Yoğun bakım ünitesindeki geriatrik hastalarda prognostik ve organ yetmezliği skorlama sistemleri ile nütrisyon skorları arasındaki ilişki
Abstract
Amaç: Bu çalışmada yoğun bakım ünitesindeki (YBÜ) geriatrik hastalarda gibi prognostik skorlama sistemleri ile nütrisyon skorları arasındaki ilişki araştırıldı.
Yöntem: Kesitsel-prospektif olan bu çalışmaya YBÜ’ye interne edilen 45 geriatrik hasta dahil edildi. Hastaların fiziki muayeneleri yapılıp kan tetkikleri analiz edildi. Nutrisyon durumu Mini Beslenme Değerlendirmesi (MNA) ve Beslenme Riski Taraması 2002 (NRS2002) ile değerlendirildi. Hastaların Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHEII), Basitleştirilmiş Akut Fizyoloji Skoru II (SAPSII), Çoklu Organ Disfonksiyon Skoru (MODS), Ardışık Organ Yetmezliği Değerlendirmesi (SOFA) ve Glasgow Koma Skorları (GKS) hesaplandı. Hastalar nutrisyon durumlarına göre normal, malnütrisyon riski altında ve malnütre olacak şekilde, prognostik skorlarına göre ise yüksek-riskli ve düşük-riskli diye gruplara ayrıldı. p<0.05 olarak kabul edildi..
Bulgular: MNA skoruna göre 45 hastanın 18’inde malnütrisyon ve 22’sinde malnütrisyon riski varken iken yalnızca 5 hasta normal nütrisyon durumundaydı. NRS2002’ye göre ise tüm hastalar malnütrisyon riski altındaydı. MNA göre malnütrisyon riski altında olan ve malnütrisyonlu grup arasında SAPSII ve GKS skoru açısından farklılık saptandı (p=0.033; p=0.040). APACHEII ve SAPSII skoruna göre yüksek riskli olan grupta NRS2002 skoru anlamlı olarak daha yüksekti (p=0.012; p=0.021). MNA ile SAPSII ve MODS arasında negatif, MNA ile GKS arasında ise pozitif korelasyon tespit edildi. NRS2002 ile APACHEII, SAPSII, MODS, SOFA arasında pozitif ve NRS2002 ile GKS ile arasında negatif korelasyon saptandı.
Sonuçlar: Çalışmamız malnütrisyonun yoğun bakımda yatan hastalarda organ yetmezliği ve prognoz üzerine önemli bir etkiye sahip olabileceğini göstermiştir.
Keywords
APACHE beslenme değerlendirmesi malnütrisyon organ bozukluğu skorları yaşlanma yoğun bakım ünitesi
References
- Allingstrup, M. J., Kondrup, J., Wiis, J., Claudius, C., Pedersen, U. G., Hein-Rasmussen, R., ... & Perner, A. (2017). Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Medicine, 43(11), 1637-1647.
- APACHE II Score Estimates ICU mortality. Available from: URL: https://www.mdcalc.com/apache-ii-score Date of access:18.01.2019
- Atalay, B. G., Yaǧmur, C., Nursal, T. Z., Atalay, H., & Noyan, T. (2008). Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support. Journal of Parenteral and Enteral Nutrition, 32(4), 454-459.
- Badosa, E. L., Tahull, M. B., Casas, N. V., Sangrador, G. E., Méndez, C. F., Meseguer, I. H., ... & Talaveron, J. M. L. (2017). Hospital malnutrition screening at admission: malnutrition increases mortality and length of stay. Nutricion hospitalaria, 34(4), 907-13.
- Cederholm, T.; Barazzoni, R.; Austin, P.; Ballmer, P.; Biolo, G.; Bischoff, S.C.; Compher, C.; Correia, I.; Higashiguchi, T.; Holst, M.; et al. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49-64.
- Corish, C. A., & Bardon, L. A. (2019). Malnutrition in older adults: Screening and determinants. Proceedings of the Nutrition Society, 78(3), 372-379.
- Ferner, M., Nauck, F., & Laufenberg-Feldmann, R. (2020). Palliativmedizin meets Intensivmedizin. AINS-Anästhesiologie· Intensivmedizin· Notfallmedizin· Schmerztherapie, 55(1), 41-53.
- Findlay, J. Y., Plenderleith, J. L., & Schroeder, D. R. (2000). Influence of social deprivation on intensive care outcome. Intensive Care Medicine, 26(7), 929-933.
- Flaatten, H., Beil, M.,&Guidet, B. (2021). Elderly Patients in the Intensive Care Unit. Seminars in Respiratory and Critical Care Medicine, 42, 10-19.
- Fleig, V., Brenck, F., Wolff, M., & Weigand, M. A. (2011). Scoring-Systeme in der Intensivmedizin. Der Anaesthesist, 60(10), 963-74.
- Gardaz, V., Doll, S., & Ricou, B. (2011). Accompagnementde fin de vie aux soins intensifs. Revue Médicale Suisse, 7, 2440-2443.
