Relationship between Nutrition Intake and 28-Day Mortality Using Modified NUTRIC Score in Patients with Sepsis.

Dae Hyun Jeong,Younkyoung Kim,Jin Won Huh,Chae-Man Lim,Sang-Bum Hong,Jarim Seo,Ji-Yeon Min,Younsuck Koh

doi:10.3390/nu11081906

Dae Hyun Jeong, Younkyoung Kim + Show 6 more

Open Access

https://doi.org/10.3390/nu11081906

Copy DOI

Journal: Nutrients	Publication Date: Aug 15, 2019
Citations: 20	License type: CC BY 4.0

Affiliation: Asan Medical Center, Ulsan College, University of Ulsan

Abstract

In critically ill patients, malnutrition is known to increase morbidity and mortality. We investigated the relationship between nutritional support and 28-day mortality using the modified NUTrition RIsk in the Critically ill (NUTRIC) score in patients with sepsis. This retrospective cohort study included patients with sepsis admitted to the medical intensive care unit (ICU) between January 2011 and June 2017. Nutritional support for energy and protein intakes at day 7 of ICU admission were categorized into <20, 20 to <25, and ≥25 kcal/kg and <1.0, 1.0 to <1.2, and ≥1.2 g/kg, respectively. NUTRIC scores ≥4 were considered to indicate high nutritional risk. Among patients with low nutritional risk, higher intakes of energy (≥25 kcal/kg) and protein (≥1.2 g/kg) were not significantly associated with lower 28-day mortality. In patients with high nutritional risk, higher energy intakes of ≥25 kcal/kg were significantly associated with lower 28-day mortality compared to intakes of <20 kcal/kg (adjusted hazard ratio (aHR): 0.569, 95% confidence interval (CI): 0.339–0.962, p = 0.035). Higher protein intakes of ≥1.2 g/kg were also significantly associated with lower 28-day mortality compared to intakes of <1.0 g/kg (aHR: 0.502, 95% CI: 0.280–0.900, p = 0.021). Appropriate energy (≥25 kcal/kg) and protein (≥1.2 g/kg) intakes during the first week may improve outcomes in patients with sepsis having high nutritional risk.

Highlights

Malnutrition is very common among critically ill patients, with a prevalence of 20–50% [1,2,3,4].Malnourished patients have increased rates of morbidity and mortality [5,6,7,8,9]
We reviewed patient data from electronic medical records, and collected information pertaining to demographics, height, weight, comorbidities, diagnosis, length of stay (LOS) in the intensive care unit (ICU), mechanical ventilation (MV), vasopressor drug use, and renal replacement therapy (RRT)
Higher energy intake was significantly associated with lower 28-day mortality in those with intakes of ≥25 kcal/kg than those taking

Summary

Introduction

Malnutrition is very common among critically ill patients, with a prevalence of 20–50% [1,2,3,4].Malnourished patients have increased rates of morbidity and mortality [5,6,7,8,9]. Malnutrition is very common among critically ill patients, with a prevalence of 20–50% [1,2,3,4]. Owing to exaggerated acute phase responses and gastrointestinal dysfunction, patients with sepsis have hypermetabolism, which results in a greater risk of malnutrition [10]. Guidelines for nutritional support in patients with sepsis are based on findings of studies among heterogenous groups of critically ill patients [11,12]. Many studies have indicated the importance of protein in nutrition support [13]; optimal protein intakes potentially lower mortality in critically ill patients [14,15]. As per the proceedings of the International Protein Summit, high doses of protein may be required in ICU settings to optimize

Results

Discussion

Conclusion