Identifying the critically ill cirrhotics who benefit the most from nutrition therapy: The mNUTRIC score study

2021 ◽  
Author(s):  
Harshita Tripathi ◽  
Jaya Benjamin ◽  
Rakhi Maiwall ◽  
Puneet Puri ◽  
Puja Bhatia Kapoor ◽  
...  
Keyword(s):  
Critically Ill ◽  
Nutrition Therapy ◽  
Nutritional Adequacy ◽  
Score Study ◽  
Nutrition Risk ◽  
Probability Of Survival ◽  
Risk Of Mortality ◽  
High Incidence ◽  
A Prospective Study

Abstract Background Malnutrition increases risk of mortality in critically ill cirrhotics. Modified Nutrition Risk in Critically ill (mNUTRIC) score is a validated tool to identify patients at nutrition risk that may benefit the most from goal directed nutrition therapy. We aimed to study the association between mNUTRIC score and 28-day mortality and its modulation by nutritional adequacy in critically ill cirrhotics. Methods A prospective study in critically ill adult cirrhotics was designed with collection of baseline and follow-up data pertaining to mNUTRIC score, clinical, hemodynamic, biochemical, nutritional parameters, use of mechanical ventilation (MV), length of ICU stay, and development of new onset infection (NOI). Daily nutritional adequacy was calculated as percentage of prescribed energy and protein received. Results 150 cirrhotics [(males-83%, age-51 ± 12.1 years, BMI-24 ± 4.7kg/m2; median LOS 6 (2–24 days)] were enrolled. At ICU admission 116 (77%) had high NUTRIC Score (HNS) and 34 (23%) low NUTRIC score (LNS). Patients with HNS had significantly higher mortality [54% vs. 10%; p = 0.008; OR(95%CI) adjusted 3.0(1.39,6.9;p = 0.006)] for etiology and blood sugar ; longer MV days [5(2–24) vs. 3(1–24) ; p = 0.02]; and high incidence of NOI [32% vs. 2.6%; p = 0.002; OR(95% CI:7(2,24.5)] compared to LNS. A logistic regression analysis for interaction of nutritional adequacy and 28 day survival revealed that the probability of survival increases with increase in nutritional adequacy (p < 0.01) in patients with HNS. Conclusion mNUTRIC score is a useful tool in recognizing nutrition risk in critically ill cirrhotics and goal directed nutrition therapy; especially in patients with high mNUTRIC score can significantly improve survival.

scholarly journals Associations of measured resting energy expenditure with predictive equations, NUTRIC score, and patient outcomes

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Elham Sobhy ◽  
Radwa Abdel Kader ◽  
Alshaimaa Aboulfotouh ◽  
Mohammed Eshra ◽  
Mohamed Sayed
Keyword(s):  
Energy Expenditure ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Indirect Calorimetry ◽  
Reference Method ◽  
Resting Energy Expenditure ◽  
Nutrition Therapy ◽  
Nutrition Risk ◽  
Penn State ◽  
Resting Energy

Abstract Background Indirect calorimetry is the reference method for measuring resting energy expenditure (REE), but the necessary equipment and technical expertise are not always available. Meanwhile, the NUTrition Risk in the Critically ill (NUTRIC) scale is designed to identify patients who would benefit from nutrition therapy, but no data are available regarding the association of NUTRIC scores with REE. Several predictive formulas are available as alternatives to indirect calorimetry for calculation of energy requirements, but they have not been compared in a homogeneous group of critically ill patients. The purpose of the study is to examine the correlations between energy expenditure and NUTRIC scores or patient outcomes, and to compare measured REE with estimations of energy expenditure. Methods In this observational, prospective study, indirect calorimetry was performed on 50 mechanically ventilated patients. Energy expenditure was also estimated with the bodyweight-based, Faisy–Fagon, and Penn-State PSUm equations. Results REE was higher in patients who survived treatment than in those who died, and was positively correlated with length of stay and duration of ventilation. NUTRIC scores did not correlate with REE. The Faisy–Fagon equation overestimated expenditure, whereas PSUm was unbiased and accurate. Calculations based on 25 kcal/kg bodyweight/day overestimated expenditure, whereas 23 kcal/kg/day produced unbiased estimates with greater accuracy than PSUm. Conclusion REE was positively associated with patient outcomes. Energy expenditure was accurately predicted by calculations of 23 kcal/kg bodyweight/day.

