Usefulness of nutritional screening for correlation with morbidity and mortality in septic and non-septic patients in the Intensive Care Unit

ABSTRACT BACKGROUND Advances in basic and clinical research have allowed physicians to understand the metabolic response to trauma in postoperative and/or infected patients, which results in exaggerated catabolism due to their underlying pathology, prolonged fasting, and inability to adapt. 1 Nutritional support is a routine part of ICU therapy. Treating and preventing malnutrition and nutrient deficiencies is recommended and generally benefits patient outcomes, although adverse effects and complications can occur. METHODS A prospective, longitudinal, observational, comparative study was conducted in the Intensive Care Unit of The Hospital Angeles Metropolitano. Patients were selected from a cohort admitted to the Intensive Care Unit and who met the inclusion criteria. Inclusion criteria: Patients admitted to the Intensive Care Unit with various diagnoses for management were calculated as percentage of ideal body weight; percentage of usual body weight, percentage of weight change; Arm circumference, triceps skinfold, arm muscle circumference, creatinine-height ratio, albumin and total lymphocyte count, Karnofsky, indexed body mass index (BMIi), Body Mass Index. A nutritional clinical history was taken with the main focus on changes in body weight, changes in diet in relation to normal, gastrointestinal symptoms (persistent greater than 2 weeks), functional capacity, disease and its relationship with nutritional requirements. Physical examination: loss of skin fat, muscle atrophy, edema RESULTS We incluyed Fourty patients, 19 female (47. 5%) and 21 male (52. 5%) and divided in two groups. Septic group (9 patients) Group Non Septic (31 patients) Age: 56 ±14. 72 years old 61. 75 ±15. 61 years old Sex: Male 55. 55% 51. 61% Female 44. 44% 48. 38% The associated pathologies that led to admission to the Intensive Care Unit were the following: Acute Ischemic Heart Disease: (13 patients) 32. 5%, Diabetes mellitus and complications (6 patients) 15%; abdominal sepsis (4 patients) 10%, Neurological Vascular Disease: (3 patients) 7. 5%; Acute Respiratory Tract Infection (2 patients) 5%, Acute Pancreatitis (2 patients) 5%, hypovolemic shock (2 patients) 5%, Hypertensive Emergency (1 patient) 2. 5%, Chronic Obstructive Pulmonary Disease (1 patient) 2. 5%; Venous Congestive Heart Failure (1 patient) 2. 5%; Status Epilepticus (1 patient) 2. 5%; perirenal abscess (1 patient) 2. 5%. Main Measurements and Results: Albumin: 2. 59 ± 0. 84 g/dL; Total lymphocyte count: 1, 500. 84 ± 1, 530. 08; Arm circumference: 28. 92 ± 2. 97 cm; PCT: 19. 57 ± 7. 74 cm; % PCI: 117. 48 ± 19. 62 cm; % PCU: 98. 62 ± 4. 33; % Weight change: 1. 31 ± 4. 17%; CMB: 29. 28 ± 6. 68; IC/T: 170. 89 ± 405. 75; IMCi: 55. 35 ± 7. 35; BMI: 27. 68 ± 4. 54; Costs/Day: 85, 843. 75 ± 76, 973. 49; Karnofsky Score: 93. 5 ± 13. 50; Age: 75. 4 ± 22. 04 years. Subjective Global Assessment: Well-nourished: 72. 50%; Moderately malnourished or at risk of malnutrition: 22. 50%; Severely malnourished: 5%. Regarding the correlation of the different variables, it was as follows: days of stay – Serum albumin level: r = -0. 330 < 0. 05; days of stay – Karnofsky Score: r = -0. 504 < 0. 01; Albumin – days of stay: r = -0. 330 < 0. 05. ; Arm circumference – PCT: r = 0. 655 - 0. 01; Arm circumference - % PCI: r = 0. 658 < 0. 01; PCT - % PCI: r = 0. 447 - 0. 01; PCT - Moderately malnourished or at risk of malnutrition: r = 0. 865 - 0. 01; %PCI - % Weight change: r = -0. 997 - 0. 01; Karnofsky score- days of stay: r = -0. 504 - 0. 01; Severely malnourished - days of stay: r = 1. 000 - 0. 01; Severely malnourished - albumin: r = 1. 000 - 0. 01; Severely malnourished - Total lymphocyte count: r = -1. 000 - 0. 01; Severely malnourished – arm circumference: r= -1. 000 - 0. 01; Severely malnourished- PCT: r= -1. 000 - 0. 01; Severely malnourished- %PCI: r= -1. 000 - 0. 01; Severely malnourished-%PCU: r= 1. 000 - 0. 01; Severely malnourished-% Weight change: r= -1. 000 - 0. 01; Severely malnourished- Karnofsky score: r= -1. 000 - 0. 01; Severely malnourished - Age: r = -1. 000 - 0. 01; CMB - arm circumference: r = 0. 422 - 0. 01; CMB - % PCI: r = 0. 353 - 0. 05; IC/T - Well-nourished: r = 0. 882 - 0. 01; Improvement - PCT: r = 0. 416 < 0. 05; Improvement - Well-nourished: r = 0. 986 - 0. 01;Improvement - Moderately malnourished or at risk of malnutrition: r = 0. 993 - 0. 01; BMI - Well-nourished: r = 0. 461 < 0. 05; BMI - Arm circumference: r = 0. 645 - 0. 01; BMI – PCT: r=. 434 - 0. 01; BMI - % PCI: r=. 938 -0. 01; Costs – days of stay: r= 1. 000 - 0. 01; Costs – albumin: r= -. 330 -0. 05; Costs – Karnofsky score: r= -. 504 p< 0. 01 Regarding the septic and non-septic groups: The variables that had statistical significance were the following: % change in weight 1. 914 r = 0. 025 p< 0. 05; BMIi 2. 579 r= 0. 01 p-0. 05; Costs/day 3. 184 r = 0. 01 p < 0. 05, Days of stay: 3. 184± 0. 025 r=-0. 01 p < 0. 05 p value < 0. 05. Conclusions The data of more correlation in the evaluation are: the levels of serum albumin, It counts total of lymphocyte, stay days-costs and mortality.