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Undernutrition Scored Using the CONUT Score with Hypoglycemic Status in ICU-Admitted Elderly Patients with Sepsis Shows Increased ICU Mortality.

ABSTRACT: This study aimed to clarify whether the influence of undernutrition status and the degree of glycemic disorders affected the prognosis of patients with sepsis. A total of 307 adult patients with sepsis were retrospectively enrolled and analyzed. Characteristics, including nutrition status, calculated according to the Controlling Nutritional Status (CONUT) score of survivors and non-survivors, were examined. The independent prognostic factors of these patients with sepsis were extracted using multivariable logistic regression analysis. The CONUT scores in three glycemic categories were compared. Most patients with sepsis (94.8%) in the study had an undernutrition status according to their CONUT scores. High CONUT scores (odds ratio, 1.214; p = 0.002), indicating a poor nutritional status, were associated with high mortality. The CONUT scores in the hypoglycemic group were significantly higher than those in other groups with an undernutrition status (vs. hyperglycemic, p < 0.001; vs. intermediate glycemic, p = 0.006). The undernutrition statuses of patients with sepsis in the study scored using the CONUT were independent predictors of prognostic factors.

SUBMITTER: Yamaguchi J

PROVIDER: S-EPMC9955230 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Undernutrition Scored Using the CONUT Score with Hypoglycemic Status in ICU-Admitted Elderly Patients with Sepsis Shows Increased ICU Mortality.

Yamaguchi Junko J Kinoshita Kosaku K Nakagawa Katsuhiro K Mizuochi Minori M

Diagnostics (Basel, Switzerland) 20230217 4

This study aimed to clarify whether the influence of undernutrition status and the degree of glycemic disorders affected the prognosis of patients with sepsis. A total of 307 adult patients with sepsis were retrospectively enrolled and analyzed. Characteristics, including nutrition status, calculated according to the Controlling Nutritional Status (CONUT) score of survivors and non-survivors, were examined. The independent prognostic factors of these patients with sepsis were extracted using mul ...[more]

PMID: 36832250

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Project description:BackgroundThe lung ultrasound score has been regarded as a decent semiquantitative score to measure the lung aeration loss. The score has been proven to be valuable in diagnosing and monitoring lung pathology, but no studies have demonstrated its relationship to the outcome. We aimed to investigate the relationship between the lung ultrasound score and outcome in shock patients in the Intensive Care Unit.MethodsThe data were extracted from the SHOCK-ICU study, a 14-month prospective study of shock patients in the Medical Intensive Care Unit in West China Hospital. A bivariate logistic regression model was established to identify the correlation between the lung ultrasound score on admission and the 28-day mortality. For subsequent analyses, we divided patients into lung ultrasound score quartiles, and survival analysis was performed using Cox stratified survival analysis and regression analysis with the Breslow method of ties.ResultsA total of 175 cases with a completed lung ultrasound exam were included. The mean APACHE II score was 23.7 ± 8.8, and the 28-day mortality was 46.3% (81/175). The multivariate analysis demonstrated that the lung ultrasound score was an independent risk factor for 28-day mortality, as well as the APACHE II score and lactate level. When divided into lung ultrasound score quartiles, after correcting for the APACHE II score, vasoactive use, PaO2/FiO2, and lactate level, the COX analysis reveals that a higher lung ultrasound score was related to a lower survival rate. Quartile 1 and quartile 2 had a significantly lower hazard ratio versus quartile 4 (OR 0.442[0.215-0.911]; 0.484[0.251-0.934], respectively).ConclusionsThe lung ultrasound score is independently related to the 28-day mortality, as well as the APACHE II score and lactate level, in Intensive Care Unit shock patients. A higher elevated lung ultrasound score on admission is associated with a worse outcome.Trial registrationThe study is registered on Clinical Trials.Trial registrationNCT03082326 ; retrospectively registered on 3 March 2017.

