Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

Abstract

BackgroundThe association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients.MethodsIn this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed.ResultsAt univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = −0.89), mid-arm muscle circumference (p = 0.050; beta = −1.29), hemoglobin (p = 0.04, beta −1.1) and albumin (p = 0.04, beta −7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ2 test = 6.47).ConclusionAlbumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.

Nutritional Assessment in Vegetative and Minimally Conscious Patients

“…This result is consistent with the previous study in Italy by Montalcini et al [11]. They reported that mean values of BMI (20 ± 3 kg/m 2 ), hemoglobin (12 ± 2 g/dL), and albumin (3.3 ± 0.4 g/dL) in chronic VS and MCS patients in Italy were within normal range of general population.…”

“…Monitoring the adequacy of nutrient provision is important for preventing malnutrition, as individual patients' nutritional need vary with current and past nutritional state. The VS and MCS patients may have a possible perception of suffering [11] but lack of expression, monitoring the adequacy of nutritional status is markedly needed in these patients.…”

Lactate Albumin Ratio is Associated with Mortality in Patients with Moderate to Severe Traumatic Brain Injury

“…The causes of hypoalbuminemia after TBI is diversi ed including initial blood loss due to injury, consumption by secondary oxidative stress injury and physiological hypoalbuminemia resulted from massive crystal liquid infusion. The reduction of serum albumin and its association with mortality after TBI have been con rmed in previous studies [46][47][48][49]. The correlation between hypoalbuminemia and poor outcome of TBI patients could be explained by the brain edema and subsequent increased intracranial pressure resulted from insu cient intravascular osmolality.…”

Role of Albumin as a Nutritional and Prognostic Marker in Elective Intestinal Surgery

“…While a number of studies have regarded albumin as a nutritional parameter [4,5,[8][9][10][11], other authors have questioned this relation, especially in healthy or nonsurgical patients [12][13][14][15]. In most clinical cohorts, low albumin levels are the result of the combined effects of inflammation and inadequate caloric intake [16].…”