Ronghai Lin
- Department of Critical Care Medicine, TaiZhou Hospital, Zhejiang, China
| | - Chao Zhang
- Department of Critical Care Medicine, TaiZhou Hospital, Zhejiang, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, QuZhou People's Hospital, Zhejiang, P. R. China
| | - Jian Luo
- Department of Critical Care Medicine, QuZhou People's Hospital, Zhejiang, P. R. China
| | - Tianzheng Lou
- Department of Critical Care Medicine, LiShui People's Hospital, Zhejiang, P. R. China
| | - Xuwei He
- Department of Critical Care Medicine, LiShui People's Hospital, Zhejiang, P. R. China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, P. R. China
| | - Wei Peng
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, P. R. China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, P. R. China
- * E-mail:
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