Background The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis. Methods: Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models. Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001). Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.
Background Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.
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BACKGROUND Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
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BACKGROUND Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease. METHODS 3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded. RESULTS Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group. CONCLUSIONS Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.
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