Fruchtenicht AVG, Poziomyck AK, Kabke GB, Loss SH, Antoniazzi JL, Steemburgo T, Moreira LF. Nutritional risk assessment in critically ill cancer patients: systematic review.
Rev Bras Ter Intensiva 2015;
27:274-83. [PMID:
26270855 PMCID:
PMC4592123 DOI:
10.5935/0103-507x.20150032]
[Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/08/2015] [Indexed: 01/10/2023] Open
Abstract
Objective
To systematically review the main methods for nutritional risk assessment used in
critically ill cancer patients and present the methods that better assess risks
and predict relevant clinical outcomes in this group of patients, as well as to
discuss the pros and cons of these methods according to the current
literature.
Methods
The study consisted of a systematic review based on analysis of manuscripts
retrieved from the PubMed, LILACS and SciELO databases by searching for the key
words “nutritional risk assessment”, “critically ill” and “cancer”.
Results
Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and
were selected for the review. The main outcomes of these studies were that resting
energy expenditure was associated with undernourishment and overfeeding. The high
Patient-Generated Subjective Global Assessment score was significantly associated
with low food intake, weight loss and malnutrition. In terms of biochemical
markers, higher levels of creatinine, albumin and urea were significantly
associated with lower mortality. The worst survival was found for patients with
worse Eastern Cooperative Oncologic Group - performance status, high Glasgow
Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment
score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index
values < 87 were significantly associated with mortality. A high Prognostic
Inflammatory and Nutritional Index score was associated with abnormal nutritional
status in critically ill cancer patients. Among the reviewed studies that examined
weight and body mass index alone, no significant clinical outcome was found.
Conclusion
None of the methods reviewed helped to define risk among these patients.
Therefore, assessment by a combination of weight loss and serum measurements,
preferably in combination with other methods using scores such as Eastern
Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and
Patient-Generated Subjective Global Assessment, is suggested given that their use
is simple, feasible and useful in such cases.
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