Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI)

Abstract

Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit.The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/-600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality.

Prognosis of critical surgical patients depending on the duration of stay in the ICU

“…Finally, the ICU patients have a moderate-to-severe degree of malnutrition and it has been shown that this degree of malnutrition has a significant negative impact on clinical outcome, factor that we have not taken into account when conducting this study. [ 17 ]…”

The Role of the Prognostic Inflammatory and Nutritional Index (PINI) in the Evolution of Patients with Chronic Kidney Disease and Other Pathologies

“…Furthermore, Gharsallah et al found that an increased PINI score was not associated with all-cause mortality. However, they identified an initial increase followed by a progressive decrease in CRP and orosomucoid values and an increase in serum prealbumin and albumin values [10].…”

“…This index represents a simple clinical assessment tool that combines two blood markers of inflammation, C-reactive protein (CRP) and α1-acid glycoprotein (also called orosomucoid), with two biomarkers that reflect the nutritional status, namely albumin and prealbumin (or transthyretin) [10][11][12]. The resulting value for PINI is a number value, with 1 representing the established reference value.…”

“…Because albumin has a large sample size for individuals of all health classes and a much longer half-life (14-20 days), it is not indicative of the immediate nutritional status and may be skewed by changes in hydration status. Serum albumin concentration may be affected by albumin infusion, dehydration, sepsis, trauma and liver disease, remaining independent of the nutritional status [10], yet it decreases in response to inflammation [13]. Albumin is the most abundant protein in plasma or serum [14,15], a valued biomarker of many conditions, which finds clinical application in the therapy of several pathologies, including hemodialysis, hemorrhage, acute respiratory distress syndrome, acute liver failure, chronic liver disease, shock and hypoalbuminemia [15].…”

“…Albumin and prealbumin are known as negative acute-phase proteins, while CRP and orosomucoid are positive acute-phase proteins [10]. Alpha1-acid glycoprotein (orosomucoid) is an inflammatory protein specific to the major acute phase, synthesized by the microvascular endothelium; its presence in the urine possibly indicates underlying inflammation in hemodialysis patients [8].…”