2023, Number 8
A more accessible tool... blood biomarkers in the assessment of malnutrition in critically ill patients
Full text
10.35366/115225
Language: Spanish
References: 27
Page: 672-685
PDF size: 406.79 Kb.
ABSTRACT
Introduction: the prevalence of malnutrition in ICU is 30-70%, nutritional assessment represents a determinant in the prognostic factor of the critically ill patient, with direct impact on mortality, length of hospital stay, days of invasive mechanical ventilation and frequency of infections. In addition to muscle ultrasound, some biomarkers have proven to be useful in nutritional assessment, among which fibrinogen levels seem to be the most promising for this purpose, as well as other blood biomarkers. However, their usefulness is not entirely clear in the assessment of critically ill patients, so having an assessment of the nutritional process evaluated by ultrasound and biomarkers represents an accessible tool in most intensive care units. Material and methods: observational, analytical and longitudinal study was conducted in a third level Intensive Care Unit (ICU), from May 1, 2022 to August 15, 2023, with a total sample of 70 patients, including: patients over 18 years of age, stay in ICU longer than 72 hours, with organ failure by SOFA and APACHE II; the following were excluded: patients with parenteral nutrition, over 65 years of age; amputation of lower extremities. A sonographic assessment was performed and a venous blood sample was taken on admission and after 72 hours. Among the biomarkers included, lymphocyte, haematocrit, albumin, fibrinogen, C-reactive protein (CRP), triglycerides and cholesterol values were determined; weight, height, body mass index and body surface area were measured; ultrasound measurements were performed using the Heckmatt scale, assigning graduation, and measurement of the anteroposterior and latero-lateral diameter of the rectus femoris muscle. Results: the median age recorded was 41.5 RIC 28, 28 males (40%) and 42 females (60%). On admission 10 patients (14.28%) presented sarcopenia; 14 patients presented sarcopenia; The Age presented a statistically significant correlation with the presence and development of sarcopenia-malnutrition (Pearson correlation), assessed at admission and at 3 days of ICU stay, both for the Heckmatt scale and for the measurement of rectus femoris muscle thickness in the anterior-posterior (USG musc RF-AP) and lateral-lateral (USG musc RF-LL) portion. In the assessment of the Heckmatt scale at day 3 of ICU stay, a negative correlation was obtained with the measurement of USG musc RF-LL (r -0.313, p 0.008) and positive correlation with the albumin/fibrinogen ratio (r 0.246, p 0.04). From the ROC analysis the comparison of Heckmatt on admission the biomarker that best AUC the Heckmatt scale at day 3 with the rest of the variables on the same day, CRP was the most representative (AUC 0.753 p < 0.001). From the result of the ROC analysis of the USG musc RF-AP on day 3, the albumin/fibrinogen ratio obtained an AUC of 0.553. The cut-off points found as predictors of sarcopenia-malnutrition were: for USG musc RF-LL 1.56 (sensitivity 84%, specificity 82%), for albumin/fibrinogen ratio it was 3.8 (sensitivity 84.6%, specificity 70.2%) and for CRP 6.25 (sensitivity 92.3%, specificity 77.2%). From the result of the multiple linear regression model by forced entry taking the variables from day 3 of stay, it was shown that there is no bias between sarcopenia-nutrition and the other variables included (biomarkers and Us. RF), demonstrating association in the main outcome (sarcopenia), contributing together up to 31.9%, being statistically significant determined by the comparison between variables of the ANOVA analysis with a p value of 0.03. Conclusions: bedside nutritional assessment by ultrasound is useful, as is assessment by biomarkers of which albumin fibrinogen ratio and CRP represented better results. Measurement of rectus femoris in the latero lateral portion, albumin/fibrinogen ratio and CRP levels are reliable predictors of sarcopenia-nutrition in critically ill patients.REFERENCES
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