- Gomes, F., Emery, P. W., & Weekes, C. E. (2016). Risk of malnutrition is an independent predictor of mortality, length of hospital stay, and hospitalization costs in stroke patients. Journal of Stroke and Cerebrovascular Diseases, 25(4), 799-806.
- Kang, M. C., KJ, R. S., & Moon, J. Y. (2018). Korean Society for parenteral and enteral nutrition (KSPEN) clinical research groups. prevalence of malnutrition in hospitalized patients: a multicenter cross-sectional study. Journal of Korean Medical Science, 33(2), e10.
- Keegan, M. T., Gajic, O., & Afessa, B. (2011). Severity of illness scoring systems in the intensive care unit. Critical Care Medicine, 39(1), 163-169.
- Kondrup, J. (2014). Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition & Metabolic Care, 17(2), 177-182.
- Kondrup, J., Rasmussen, H. H., Hamberg, O. L. E., Stanga, Z., & An ad hoc ESPEN Working Group. (2003). Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition, 22(3), 321-336.
- Lew, C. C. H., Yandell, R., Fraser, R. J., Chua, A. P., Chong, M. F. F., & Miller, M. (2017). Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. Journal of Parenteral and Enteral Nutrition, 41(5), 744-758.
- Lim, S. L., Ong, K. C. B., Chan, Y. H., Loke, W. C., Ferguson, M., & Daniels, L. (2012). Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical Nutrition, 31(3), 345-350.
- Multiple Organ Dysfunction Score (MODS) Available from: URL:https://www.merckmanuals.com/professional/multimedia/clinical-calculator/clinicalcalculator_en_v48814872 Date of access: 17.02.2019
- Rowley, G., & Fielding, K. (1991). Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. The Lancet, 337(8740), 535-538.
- Sequential Organ Failure Assessment (SOFA) Score Predicts ICU mortality based on lab results and clinical data. Available from: URL:https://www.mdcalc.com/sequential-organ-failure-assessment-sofa-score Date of access: 23.02.2019
- Sheean, P. M., Peterson, S. J., Chen, Y., Liu, D., Lateef, O., & Braunschweig, C. A. (2013). Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU). Clinical Nutrition, 32(5), 752-757.
- Simplified Acute Physiology Score (SAPS) II Estimates mortality in ICU patients, comparable to APACHE II. Available from: URL:https://www.mdcalc.com/simplified-acute-physiology-score-saps-ii Date of access: 29.01.2019
- Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., ... & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 38(1), 48-79.
- Vincent, J. L., & Moreno, R. (2010). Clinical review: scoring systems in the critically ill. Critical Care, 14(2), 1-9.
- Weil, M. H., & Tang, W. (2011). From intensive care to critical care medicine: a historical perspective. American Journal of Respiratory and Critical Care Medicine, 183(11), 1451-1453.
The relationship between prognostic and organ failure scoring systems and nutritional scores in geriatric patients in intensive care unit
Abstract
Aim: The relationship between prognostic and organ failure scoring systems and nutritional scores was investigated in geriatric patients in the intensive care unit (ICU).
Methods: This cross-sectional study included 45 geriatric patients who were admitted to the ICU. Physical examinations were performed, and blood tests were analysed. Nutritional status was assessed by Mini Nutritional Assessment (MNA) and Nutritional Risk Screening 2002 (NRS2002). Acute Physiology and Chronic Health Evaluation II (APACHEII), Simplified Acute Physiology Score (SAPSII), Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) of patients were calculated. The patients were divided into groups as normal nutrition status, at risk of malnutrition and malnourished according to nutritional status, and high-risk and low-risk according to prognostic scores. Significance was accepted as p<0.05.
Results: According to the MNA score, 18 of 45 patients had malnutrition and 22 had malnutrition risk, while only 5 patients had normal nutrition status. According to NRS2002, all patients were at risk of malnutrition. There was a difference in SAPSII and GCS scores between the malnourished group and those at risk of malnutrition according to MNA (p=0.033;p=0.040). NRS2002 score was significantly higher in the high-risk group according to the APACHEII and SAPSII score (p=0.012;p=0.021). There was negative correlation between MNA and SAPSII and MODS, and positive correlation between MNA and GCS. There was positive correlation between NRS2002 and APACHEII, SAPSII, MODS, SOFA.
Conclusion: We found that malnutrition can have a significant impact on organ failure and prognosis in patients hospitalized in ICU.
Keywords
aged APACHE ıntensive care units malnutrition nutrition assessment organ dysfunction scores
References
- Allingstrup, M. J., Kondrup, J., Wiis, J., Claudius, C., Pedersen, U. G., Hein-Rasmussen, R., ... & Perner, A. (2017). Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Medicine, 43(11), 1637-1647.
- APACHE II Score Estimates ICU mortality. Available from: URL: https://www.mdcalc.com/apache-ii-score Date of access:18.01.2019
- Atalay, B. G., Yaǧmur, C., Nursal, T. Z., Atalay, H., & Noyan, T. (2008). Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support. Journal of Parenteral and Enteral Nutrition, 32(4), 454-459.
