Insufficient Nutrition and Mortality Risk in Septic Patients Admitted to ICU with a Focus on Immune Dysfunction

Hung, Kuo‐Chi; Chen, Yu‐Mu; Wang, Chin‐Chou; Wang, Yi‐Hsi; Lin, Chiung-Yu; Chang, Ya‐Ting; Huang, Kuo‐Tung; Lin, Meng-Chih; Fang, Wen‐Feng

doi:10.3390/nu11020367

Cited by 26 publications

(22 citation statements)

References 48 publications

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“…Insufficient nutrition and immune dysfunction had no synergistic effect on mortality in critically ill septic patients [19]. As expected, a well-fed patient with normal immune function had the best chance to survive.…”

Section: Caloriessupporting

confidence: 64%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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Nutrition therapy in sepsis is challenging and differs from the standard feeding approach in critically ill patients. The dysregulated host response caused by infection induces progressive physiologic alterations, which may limit metabolic capacity by impairing mitochondrial function. Hence, early artificial nutrition should be ramped-up and emphasis laid on the post-acute phase of critical illness. Caloric dosing is ideally guided by indirect calorimetry, and endogenous energy production should be considered. Proteins should initially be delivered at low volume and progressively increased to 1.3 g/kg/day following shock symptoms wane. Both the enteral and parenteral route can be (simultaneously) used to cover caloric and protein targets. Regarding pharmaconutrition, a low dose glutamine seems appropriate in patients receiving parenteral nutrition. Supplementing arginine or selenium is not recommended. High-dose vitamin C administration may offer substantial benefit, but actual evidence is too limited for advocating its routine use in sepsis. Omega-3 polyunsaturated fatty acids to modulate metabolic processes can be safely used, but non-inferiority to other intravenous lipid emulsions remains unproven in septic patients. Nutrition stewardship, defined as the whole of interventions to optimize nutritional approach and treatment, should be pursued in all septic patients but may be difficult to accomplish within a context of profoundly altered cellular metabolic processes and organ dysfunction caused by time-bound excessive inflammation and/or immune suppression. This review aims to provide an overview and practical recommendations of all aspects of nutritional therapy in the setting of sepsis.

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Section: Caloriessupporting

confidence: 64%

Nutrition in Sepsis: A Bench-to-Bedside Review

2020

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“…The extension study was a post hoc analysis of an integrative research program, consisting of prospective observational investigation and retrospective medical record review 6,12–15 . This study retrospectively investigated the clinical factors (e.g., whole blood leukocyte count and dynamic SeMo ratio) in predicting outcomes in sepsis patients.…”

Section: Methodsmentioning

confidence: 99%

“…Sepsis patients suffer from life-threatening organ dysfunction due to a dysregulated host inflammatory response to infection 2 and other factors such as endothelial dysfunction with interaction of leukocytes 3 . Because many factors other than the initial severity contribute to the mortality 4–6 and patients usually present with different manifestations, many risk scores consist of several domains. However, simple dynamic tools for risk stratification are limited.…”

Section: Introductionmentioning

confidence: 99%

Incorporation of dynamic segmented neutrophil-to-monocyte ratio with leukocyte count for sepsis risk stratification

Fang

Chen

Wang

et al. 2019

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The association between sepsis and segmented neutrophil-to-monocyte (SeMo) ratio is unclear. We postulated that an increase in dynamic SeMo ratio measurement can be applied in risk stratification. This retrospective study included 727 consecutive sepsis patients in medical intensive care units (ICUs), including a subpopulation of 153 patients. According to the leukocyte (white blood cell, WBC) count on day 3 (normal range, between 4,000/µL and 12,000/µL) and delta SeMo (value of SeMo ratio on day 3 minus value of SeMo ratio on day 1; normal delta SeMo, <7), patients were grouped into 3 (delta SeMo & WBC tool). The survival lines separated significantly with hazard ratios of 1.854 (1.342–2.560) for the delta SeMo or WBC abnormal group and 2.860 (1.849–4.439) for the delta SeMo and WBC abnormal group compared to the delta SeMo and WBC normal group. Delta SeMo & WBC tool and delta sequential organ failure assessment (SOFA) tool performed better than the other tools (delta SeMo, delta WBC, day 3 WBC, and day 1 WBC). Severity in delta SeMo & WBC tool and delta SeMo tool reflected the immune dysfunction score, cytokine expression, and human leukocyte antigen D-related monocyte expression on day 1 and day 3. There was correspondence between delta SOFA and delta WBC and between delta SeMo and delta cytokine expression. Incorporation of dynamic SeMo ratio with WBC count provides risk stratification for sepsis patients admitted in the ICU.

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“…Many factors affect the outcomes of sepsis patients 33 . The severity scores (APACHE II and SOFA scores) on day 1 were comparable.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

Fang

Huang

et al. 2020

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We hypothesized that Ventilator-Associated Event (VAE) within 28 days upon admission to medical intensive care units (ICUs) can be a predictor for poor outcomes in sepsis patients. We aimed to determine the risk factors and associated outcomes of VAE. A total of 453 consecutive mechanically ventilated (MV) sepsis patients were enrolled. Of them, 136 patients had immune profile study. Early VAE (< 7-day MV, n = 33) was associated with a higher mortality (90 days: 81.8% vs. 23.0% [non-VAE], P < 0.01), while late VAE (developed between 7 and 28 days, n = 85) was associated with longer MV day (43.8 days vs. 23.3 days [non-VAE], P < 0.05). The 90-day Kaplan-Meier survival curves showed three lines that separate the groups (non-VAE, early VAE, and late VAE). Cox regression models with time-varying coefficient covariates (adjusted for the number of days from intubation to VAE development) confirmed that VAE which occurred within 28 days upon admission to the medical ICUs can be associated with higher 90-day mortality. The risk factors for VAE development include impaired immune response (lower human leukocyte antigen D-related expression, higher interleukin-10 expression) and sepsis progression with elevated SOFA score (especially in coagulation sub-score). Ventilator-associated event (VAE) 1,2 was proposed to overcome the limitations of only focusing on ventilatorassociated pneumonia (VAP) 3 surveillance in mechanically ventilated (MV) patients in the context of surveying quality improvement. The limitations of previous VAP surveillance, which is proven to be neither sensitive nor specific 4 , hindered its application in quality improvement programs 5. Although VAE surveillance was a promising early warning tool for VAP prevention 6 , VAP prevention bundle compliance was not associated with a reduced risk of VAE 7. VAEs are defined as respiratory deterioration after a period of improved or stable gas exchange. The definition of VAE shifted the focus of surveillance from pneumonia to all conditions caused by mechanical ventilation including infectious or noninfectious conditions. The purpose was to expand the scope of surveillance to include multiple serious complications in ventilated patients, not just pneumonia, as well as to make surveillance more objective, efficient, and suitable for electronic implementation. Sepsis patients developed life-threatening organ dysfunctions (e.g., acute respiratory failure) caused by dysregulated host immune response to infection 8-10. An increase in sequential organ failure assessment (SOFA) score (including respiratory and other five sub-scores) has prognostic accuracy for in-hospital mortality in sepsis patients in the intensive care units (ICUs) 11. Since mechanical ventilator support and aggressive fluid resuscitation

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Insufficient Nutrition and Mortality Risk in Septic Patients Admitted to ICU with a Focus on Immune Dysfunction

Cited by 26 publications

References 48 publications

Nutrition in Sepsis: A Bench-to-Bedside Review

Nutrition in Sepsis: A Bench-to-Bedside Review

Incorporation of dynamic segmented neutrophil-to-monocyte ratio with leukocyte count for sepsis risk stratification

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

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