Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

Abstract

The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition.Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; ,18.5 kg?m The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (o3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB.A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

“…16,17,26 Various nutritional markers, individually or collectively, are associated with prognosis in older patients, but confounding remains uncertain. 5,17,18,20,[26][27][28][29][30][31][32] Several methods used to assess nutritional or functional status require complex scoring systems, or additional measurements such as skin fold or arm circumflex; in contrast, the nutritional index employed in the present study comprised only body mass index scores and simple biochemical parameters routinely measured in patients admitted to the ICU. This nutritional score can be easily used to predict the progress of very elderly patients admitted to the ICU.…”

“…The principal reason for ICU admission in very elderly subjects was pneumonia (16%). The median SAPS II and APACHE II scores on ICU admission were 37 (IQR, 28 -50) and 14 (IQR, [11][12][13][14][15][16][17][18][19][20][21][22].…”

“…14,15 Nutritional status was assessed according to a single anthropometric value (body mass index) and 3 routine laboratory tests (serum albumin, serum cholesterol, lymphocyte count), which are known to be simple parameters associated with nutritional status. 5,[16][17][18][19][20][21][22] Poor nutrition was defined as having at least 3 of the following: body mass index Ͻ 18.5 kg/m 2 , serum albumin Ͻ 3.0 g/dL, serum cholesterol Ͻ 130 mg/dL, and total lymphocyte count Ͻ 1,000/mm 3 . 5,[16][17][18][19][20][21][22] Subjects Ն 90 y of age who were admitted to the ICU and for whom DNR orders were in effect received all indicated medical treatments except for cardiopulmonary resuscitation.…”

Investigation of nutritional status and body composition in patients with tuberculosis

“…Среди умер ших пациентов среднее время дожития при нор мальном статусе питания составило 438 суток, при умеренном нарушении нутритивного статуса -344, а при выраженном нарушении -118. В ретроспек тивном исследовании 56 больных милиарным тубер кулезом [24] повышенная частота развития острой дыхательной недостаточности и летальность значи мо ассоциировались с высокой балльной оценкой выраженности нарушений статуса питания, которая формировалась исходя из наличия (1 балл) или отсутствия (0 баллов) у пациента следующих 4 при знаков: низкого ИМТ (< 18,5 кг / м 2 ), низкого со держания альбумина (< 30 мг / мл), холестерина (< 2,33 ммол / л) и лимфоцитопении (< 700 кл / мл). Высокими считались значения суммы баллов, рав ные 3 или 4.…”

Nutritional deficit in miliary tuberculosis: prognostic value

“…Under 4-point Nutritional Risk Score, KIM et al [1] have used severe lymphocytopenia and hypocholesterolaemia as the parameters of poor nutritional status. MTB is characterised by compartmentalisation of lymphocytes at the site of inflammation (lymphocytic alveolitis), leading to their reduced number in peripheral blood [2].…”