- Badosa, E. L., Tahull, M. B., Casas, N. V., Sangrador, G. E., Méndez, C. F., Meseguer, I. H., ... & Talaveron, J. M. L. (2017). Hospital malnutrition screening at admission: malnutrition increases mortality and length of stay. Nutricion hospitalaria, 34(4), 907-13.
- Cederholm, T.; Barazzoni, R.; Austin, P.; Ballmer, P.; Biolo, G.; Bischoff, S.C.; Compher, C.; Correia, I.; Higashiguchi, T.; Holst, M.; et al. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49-64.
- Corish, C. A., & Bardon, L. A. (2019). Malnutrition in older adults: Screening and determinants. Proceedings of the Nutrition Society, 78(3), 372-379.
- Ferner, M., Nauck, F., & Laufenberg-Feldmann, R. (2020). Palliativmedizin meets Intensivmedizin. AINS-Anästhesiologie· Intensivmedizin· Notfallmedizin· Schmerztherapie, 55(1), 41-53.
- Findlay, J. Y., Plenderleith, J. L., & Schroeder, D. R. (2000). Influence of social deprivation on intensive care outcome. Intensive Care Medicine, 26(7), 929-933.
- Flaatten, H., Beil, M.,&Guidet, B. (2021). Elderly Patients in the Intensive Care Unit. Seminars in Respiratory and Critical Care Medicine, 42, 10-19.
- Fleig, V., Brenck, F., Wolff, M., & Weigand, M. A. (2011). Scoring-Systeme in der Intensivmedizin. Der Anaesthesist, 60(10), 963-74.
- Gardaz, V., Doll, S., & Ricou, B. (2011). Accompagnementde fin de vie aux soins intensifs. Revue Médicale Suisse, 7, 2440-2443.
- Gomes, F., Emery, P. W., & Weekes, C. E. (2016). Risk of malnutrition is an independent predictor of mortality, length of hospital stay, and hospitalization costs in stroke patients. Journal of Stroke and Cerebrovascular Diseases, 25(4), 799-806.
- Kang, M. C., KJ, R. S., & Moon, J. Y. (2018). Korean Society for parenteral and enteral nutrition (KSPEN) clinical research groups. prevalence of malnutrition in hospitalized patients: a multicenter cross-sectional study. Journal of Korean Medical Science, 33(2), e10.
- Keegan, M. T., Gajic, O., & Afessa, B. (2011). Severity of illness scoring systems in the intensive care unit. Critical Care Medicine, 39(1), 163-169.
- Kondrup, J. (2014). Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition & Metabolic Care, 17(2), 177-182.
- Kondrup, J., Rasmussen, H. H., Hamberg, O. L. E., Stanga, Z., & An ad hoc ESPEN Working Group. (2003). Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition, 22(3), 321-336.
- Lew, C. C. H., Yandell, R., Fraser, R. J., Chua, A. P., Chong, M. F. F., & Miller, M. (2017). Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. Journal of Parenteral and Enteral Nutrition, 41(5), 744-758.
- Lim, S. L., Ong, K. C. B., Chan, Y. H., Loke, W. C., Ferguson, M., & Daniels, L. (2012). Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical Nutrition, 31(3), 345-350.
- Multiple Organ Dysfunction Score (MODS) Available from: URL:https://www.merckmanuals.com/professional/multimedia/clinical-calculator/clinicalcalculator_en_v48814872 Date of access: 17.02.2019
- Rowley, G., & Fielding, K. (1991). Reliability and accuracy of the Glasgow Coma Scale with experienced and inexperienced users. The Lancet, 337(8740), 535-538.
- Sequential Organ Failure Assessment (SOFA) Score Predicts ICU mortality based on lab results and clinical data. Available from: URL:https://www.mdcalc.com/sequential-organ-failure-assessment-sofa-score Date of access: 23.02.2019
- Sheean, P. M., Peterson, S. J., Chen, Y., Liu, D., Lateef, O., & Braunschweig, C. A. (2013). Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU). Clinical Nutrition, 32(5), 752-757.
- Simplified Acute Physiology Score (SAPS) II Estimates mortality in ICU patients, comparable to APACHE II. Available from: URL:https://www.mdcalc.com/simplified-acute-physiology-score-saps-ii Date of access: 29.01.2019
- Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., ... & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 38(1), 48-79.
- Vincent, J. L., & Moreno, R. (2010). Clinical review: scoring systems in the critically ill. Critical Care, 14(2), 1-9.
- Weil, M. H., & Tang, W. (2011). From intensive care to critical care medicine: a historical perspective. American Journal of Respiratory and Critical Care Medicine, 183(11), 1451-1453.
Details
| Primary Language | English |
|---|---|
| Subjects | Public Health (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 30, 2021 |
| Published in Issue | Year 2021 Volume: 2 Issue: 3 |
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