Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit. The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/- 600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality.
| Published in | International Journal of Nutrition and Food Sciences (Volume 3, Issue 5) |
| DOI | 10.11648/j.ijnfs.20140305.27 |
| Page(s) | 477-483 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2014. Published by Science Publishing Group |
Nutrition Status, Inflammation, Biological Markers, Prognosis, Enteral Nutrition, Surgical Intensive Care Unit, PINI
| [1] | Ait Hssain A, B Souweine, NJ Cano : Pathophysiology of malnutrition in ICU. Nutr Clin Metaboli 2011 ,25:29-35. |
| [2] | P Erny: Nutrition assaulted: consensus conference. Ann Fr Anesth Réanim 1998,17:1274-84. |
| [3] | Herridge MS, Cheung AM, Tansey CM et al: One-year outcomes in Survivors of the acute respiratory distress syndrome. N Engl J Med 2003, 348:683-93. |
| [4] | Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G, Wernerman J, Ebner C et al: ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 2006 , 25(2):210-223. |
| [5] | McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G:Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.). Jpen 2009, 33(3):277-316. |
| [6] | Hill SA, Nielsen MS, Lennard-Jones JE: Nutritional support in intensive care units in England and Wales: a survey. Eur J Clin Nutr 1995,49:371–8. |
| [7] | Berger MM, Chiole´ro RL, Pannatier A, Cayeux MC, Tappy L: A 10-year survey of nutritional support in a surgical ICU: 1986–1995. Nutrition 1997,13:870–7. |
| [8] | Preiser JC, Berre´ J, Carpentier Y, Joilliet P, Pichard C,Van Gossum A et al: Management of nutrition in European intensive care units: results of a questionnaire. Intens Care Med 1999,25:95–101. |
| [9] | Albert H. Verhage, Adrie C.M. van Vliet: Clinical practice of nutritional support in Dutch intensive care units: a survey. Eur J Intern Med 2002, 13(8):496-499. |
| [10] | Campillo B, Paillaud E, Uzan I, Merlier I, Abdellaoui M, Perennec J, et al:Value of body mass index in the detection of severe malnutrition: influence of the pathology and changes in anthropometric parameters. Clin Nutr 2004,23(4):551-9. |
| [11] | Jeejeebhoy KN: Nutritional assessment. Nutrition 2000,16(7-8):585-90. |
| [12] | Robinson MK, Trujillo EB, Mogensen KM, et al: Improving nutritional screening of hospitalized patients: the role of prealbumin. J Parenter Enteral Nutr 2003, 27(6):389–95. |
| [13] | Gariballa S, Forster S:Effects of acute-phase response on nutritional status and clinical outcome of hospitalized patients. Nutrition 2006 ,22(7–8):750–7. |
| [14] | Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH: Transthyretin as a marker to predict outcome in critically ill patients. Clin Biochem 2008 ,41(14–15):1126–30. |
| [15] | Raguso CA, Dupertuis YM, Pichard C:The role of visceral proteins in the nutritional assessment of intensive care unit patients.Curr Opin Clin Nutr Metab Care 2003,6(2):211–6. |
| [16] | López-Hellin J, Baena-Fustegueras JA, Schwartz-Riera S, García-Arumí E: Usefulness of short-lived proteins as nutritional indicators surgical patients. Clin Nutr 2002 ,21(2):119–25. |
| [17] | Higgins PA, Daly BJ, Lipson AR, Su-Er G:Assessing nutritional status in chronically ill adult patients. Am J Crit Care 2006,15:1–99. |
| [18] | Sung J, Bochicchio GV, Joshi M, et al: Admission serum albumin is predicitve of outcome in critically ill trauma patients. Am Surg 2004 ,70(12):1099–102. |
| [19] | Mahmoud FA, Rivera NI :The role of C-reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep 2002 ,4:250–255. |
| [20] | Koenig W, Pepys MB :C-reactive protein risk prediction: low specificity, high sensitivity. Ann Intern Med 2002 ,136 :550–552. |
| [21] | Prins A: Nutritional assessment of the critically ill patient. S Afr J Clin Nutr 2010,23(1):11-18. |
| [22] | Ingenbleek Y, Carpentier YA :A prognostic inflammatory and nutritional index scoring critically ill patients. Int J Vitam Nutr Res 1985 ,55:91–101. |
| [23] | Ho SY, Guo R Hf, HHW Chen, CJ Peng: Nutritional predictors of survival in terminally ill cancer patients.J Formosa Med Assoc 2003,102:544-550. |
| [24] | Nelson K, Walsh D:The cancer anorexia-cachexia syndrome; a survey of the prognostic inflammatory and nutritional index (PINI) in advanced disease. J Pain Symptom Manage 2002,24:424–428. |
APA Style
Hedi Gharsallah, Zied Hajjej, Imen Naas, Zied Aouni, Nejla Stambouli, et al. (2014). Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI). International Journal of Nutrition and Food Sciences, 3(5), 477-483. https://doi.org/10.11648/j.ijnfs.20140305.27
ACS Style
Hedi Gharsallah; Zied Hajjej; Imen Naas; Zied Aouni; Nejla Stambouli, et al. Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI). Int. J. Nutr. Food Sci. 2014, 3(5), 477-483. doi: 10.11648/j.ijnfs.20140305.27
AMA Style
Hedi Gharsallah, Zied Hajjej, Imen Naas, Zied Aouni, Nejla Stambouli, et al. Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI). Int J Nutr Food Sci. 2014;3(5):477-483. doi: 10.11648/j.ijnfs.20140305.27
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijnfs.20140305.27,
author = {Hedi Gharsallah and Zied Hajjej and Imen Naas and Zied Aouni and Nejla Stambouli and Iheb Labbène and Mustapha Ferjani},
title = {Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI)},
journal = {International Journal of Nutrition and Food Sciences},
volume = {3},
number = {5},
pages = {477-483},
doi = {10.11648/j.ijnfs.20140305.27},
url = {https://doi.org/10.11648/j.ijnfs.20140305.27},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijnfs.20140305.27},
abstract = {Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit. The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/- 600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality.},
year = {2014}
}
TY - JOUR T1 - Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI) AU - Hedi Gharsallah AU - Zied Hajjej AU - Imen Naas AU - Zied Aouni AU - Nejla Stambouli AU - Iheb Labbène AU - Mustapha Ferjani Y1 - 2014/09/30 PY - 2014 N1 - https://doi.org/10.11648/j.ijnfs.20140305.27 DO - 10.11648/j.ijnfs.20140305.27 T2 - International Journal of Nutrition and Food Sciences JF - International Journal of Nutrition and Food Sciences JO - International Journal of Nutrition and Food Sciences SP - 477 EP - 483 PB - Science Publishing Group SN - 2327-2716 UR - https://doi.org/10.11648/j.ijnfs.20140305.27 AB - Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit. The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/- 600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality. VL - 3 IS - 5 ER -
Email: