The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit

Pakize Özçiftci Yılmaz 1 * , Cihangir Doğu 2
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1 Intensive Care Unit, Aydin Adnan Menderes University, Aydın, Turkey
2 Intensive Care Unit, Health Sciences University, Ankara City Hospital, Ankara, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 4, Issue 58, pp. 57-61. https://doi.org/10.23950/1812-2892-JCMK-00789
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ABSTRACT

Introduction: Malnutrition, which is a clinical process starting with systemic inflammation and extending to immune deficiency is a common problem in intensive care units. In this study, we aimed to investigate the effect of malnutrition on prognosis in surgical patients followed in intensive care unit.
Material and methods: The study is retrospective, and the files of the surgical patients hospitalized in the intensive care units of Aydin State Hospital between January 2018 and January 2020 were reviewed. The demographic data of the patients, the duration of hospitalization in the intensive care unit and the hospital, the type of surgery being urgent-elective, and the ex-discharge status of the patients were recorded. For malnutrition screening, in addition to NRS-2002 and MNA-SF scores at the time of hospitalization, statistical analysis was performed by recording C-reactive protein, albumin, total protein and C-reactive protein/albumin values as markers.
Results: A total of 160 patients were included in this study. The mean NRS-2002 score was 2.20±1.85, while the MNA-SF score was 11.39±2.99. The mean C-reactive protein/albumin value was 39.10, the hospital stay in intensive care was 3.4 days, and hospital stay was 13.58 days. It was observed that as the NRS-2002 scores at the time of hospitalization increased and MNA-SF scores decreased, the duration of hospitalization in the intensive care and the hospital increased (p<0.001). However, as the NRS-2002 scores increased and MNA-SF scores decreased, the need for mechanical ventilator and mortality rate increased (p <0.001).
Conclusion: Malnutrition is a condition that triggers the inflammatory cascade in surgical patients and has a negative effect on prognosis. Its effect is more pronounced in patients who need intensive care for surgical reasons. We think that the early identification of the risk of malnutrition and providing the necessary nutritional support in the perioperative period, especially in surgical patients who need intensive care, would affect the prognosis positively.
Keywords: malnutrition, surgery, MNA-SF, NRS-2002, mortality

CITATION

Özçiftci Yılmaz P, Doğu C. The effect of malnutrition on prognosis in surgical inpatients in the intensive care unit. Journal of Clinical Medicine of Kazakhstan. 2020;4(58):57-61. https://doi.org/10.23950/1812-2892-JCMK-00789

REFERENCES

  • Lew CCH, Yandell R., Fraser RJ, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: A systematic review. J. Parenter. Enter. Nutr. 2017; 41:744-758. https://doi.org/10.1177/0148607115625638
  • Merhi VL, Aquino JL. Determinants of Malnutrition and Post-operative Complications in Hospitalized Surgical Patients. J Health Popul Nutr. 2014; 32(3):400-410.
  • AbdulLatif NSM, Ahmad N, Islahudin F. Complications associated with malnutrition in elective surgical patients in a Malaysian setting. Tropical Journal of Pharmaceutical Research. 2016; 15(6):1321-1325. https://doi.org/10.4314/tjpr.v15i6.27
  • Powers J, Samaan K. Malnutrition in the ICU patient population. Crit Care NursClin North Am. 2014; 26(2):227-242. https://doi.org/10.1016/j.ccell.2014.01.003
  • Yılmaz EM, Cartı EB, Karacan E, Bilgiç E, Boylu Ş. Nutritional Condition Scanning in Gastrointestinal Cancer Patients. Kocaeli Medical J. 2016; 5(2):21-25.
  • Gülen ŞT, Yılmaz PÖ. KOAH'da Nutrisyonel Durumun Değerlendirmesinde Mini Nutrisyonel Anketin Kullanılabilirliği ve Solunum Fonksiyon Parametreleriyle İlişkisi. Kocaeli Medical J. 2017; 6(2):38-42.
  • Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for under nutrition in geriatric practice: developing the short form mini-nutritional assessment (MNA-SF). Gerontol A BiolSci Med Sci. 2001; 56:M366-M372. https://doi.org/10.1093/gerona/56.6.M366
  • Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. The journal of nutrition, health & aging. 2009; 13 (9):782-8. https://doi.org/10.1007/s12603-009-0214-7
  • Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee to et al. ESPEN Guidelines for Nutrition Screening. 2002. ClinNutr. 2003; 22(4):415-21. https://doi.org/10.1016/S0261-5614(03)00098-0
  • Ridley E, Gantner D, Pellegrino V. Nutrition therapy in critically ill patients- a review of current evidence for clinicians. ClinNutr. 2015; 34(4):565-71. https://doi.org/10.1016/j.clnu.2014.12.008
  • Osooli F, Abbas S, Farsaei S, AdibiP. Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital. AdvPharmBull. 2019; 9(2):314-320. https://doi.org/10.15171/apb.2019.037
  • Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, et al. Malnutrition at intensive care unit admission predicts mortality in emergency general surgery patients. JPEN J ParenterEnteralNutr. 2018; 42(1):156-63. https://doi.org/10.1177/0148607116676592
  • Mogensen KM, Horkan CM, Purtle SW, Moromizato T, Rawn JD, Robinson MK., et al. Malnutrition, critical illness survivors, and postdischarge outcomes: a cohort study. JPEN J ParenterEnteralNutr. 2017:148,607,117,709,766. https://doi.org/10.1177/0148607117709766.
  • Tripathi S, Kaur H, Varayil JE, Hurt RT Effects of enteral nutrition on clinical outcomes among mechanically ventilated and sedated patients in the pediatric intensive care unit. SignaVitae. 2015; 10(2):131-148. https://doi.org/10.22514/SV102.1220
  • Zaki DSD, Zakaria DM, Abd El-Galil HM. Prevalence of Malnutrition among Hospitalized Medical Intensive Care Unit Patients in a University Hospital, Cairo, Egypt: Hospital Based Survey. International Journal of Internal Medicine. 2018; 7(4): 54-59.
  • Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. ArchInternMed. 1992; 152(1):125-30. https://doi.org/10.1001/archinte.152.1.125
  • Shpata V., Kreka M., Mjekaj E., Naço M., Gjyzari A., Soxhuku A. Malnutrition affects negatively the outcome of intensive care unit (ICU) patients. European Journal of Anesthesiology (EJA). 2013; 30:189-189. https://doi.org/10.1097/00003643-201306001-00589
  • Mogensen KM, Horkan CM, Moromizato T, Rawn JD, Robinson RD, Christopher KB. Malnutrition, Critical Illness Survivors and post-discharge outcomes: a cohort study. JPEN JParenterEnteralNutr. 2018; 42(3):557-565. https://doi.org/10.1177/0148607117709766