Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance

Abstract

Several studies have attempted to define nutritional parameters that can be used to select undernourished hospitalized patients and identify those who present higher risk of postoperative septic complications. Nevertheless, the majority of these studies do not take into consideration the severity of infectious episodes. Systems for scoring the severity of illness are of critical importance in hospital practice and clinical research. In fact, they could be used for the following purposes: (a) a more correct stratification of patients in clinical studies; (b) monitoring the evolution of the infectious complication; (c) prediction of survival; (d) optimization of the criteria for admission to and discharge from intensive care units; and (e) evaluation of quality, quantity, and costs of nutritional therapy in critically ill patients. In this article, the authors present a critical review on the clinical relevance of the methods of nutritional assessment more commonly used in clinical practice; and, moreover they discuss the more recently proposed systems for scoring the severity of illness.

Protein–energy undernutrition in hospital in-patients

“…Systems for scoring the severity of illness should be used in clinical studies to stratify patients and in the evaluation of quality, quantity and costs of nutritional therapy in ill patients. A number of scoring systems are available which link severity of illness at presentation to outcome (Dionigi et al 1986). Severity of illness was the best discriminator for the development of nutrition-associated complications in one study of 231 elderly medical patients, who were assessed (clinically and nutritionally) on admission to hospital and followed to 1 month after discharge.…”

Faktor Prediktor Malnutrisi Rumah Sakit pada Anak

“…Selain itu, MRS berat terkait dengan beratnya penyakit dan komplikasi yang terjadi. 12,13 Derajat penyakit 3 didefinisikan sebagai penyakit kronis yang mengalami perburukan atau penyakit berat yang berada pada episode akut.…”

“…13 Perburukan yang terjadi tidak hanya terlihat secara antropometri (penurunan berat badan), tetapi juga berdasarkan pemeriksaan biokimia dan imunologi, seperti pemeriksaan kadar albumin dan imunoglobulin yang cenderung turun seiring dengan perburukan penyakit. Respon metabolik pada kondisi critically ill di antaranya terjadi peningkatan kadar CRP, α1-antitripsin dan fibronetin.…”

“…22,23 Scoring of pyrexia menyebutkan bahwa suhu di atas 37,5˚C memiliki risiko mengalami sepsis terutama pada pasien dengan derajat penyakit yang lebih berat sehingga perlu dilakukan skoring. 13 Asupan makan, status nutrisi, diare, dan keganasan bukan merupakan faktor prediktor dalam penelitian kami. Pada awal rawat, anak cenderung mengalami penurunan nafsu makan karena berada di lingkungan baru sehingga perlu adaptasi, di samping rasa dan teknik penyajian menu turut berpengaruh.…”

Verlaufskontrolle septischer Patienten auf der Intensivstation mit Hilfe von ?Sepsisscore?, Endotoxin- und AT III-Bestimmung

“…Verschiedene Vorschl~ge wurden gemacht, mit einem Punktesystem den Schweregrad der Krankheit zu bewerten [3, 4, 11-14, 16, 17]. Mit dieser Punktebewertung soil es mrglich sein, relativ einfach den Schweregrad der postoperativen Sepsis zu definieren und zwischen iiberlebenden und verstorbenen Patienten zu unterscheiden [5][6][7]. Mit dieser Punktebewertung soil es mrglich sein, relativ einfach den Schweregrad der postoperativen Sepsis zu definieren und zwischen iiberlebenden und verstorbenen Patienten zu unterscheiden [5][6][7].…”