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Vest MT, Papas MA, Shapero M, McGraw P, Capizzi A, Jurkovitz C. Characteristics and Outcomes of Adult Inpatients With Malnutrition. JPEN J Parenter Enteral Nutr 2017; 42:1009-1016. [PMID: 29360158 DOI: 10.1002/jpen.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The diagnosis of malnutrition remains controversial. Furthermore, it is unknown if physician diagnosis of malnutrition impacts outcomes. We sought to compare outcomes of patients with physician diagnosed malnutrition to patients recognized as malnourished by registered dietitians (RDs), but not physicians, and to describe the impact of each of 6 criteria on the diagnosis of malnutrition. METHODS We conducted a retrospective cohort study of adult patients identified as meeting criteria for malnutrition. Pediatric, psychiatric, maternity, and rehabilitation patients were excluded. Patient demographics, clinical data, malnutrition type and criteria, nutrition interventions, and outcomes were abstracted from the electronic medical record. RESULTS RDs identified malnutrition for 291 admissions during our study period. This represents 4.1% of hospital discharges. Physicians only diagnosed malnutrition on 93 (32%) of these cases. Physicians diagnosed malnutrition in 43% of patients with a body mass index <18.5 but only 26% of patients with body mass index higher than 18.5. Patients with a physician diagnosis had a longer length of stay (mean 14.9 days vs 7.1 days) and were more likely to receive parenteral nutrition (PN) (20.4% vs 4.6%). Of the patients, 62% had malnutrition due to chronic illness. Of the 6 criteria used to identify malnourished patients, weight loss and reduced energy intake were the most common. CONCLUSIONS Malnutrition is underrecognized by physicians. However, further research is needed to determine if physician recognition and treatment of malnutrition can improve outcomes. The most important criteria for identifying malnourished patients in our cohort were weight loss and reduced energy intake.
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Affiliation(s)
- Michael T Vest
- Critical Care Medicine, Department of Medicine, Christiana Care Healthcare System, Christiana Care Value Institute, Sidney Kimmel Medical College, Newark, Delaware
| | - Mia A Papas
- Christiana Care Value Institute, Newark, Delaware
| | - Mary Shapero
- Department of Food and Nutrition Services, Christiana Care Healthcare System, Newark, Delaware
| | - Patty McGraw
- Department of Medicine Research Christiana Care Healthcare System, Newark, Delaware
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Buter H, Veenstra JA, Koopmans M, Boerma CE. Phase angle is related to outcome after ICU admission; an observational study. Clin Nutr ESPEN 2017; 23:61-66. [PMID: 29460815 DOI: 10.1016/j.clnesp.2017.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/07/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Malnutrition at the time of ICU admission is associated with an increased morbidity and mortality. Malnutrition is most often assessed by a questionnaire but can also be determined with bio-impedance and measurement of phase angle. In a single-centre observational study we compared the percentage of malnutrition in patients admitted to our ICU, according to the Short Nutritional Assessment Questionnaire (SNAQ) with the phase angle measured with bio-impedance. Furthermore, we questioned whether malnutrition is related to outcome parameters. METHODS In a 15 week period consecutive patients admitted to the ICU were included. Exclusion criteria included age <18 years, anatomical and/or neurological abnormalities of the limbs and an ICU stay less than 6 h. Bio-impedance measurements were performed shortly after admission, the SNAQ was obtained from the patient or legal representative. Malnutrition is considered with a SNAQ ≥2 or a phase angle of <5° for men and <4.6° for women. The study was approved by our local ethical committee (MCL, nWMO 77, April 18, 2015). RESULTS 299 Patients were included (66% male, age 66 ± 12 year, BMI 27 ± 4 kg/m2 and APACHE II score 14 [11-17]), of which 64% elective and 36% acute admissions. Hospital mortality was 7.4%. Malnutrition was present in 16% according to the SNAQ and in 36% according to phase angle. There was a fair accordance between the SNAQ and phase angle. Phase angle was significantly higher in patients with a SNAQ score of 0-1 (5.5°±1.3) in comparison with patients with a SNAQ score ≥2 (4.4°± 1.1) (p < 0.001). Logistic regression analysis showed a significant relation between SNAQ and BMI, malignant disease and hospital length of stay and between phase angle and age, sex, BMI, malignant disease, hospital length of stay and hospital mortality. CONCLUSION Malnutrition was present in 16% according to the SNAQ and in 36% according to phase angle in our IC population. Malnutrition was associated with prolonged hospital length of stay. In this small population of mixed ICU patients, a low phase angle was found to independently predict hospital mortality. CLINICAL TRIALS. GOV NUMBER NCT02911181.
