Assessment of nutritional status of critically ill neurosurgical patients and parameters predicting the outcome: An institutional observational study

Abstract

Backdrop: Nutritional status has been proven to affect surgical outcome in various studies worldwide. Accurate nutritional assessment tools can help the clinician in taking appropriate steps at the right time in order to improve the surgical outcome. This is especially relevant in neurosurgical cases because of the long hospital stay and high incidence of complications. In the present study we aim to find out the prevalence of severe malnutrition in the patients admitted to NICU and the correlation of the same with mortality. We also intend to find out the best predictor of mortality amongst the malnutrition parameters. Materials and Methods: This is a prospective observational study conducted at Bangur Institute of neurosciences (BIN), Kolkata on 50 patients who were admitted in NICU for more than 5 days. Various nutritional paramaters like SGA, albumin and transferrin values were studied. Statistical Analysis was performed with help of Epi Info (TM) 3.5.3. Chi-square test was used to find the associations. Odds Ratio (OR) with 95% confidence interval (CI) was calculated to find the risk factors. Results: Glioma and meningioma were the most common clinical conditions in the study populations followed by space occupying lesions of the CP angle and aneurysm, PF SOL and pituitary adenoma. Nearly 42% (21/50) were severely malnourished, 36% (18/50) were moderately malnourished whereas 22% (11/50) had a normal nutritional status. CP angle SOLs were most commonly associated with severe malnutrition followed by PF SOL and pituitary adenoma. Association of various parameters namely SGA, serum albumin and serum transferrin with mortality was found to be statistically significant. This association was found to be the strongest with severe malnutrition by SGA ) as compared to serum transferrin and serum albumin levels (odds ratio of 4.37 (1.29-14.77) and 6.95 (0.80-60.13) respectively. Conclusion: In countries like India where malnutrition is very high in general and in critically ill patients, SGA is a potential tool for categorising patients with high risk of mortality at the time of admission. An early nutritional intervention thereafter might help in improving the outcome of such patients and might reduce the economic burden on part of the healthcare setting and the individual.

Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study

“…[ 21 ] Recent data from a neurosurgical ICU in India reported that 42% of their patients were severely malnourished and 36% were moderately malnourished as per the SGA evaluation. [ 22 ] In a similar study in 500 critically ill patients, 39.6% of patients were moderately malnourished, whereas only one patient was noted to have severe malnutrition as per the SGA. [ 1 ]…”

Malnutrition Essentials for Neurologists and Neurosurgeons: A Review of the Literature

“…41,42 In a study performed by Bandlish et al in a neurosurgical intensive care unit in India, 36% of 50 elective cases had moderate and 42% had severe malnutrition. 43 The overall mortality rate of these patients was 36%. 43 They assessed severe malnutrition as serum albumin < 3.5 mg/dL and serum transferrin < 150mg/dL which were significantly associated with higher mortality in their study.…”

“…43 The overall mortality rate of these patients was 36%. 43 They assessed severe malnutrition as serum albumin < 3.5 mg/dL and serum transferrin < 150mg/dL which were significantly associated with higher mortality in their study. 43 In German hospitals, Pirlich et al found that approximately 25% of patients is malnourished.…”

“…43 They assessed severe malnutrition as serum albumin < 3.5 mg/dL and serum transferrin < 150mg/dL which were significantly associated with higher mortality in their study. 43 In German hospitals, Pirlich et al found that approximately 25% of patients is malnourished. 44 In a meta-analysis of American and European studies, nearly 30% of patients is malnourished.…”