A reference standard for plasma proteins is required for nutritional assessment of adult burn patients

Manelli, J.C.; Badetti, C.; Botti, Gerardo; M, Golstein; Bernini, V.; Bernard, Dirk

doi:10.1016/s0305-4179(98)00031-x

Cited by 25 publications

(14 citation statements)

References 29 publications

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“…Serum albumin levels have historically been linked in clinical practice to nutritional status (1,2). Particularly with burn injuries, many physicians are still using serum albumin level as a marker of nutritional status, especially for During the acute phase of burns, hypoalbuminemia is related to the acute inflammatory response (8). Albumin is considered to be a negative acutephase protein, which decreases during inflammation (9).…”

Section: Discussionmentioning

confidence: 99%

Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study

et al. 2014

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The aim of this retrospective study was to examine whether serum albumin levels offer a good marker of nutritional status in patients with burns. Serum albumin levels have been used to evaluate nutritional status in burns patients, even though these levels are affected by various factors and are not specific to malnutrition. To clarify whether provision of nutrition or presence of inflammation affects serum albumin levels, we studied serum albumin levels, C-reactive protein (CRP) levels and caloric intake over time in 30 patients with burns. Serum albumin levels did not respond to provision of nutrition, but correlated negatively with CRP levels, suggesting that serum albumin levels are more closely associated with inflammation than nutrition. This study also suggests that hypoalbuminemia is a good indicator of the severity of burns or associated complications. We conclude that serum albumin levels do not offer a good nutritional marker in burns patients.

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Section: Discussionmentioning

confidence: 99%

Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study

et al. 2014

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“…Mineral deficiencies can be detected at an early stage and persist until wound healing is complete, as a result of skin loss, alterations in the concentrations of transport proteins, increased excretion in the urine, and by their recruitment to the interstitial space. 20 However, stable isotope infusion techniques showed that protein synthesis is enhanced during the flow phase in severely burned patients. The hypoproteinemia may be due to several factors, including hemodilution, 18 losses of proteins in wound exudates 19 and microvascular hyperpermeability.…”

Section: Discussionmentioning

confidence: 99%

“…The TBSA was 22% (ranging from 10-41) in eight patients who were burned by fire and 8% (ranging from [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] in three cases with electrical burn. The final sample consisted of 11 burn adults (Burn Group), 34.3 years (SD, 9.3), 82% of males and the body mass index was 22.3 kg/m 2 (SD, 2.9).…”

Section: Methodsmentioning

confidence: 99%

Effect of Acute Thermal Injury in Status of Serum Vitamins, Inflammatory Markers, and Oxidative Stress Markers

Vinha

Martinez

Vannucchi

et al. 2013

Journal of Burn Care & Research

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The objective of this study was to evaluate the vitamin status, inflammatory markers, and oxidative stress markers in adult patients up to 3 days after thermal injury. This prospective study was conducted with 11 patients 24 to 72 hours after thermal injury (Burn Group), total surface area ranging from 10 to 41%, 34.3 ± 9.3 years, 82% of males, body mass index of 22.3 ± 2.9 kg/m(2). We included 11 healthy adults (Control Group), 36.5 ± 7.6 years, 73% of males, and body mass index of 23.8 ± 2.5 kg/m(2). Laboratory data were measured (plasma total protein, albumin, transferrin, lymphocyte counts, zinc, and iron), as well as serum vitamins (folic acid, vitamin B12, and vitamins A, C, and E), inflammatory stress markers (C-reactive protein, ferritin, and acid α1-glycoprotein) and oxidative stress markers such as glutathione peroxidase (GPx) and thiobarbituric acid reactive substances. The inflammatory stress was characterized by lower levels of total protein (median difference 1.2 g/dL, 95% CI: 0.4-2.1) and albumin (median difference 0.9 g/dL, 95% CI: 0.5-1.5), and higher levels of C-reactive protein (median difference -8.12 mg/dL, 95% CI: -11.62 to 4.61) and α-1 glycoprotein acid (median difference -28.56 mg/dL, 95% CI: -51.57 to -5.07) in burn patients. Decreased serum levels of vitamin A (median difference 1.10 μmol/L, 95% confidence interval [CI]: 0.42-1.66) and vitamin C (median difference 0.82 mg/dL, 95% CI: 0.50-1.04) were also detected. There was no statistical evidence of difference in the serum levels of glutathione peroxidase and thiobarbituric acid reactive substances between burn patients and controls, respectively. Even though there is an inflammatory stress, the obtained data showed that oxidative stress markers are normal 24 to 72 hours after burn injury. The decrease in negative acute phase protein may account for the diminished serum levels of vitamin A, which seems to be related to inflammatory stress. The marked decrease in the serum levels of vitamin C can be justified by augmented cutaneous loss and consumption in the regeneration of vitamin E.

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“…However, in patients with weight loss and malnutrition, CRP and albumin both remain low [19] While data is limited, one study evaluated the routine utilization of CRP, albumin, and prealbumin in burn patients, and recommended the following framework. In patients with low albumin, prealbumin, and high CRP they argue inflammation is the likely culprit, in patients where all three remain low, malnutrition is the likely culprit [20]. This method likely oversimplifies the problem as these acute phase markers peak at various time periods during the inflammatory response limiting their usefulness clinically.…”

Section: Indicators Of Nutritional Statusmentioning

confidence: 99%

Hospital Based Nutrition Support: A Review of the Latest Evidence

Tignanelli¹,

Cherry-Bukowiec²

2017

J Clin Nutr Diet

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Meeting appropriate nutritional demands in the inpatient setting is a fundamental aspect of optimal patient care. Optimizing nutrition delivery and preventing malnutrition can have a significant positive effect on clinical outcomes and costs of care. Despite extensive research, many questions remain regarding the delivery of nutrients to hospitalized patients, especially in the critically ill. Recent advances have been made over the past decade, and landmark studies have yielded an end to many controversial topics, such as the broad utilization of immunonutrition. However, there are still many questions that remain unanswered, for example how do we objectively define malnutrition? Cutting edge research in the areas of morphomics and metabolomics are raising new questions which are poised to revolutionize how we will answer today's questions. In this review, we summarize the historical pedagogy underlying nutritional practice alongside contemporary evidence supporting current practice guidelines. Furthermore, we identify and explore key barriers preventing the rapid identification and treatment of malnutrition. We introduce two emerging technologies foremost in nutritional research that may eventually disrupt current barriers. And finally, we discuss key populations at specifically high risk for the development of malnutrition.

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A reference standard for plasma proteins is required for nutritional assessment of adult burn patients

Cited by 25 publications

References 29 publications

Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study

Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study

Effect of Acute Thermal Injury in Status of Serum Vitamins, Inflammatory Markers, and Oxidative Stress Markers

Hospital Based Nutrition Support: A Review of the Latest Evidence

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