Nutrition Care of Critically Ill Patients with Leukemia: A Retrospective Study

2019 ◽  
Vol 80 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Kristen N. MacEachern ◽  
Alan P. Kraguljac ◽  
Sangeeta Mehta
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Therapy ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Discharge Data ◽  
Treatment Side Effects ◽  
Nutrition Care ◽  
Surgical Icu

Adults with acute leukemia (AL) are at high risk of malnutrition due to their disease and treatment side effects and may be admitted to the intensive care unit (ICU), further increasing the risk of malnutrition. Although ICU care includes some form of nutrition, patients typically receive less than prescribed energy and protein. Our objective was to characterize the nutrition care for critically ill patients with AL. We completed a retrospective review of adults with AL admitted to the Medical/Surgical ICU >24 hours. Descriptive statistics were performed on collected data including: demographics, APACHE II and Nutric scores, nutrition therapy, reasons for withholding nutrition, and mortality status at discharge. Data were collected on 154 AL patients with an average APACHE II score of 27 and Nutric score of 5.96. ICU mortality was 36%. Enteral nutrition (EN) was most commonly prescribed. Patients on EN received 55% of energy and 51% of protein prescribed. EN was commonly withheld for airway management and gastrointestinal impairment. Patients with AL received low amounts of energy and protein in the ICU and had a high Nutric score. Strategies and barriers to improve protein intake in this population are identified.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

scholarly journals Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kátia M. Wahrhaftig ◽  
Luis C. L. Correia ◽  
Denise Matias ◽  
Carlos A. M. De Souza
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Risk Of Death ◽  
Rifle Classification ◽  
Critical Patients

Introduction.The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients.Objective.To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients.Methods.An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011.Results.The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97–3.38, ), grade injury (RR = 3.7 CI:1.71–8.08, ), and class failure (RR = 4.79 CI:2.10–10.6, ). The APACHE II had C-statistics of 0.75, 95% (CI:0.68–0.80, ) and 0.80 (95% CI:0.74 to 0.86, ) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, .Conclusion.The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

scholarly journals Plasma Neutrophil Gelatinase-Associated Lipocalin Is Useful for Predicting Mortality in Critically Ill Patients

2021 ◽  
Vol 10 (12) ◽  
pp. 2576
Author(s):  
Izabela Duda ◽  
Łukasz Krzych
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Elevated neutrophil gelatinase-associated lipocalin (NGAL) occurs in a wide range of systemic diseases. This study examined the clinical utility of plasma NGAL to predict intensive care unit (ICU) and in-hospital mortality in critically ill patients. A total of 62 patients hospitalized in a mixed ICU were included; pNGAL, creatinine, and C-reactive protein (CRP) were assayed on four consecutive days (D1-D4) following ICU admission. APACHE II score (Acute Physiology and Chronic Health Evaluation) was calculated 24 h post-admission. ICU mortality reached 35% and in-hospital mortality was 39%. The median pNGAL at admission was 142.5 (65.6–298.3) ng/mL. pNGAL was significantly higher in non-survivors compared to survivors. The highest accuracy for ICU mortality prediction was achieved at the pNGAL cutoff of 93.91 ng/mL on D4 area under the curve (AUC) = 0.89; 95%CI 0.69–0.98 and for in-hospital mortality prediction was achieved at the pNGAL cutoff of 176.64 ng/mL on D3 (AUC = 0.86; 95%CI 0.69–0.96). The APACHE II score on ICU admission predicted ICU mortality with AUC = 0.89 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.86 (95%CI 0.75–0.94). Although pNGAL on D1 poorly correlated with APACHE II (R = 0.3; p = 0.01), the combination of APACHE II and pNGAL on D1 predicted ICU mortality with AUC = 0.90 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.95 (95%CI 0.78–0.99). Maximal CRP during study observation failed to predict ICU mortality (AUC = 0.62; 95%CI 0.49–0.74), but helped to predict in-hospital mortality (AUC = 0.67; 95%CI 0.54–0.79). Plasma NGAL with combination with the indices of critical illness is a useful biomarker for predicting mortality in heterogeneous population of ICU patients.

