Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Selection Criteria
2.3. Data Extraction
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Prevalence of Malnutrition Risk
3.3. Outcomes
3.4. Predictors of Malnutrition Risk
Parameters | Traumatic Brain Injury, n = 267 | Ischemic Stroke, n = 825 | Hemorrhagic Stroke, n = 260 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Normal Nutrition (Not at Risk of Malnutrition) n = 125 PNI ≥ 33.8 † | At Risk of Malnutrition n = 142 PNI < 33.8 † | p Value | Normal Nutrition (Not at Risk of Malnutrition) n = 478 PNI ≥ 30.8 † | At Risk of Malnutrition n = 347 PNI < 30.8 † | p Value | Normal Nutrition (Not at Risk of Malnutrition) n = 124 PNI ≥ 31.6 † | At Risk of Malnutrition n = 136 PNI < 31.6 † | p Value | ||
Sex | male | 85, 68% | 108, 76% | 0.142 1 | 274, 57% | 175, 50% | 0.05 1 | 82, 66% | 66, 49% | 0.004 1 |
female | 40, 32% | 34, 24% | 204, 43% | 172, 50% | 42, 34% | 70, 51% | ||||
Age, years | 34 (IQR 24–48) | 48 (IQR 37–60) | <0.001 2 | 66 (IQR 58–75) | 72 (IQR 63–81) | <0.001 2 | 52.5 (IQR 41–63.5) | 63 (IQR 56–69.5) | <0.001 2 | |
BMI, kg/m2 | * n = 113, 21.6 (IQR 19.0–24.6) | n = 127, 22.1 (IQR 18.9–25.4) | 0.4 2 | n = 425, 26.1 (IQR 23.0–30.5) | n = 319, 26.1 (IQR 22.8–30.8) | 0.8 2 | n = 118, 25.6 (IQR 21.8–29.4) | n = 122, 25.5 (IQR 22.6–30.03) | 0.86 | |
SOFA at admission, score | n = 78, 2 (IQR 1–3) | n = 104, 3 (IQR 2–5) | <0.001 2 | n = 330, 2 (IQR 1–3) | n = 269, 4 (IQR 3–6) | <0.001 2 | n = 89, 2 (IQR 0–3) | n = 92, 3 (IQR 2–4) | <0.001 2 | |
FOUR at admission, score | n = 79, 15 (IQR 14–16) | n = 110, 13 (IQR 10–15) | <0.001 2 | n = 352, 16 (IQR 15–16) | n = 269, 13 (IQR 9–16) | <0.001 2 | n = 97, 16 (IQR 14–16) | n = 94, 13 (IQR 11–16) | <0.001 2 | |
GCS at admission, score | n = 81, 13 (IQR 10–15) | n = 111, 10 (IQR 8–14) | <0.001 2 | n = 358, 15 (IQR 12–15) | n = 277, 11 (IQR 8–14) | <0.001 2 | n = 98, 14 (IQR 12–15) | n = 97, 11 (IQR 9–14) | <0.001 2 | |
CRS-R at admission, score | n = 59, 14 (IQR 5–22) | n = 69, 10 (IQR 5–18) | 0.037 2 | n = 228, 22 (IQR 17–23) | n = 165, 13 (IQR 5–20) | <0.001 2 | n = 54, 21 (IQR 17–22) | n = 67, 12 (IQR 5–20) | <0.001 2 | |
Pneumonia at admission | 31, 25% | 57, 40% | 0.008 1 | 108, 23% | 184, 53% | <0.001 1 | 24, 20% | 65, 48% | <0.001 1 | |
Coronary artery disease | 2, 1.6% | 15, 10.6% | 0.002 3 | 88, 19% | 125, 36% | <0.001 1 | 13, 11% | 31, 23% | 0.008 1 | |
Arterial hypertension | 23, 18% | 59, 42% | <0.001 1 | 376, 79% | 257, 74% | 0.123 1 | 92, 74% | 105, 77% | 0.6 1 | |
Type 2 diabetes | 0, 0% | 3, 2.1% | 0.3 3 | 26, 5.4% | 26, 7.5% | 0.2 3 | 6, 4.8% | 5, 3.7% | 0.7 3 | |
