Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool.

Abstract

INTRODUCTION:

To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU).

METHODS:

A prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality.

RESULTS:

A total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01).

CONCLUSIONS:

This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.

• Authors: Daren K Heyland, Rupinder Dhaliwal, Xuran Jiang, Andrew G Day
• Journal: Critical care (London, England) (Crit Care) Vol. 15 Issue 6 Pg. R268 ( 2011) ISSN: 1466-609X [Electronic] England
• PMID: 22085763 (Publication Type: Journal Article, Validation Study)

Chemical References

• CALCA protein, human
• Interleukin-6
• Protein Precursors
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• APACHE
• Aged
• Body Mass Index
• C-Reactive Protein (analysis)
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Chi-Square Distribution
• Critical Illness (mortality, therapy)
• Eating
• Female
• Humans
• Interleukin-6 (blood)
• Length of Stay
• Logistic Models
• Male
• Middle Aged
• Nutrition Assessment
• Nutrition Therapy (statistics & numerical data)
• Nutritional Status
• Prospective Studies
• Protein Precursors (blood)
• Risk Assessment
• Statistics, Nonparametric
• Weight Loss