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Affiliation(s)
- Hanneke Buter
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Janny A Veenstra
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Matty Koopmans
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Christiaan E Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
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Mogensen KM, Horkan CM, Purtle SW, Moromizato T, Rawn JD, Robinson MK, Christopher KB. Malnutrition, Critical Illness Survivors, and Postdischarge Outcomes: A Cohort Study. JPEN J Parenter Enteral Nutr 2017; 42:557-565. [PMID: 28521598 DOI: 10.1177/0148607117709766] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. METHODS We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. RESULTS The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90-day postdischarge mortality. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, sex, Deyo-Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8%, and 21.9% in patients without malnutrition, those at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition, respectively. The odds of 90-day postdischarge mortality in patients at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition fully adjusted were 1.77 (95% confidence interval [CI], 1.23-2.54), 2.51 (95% CI, 1.36-4.62), and 3.72 (95% CI, 2.16-6.39), respectively, relative to patients without malnutrition. Furthermore, the presence of malnutrition is a significant predictor of the odds of unplanned 30-day hospital readmission. CONCLUSIONS In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.
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Affiliation(s)
- Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clare M Horkan
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven W Purtle
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Boulder, Colorado, USA
| | - Takuhiro Moromizato
- Renal and Rheumatology Division, Internal Medicine Department, Okinawa Southern Medical Center and Children's Hospital, Naha, Japan
| | - James D Rawn
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Malcolm K Robinson
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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The Obesity Paradox Is Not Observed in Critically Ill Patients on Early Enteral Nutrition. Crit Care Med 2017; 45:828-834. [PMID: 28288028 DOI: 10.1097/ccm.0000000000002326] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate the association between body mass index and mortality in a large, ICU population and determine if the relationship is observed among a subgroup of patients ordered early enteral nutrition. DESIGN Retrospective cohort study within a national clinical mixed ICU database of patients admitted between January 1, 2008, and June 30, 2015. SETTING Initial ICU admissions among patients monitored by tele-ICU programs and recorded in the Philips eICU Research Institute database. PATIENTS A total of 1,042,710 adult patient stays with ICU length of stay more than 24 hours, of which 74,771 were ordered enteral nutrition within the first 48 hours. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Patient stays from 409 ICUs were included. The average age, Acute Physiology and Chronic Health Evaluation IV score, and hospital mortality were 63.6 years, 56.7, and 9.0%, respectively. Hospital mortality among body mass index categories was estimated by multivariable modified Poisson regression models. Compared with the body mass index category 25.0-29.9 kg/m, hospital mortality was higher among underweight (body mass index, < 18.5; relative risk, 1.35; 95% CI, 1.32-1.39), normal weight (body mass index, 18.5-24.9; relative risk, 1.10; 95% CI, 1.09-1.12), and the extremely obese (body mass index, ≥ 50.0; relative risk, 1.10; 95% CI, 1.05-1.15). However, the risk was not statistically different from patients with body mass index 30.0-49.9 kg/m. Among patients ordered early enteral nutrition, the risk of mortality in the body mass index category 25.0-29.9 kg/m was not statistically different from those in the normal weight or extremely obese groups. CONCLUSIONS A survival advantage for overweight and obese patients was observed in this large cohort of critically ill patients. However, among those ordered early enteral nutrition, the survival disadvantage for body mass index categories less than 25.0 kg/m was minimal or unobservable when compared with higher body mass index categories.