Anemia | 5, 4.0% | 12, 8.5% | 0.2 3 | 7, 1.5% | 13, 3.7% | 0.04 3 | 3, 2.4% | 10, 7.4% | 0.089 3 | |
WBC, 109/L | 7.4 (IQR 6.2–9.7) | 9.1 (IQR 7.1–11.5) | 0.002 2 | 8.3 (IQR 6.6–10.6) | 9.83 (IQR 7.3–12.6) | <0.001 2 | 8.5 (IQR 6.45–11.575) | 8.7 (IQR 6.6–11.62) | 0.66 | |
NLR | 3.2 (IQR 2.2–5.3) | 5.0 (IQR 3.2–8.2) | <0.001 2 | 3.9 (IQR 2.6–6.6) | 7.1 (IQR 4.2–12.6) | <0.001 2 | 3.5 (IQR 2.5–7.4) | 6 (IQR 3.9–10.0) | <0.001 2 | |
Platelets, 109/L | 344 (IQR 260–442) | 325 (IQR 244–416) | 0.3 2 | 264 (IQR 212–332) | 242 (IQR 185–314) | <0.001 2 | 311 (IQR 231–379.5) | 294 (IQR 226–376.5) | 0.5 2 | |
INR | n = 123, 1.14 (IQR 1.06–1.27) | n = 139, 1.21 (IQR 1.13–1.36) | 0.004 2 | n = 474, 1.11 (IQR 1.02–1.24) | n = 342, 1.225 (IQR 1.1–1.35) | <0.001 2 | n = 123, 1.12 (IQR 1.06–1.22) | n = 135, 1.2 (IQR 1.08–1.35) | 0.001 2 | |
Albumin, g/L | 37.9 (IQR 35.9–40.7) | 28.35 (IQR 25.1–31.9) | <0.001 2 | 36 (IQR 33.4–38.8) | 26.5 (IQR 23.8–28.7) | <0.001 2 | 35.85 (IQR 33.55–38.15) | 28 (IQR 25.55–30) | <0.001 2 | |
Total protein, g/L | n = 124, 68.8 (IQR 66.4–72.2) | n = 140, 59.2 (IQR 54.5–64.9) | <0.001 2 | n = 460, 66.2 (IQR 62.2–70.2) | n = 335, 55.4 (IQR 50.7–59.4) | <0.001 2 | n = 119, 65.7 (IQR 62.6–70.1) | n = 135, 57 (IQR 53.2–61.6) | <0.001 2 | |
Cholesterol, mmol/L | n = 12, 5.71 (IQR 4.52–6.37) | n = 4, 3.79 (IQR 3.13–4.52) | 0.02 2 | n = 39, 4.42 (IQR 3.62–5.43) | n = 25, 3.37 (IQR 2.92–3.82) | 0.002 2 | n = 10, 5.46 (IQR 4.43–6.02) | n = 13, 3.61 (IQR 2.88–4.38) | 0.004 2 | |
Outcomes | ||||||||||
Hospital mortality | 4, 3.2% | 14, 9.9% | 0.048 3 | 43, 9.0% | 79, 22.8% | <0.001 3 | 7, 5.6% | 14, 10.3% | 0.181 3 | |
Hospital length of stay, days | 38 (IQR 27–62) | 39.5 (IQR 22–64) | 0.9 2 | 34 (IQR 23–47) | 25 (IQR 22–47) | <0.001 2 | 36.5 (IQR 26.5–52) | 35 (IQR 23–60) | 0.6 2 | |
Need for MV | 42, 34% | 84, 59% | <0.001 1 | 123, 26% | 237, 68% | <0.001 1 | 47, 38% | 90, 66% | <0.001 1 | |
Use of vasoactive drugs | 12, 9.6% | 32, 23% | 0.005 2 | 52, 11% | 92, 27% | <0.001 1 | 11, 8.9% | 23, 16.9% | 0.066 2 |
4. Discussion
4.1. Key Findings
4.2. Relationship with Previous Studies
4.3. Significance of the Study Findings
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | Traumatic Brain Injury (1), n = 267 | Ischemic Stroke (2), n = 825 | Hemorrhagic Stroke (3), n = 260 | p 1–2–3 | p 1–2 † | p 1–3 † | p 2–3 † | |
---|---|---|---|---|---|---|---|---|
Sex | male | 193, 72% | 449, 54% | 148, 57% | <0.001 1 | <0.001 1 | <0.001 1 | 0.51 |
female | 74, 28% | 376, 46% | 112, 43% | |||||
Age, years | 42 (IQR 29–56) | 69 (IQR 60–78) | 59 (IQR 48–68) | <0.001 2 | <0.001 4 | <0.001 4 | <0.001 4 | |
