Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients

Abstract

Background: Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease.Methods: 3,758 patients adtnitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded.Results: Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exlnbiting mild severity of disease, tnoderate and severe malnutrition groups have 3-5 times the mortality rate than the well group.Conclusions: Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4 -29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy

“…분석 결과는 사망환자 를 포함하여 분석한 결과와 사망환자를 제외한 생존환자 만을 대상으로 분석한 결과를 구분하여 Table 4에 제시하 였다. 전체 환자를 대상으로 분석한 결과 에너지 충족률에따라서는 헤마토크릿 변화가 70% 이상 충족군에서 유의하 게 개선되었으나 (p = 0.006), 혈중 칼슘은 오히려 에너지 충족률이 높은 군에서 증가율이 낮게 나타났다 (p = 0.046).Ahn 등의 5.5일,24 Chi 등의 14.4일,25 Moon 등의 16.0일 26 의 재원일수에 비해 긴 것으로 나타났는데, 이는 본 연구에 서는 CRRT를 시행 받는 환자만을 대상으로 했기 때문에 질환의 중증도가 반영된 결과라고 생각된다. Faubel은 급 성 신손상 환자에서 비정상적인 수분대사가 호흡부전 합 병증의 발생위험을 높인다고 하였으며 이 경우 사망률이 80%나 증가한다고 하였다.…”