Validation of Malnutrition Clinical Characteristics in Critically Ill Patients

Abstract

Background: This study aimed to validate the Malnutrition Clinical Characteristics (MCC) compared with the Subjective Global Assessment (SGA), considering anthropometric measures, comorbidities, and mortality in critically ill patients. Methods: This longitudinal observational study included patients admitted to the general intensive care unit (ICU) of a public hospital. SGA was used as the reference standard for diagnosing malnutrition. The inclusion criteria were patients receiving nutrition support therapy and age >18 years. The nutrition therapy was optimized as close as possible to 100% of the patients' energy and protein needs regardless of the access route. Hospital length of stay (LOS), comorbidities on admission, and death were documented during the entire hospitalization of each patient. Body mass index (BMI), midarm circumference (MAC), and calf circumference (CC) were considered anthropometric measures. Results: The convenience sample comprised 102 ICU patients. Comparing the original malnutrition classifications of SGA with MCC, the specificity was 87.5%, sensitivity was 100%, accuracy was 93.3%, positive predictive value was 87.5%, and negative predictive value was 100%. When classified in 2 groups, namely "well-nourished" and "malnourished," specificity and sensitivity were 100% between both groups. Malnourished patients had significantly higher mortality rates (P = .006) and longer LOSs (P <.001). As expected, BMI, MAC, and CC results were similar for SGA and MCC. Conclusions: MCC was a valid tool for classifying malnutrition in ICU patients. Because the evaluation is fast and does not require expensive equipment that is difficult to handle, it is believed to be practical, low-cost, and easy to use.

Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

“…Our findings reinforce the PNI as a feasible tool associated with hospital length of stay, although other factors may have contributed to the lack of statistical significance in the other models analyzed here. In line with the Vavruk et al ( 1 ), malnourished patients admitted to the ICU evaluated using SGA had significantly higher mortality rates and longer hospital length of stay compared to well-nourished patients. Likewise, the association of oxygen therapy requirement with the reduced potential to discharge reach statistical significance in the unadjusted and adjusted Cox regression model and time-dependent covariate Cox regression model, suggesting the prognostic effect of the oxygen therapy requirement as a predictor of hospital length of stay in COVID-19 patients.…”

“…Nutritional assessment emerges as an indispensable management at hospital admission because malnourished patients imply a significantly longer hospital length of stay and high mortality rates ( 1 ). Regarding coronavirus disease 2019 (COVID-19), the results have been similar.…”

Key approaches to diagnosing malnutrition in adults

“…MNA is a reliable tool and has been validated for older adults (≥65 years) in clinics, hospitals, and long‐term care settings 15,16,18 . Emerging data are beginning to highlight that the Academy/ASPEN approach may be able to predict adverse outcomes and diagnose malnutrition; however, significantly more study in multiple populations that compares the approach to a “gold standard” such as SGA is required for this approach to be considered valid 24–31 . Guidance for the review of GLIM validation studies, as outlined by Keller et al, will be valuable for evaluating such studies as they are published 54 .…”

“…Multiple studies evaluating the AACCs have been published, 22 – 30 and a large, multisite validation study is underway 21 . A recent review that included five studies 22–26 using the AACCs in adults found that those diagnosed with malnutrition through this tool had longer hospital lengths of stay, higher odds of readmission within 30 days of discharge, and higher odds of mortality 27 …”

“…For those patients who survived their hospital stay and were discharged, patients with malnutrition had approximately 1.5 times the risk of readmission within 6 months and a risk of postdischarge mortality approximately five times higher than those of patients without malnutrition. A second study conducted in Brazil by Vavruk et al 31 aimed to validate the AACCs in a critical care population using SGA as the standard for comparison. A convenience sample of 102 patients was evaluated.…”