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Thongprayoon C, Cheungpasitporn W, Kittanamongkolchai W, Harrison AM, Kashani K. Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients. Am J Med 2017; 130:545-554.e1. [PMID: 27998681 DOI: 10.1016/j.amjmed.2016.11.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients. METHODS This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality. RESULTS Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients. CONCLUSIONS Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients.
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Affiliation(s)
| | | | | | - Andrew M Harrison
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.
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Abstract
PURPOSE OF REVIEW In this review, we discuss the causes for a failed weaning trial and specific diagnostic tests that could be conducted to identify the cause for weaning failure. We briefly highlight treatment strategies that may enhance the chance of weaning success. RECENT FINDINGS Impaired respiratory mechanics, respiratory muscle dysfunction, cardiac dysfunction, cognitive dysfunction, and metabolic disorders are recognized causes for weaning failure. In addition, iatrogenic factors may be at play. Most studies have focused on respiratory muscle dysfunction and cardiac dysfunction. Recent studies demonstrate that both ultrasound and electromyography are valuable tools to evaluate respiratory muscle function in ventilated patients. Sophisticated ultrasound techniques and biomarkers such as B-type natriuretic peptide, are valuable tools to identify cardiac dysfunction as a cause for weaning failure. Once a cause for weaning failure has been identified specific treatment should be instituted. Concerning treatment, both strength training and endurance training should be considered for patients with respiratory muscle weakness. Inotropes and vasodilators should be considered in case of heart failure. SUMMARY Understanding the complex pathophysiology of weaning failure in combination with a systematic diagnostic approach allows identification of the primary cause of weaning failure. This will help the clinician to choose a specific treatment strategy and therefore may fasten liberation from mechanical ventilation.
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108
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Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, Salim A, Christopher KB. Malnutrition at Intensive Care Unit Admission Predicts Mortality in Emergency General Surgery Patients. JPEN J Parenter Enteral Nutr 2016; 42:156-163. [DOI: 10.1177/0148607116676592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Joaquim M. Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alexandra B. Columbus
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Olubode A. Olufajo
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kris M. Mogensen
- Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - James D. Rawn
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ali Salim
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kenneth B. Christopher
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Hiller LD, Shaw RF, Fabri PJ. Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics. JPEN J Parenter Enteral Nutr 2016; 41:1316-1324. [DOI: 10.1177/0148607116668523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Lynn D. Hiller
- Nutrition and Food Services, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Robert F. Shaw
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
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Abstract
OBJECTIVES Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge. DESIGN Single-center retrospective cohort study. SETTING Academic Medical Center. PATIENTS Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p < 0.001]). In patients who had at least 7 days of physical therapy treatment prior to hospital discharge (n = 2,293), the adjusted odds of 90-day postdischarge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status (odds ratio, 0.36 [95% CI, 0.24-0.53]; p < 0.001). CONCLUSIONS Lower functional status at hospital discharge in survivors of critical illness is associated with increased postdischarge mortality. Furthermore, patients whose functional status improves before discharge have decreased odds of postdischarge mortality.