BMI, kg/m2 | * n = 240, 21.8 (IQR 18.9–24.9) | n = 744, 26.1 (IQR 23–30.6) | n = 240, 25.6 (IQR 22.4–29.8) | <0.001 2 | <0.001 4 | <0.001 4 | 0.4 4 | |
Transfer from other hospital | 250, 64% | 803, 97% | 254, 98% | 0.016 3 | 0.007 3 | 0.031 3 | 0.9 3 | |
APACHE II at admission, score | n = 15, 6 (IQR 3–10) | n = 28, 7.5 (IQR 5–13.5) | n = 10, 8 (IQR 6–14) | 0.4 2 | - | - | - | |
SOFA at admission, score | n = 182, 3 (IQR 2–4) | n = 599, 3 (IQR 1–5) | n = 181, 3 (IQR 1–4) | 0.111 2 | - | - | - | |
FOUR at admission, score | n = 189, 14 (IQR 11–16) | n = 621, 16 (IQR 13–16) | n = 191, 15 (IQR 12–16) | <0.001 2 | <0.001 4 | 0.1 4 | 0.7 4 | |
GCS at admission, score | n = 192, 11 (IQR 9–14) | n = 635, 14 (IQR 10–15) | n = 195, 14 (IQR 10–15) | <0.001 2 | <0.001 4 | <0.001 4 | 0.9 4 | |
CRS-R at admission, score | n = 128, 11 (IQR 6–19) | n = 393, 20 (IQR 11–23) | n = 121, 18 (IQR 8–22) | <0.001 2 | <0.001 4 | 0.017 4 | 0.042 4 | |
Pneumonia at admission | 88, 33% | 292, 35% | 89, 34% | 0.8 1 | - | - | - | |
Comorbidity | ||||||||
Coronary artery disease | 17, 6.4% | 213, 26% | 44, 17% | <0.001 3 | <0.001 1 | <0.001 1 | 0.003 1 | |
Arterial hypertension | 82, 31% | 633, 77% | 197, 76% | <0.001 1 | <0.001 1 | <0.001 1 | 0.8 1 | |
Type 2 diabetes | 3, 1.1% | 52, 6.3% | 11, 4.2% | <0.001 3 | <0.001 3 | 0.031 3 | 0.3 3 | |
Anemia | 17, 6.4% | 20, 1.4% | 13, 5.0% | 0.005 3 | 0.005 3 | 0.6 3 | 0.06 3 | |
Laboratory parameters and malnutrition risk assessment at admission | ||||||||
PNI score | 33.4 (IQR 28.2–37.7) | 32.2 (IQR 27.3–36.7) | 31.3 (IQR 27.9–35.3) | 0.025 2 | 0.1 4 | 0.016 4 | 0.7 4 | |
Status | Normal | 60, 23% | 159, 20% | 32, 12% | 0.012 1 | 0.4 1 | 0.002 1 | 0.014 1 |
Moderate | 47, 18% | 135, 16% | 37, 14% | |||||
Severe | 160, 60% | 531, 64% | 191, 74% | |||||
WBC, 109/L | 8.2 (IQR 6.6–11) | 8.8 (IQR 6.8–11.5) | 8.6 (IQR 6.5–11.6) | 0.127 2 | - | - | - | |
Lymphocyte count, 109/L | 1.4 (IQR 1.1–1.8) | 1.2 (IQR 0.9–1.8) | 1.2 (IQR 0.9–1.8) | 0.005 2 | 0.004 4 | 0.1 4 | 0.9 4 | |
Neutrophil count, 109/L | 5.6 (IQR 4.3–8.4) | 6.4 (IQR 4.5–9.2) | 6.4 (IQR 4.5–8.9) | 0.027 2 | 0.024 4 | 0.1 4 | 0.9 4 | |
NLR | 4.3 (IQR 2.6–6.9) | 5 (IQR 3.1–9) | 5 (IQR 2.9–8.7) | <0.001 2 | 0.001 4 | 0.02 4 | 0.9 4 | |
Platelets, 109/L | 337 (IQR 251–429) | 255 (IQR 201–328) | 305 (IQR 228.5–379.5) | <0.001 2 | <0.001 4 | 0.01 4 | <0.001 4 | |
INR | n = 262, 1.18 (IQR 1.1–1.3) | n = 816, 1.15 (IQR 1.1–1.3) | n = 258, 1.15 (IQR 1.1–1.3) | 0.026 2 | 0.02 4 | 0.4 4 | 0.9 4 | |
Albumin, g/L | 33.4 (IQR 28.2–37.7) | 32.2 (IQR 27.3–36.7) | 31.3 (IQR 27.9–35.3) | 0.025 2 | 0.1 4 | 0.025 4 | 0.7 4 | |
