Critical Care |

Malnutrition Effects on Critically Ill Patients With Acute Myelogenous Leukemia FREE TO VIEW

Mohamed Abdelfatah, MD; Ala Nijim, MD; Rabih Nayfe, MD; Ahmed Elkhanany, MD
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Akron General Medical Center, Northeast Ohio Universty, Akron, OH

Chest. 2014;146(4_MeetingAbstracts):246A. doi:10.1378/chest.1991960
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Malnutrition is a common complication in critically ill patients. Recovery from this critical illness is characterized when the rate of anabolism exceeds that of catabolism. Adequate nutrition provide substrate for anabolic state1, recent evidence suggests that starting feeding early in those patients can markedly affect the outcome1. Acute myelogenous leukemia [AML], one of the most debilitating diseases in critically ill patients. The purpose of the study is to evaluate the effect of malnutrition on the outcome of critically ill AML patients

METHODS: A total of 188 adult patients with Acute AML between 2002-2012 were enrolled. Retrospective data obtained included: demographic information, labs, bone marrow (BM) biopsy, cytogenetics, outcome, and overall survival (OS) were obtained. Low serum prealbumin was defined as <18mg/dl.

RESULTS: The median age was 70 years, 98 were men. 46 patients had moderate to sever BM fibrosis, 45 patients had complex cytogenetics, 10 patients (5%) were underweight, 34 (18%) had normal BMI, 59 (32%) were overweight, and 84 (45%) were obese. 149 patients (80%) were not diabetic, 12 patients (6%) had high risk for DM, and 26 patients (14%) uncontrolled DM. Overall median OS was 23 weeks, in univariate line regression a definitive correlation exists between survival in weeks and age (r=-0.34, P<0.0001). In univariate OS, when compared across groups, significant correlation was found with low Prealbumin (p< 0.0001), where median survivals for low versus normal levels were 21 and 352 weeks respectively, and complex Cytogenetics (p=0.03) with median survival 126 versus 150 weeks. However, other parameters of the cohort were mostly non-significant, including DM control (p=0.39), BMI subcategories (p=0.4), GFR status (p=0.1), and concomitant diagnosis of BM Fibrosis (p=0.71). In multivariate analysis using Cox regression, adjusting for age, sex, BMI, Prealbumin, cytogenetics, there were significant impact of both age (P <0.0001) and Prealbumin level (OR=3.86 compared with normal level, P=0.0004) on survival.

CONCLUSIONS: Low Prealbumin has all been shown to have a statistically significant effect on survival in critically ill AML patients.

CLINICAL IMPLICATIONS: According to our data we recommend that intensivists monitor nutritional status and correct malnutrition early as it is crucial in critically ill patients especially leukemia patients.

DISCLOSURE: The following authors have nothing to disclose: Mohamed Abdelfatah, Ala Nijim, Rabih Nayfe, Ahmed Elkhanany

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