Effects of daily treatment with acid suppressants for stress ulcer prophylaxis on risk of ventilator-associated events

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Xiaojuan Li ◽  
Michael Klompas ◽  
John T. Menchaca ◽  
Jessica G. Young
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Cumulative Risk ◽  
Daily Treatment ◽  
High Dose ◽  
Risk Of Mortality ◽  
Competing Events ◽  
Ulcer Prophylaxis

Abstract Objective: To estimate the effects of continuous daily treatment with different acid suppressants on the risk of ventilator-associated events in critically ill patients. Design: Retrospective cohort study. Patients: Adult critically ill patients who underwent mechanical ventilation for ≥3 days during an inpatient admission between January 2006 and December 2014. Methods: We estimated the 30-day cumulative risk ratios (RRs) for ventilator-associated events comparing daily proton pump inhibitor (PPI) versus daily histamine-2-receptor antagonist (H2RA) strategies while controlling for time-fixed and time-varying confounding and accounting for competing events. Results: Of 6,133 patients, on ventilation day 3, 58.8% received H2RAs, 26.1% received PPIs, and 4.1% received sucralfate. Patients frequently changed treatment throughout follow-up. Among 4,595 patients receiving PPIs or H2RAs on day 3, we found no differences in risk estimates for ventilator mortality and extubation alive comparing daily PPI versus daily H2RA strategies: RR, mortality, 1.03 (95% CI, 0.89–1.22); extubation alive, 1.00 (95% CI, 0.96–1.03). We found similar results after accounting for PPI dose. For possible ventilator-associated pneumonia (PVAP) and infection-related ventilator-associated complication (IVAC), point estimates were larger, but the 95% CIs crossed 1.0: RR PVAP, 1.25 (95% CI, 0.80–1.94); IVAC, 0.89 (95% CI, 0.64–1.17). The magnitude of effect estimates depended on PPI dose. The RR for PVAP, high-dose PPI versus H2RA, was 1.53 (95% CI, 0.82–2.51), and for low-dose PPI versus H2RA, the RR was 0.97 (95% CI, 0.47–1.63). For IVAC, high-dose PPI versus H2RA, the RR was 1.01 (95% CI, 0.66–1.42), and for low-dose PPI versus H2RA, the RR was 0.78 (95% CI, 0.50–1.11). Conclusions: We estimated no effect of daily PPI versus daily H2RA on risk of mortality or extubation alive in critically ill patients. Further investigation with larger samples is warranted for PVAP and IVAC.

scholarly journals Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 959
Author(s):  
Cesar Copaja-Corzo ◽  
Miguel Hueda-Zavaleta ◽  
Vicente A. Benites-Zapata ◽  
Alfonso J. Rodriguez-Morales
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Healthcare Associated Infection ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Selection Of

Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher; the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

scholarly journals Enteral Nutrition Feeding Adequacy among Mechanically Ventilated Critically Ill Patients with High Nutrition Risk in a selected Public Hospital in Malaysia : A preliminary study

2016 ◽  
Vol 4 (1) ◽  
pp. 9-13
Author(s):  
Zheng Yii Lee ◽  
Mohd Yusof Barakatun Nisak ◽  
Ibrahim Noor Airini
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Therapy ◽  
Critically Ill Patient ◽  
Protein Requirement ◽  
Nutrition Risk ◽  
Mechanically Ventilated ◽  
Icu Admission ◽  
Risk Patients ◽  
Nutrition Intake

Background : Critically Ill patients with high nutrition risk require optimal amount of nutrition therapy for a better clinical outcome.Objective : The objective of this study was to study EN feeding adequacy among mechanically ventilated critically ill patient with high nutrition risk.Method : A prospective observational study was carried out at General Intensive Care Unit (ICU), Hospital Serdang. Adult patients (? 18 years old) who were intubated and mechanically ventilated within 48 hours of ICU admission, stayed in ICU for ? 72 hours and exclusively fed with EN were included. Eligible patients were followed in ICU for a maximum of 12 days or until death or discharge from ICU. High nutrition risk is determined by a validated nutrition risk screening tool -- the Modified Nutrition Risk in the Critically Ill (NUTRIC) score of ? 6.Results : A total of 25 patients were sampled. Mean age was 53 ± 17 years and mean BMI was 26.3 ± 5.3 kg/m2. Median time of EN initiation since ICU admission was 8 (Interquartile range [IQR] 3.5-17.5) hours. Among 17 (68%) patients with high nutrition risk, 15 (88.2%) did not receive the recommended optimal nutrition requirement (? 80% of calculated energy and protein requirement), despite the fact that the overall energy and protein adequacy was 71.8 ± 14.8% and 62.4 ± 15.1%, performing better than the international average of 61.2 ± 29.4% and 57.6% ± 29.6%, respectively.Conclusion : EN feeding adequacy was suboptimal among critically ill patients with high nutrition risk, as evidenced by 88.2% of high nutrition risk patients not receiving the recommended energy and protein requirement. Identification of patients with high nutrition risk is important to optimize nutrition intake in patients most likely to benefit from optimal amounts of nutrition therapy.Bangladesh Crit Care J March 2016; 4 (1): 9-13

scholarly journals Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Jessica González ◽  
Iván D. Benítez ◽  
David de Gonzalo-Calvo ◽  
Gerard Torres ◽  
Jordi de Batlle ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Risk Of Mortality ◽  
Early Intubation ◽  
Delayed Group

Abstract Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

scholarly journals Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital

2019 ◽  
Vol 9 (2) ◽  
pp. 314-320 ◽  
Author(s):  
Fatemeh Osooli ◽  
Saeed Abbas ◽  
Shadi Farsaei ◽  
Payman Adibi
Keyword(s):  
Prospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Small Body ◽  
Trauma Patients ◽  
Medical Patients ◽  
Nutrition Risk ◽  
Factors Associated ◽  
To Receive

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.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

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