2010, Number 2
Prognostic value of delta of prealbumin in critically ill patients with high risk of malnutrition
Sandoval AJ, Franco GJ, Aguirre SJ, Poblano MM, López PHR
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Language: Spanish
References: 15
Page: 84-89
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ABSTRACT
Introduction: Critical illness is characterized by a hypermetabolic stress state in which patients most commonly demonstrate systemic inflammatory response syndrome (SIRS) and associated complications of increased infectious morbidity, multiorgan dysfunction syndrome (MODS), prolonged hospitalization, and excessive mortality. More recently, the provision of early nutrition has become to be seen as a proactive therapeutic strategy by which the clinician may actually attenuate disease severity, reduce metabolic complications, and benefit patient outcome. Prealbumin (PA) value is considered one of the gold standards for assessing and monitoring the nutritional status on admission of critical ill patients. The normal value of PA in adult population is 16 to 45 mg/dL. Until 50% of patients in critical care unit are at risk for malnutrition. A value of PA ‹ 10 mg/dL stratify patients at high risk for malnutrition PA ‹ 5 mg/dL it’s a poor prognosis predictor.Aim: Determine if a PA ≤ 10 mg/dL at admission (high risk for malnutrition) or a Delta of PA ≤ 8 mg/dL at the first 8 days were are predictor of mortality and outcome for critically ill patients.
Methods: A prospective trial in the ICU. We describe demographics variables: age, sex, BMI, diagnosis, infection, nutrition type, APACHE II, SOFA, length of stay (LOS) and determine at admission and day 8th, PA, PCR, transferring, protein intake, total calories, renal function. We analyze the data with SPSS v.15.0
Results: Total patients (p) N = 60. 28 p with PA ≤ 10 mg/dL (high risk for malnutrition) and 32p with PA ≥ 10 mg/dL. The mortality was 25% for the total population. A delta of PA ≤ 8 mg/dL during the first 8 days in the patients at high risk for malnutrition was associated with mortality (p = 0.003) with a sensibility of 75% and specificity of 60% (AUC = 0.75). A higher protein intake at day 8th was associated with survival (p = 0.01). We did not found any statistical difference in the value of PA at admission between the survivors and non survivors.
Conclusion: A delta of PA ≤ 8 mg/dL during the first 8 days in the patients at high risk for malnutrition (PA ≤ 10 mg/dL) was a predictor of mortality in critical ill patients.
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