Project description:ObjectivesThe aim of this study was to elucidate the impact of nutritional status on survival per Controlling Nutritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI) in patients with hypertension over 80 years of age.DesignProspective follow-up study.ParticipantsA total of 336 hypertensive patients over 80 years old were included in this study.Outcome measuresAll-cause deaths were recorded as Kaplan-Meier curves to evaluate the association between CONUT and all-cause mortality at follow-up. Cox regression models were used to investigate the prognostic value of CONUT and GNRI for all-cause mortality in the 90-day period after admission.ResultsHypertensive patients with higher CONUT scores exhibited higher mortality within 90 days after admission (1.49%, 6.74%, 15.38%, respectively, χ2=30.92, p=0.000). Surviving patients had higher body mass index (24.25±3.05 vs 24.25±3.05, p=0.012), haemoglobin (123.78±17.05 vs 115.07±20.42, p=0.040) and albumin levels, as well as lower fasting blood glucose (6.90±2.48 vs 8.24±3.51, p=0.010). Higher GRNI score (99.42±6.55 vs 95.69±7.77, p=0.002) and lower CONUT (3.13±1.98 vs 5.14±2.32) both indicated better nutritional status. Kaplan-Meier curves indicated that survival rates were significantly worse in the high-CONUT group compared with the low-CONUT group (χ1 =13.372, p=0.001). Cox regression indicated an increase in HR with increasing CONUT risk (from normal to moderate to severe). HRs (95% CI) for 3-month mortality was 1.458 (95% CI 1.102 to 1.911). In both respiratory tract infection and 'other reason' groups, only CONUT was a sufficiently predictor for all-cause mortality (HR=1.284, 95% CI 1.013 to 1.740, p=0.020 and HR=1.841, 95% CI 1.117 to 4.518, p=0.011). Receiver operating characteristic showed that CONUT higher than 3.0 was found to predict all-cause mortality with a sensitivity of 77.8% and a specificity of 64.7% (area under the curve=0.778, p<0.001).ConclusionNutritional status assessed via CONUT is an accurate predictor of all-cause mortality 90 days postadmission. Evaluation of nutritional status may provide additional prognostic information in hypertensive patients.

Project description:Background and objectivesNociceptin/Orphanin FQ (N/OFQ) is a non-classical endogenous opioid peptide that modulates immune function in vitro. Its importance in inflammation and human sepsis is unknown. The objectives of this study were to determine the relationship between N/OFQ, transcripts for its precursor (pre-pro-N/OFQ [ppNOC]) and receptor (NOP), inflammatory markers and clinical outcomes in patients undergoing cardiopulmonary bypass and with sepsis.MethodsA prospective observational cohort study of 82 patients admitted to Intensive Care (ICU) with sepsis and 40 patients undergoing cardiac surgery under cardiopulmonary bypass (as a model of systemic inflammation). Sixty three healthy volunteers, matched by age and sex to the patients with sepsis were also studied. Clinical and laboratory details were recorded. Polymorph ppNOC and NOP receptor mRNA were determined using quantitative PCR. Plasma N/OFQ was determined using ELISA and cytokines (TNF- α, IL-8, IL-10) measured using radioimmunoassay. Data from patients undergoing cardiac surgery were recorded before, 3 and 24 hours after cardiopulmonary bypass. ICU patients with sepsis were assessed on Days 1 and 2 of ICU admission, and after clinical recovery.Main resultsPlasma N/OFQ concentrations increased (p<0.0001) on Days 1 and 2 of ICU admission with sepsis compared to matched recovery samples. Polymorph ppNOC (p= 0.019) and NOP mRNA (p<0.0001) decreased compared to healthy volunteers. TNF-α, IL-8 and IL-10 concentrations increased on Day 1 compared to matched recovery samples and volunteers (p<0.0001). Similar changes (increased plasma N/OFQ, [p=0.0058], decreased ppNOC [p<0.0001], increased IL-8 and IL-10 concentrations [both p<0.0001]) occurred after cardiac surgery but these were comparatively lower and of shorter duration.ConclusionsThe N/OFQ system is modulated in ICU patients with sepsis with similar but reduced changes after cardiac surgery under cardiopulmonary bypass. Further studies are required to clarify the role of the N/OFQ system in inflammation and sepsis, and the mechanisms involved.