APACHE II score for critically ill patients with a solid tumor: A reclassification study

2018 ◽  
Vol 65 (8) ◽  
pp. 447-455 ◽  
Author(s):  
F.D. Martos-Benítez ◽  
I. Cordero-Escobar ◽  
A. Soto-García ◽  
I. Betancourt-Plaza ◽  
I. González-Martínez
Keyword(s):  
Critically Ill ◽  
Solid Tumor ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Apache Ii Score

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

scholarly journals The Diagnostic Criteria of Refeeding Syndrome in Critically Ill Patients from four Chinese Hospitals: A Multicenter Prospective Study

2021 ◽  
Author(s):  
Kongmiao Lu ◽  
Xuping Shen ◽  
Xiangxin Zheng ◽  
Xin Xu ◽  
Zhijun Xu ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Phosphate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Serum Phosphate Level ◽  
Refeeding Syndrome ◽  
Group 3 ◽  
Group 2

Abstract Background: Refeeding syndrome (RFS) is a group of metabolic disorders associated with refeeding after starvation. However, the diagnostic criteria of RFS are highly heterogeneous. This study aimed to identify the best diagnostic criteria of RFS in critically ill patients.Methods: A multicenter, parallel, prospective trial enrolled patients (≥18 years) with mechanical ventilation for more than 3 days. RFS, defined as new-onset hypophosphatemia (<0.87mmol/L) within 72h after feeding and a decreased concentration of serum phosphate of more than 30%, from four hospital ICU of Zhejiang provinces in China. The primary endpoint was the 28-day mortality. Results: Between May 1, 2019 and April 30, 2020, 312 patients were enrolled. Of these, 302 patients were included and completed the trial. Except for APACHE II, there were no significant differences in age, gender, admission type, diagnosis, furosemide application, and hormone application. In the RFS2 and RFS3 groups, the APACHE II score was significantly higher than the non-RFS group (p=0.009 and p=0.01, respectively). In the nutritional baseline data, there were no significant differences between the groups in the PNI index, time to start of nutrition treatment, percentage of start nutrition within 48 hours, parenteral nutrition, feeding intolerance, and caloric intake and protein intake within first week. The NRS2002 score in group 2 and 3 was higher than the non-RFS group (p<0.001 and p=0.001, respectively). Moreover, the BMI index in group 3 was lower than the non-RFS group(p=0.001). Furthermore, the 28-day mortality increased in group 2 compared with the non-RFS group. The length of hospital stay in group 3 was significantly longer than that in the non-RFS group (p=0.008). More importantly, according to the preliminary RFS2 screening criteria, patients were further divided into patients with modified RFS and modified non-RFS. The nosocomial infection rate and 28- or 90-day mortality in the modified RFS group were higher than those of the modified non-RFS group (p=0.006 and p=0.02, respectively).Conclusions: The optimal criterion of RFS was a decrease in serum phosphate level of 0.65mmol/L and below, and a reduction of greater than 0.16 mmol/L within 72 h after starting nutritional support. Trial registration: ClinicalTrials.gov database, NCT04005300. Registered 1 July 2019, https://clinicaltrials.gov/ct2/show/ NCT04005300

scholarly journals Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: results from the prospective AspCOVID-19 study

2020 ◽  
Author(s):  
Tobias Lahmer
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Stage ◽  
Invasive Pulmonary Aspergillosis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Pulmonary Aspergillosis ◽  
Time Period ◽  
Incidence Risk ◽  
Standardized Screening

Background: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. Methods: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from bronchial aspirates. We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. Findings: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p=0.340) and days of mechanical ventilation (20 versus 15 days; p=0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. Interpretation: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.

Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

2018 ◽  
Vol 35 (7) ◽  
pp. 663-671 ◽  
Author(s):  
Sunmi Ju ◽  
Sun Mi Choi ◽  
Young Sik Park ◽  
Chang-Hoon Lee ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Muscle Mass ◽  
Critically Ill Patients ◽  
Mass Change ◽  
Apache Ii Score ◽  
Muscle Loss ◽  
Icu Mortality ◽  
Skeletal Muscle Index ◽  
The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

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