Malnutrition at the Time of Surgery Affects Negatively the Clinical Outcome of Critically Ill Patients with Gastrointestinal Cancer

Abstract

Introduction:Malnutrition is a frequent concomitant of surgical illness, especially in gastrointestinal cancer surgery. The aim of the study was to assess the prevalence of malnutrition in the GI cancer patients and its relation with clinical outcome. We also examined associations between the energy balance and clinical outcomes in these patients.Methods:Prospective study on 694 surgical patients treated in the ICU of the UHC of Tirana. Patients were divided into well-nourished and malnourished groups according to their nutritional status. Multiple regression analysis was used to analyze the effect of malnutrition and cumulated energy balance on clinical outcome.Results:The prevalence of pre-operative malnutrition was 65.3% for all surgical patients and 84.9% for gastrointestinal cancer patients. Malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor for higher complications, infections, and mortality, longer stay in the ventilator and ICU. Also this model showed that cumulated energy balance correlated with infections, and mortality and was independently associated with the length ventilator and ICU stay.Conclusion:This study shows that malnutrition is a significant problem in surgical patients, especially in patients with gastrointestinal cancer. Malnutrition and cumulated energy deficit in gastro-intestinal surgery patients with malignancy is an independent risk factor on increased post-operative morbidity and mortality.

Predictive value of prognostic nutritional index in patients with oral squamous cell carcinoma

“…Consistently, reduced peripheral lymphocyte count indicated impairment of innate cellular immunity, which was usually associated with disease severity and poor prognosis (Fogar et al, 2006; Kobayashi et al, 2012). On the other side, malnutrition is prevalent in patients with advanced cancer and associated with inferior prognosis in various cancers (Barret et al, 2011; Shpata et al, 2014). Serum albumin is a simple surrogate marker utilized as an indicator of nutritional status.…”

Utility of nutritional evaluation for the clinical risk assessment of postoperative complications. Does oncology need the NRS 2002 scale?

“…Relatively frequent, the phenomenon occurs in 20-60% of cancer patients [1][2][3] and may considerably affect the quality of life and treatment results [8]; everyone, including those treated in highly developed countries of the European Union [9], is at risk. Importantly, malnutrition requires longer hospital stays, and, as a consequence, a more lengthy and expensive treatment process [4,[10][11][12][13], which may take up to twice as long as in properly nourished patients with the same diagnosis [2].…”

“…Its causes include the loss of appetite, reduced food intake, metabolic changes due to the tumor and cancer-related chronic inflammation, as well as the side effects of cancer treatment, including surgery and chemo-and radiotherapy. In operated patients with GI cancers, malnutrition is an independent risk factor for an increased incidence of complications, nosocomial infections, and perioperative mortality [1][2][3][4][5][6].…”

Geriatric Nutritional Risk Index, a predictive assessment tool, for postoperative complications after abdominal surgery: A prospective multicenter cohort study

“…In addition, malnutrition in older populations is associated with adverse medical consequences that contribute to sarcopenia, morbidity and mortality . Nutrition status, as it relates to frailty in older patients, is an important area of concern, as studies have reported 40–50% of surgical patients to be malnourished on admission to hospital . As malnutrition affects postoperative complications and progress, it is important to evaluate the preoperative nutritional status.…”