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111
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Mogensen KM, Lasky-Su J, Rogers AJ, Baron RM, Fredenburgh LE, Rawn J, Robinson MK, Massarro A, Choi AMK, Christopher KB. Metabolites Associated With Malnutrition in the Intensive Care Unit Are Also Associated With 28-Day Mortality. JPEN J Parenter Enteral Nutr 2016; 41:188-197. [PMID: 27406941 DOI: 10.1177/0148607116656164] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We hypothesized that metabolic profiles would differ in critically ill patients with malnutrition relative to those without. MATERIALS AND METHODS We performed a prospective cohort study on 85 adult patients with systemic inflammatory response syndrome or sepsis admitted to a 20-bed medical intensive care unit (ICU) in Boston. We generated metabolomic profiles using gas and liquid chromatography and mass spectroscopy. We followed this by logistic regression and partial least squares discriminant analysis to identify individual metabolites that were significant. We then interrogated the entire metabolomics profile using metabolite set enrichment analysis and network model construction of chemical-protein target interactions to identify groups of metabolites and pathways that were differentiates in patients with and without malnutrition. RESULTS Of the cohort, 38% were malnourished at admission to the ICU. Metabolomic profiles differed in critically ill patients with malnutrition relative to those without. Ten metabolites were significantly associated with malnutrition ( P < .05). A parsimonious model of 5 metabolites effectively differentiated patients with malnutrition (AUC = 0.76), including pyroglutamine and hypoxanthine. Using pathway enrichment analysis, we identified a critical role of glutathione and purine metabolism in predicting nutrition. Nutrition status was associated with 28-day mortality, even after adjustment for known phenotypic variables associated with ICU mortality. Importantly, 7 metabolites associated with nutrition status were also associated with 28-day mortality. CONCLUSION Malnutrition is associated with differential metabolic profiles early in critical illness. Common to all of our metabolome analyses, glutathione and purine metabolism, which play principal roles in cellular redox regulation and accelerated tissue adenosine triphosphate degradation, respectively, were significantly altered with malnutrition.
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Affiliation(s)
- Kris M Mogensen
- 1 Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jessica Lasky-Su
- 2 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Angela J Rogers
- 3 Pulmonary & Critical Care Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Rebecca M Baron
- 4 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura E Fredenburgh
- 4 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James Rawn
- 5 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Malcolm K Robinson
- 5 Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anthony Massarro
- 4 Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Augustine M K Choi
- 6 Department of Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Kenneth B Christopher
- 7 The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
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112
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Lewis SR, Butler AR, Alderson P, Smith AF. Enteral versus parenteral nutrition for adults in the intensive care unit. Hippokratia 2016. [DOI: 10.1002/14651858.cd012276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Sharon R Lewis
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 1RP
| | - Andrew R Butler
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 1RP
| | - Phil Alderson
- National Institute for Health and Care Excellence; Level 1A, City Tower, Piccadilly Plaza Manchester UK M1 4BD
| | - Andrew F Smith
- Royal Lancaster Infirmary; Department of Anaesthesia; Ashton Road Lancaster Lancashire UK LA1 4RP
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Thongprayoon C, Cheungpasitporn W, Kashani K. Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients. J Thorac Dis 2016; 8:E305-11. [PMID: 27162688 DOI: 10.21037/jtd.2016.03.62] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serum creatinine (SCr) has been widely used to estimate glomerular filtration rate (GFR). Creatinine generation could be reduced in the setting of low skeletal muscle mass. Thus, SCr has also been used as a surrogate of muscle mass. Low muscle mass is associated with reduced survival in hospitalized patients, especially in the intensive care unit (ICU) settings. Recently, studies have demonstrated high mortality in ICU patients with low admission SCr levels, reflecting that low muscle mass or malnutrition, are associated with increased mortality. However, SCr levels can also be influenced by multiple GFR- and non-GFR-related factors including age, diet, exercise, stress, pregnancy, and kidney disease. Imaging techniques, such as computed tomography (CT) and ultrasound, have recently been studied for muscle mass assessment and demonstrated promising data. This article aims to present the perspectives of the uses of SCr and other methods for prediction of muscle mass and outcomes of ICU patients.
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Affiliation(s)
- Charat Thongprayoon
- 1 Division of Nephrology and Hypertension, 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- 1 Division of Nephrology and Hypertension, 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush Kashani
- 1 Division of Nephrology and Hypertension, 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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114
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Must Our Malnourished Patients Eat Right or Die? Crit Care Med 2016; 43:2689-91. [PMID: 26575662 DOI: 10.1097/ccm.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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115
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Ridley E, Gantner D, Pellegrino V. Reply Letter to the Editor - Nutrition therapy in critically ill patients - A review of current evidence for clinicians. Clin Nutr 2015; 35:244. [PMID: 26652246 DOI: 10.1016/j.clnu.2015.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Emma Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia; Nutrition Department, Alfred Health, Melbourne, Australia.
| | - Dashiell Gantner
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia; Department of Intensive Care, Western Health, Melbourne, Australia; Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
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