Adductor Pollicis Muscle Thickness, Energy Intake, Serum Albumin, and Neutrophil-to-Lymphocyte Ratio as Predictors of Mortality in Critically Ill Patients

Abstract

Background: Critically ill patients usually experience muscle wasting, inadequate energy intake and hypoalbuminemia, all of which were associated with poor outcomes. Adductor pollicis muscle thickness (APMT) can be used to assess nutritional status. Assessment of nutritional status cannot ignore the importance of inflammatory process. Neutrophil-to-lymphocyte ratio (NLR) was recently introduced as an inflammatory biomarker. Aims: To analyze the relationship between APMT, energy intake, serum albumin, and NLR with 28-day mortality. Methods: A prospective study was conducted in intensive care unit (ICU)’s of a tertiary care hospital, Indonesia, from February to March 2020. APMT was measured at admission with a caliper. Energy intake was calculated based on the number of calories received by the patient. Albumin serum and leukocyte differential count were checked at ICU admission. The primary outcome was 28-day mortality. Results: This study involved 49 patients with mortality rate of 20.4%. There was no statistically significant difference in the mean APMT between non-survivor and survivor groups (24.25±4.65 vs. 24.97±3.59 mm, p=0.596). Mean energy intake at first day was 552.2±235.6 kcal or 47.0% of the target. There was no statistically significant relationship between energy intake and mortality (less energy intake category as a comparison). There was no statistically significant difference in the mean serum albumin between non-survivor and survivor groups (2.67±0.54 vs. 2.64±0.80 g/dl, p=0.928). Median value of NLR of all subjects was 13.28 (minimum 3.50 – maximum 59.56). There was statistically significant relationship between the subject group with high NLR (≥13.28) and low NLR group (<13.28) for mortality (p=0.031). Multivariate analysis to assess combined ability of independent variables to predict mortality obtained a satisfactory area under curve (AUC) value of 78.7%. Conclusions: The combination of APMT, energy intake, serum albumin, and NLR can be considered as predictors of mortality in critically ill patients.