Use of Subjective Global Assessment and Clinical Outcomes in Critically Ill Geriatric Patients Receiving Nutrition Support

Abstract

The objective of this study is to examine the prevalence of malnutrition and evaluate the nutrition status and clinical outcome in hospitalized patients aged 65 years and older receiving enteral-parenteral nutrition. This retrospective study was carried out at Başkent University Hospital, Adana, Turkey. A total of 119 patients older than 65 years were recruited. Patients were classified into 3 groups: protein-energy malnutrition (PEM), moderate PEM, and well nourished according to subjective global assessment (SGA) at admission. All patients were fed by enteral or parenteral route. Acute physiological and chronic health evaluation (APACHE-2) and simplified acute physiology (SAPS 2) scores were recorded in patients followed in the intensive care unit (ICU). Nutrition status was assessed with biochemical (serum albumin, serum prealbumin) parameters. These results were compared with mortality rate and length of hospital stay (LOS). The subjects' mean (±SD) age was 73.1 ± 5.4 years. Using SGA, 5.9% (n = 7) of the patients were classified as severely PEM, 27.7% (n = 33) were classified as moderately PEM, and 66.4% (n = 79) were classified as well nourished. Some 73.1% (n = 87) of the patients were followed in the ICU. Among all patients, 42.9% (n = 51) were fed by a combined enteral-parenteral route, 31.1% (n = 37) by an enteral route, 18.5% (n = 22) by a parenteral route, and 7.6% (n = 9) by an oral route. The average length of stay for the patients was 18.9 ± 13.7 days. The mortality rate was 44.5% (n = 53). The mortality rate was 43% (n = 34) in well-nourished patients (n = 79), 48.5% (n = 16) in moderately PEM patients (n = 33), and 42.9% (n = 3) in severely PEM patients (n = 7) (P = .86). The authors observed no difference between well-nourished and malnourished patients with regard to the serum protein values on admission, LOS, and mortality rate. In this study, malnutrition as defined by SGA did not influence the mortality rate of critically ill geriatric patients receiving enteral or parenteral nutrition. Furthermore, no factor was found to be a good predictor of survival.

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References

Sobotka L. Klinik Nütrisyon Temel Kavramlar, ESPEN Kurslar Yayéné, I°kinci Baské, Logos Yayéncélék. I°stanbul;2000.

Allison SP, Rawlings J, Field J, Bean N, Stephen AD. Nutrition in the elderly hospital patient Nottingham Studies. J Nutr Health Aging. 2000;4:54 -57.

Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part 1: history, examination, body composition and screening tools, Nutrition.2000 ;16:50 -63.

Pennington CR. Disease-associated malnutrition in the year 2000. Postgrad Med J.1998 ;74:65 -71.

Sullivan DH. The role of nutrition in increased morbidity and mortality. Clin Geriatr Med.1995 ;11:661 -674.

Akner GA, Cederholm T. Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr.2001 ;74:6 -24.

Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2005;(2):CD003288 .

Gadek JE, DeMichele SJ, Karlstad MD, et al. Effect of enteral feeding with eicosapentaenoic acid, gamma linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med.1999 ;27;1409 -1420.

Elamin E, Hughes L, Drew D. Effect of enteral nutrition with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and antioxidants reduces alveolar inflammatory mediators and protein influx in patients with acute respiratory distress syndrome (ARDS) [abstract]. Chest. 2005;128:225S . Abstract 3472K.

10.

Mayes T, Gottschlich M, Carman B, Kagan R. An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure [abstract]. Nutr Clin Pract.2005 ;20: 30-31. Abstract N027.

11.

Singer P, Theilla M, Fisher H, Gibstein L, Grozovski E, Cohen J. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med.2006 ;34:1033 -1038.

12.

Pontes-Arruda A, Aragao AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gammalinolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med.2006 ;34:1033 -1038.

13.

Detsky A, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11:8 -13.

14.

Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR. Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: different sides of different coins? J Am Geriatr Soc. 2002;50:631 -637.

15.

James JP, Grimble G, Silk D. Artificial Nutrition Support in Clinical Practice. 2nd ed. London, UK: Cambridge University Press; 2001.

16.

Bos C, Benamouzig R, Bruhat A, et al. Nutritional status after short-term dietary supplementation in hospitalized malnourished geriatric patients. Clin Nutr.2001 ;20:225 -233.

17.

Duerksen DR, Yeo TA, Siemens JL, O'Connor MP. The validity and reproducibility of clinical assesment of nutritional status in elderly. Nutrition.2000 ;16:740 -744.

18.

Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part 2: laboratory evaluation. Nutrition.2000 ;16:131 -140.

19.

Isabel M, Correia TD, Waitzberg DL. The impact of malnutrition on morbidity, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr.2003 ;22:235 -239.