Nutritional status as a predictor of 30-day mortality among intensive care unit patients in sub-Saharan Africa: a prospective cohort study

Abstract

BackgroundMalnutrition is a major public health issue, causing significant mortality and morbidity, especially in developing nations. However, the magnitude and its impact on clinical outcomes in Intensive Care Unit (ICU) patients need to be investigated better in Sub-Saharan Africa, and this study was intended to address these issues.ObjectiveThe objective of this study was to assess the effect of malnutrition on clinical outcomes among ICU patients.MethodA prospective cohort study was conducted among 436 ICU patients, 218 of whom were malnourished. After obtaining ethical approval, malnourished and well-nourished patients were followed for thirty days to examine the effects of nutritional status on clinical outcomes and its determinants. At admission, nutritional screening and evaluation were performed with Subjective Global Assessment (SGA) and Malnutrition Universal Screening Tool (MUST), and during the next thirty days, it was evaluated every seven days with SGA, MUST, and modified Nutrition Risk in Critically Ill (NUTRIC).ResultThis study demonstrated that the incidence of 30-day mortality was 47.9%( 95% CI: 43.2 to 52.6). The hazards of death in patients with malnutrition increased by 40% as compared to well-nourished patients (aHR = 1.4, 95% CI: 1.33 to 2.56), and patients with diabetes mellitus had 4 times the hazards of death (aHR = 4.2, 95% CI: 2.12 to 8.28).ConclusionMalnutrition is prevalent in adult ICU patients and has been linked to a higher 30-day mortality and a more extended ICU stay. MUST, SGA, and NUTRIC, well-validated, practical, cost-effective, and non-invasive techniques for routinely evaluating nutritional status in critically ill patients, were good predictors of mortality.