Matthew F Mart1, Timothy D Girard2, Jennifer L Thompson3, Hannah Whitten-Vile4, Rameela Raman5, Pratik P Pandharipande6, Daren K Heyland7, E Wesley Ely8, Nathan E Brummel9. 1. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA. 2. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA. 4. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA. 5. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA. 6. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 8. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Vanderbilt Center for Quality Aging, Nashville, TN, USA. 9. Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, Columbus OH, USA; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: nathan.brummel@osumc.edu.
Abstract
BACKGROUND AND AIMS: Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study's objective was to determine whether greater nutritional risk at ICU admission is associated with greater disability, worse cognition, and worse HRQOL at 3 and 12-month follow-up. METHODS: We enrolled adults (≥18 years of age) with respiratory failure or shock treated in medical and surgical intensive care units from two U.S. centers. We measured nutritional risk using the modified Nutrition Risk in Critically Ill (mNUTRIC) score (range 0-9 [highest risk]) at intensive care unit admission. We measured associations between mNUTRIC scores and discharge destination, disability in basic activities of daily living (ADLs) using the Katz ADL, instrumental ADLs using the Functional Activities Questionnaire (FAQ), global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), executive function using the Trail Making Test Part B (Trails B), and health-related quality of life using the SF-36, adjusting for sex, education, BMI, baseline frailty, disability, and cognition, severity of illness, days of delirium, coma, and mechanical ventilation. RESULTS: Of the 821 patients enrolled in the ICU, 636 patients survived to hospital discharge. We assessed outcomes in 448 of 535 survivors (84%) at 3 months and 382 of 476 survivors (80%) at 12 months. Higher mNUTRIC scores predicted greater odds of discharge to an institution (OR 2.0, 95% CI: 1.6 to 2.6; P < 0.01). Higher mNUTRIC scores were associated with a trend towards greater disability in basic activities of daily living (IRR 1.3, 95% CI 1.0 to 1.7) at 3 months that did not reach significance (p = 0.09) with no association demonstrated at 12 months. There were no associations between mNUTRIC scores and FAQ, RBANS, or Trails B scores. mNUTRIC scores were inconsistently associated with SF-36 physical and mental component scale scores. CONCLUSIONS: Greater nutritional risk at ICU admission is associated with disability in survivors of critical illness. Future studies should evaluate interventions in those at high nutritional risk as a means to speed recovery.
BACKGROUND AND AIMS: Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study's objective was to determine whether greater nutritional risk at ICU admission is associated with greater disability, worse cognition, and worse HRQOL at 3 and 12-month follow-up. METHODS: We enrolled adults (≥18 years of age) with respiratory failure or shock treated in medical and surgical intensive care units from two U.S. centers. We measured nutritional risk using the modified Nutrition Risk in Critically Ill (mNUTRIC) score (range 0-9 [highest risk]) at intensive care unit admission. We measured associations between mNUTRIC scores and discharge destination, disability in basic activities of daily living (ADLs) using the Katz ADL, instrumental ADLs using the Functional Activities Questionnaire (FAQ), global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), executive function using the Trail Making Test Part B (Trails B), and health-related quality of life using the SF-36, adjusting for sex, education, BMI, baseline frailty, disability, and cognition, severity of illness, days of delirium, coma, and mechanical ventilation. RESULTS: Of the 821 patients enrolled in the ICU, 636 patients survived to hospital discharge. We assessed outcomes in 448 of 535 survivors (84%) at 3 months and 382 of 476 survivors (80%) at 12 months. Higher mNUTRIC scores predicted greater odds of discharge to an institution (OR 2.0, 95% CI: 1.6 to 2.6; P < 0.01). Higher mNUTRIC scores were associated with a trend towards greater disability in basic activities of daily living (IRR 1.3, 95% CI 1.0 to 1.7) at 3 months that did not reach significance (p = 0.09) with no association demonstrated at 12 months. There were no associations between mNUTRIC scores and FAQ, RBANS, or Trails B scores. mNUTRIC scores were inconsistently associated with SF-36 physical and mental component scale scores. CONCLUSIONS: Greater nutritional risk at ICU admission is associated with disability in survivors of critical illness. Future studies should evaluate interventions in those at high nutritional risk as a means to speed recovery.
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Authors: M Martínez-Reig; L Gómez-Arnedo; S A Alfonso-Silguero; G Juncos-Martínez; L Romero; P Abizanda Journal: J Nutr Health Aging Date: 2014-03 Impact factor: 4.075
Authors: Adam M Deane; Lorraine Little; Rinaldo Bellomo; Marianne J Chapman; Andrew R Davies; Suzie Ferrie; Michael Horowitz; Sally Hurford; Kylie Lange; Edward Litton; Diane Mackle; Stephanie O'Connor; Jane Parker; Sandra L Peake; Jeffrey J Presneill; Emma J Ridley; Vanessa Singh; Frank van Haren; Patricia Williams; Paul Young; Theodore J Iwashyna Journal: Am J Respir Crit Care Med Date: 2020-04-01 Impact factor: 21.405
Authors: Roger Y Kim; Terrence E Murphy; Margaret Doyle; Catherine Pulaski; Maura Singh; Sui Tsang; Dawn Wicker; Margaret A Pisani; Geoffrey R Connors; Lauren E Ferrante Journal: Crit Care Explor Date: 2019-11-11