Impact of medical nutrition therapy on clinical outcomes in adult critically ill intensive care unit (ICU) patients in Europe: results from the europn study

IntroductionWe analysed blood DNAemia of TTV and four herpesviruses (CMV, EBV, HHV6, and HSV-1) in the REAnimation Low Immune Status Marker (REALISM) cohort of critically ill patients who had presented with either sepsis, burns, severe trauma, or major surgery. The aim was to identify common features related to virus and injury-associated pathologies and specific features linking one or several viruses to a particular pathological context.MethodsOverall and individual viral DNAemia were measured over a month using quantitative PCR assays from the 377 patients in the REALISM cohort. These patients were characterised by clinical outcomes [severity scores, mortality, Intensive Care Unit (ICU)-acquired infection (IAI)] and 48 parameters defining their host response after injury (cell populations, immune functional assays, and biomarkers). Association between viraemic event and clinical outcomes or immune markers was assessed using χ2-test or exact Fisher’s test for qualitative variables and Wilcoxon test for continuous variables.ResultsThe cumulative incidence of viral DNAemia increased from below 4% at ICU admission to 35% for each herpesvirus during the first month. EBV, HSV1, HHV6, and CMV were detected in 18%, 12%, 10%, and 9% of patients, respectively. The incidence of high TTV viraemia (>10,000 copies/ml) increased from 11% to 15% during the same period. Herpesvirus viraemia was associated with severity at admission; CMV and HHV6 viraemia correlated with mortality during the first week and over the month. The presence of individual herpesvirus during the first month was significantly associated (p < 0.001) with the occurrence of IAI, whilst herpesvirus DNAemia coupled with high TTV viraemia during the very first week was associated with IAI. Herpesvirus viraemia was associated with a lasting exacerbated host immune response, with concurrent profound immune suppression and hyper inflammation, and delayed return to immune homeostasis. The percentage of patients presenting with herpesvirus DNAemia was significantly higher in sepsis than in all other groups. Primary infection in the hospital and high IL10 levels might favour EBV and CMV reactivation.ConclusionIn this cohort of ICU patients, phenotypic differences were observed between TTV and herpesviruses DNAemia. The higher prevalence of herpesvirus DNAemia in sepsis hints at further studies that may enable a better in vivo understanding of host determinants of herpesvirus viral reactivation. Furthermore, our data suggest that EBV and TTV may be useful as additional markers to predict clinical deterioration in ICU patients.

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Medical nutrition therapy for patients with malnutrition post–intensive care unit discharge: A case report of recovery from coronavirus disease 2019 (COVID‐19)

Nutrition in Clinical Practice ◽

10.1002/ncp.10728 ◽

2021 ◽

Author(s):

Ryan Burslem ◽

Anna Parker

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Intensive Care Unit Discharge ◽

Nutrition Therapy ◽

Medical Nutrition Therapy ◽

Unit Discharge ◽

Medical Nutrition

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Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-021-01439-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Na Wang ◽

Mei-Ping Wang ◽

Li Jiang ◽

Bin Du ◽

Bo Zhu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Outcomes ◽

Critically Ill ◽

Secondary Analysis ◽

Nutritional Risk ◽

Icu Patients ◽

Nutrition Risk ◽

Risk Patients ◽

Youden’S Index

Abstract Background Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores. Methods This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%. Results Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740–0.786). According to Youden’s index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality. Conclusions Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score. Trial registration This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.

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Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: A secondary analysis of a large prospective observational study

10.21203/rs.3.rs-243502/v1 ◽

2021 ◽

Author(s):

Na Wang ◽

Mei-Ping Wang ◽

Li Jiang ◽

Bin Du ◽

Bo Zhu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Prospective Observational Study ◽

