The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit?

Abstract

Cachexia syndrome has been estimated to be responsible for the death of a significant amount of cancer patients. It is characterized mainly by reduced intake, systemic inflammation and anomalous metabolism. Progressive loss of body weight, muscle wasting and functional impairment are remarkable features of the entity. Muscle wasting is due to a combination of both a diminution of protein synthesis and an increase in protein degradation. Progressive reduction of muscle protein drives to muscle fibre lessening and a reduction in its cross sectional area. Likewise, there is some evidence that a specific type of fiber is targeted in this setting. Defined cut points for sarcopenia are essential to diagnose skeletal muscle depletion and various methods have been carried out. The ubiquitin-proteasome pathway seems to play the main role in the breakdown of myofibrillar proteins. The trend to lose muscle in cancer cachexia patients may be associated to the triggering of catabolic signals by pro-inflammatory cytokines or tumour-specific agents such as proteolysis-inducing factor. Regarding prognostication, mortality risk is documented in sarcopenic cancer patients but is particularly accentuated in sarcopenic obese ones. A relationship between severe muscle depletion and survival has been shown in patients with different types of cancer such us pancreas, lung, biliary tract and colorrectal cancer. Therapeutic interventions for cancer cachexia syndrome are likely to require treatments from various groups including a combination of nutritional support, drugs with orexigenic, anabolic, anti-inflammatory effects and also non-pharmacologic interventions such as exercise. El músculo, elemento clave para la supervivencia en el enfermo neoplásico Muscle wasting as a key predictor of survival in cancer patients

Análisis de sobrevida en pacientes críticos con soporte nutricional según el puntaje mNUTRIC

“…De manera similar, el estudio de Wu y colaboradores reportó una sobrevida del 50 % en promedio a los 28 días en pacientes críticos con NE independientemente del mNUTRIC. En cambio, Bernasconi y colaboradores informaron una probabilidad de sobrevida del 72,8 % en los pacientes con un puntaje menor de 5 y del 6,4 % con puntajes > 5 (p < 0,001) (15,21) .…”

“…Con respecto a los factores asociados a la sobrevida a los 30 días, en el estudio de Bernasconi y colaboradores (15) , el diagnóstico clínico (frente al quirúrgico) y el mNUTRIC > 5 (frente a < 5) aumentaron el riesgo de muerte. En el presente trabajo no se observaron diferencias según el mNUTRIC y no fue posible realizar un análisis según el diagnóstico debido a la heterogeneidad hallada.…”

“…Diversas investigaciones analizaron la asociación entre los puntajes del NUTRIC con la evolución de los pacientes, aunque la mayoría de ellos sin ajustar por el aporte calórico-proteico a través de la NE exclusiva. En este sentido, se reportó una mayor mortalidad a los 28 días y mayor duración de la estancia hospitalaria en pacientes con puntajes más altos del NUTRIC y menor ingesta proteica y calórica (11)(12)(13)(14)(15) .…”

NUTRIC score as a predictor of outcome in COVID-19 ARDS patients: A retrospective observational study

“…[ 19 ] The NUTRIC score has been predicted to be a risk factor associated with survival time in ICUs. [ 20 ]…”

Nutritional therapy in hospital care of in-patients with Covid-19: evidence, consensus and practice guidelines

“…In the case of critical patients in an intensive care unit, fed exclusively with enteral nutrition, in a prospective study, more complications, mechanical complications and a higher risk of PCR/albumin were observed in those patients with critical caloric deficit in enteral therapy [47]. In patients with energy and protein deficit, one can observe more complications, longer hospital stay and more time receiving mechanical ventilation, increased risk of infections and prolonged hospitalization [47][48][49].…”