Abstract
For patients undergoing abdominal surgery, malnutrition further increases the susceptibility to infection, surgical complications, and mortality. However, there is no standard tool for identifying high-risk groups of malnutrition or exact criteria for the optimal target of nutrition supply. We aimed to identify the nutritional risk in critically ill patients using modified Nutrition Risk in the Critically Ill (mNUTRIC) scores and assessing the relationship with clinical outcomes. Furthermore, we identified the ideal target of energy intake during the acute postoperative period. A prospective observational study was conducted. mNUTRIC scores and the average calories prescribed and given were calculated. To identify the high-risk group of malnutrition, receiver operating characteristic curves were plotted. The ideal target of energy adequacy and predisposing factors of 90-day mortality were assessed using multiple logistic regression analyses. A total of 206 patients were analyzed. The cutoff value for mNUTRIC score predicting 90-day mortality was 5 (Area under the curve = 0.7, 95% confidence interval (Cl) 0.606–0.795, p < 0.001). A total of 75 patients (36.4%) were classified in the high mNUTRIC group (mNUTRIC ≥ 5) and had a significantly higher postoperative complication and longer length of surgical intensive care unit stay. High mNUTRIC scores (odds ratio = 2.548, 95% CI 1.177–5.514, p = 0.018) and energy adequacy less than 50% (odds ratio = 6.427, 95% CI 1.674–24.674, p = 0.007) were associated with 90-day mortality.
Highlights
Patients who undergo abdominal surgery usually have alterations in the structural barrier of the gastrointestinal tract or the absorptive ability of nutrients
Patients admitted to the surgical intensive care unit (SICU) for more than 48 h after abdominal surgery were eligible for study enrollment
A total of 276 patients were admitted to the SICU following abdominal surgery
Summary
Patients who undergo abdominal surgery usually have alterations in the structural barrier of the gastrointestinal tract or the absorptive ability of nutrients. Surgeons’ concern about the firmness of surgical anastomosis can limit the early initiation of enteral feeding in these patients. After abdominal surgery, patients are predisposed to malnutrition [1]. Identifying critically ill patients who are at risk of malnutrition after abdominal surgery and providing adequate nutritional support would be important [2]. Many guidelines, including the American Society for Parenteral and Enteral Nutrition (ASPEN), the Society for Critical Care Medicine, and the European Society for Clinical Nutrition and Metabolism (ESPEN), suggest early nutritional intervention for patients admitted to a surgical intensive care unit (SICU) [3,4]. It is difficult to collectively specify the target patients for nutritional support among those who have undergone various types of surgery on different organs
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