Nutritional Risk ◽

Icu Patients ◽

Nutrition Risk ◽

Risk Patients

Abstract Background: Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The nutrition risk in the critically ill score (NUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients. This score uses interleukin-6 (IL-6), a biomarker that is not always available. This prospective observational study was conducted to identify the nutritional risk in ICU patients using the modified NUTRIC (mNUTRIC) score (which does not include IL-6) and to explore the relationship between 28-day mortality and high mNUTRIC scores.Methods: The data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). This trial was a prospective, observational, multi-centre study conducted in 30 ICUs at 28 tertiary hospitals in Beijing, China, from March 1 to August 31, 2012. In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis. The significance level was set at 5%.Results: Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). High nutritional risk patients were older (P<0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740 - 0.786).Conclusions: Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality.Trial Registration: This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.Key words:The modified nutrition risk in critically ill score, Intensive care unit, Mortality

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Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

10.21203/rs.3.rs-923773/v1 ◽

2021 ◽

Author(s):

Zi-Hong Xiong ◽

Xue-Mei Zheng ◽

Guo-Ying Zhang ◽

Meng-Jun Wu ◽

Yi Qu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nutritional Status ◽

Clinical Outcomes ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Phase Angle ◽

Pediatric Intensive Care ◽

Critically Ill Children ◽

Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review

Journal of Intensive Care Medicine ◽

10.1177/0885066619843782 ◽

2019 ◽

Vol 35 (7) ◽

pp. 615-626 ◽

Cited By ~ 2

Author(s):

Angel Joel Cadena ◽

Sara Habib ◽

Fred Rincon ◽

Stephanie Dobak

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Clinical Outcomes ◽

Critically Ill ◽

Nutrition Support ◽

Mechanical Ventilation Duration ◽

The Impact

Malnutrition is frequently seen among patients in the intensive care unit. Evidence shows that optimal nutritional support can lead to better clinical outcomes. Recent clinical trials debate over the efficacy of enteral nutrition (EN) over parenteral nutrition (PN). Multiple trials have studied the impact of EN versus PN in terms of health-care cost and clinical outcomes (including functional status, cost, infectious complications, mortality risk, length of hospital and intensive care unit stay, and mechanical ventilation duration). The aim of this review is to address the question: In critically ill adult patients requiring nutrition support, does EN compared to PN favorably impact clinical outcomes and health-care costs?

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Role of sepsis in the development of limb muscle weakness in a porcine intensive care unit model

Physiological Genomics ◽

10.1152/physiolgenomics.00031.2012 ◽

2012 ◽

Vol 44 (18) ◽

pp. 865-877 ◽

Cited By ~ 11

Author(s):

Sudhakar Aare ◽

Peter Radell ◽

Lars I. Eriksson ◽

Yi-Wen Chen ◽

Eric P. Hoffman ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Heat Shock ◽

Critically Ill ◽

Muscle Function ◽

Muscle Wasting ◽

Limb Muscle ◽

Negative Consequences ◽

Icu Patients ◽

Biceps Femoris Muscle

Severe muscle wasting and loss of muscle function in critically ill mechanically ventilated intensive care unit (ICU) patients have significant negative consequences on their recovery and rehabilitation that persist long after their hospital discharge; moreover, the underlying mechanisms are unclear. Mechanical ventilation (MV) and immobilization-induced modifications play an important role in these consequences, including endotoxin-induced sepsis. The present study aims to investigate how sepsis aggravates ventilator and immobilization-related limb muscle dysfunction. Hence, biceps femoris muscle gene expression was investigated in pigs exposed to ICU intervention, i.e., immobilization, sedation, and MV, alone or in combination with sepsis, for 5 days. In previous studies, we have shown that ICU intervention alone or in combination with sepsis did not affect muscle fiber size on day 5, but a significant decrease was observed in single fiber maximal force normalized to cross-sectional area (specific force) when sepsis was added to the ICU intervention. According to microarray data, the addition of sepsis to the ICU intervention induced a deregulation of >500 genes, such as an increased expression of genes involved in chemokine activity, kinase activity, and transcriptional regulation. Genes involved in the regulation of the oxidative stress response and cytoskeletal/sarcomeric and heat shock proteins were on the other hand downregulated when sepsis was added to the ICU intervention. Thus, sepsis has a significant negative effect on muscle function in critically ill ICU patients, and chemokine activity and heat shock protein genes are forwarded to play an instrumental role in this specific muscle wasting condition.

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