PURPOSE: The incidence of malnutrition in hospitalized patients can exceed 50%, and it is even higher in critically ill patients. Laboratory tests can currently assess nutritional status, however, hospital personnel continue to perform assessments relying on subjective observation. We evaluated a laboratory algorithm for early identification of risk of malnutrition.
METHODS: Fifty-five consecutive patients admitted to a medical intensive care unit in a community hospital in New York were enrolled in a prospective observational study. All the patients were assessed for high risk for malnutrition diagnosis (sepsis, end stage renal disease, advanced liver disease, cachexia, dysphagia, malabsorption), poor oral intake >10 days, presence of a wound, serum albumin and cholesterol levels on the day of admission. APACHE II score was calculated on the day of admission. Transthyretin (TTR), also known as prealbumin, was obtained on days 1,3, and 7. All the patients were assessed for receiving their daily estimated nutritional requirement. The TTR results were compared with other parameters for predicting malnutrition risk. The database was analyzed through one-way analysis of variance, t-test and chi-square.
RESULTS: Cross table analysis of the dietician’s assessment with both TTR, and albumin for diagnosis of malnutrition was not concordant (p>0.05). Analysis for change in TTR from day 1 to day 3 shows a decline in nutrition status (p<0.05), in spite of providing nutritional support. Sixty seven percent of patients had a low TTR and high APACHE II scores (>15). Low albumin and low TTR showed close correlation (p<0.002), and both markers correlated with poor oral intake and high-risk diagnosis (p<0.002).
CONCLUSION: The present study confirms close correlation between albumin, TTR, high risk for malnutrition diagnosis and poor oral feeding. This study showed advantages of TTR over other key features for identifying malnutrition risk in the ICU setting. The decrease of TTR in three days of ICU stay is attributable to the high stress state.
CLINICAL IMPLICATIONS: TTR on the third day is at its nadir for monitoring improvement with nutritional intervention.
DISCLOSURE: Arun Devakonda, None.