Analysis of total calories balance and in-hospital mortality in criticallyill patients during acute phase

doi:10.3969/j.issn.1006-7795.2021.06.005

Abstract

Abstract: Objective To analyze the correlation of energy delivery and in-hospital mortality in acute phase of critical illness in intensive care unit (ICU). Methods The patients who were admitted to general ICU, Beijing Tsinghua Changgung Hospital for more than 7 days from April 2019 to April 2021 were enrolled.The clinical and nutritional data on the first 7 days were retrospectively collected. Multivariate Logistic regression was used to analyze the risk factors of in-hospital mortality. Results A total of 61 patients were recruited, and 18 of them died during hospitalization. The results of multivariate logistic regression showed thatNutrition Risk Screening(NRS) 2002 score (P=0.018), days of continuous renal replacement therapy (CRRT) (P=0.013) and total calories risk (TCB) in the first 3d (P=0.044) were the risk factors of in-hospital mortality. The risk of in-hospital mortality increased by 120% per each 500 kcal (1 kcal=4.186 kJ) of total calories balance during the first 3 days of ICU. For the patients with high nutritional risk (NRS 2002≥5), TCB in the first-3d (P=0.042) and days of CRRT (P=0.019) were also the high risk factors of in-hospital mortality. While they were no predictive values in the patients with lower nutrition risk (NRS 2002<5). Conclusion NRS 2002 score, days of CRRT and TCB in the first-3d were the risk factors of in-hospital mortality for critically ill patients in ICU, particularly for the high nutritional risk one.

Key words: energy expenditure, nutrition, mortality, critical illness, case-control study

CLC Number:

R459.3

Gao Ming, Zhou Yingli, Zhu Yan, Qin Junping, Huang Huibin, Ren Yu, Tan Li, Zhou Hua, Xu Yuan. Analysis of total calories balance and in-hospital mortality in criticallyill patients during acute phase[J]. Journal of Capital Medical University, 2021, 42(6): 931-935.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2021.06.005

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2021/V42/I6/931

References

[1] Thiessen S E, Van den Berghe G, Vanhorebeek I. Mitochondrial and endoplasmic reticulum dysfunction and related defense mechanisms in critical illness-induced multiple organ failure[J]. Biochim Biophys Acta Mol Basis Dis, 2017, 1863(10 Pt B): 2534-2545.
[2] Wernerman J, Christopher K B, Annane D, et al. Metabolic support in the critically ill: a consensus of 19[J]. Crit Care, 2019, 23(1): 318.
[3] Zusman O, Theilla M, Cohen J, et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study[J]. Crit Care, 2016, 20(1): 367.
[4] Singer P, Blaser A R, Berger M M, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1): 48-79.
[5] Tah P C, Lee Z Y, Poh B K, et al. A single-center prospective observational study comparing resting energy expenditure in different phases of critical illness: indirect calorimetry versus predictive equations[J]. Crit Care Med, 2020, 48(5): e380-e390.
[6] 赵士兵, 段立彬, 余刚, 等. 应用代谢车监测ICU患者REE变化规律并指导营养支持的前瞻性研究[J]. 中华危重病急救医学, 2019, (12): 1512-1516.
[7] Moonen H P F X, Van Zanten A R H. Mitochondrial dysfunction in critical illness during acute metabolic stress and convalescence: consequences for nutrition therapy[J]. Curr Opin Crit Care, 2020, 26(4): 346-354.
[8] 吴国豪. 外科危重症患者营养支持治疗热点问题及对策[J]. 中华消化外科杂志, 2019, 18(10): 908-911.
[9] Mukhopadhyay A, Tan Z Y, Cheong S H L, et al. Differential effects of early energy and protein inadequacies on the outcome of critically Ⅲ patients[J]. Nutr Clin Pract, 2021, 36(2): 456-463.
[10] 高明, 周华, 朱研, 等. 间接测热法与预测公式对肝脏术后患者能量消耗评估的差异性分析[J]. 临床急诊杂志, 2021, 22(1): 42-45.
[11] 石俊, 席力罡, 迟天航, 等. 静息能量监测在机械通气患者营养支持治疗中的应用价值[J]. 中华危重病急救医学, 2019, (1): 98-101.
[12] TARGET Investigators, for the ANZICS Clinical Trials Group, Chapman M, Peake S L, et al. Energy-dense versus routine enteral nutrition in the critically ill[J]. N Engl J Med, 2018, 379(19): 1823-1834.
[13] Hoffer L J, Bistrian B R. Why critically ill patients are protein deprived[J]. JPEN J Parenter Enteral Nutr, 2013, 37(3): 300-309.
[14] Weijs P J M, Mogensen K M, Rawn J D, et al. Protein intake, nutritional status and outcomes in ICU survivors: A Single Center Cohort Study[J]. J Clin Med, 2019, 8(1):43.
[15] Allingstrup M J, Kondrup J, Wiis J, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial[J]. Intensive Care Med, 2017, 43(11): 1637-1647.
[16] Koekkoek W A C K, van Setten C H C, Olthof L E, et al. Timing of protein intake and clinical outcomes of adult critically ill patients on prolonged mechanical ventilation: the protinvent retrospective study[J]. Clin Nutr, 2019, 38(2): 883-890.