Nutritional risk factors for all-cause mortality of critically ill patients: a retrospective cohort study

Abstract

ObjectivesThis study aimed to explore the predictive value of single and multiple risk factors for the clinical outcomes of critically ill patients receiving enteral nutrition and to establish an effective evaluation model.DesignRetrospective cohort study.SettingData from the 2020–2021 period were collected from the electronic records of the First Affiliated Hospital, Nanjing Medical University.Participants459 critically ill patients with enteral nutrition in the geriatric intensive care unit were included in the study.Primary and secondary outcome measuresThe primary outcome was 28-day mortality. The secondary outcomes were 28-day invasive mechanical ventilation time, intensive care unit stay, Nutrition Risk Screening 2002 (NRS2002) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score.ResultsIndependent prognostic factors, including prealbumin/procalcitonin (PCT) ratio and APACHE II score, were identified using a logistic regression model and used in the nomogram. The area under the receiver operating characteristic curve and concordance index indicated that the predictive capacity of the model was 0.753. Moreover, both the prealbumin/PCT ratio and the combination model of PCT, prealbumin and NRS2002 had a higher predictive value for clinical outcomes. Subgroup analysis also identified that a higher inflammatory state (PCT >0.5 ng/mL) and major nutritional risk (NRS2002 >3) led to worse clinical outcomes. In addition, patients on whole protein formulae bore less nutritional risk than those on short peptide formulae.ConclusionsThis nomogram had a good predictive value for 28-day mortality in critically ill patients receiving enteral nutrition. Both the prealbumin/PCT ratio and the combination model (PCT, prealbumin and NRS2002), as composite models of inflammation and nutrition, could better predict the prognosis of critically ill patients.

Harnessing the Promise of the Cold Stress Response for Acute Brain Injury and Critical Illness in Infants and Children

“…In a recent report on more than 6,000 adults with sepsis, greater than 20% of cases presented with hypothermia-a conservative number given that normothermia was defined as a temperature greater than or equal to 35.6°C (54). Similarly, a recent study of more than 1,000 children found that hypothermia (< 36.5°C) at admission was observed in 13.6% of cases (55). A possible role for CSR was not discussed in either report.…”

Impact of Using Blood Warmer During Continuous Kidney Replacement Therapy in Patients With Acute Kidney Injury

“…22 In a study in pediatric patients, extremes of temperatures have been associated with worse outcomes in sepsis. 23 Interventions aimed to correct or induce hypothermia have yielded different results. In a study of patients with cardiogenic shock receiving venoarterial extracorporeal membrane oxygenation, moderate hypothermia for 24 h compared with normothermia did not significantly decrease 30-day mortality.…”

Ratio of procalcitonin/Simpson’s dominance index predicted the short-term prognosis of patients with severe bacterial pneumonia

“…Previous research have shown that the ratio of PCT and CRP to indicators such as serum prealbumin or erythrocyte sedimentation rate (ESR) has clinical significance in the diagnosis, management, and prognosis, such as the study by Christopher et al (2021), which showed that ESR/CRP helps to determine the duration of periprosthetic joint infection and informs the physician's treatment choice. Another study showed that serum prealbumin/PCT was negatively associated with time in intensive care and death, and could be used as an indicator of patient severity and short-term prognosis (Wang et al, 2022). Given the high and low variability of PCT, CRP, and SDI in the context of bacterial infection in patients, the ratio of inflammatory indexes to SDI was used exploratively in this study.…”