Total protein, g/L | n = 264, 65.1 (IQR 58.5–69.7) | n = 795, 62 (IQR 56.1–67.6) | n = 254, 61.8 (IQR 56.2–66.3) | <0.001 2 | <0.001 4 | <0.001 4 | 0.9 4 | |
Cholesterol, mmol/L | n = 16, 4.9 (IQR 4.4–6.3) | n = 64, 3.9 (IQR 3.1–4.7) | n = 23, 4.4 (IQR 3.1–5.6) | 0.009 2 | 0.008 4 | 0.3 4 | 0.7 4 | |
Outcomes | ||||||||
Hospital mortality | 18, 6.7% | 122, 14.8% | 21, 8.1% | <0.001 3 | <0.001 3 | 0.6 3 | 0.004 3 | |
Hospital length of stay, days | 39 (IQR 24–63) | 31 (IQR 22–47) | 36 (IQR 24–56) | <0.001 2 | <0.001 4 | 0.9 4 | 0.001 4 | |
Need for MV | 126, 47% | 360, 44% | 137, 53% | 0.035 1 | 0.3 1 | 0.2 1 | 0.011 1 | |
Use of vasoactive drugs | 44, 17% | 144, 18% | 34, 13% | 0.3 1 | - | - | - | |
Discharge department | ICU palliative psych. ward neurorehabilitation | 126, 43% | 386, 47% | 130, 50% | 0.5 1 | - | - | - |
69, 26% | 209, 25% | 72, 28% | ||||||
72, 27% | 230, 28% | 58, 22% |
Parameters | Univariate Analysis HR (95% CI) | p Value | Multivariable Analysis adj. HR (95% CI) | p Value |
---|---|---|---|---|
Sex (ref. male) | 1.59 (1.16–2.16) | 0.003 | 0.8 | |
Age * | 1.044 (1.032–1.055) | <0.001 | 1.038 (1.023–1.052) | <0.001 |
SOFA * | 1.37 (1.30–1.45) | <0.001 | 1.33 (1.26–1.41) | <0.001 |
FOUR | 0.85 (0.82–0.89) | <0.001 | 0.4 | |
GCS | 0.85 (0.81–0.90) | <0.001 | 0.2 | |
CRS-R | 0.94 (0.91–0.97) | <0.001 | ||
Pneumonia at admission | 2.17(1.59–2.96) | <0.001 | 0.3 | |
Coronary artery disease | 2.23 (1.58–3.14) | <0.001 | 0.1 | |
Arterial hypertension | 1.84 (1.28–2.64) | <0.001 | 0.9 | |
Type 2 diabetes | 2.08 (1.12–3.86) | 0.020 | 0.9 | |
Anemia | 0.67 (0.21–2.11) | 0.5 | - | |
Ischemic stroke (ref. TBI) | 3.06 (1.85–5.04) | <0.001 | 0.4 | |
Hemorrhagic stroke (ref. TBI) | 1.45 (0.77–2.73) | 0.3 | - | |
PNI score | 0.918 (0.893–0.943) | <0.001 | 0.8 |
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Shestopalov, A.E.; Yakovleva, A.V.; Yadgarov, M.Y.; Sergeev, I.V.; Kuzovlev, A.N. Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records. Nutrients 2024, 16, 2396. https://doi.org/10.3390/nu16152396
Shestopalov AE, Yakovleva AV, Yadgarov MY, Sergeev IV, Kuzovlev AN. Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records. Nutrients. 2024; 16(15):2396. https://doi.org/10.3390/nu16152396
Chicago/Turabian StyleShestopalov, Alexander E., Alexandra V. Yakovleva, Mikhail Ya. Yadgarov, Ivan V. Sergeev, and Artem N. Kuzovlev. 2024. "Prevalence and Impact of Malnutrition Risk on Outcomes in Critically Ill Patients with Traumatic Brain Injury and Stroke: A Retrospective Cohort Study Using Electronic Health Records" Nutrients 16, no. 15: 2396. https://doi.org/10.3390/nu16152396