Project description:BackgroundSepsis is the most common cause of premature death among patients with systemic lupus erythematosus (SLE) aged ≤ 50 years in the United States, and infection is the most common cause of admission to the ICU among SLE patients. However, there are no population-level data on the patterns of the demand for critical care services among hospitalized septic patients with SLE or the outcomes of those admitted to the ICU.MethodsWe performed a retrospective cohort study, using the Texas Inpatient Public Use Data File, to identify SLE hospitalizations aged ≥ 18 years and the subgroups with sepsis and ICU admission during 2009-2014. The patterns of ICU admission among septic hospitalizations were examined. Logistic regression modeling was used to identify predictors of short-term mortality (defined as hospital death or discharge to hospice) among ICU admissions with sepsis and to estimate the risk-adjusted short-term mortality among ICU admissions with and without sepsis.ResultsAmong 94,338 SLE hospitalizations, 17,037 (18.1%) had sepsis and 9409 (55.2%) of the latter were admitted to the ICU. Sepsis accounted for 51.5% of the growth in volume of ICU admissions among SLE hospitalizations during the study period. Among ICU admissions with sepsis, 25.3% were aged ≥ 65 years, 88.6% were female, and 64.4% were non-white minorities. The odds of short-term mortality among septic ICU admissions were increased among those lacking health insurance (adjusted odds ratio 1.40 [95% confidence interval 1.07-1.84]), while being unaffected by gender and race/ethnicity, and remaining unchanged over the study period. On adjusted analyses among ICU admissions, the short-term mortality among those with and without sepsis was 13% (95% CI 12.6-13.3) and 2.7% (95% CI 2.6-2.8), respectively. Sepsis was associated with 63.6% of all short-term mortality events.ConclusionsSepsis is a major, incremental driver of the demand for critical care services among SLE hospitalizations. Despite its relatively low mortality, sepsis was associated with most of the short-term deaths among ICU patients with SLE.

Project description:BackgroundPatients ≥80 years of age are increasingly being admitted to the intensive care unit (ICU). The impact of relevant variables, such comorbidities and performance status, on short-term outcomes in the very elderly is largely unknown. Few studies address the calibration of illness severity scores (SAPS3 score) within this population. We investigated the risk factors for hospital mortality in critically ill patients ≥80 years old, emphasizing performance status and comorbidities, and assessed the calibration of SAPS3 scores in this population.Methods1129 very elderly patients admitted to a tertiary ICU in Brazil during a two-year period were retrospectively included in this study. Demographic features, reasons for admission, illness severity, comorbidities (including the Charlson Comorbidity Index) and a simplified performance status measurement were obtained. After univariate analysis, a multivariate model was created to evaluate the factors that were associated with hospital mortality. Alternatively, a conditional inference tree with recursive partitioning was constructed. Calibration of the SAPS3 scores and the multivariate model were evaluated using the Hosmer-Lemeshow test and a calibration plot. Discrimination was assessed using a receiver operating characteristics curve.ResultsOn multivariate analysis after stepwise regression, only the SAPS3 score (OR 1.08, 95% CI 1.06-1.10), Charlson Index (OR 1.16, 95% CI 1.07-1.27), performance status (OR 1.61, 95% CI 1.05-2.64 for partially dependent patients and OR 2.39, 95% CI 1.38-4.13 for fully dependent patients) and a non-full code status (OR 11.74, 95% CI 6.22-22.160) were associated with increased hospital mortality. Conditional inference tree showed that performance status and Charlson Index had the greatest influence on patients with less severe disease, whereas a non-full code status was prominent in patients with higher illness severity (SAPS3 score >61). The model obtained after logistic regression that included the before mentioned variables demonstrated better calibration and greater discrimination capability (AUC 0.86, 95% CI 0.83-0.89 versus AUC 0.81, 95% CI 0.78-0.84, respectively; p < 0.001) than the SAPS3 score alone.ConclusionsPerformance status and comorbidities are important determinants of short-term outcome in critically ill elderly patients ≥80 years old. The addition of simple background information may increase the calibration of the SAPS3 score in this population.

Dataset Information

Undernutrition Scored Using the CONUT Score with Hypoglycemic Status in ICU-Admitted Elderly Patients with Sepsis Shows Increased ICU Mortality.

Publications

Undernutrition Scored Using the CONUT Score with Hypoglycemic Status in ICU-Admitted Elderly Patients with Sepsis Shows Increased ICU Mortality.

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