Esmee A H Verheul, Suzan Dijkink, Pieta Krijnen, Jochem M Hoogendoorn, Sesmu Arbous, Ron Peters, George C Velmahos, Ali Salim, Daniel D Yeh, Inger B Schipper
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Complications included systemic-, surgery-, and fracture-related complications, pneumonia, urinary tract infection, deep venous thrombosis, and pulmonary embolism. In-ICU and in-hospital mortality were recorded separately. The complication rate was compared between patients who had or developed malnutrition and patients who remained well-nourished, using multivariable logistic regression analysis.</p><p><strong>Results: </strong>Of 100 included patients, twelve (12%) were malnourished at admission. Of the 88 well-nourished patients, 44 developed malnutrition during ICU admission, (ICU incidence 50%, 95% confidence interval [CI] 40-60%). Another 18 patients developed malnutrition at the ward (overall in-hospital incidence 70%, 95% CI 61-80%). The 62 patients who developed malnutrition and 12 patients who were malnourished upon admission had more complications than the 26 patients who remained well-nourished (58% vs. 50% vs. 27% respectively; p = 0.03; Odds Ratio 3.4, 95% CI 1.2-9.6).</p><p><strong>Conclusions: </strong>50% of severely injured patients developed malnutrition during ICU admission, increasing to 70% during hospital admission. Malnutrition was related to an increased risk of complications. Recognition of sub-optimally nourished severely injured patients and assessment of nutritional needs could be valuable in optimizing their clinical outcomes.</p><p><strong>Level of evidence: </strong>Level III, Prognostic/Epidemiological.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"72"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761767/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prevalence, incidence, and complications of malnutrition in severely injured patients.\",\"authors\":\"Esmee A H Verheul, Suzan Dijkink, Pieta Krijnen, Jochem M Hoogendoorn, Sesmu Arbous, Ron Peters, George C Velmahos, Ali Salim, Daniel D Yeh, Inger B Schipper\",\"doi\":\"10.1007/s00068-024-02711-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Severely injured patients may suffer from acute disease-related or injury-related malnutrition involving a marked inflammatory response. This study investigated the prevalence and incidence of malnutrition and its relation with complications in severely injured patients admitted to the intensive care unit (ICU).</p><p><strong>Methods: </strong>This observational prospective cohort study included severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU of five level-1 trauma centers in the Netherlands and United States. Malnutrition was defined as a Subjective Global Assessment score ≤ 5. Complications included systemic-, surgery-, and fracture-related complications, pneumonia, urinary tract infection, deep venous thrombosis, and pulmonary embolism. In-ICU and in-hospital mortality were recorded separately. The complication rate was compared between patients who had or developed malnutrition and patients who remained well-nourished, using multivariable logistic regression analysis.</p><p><strong>Results: </strong>Of 100 included patients, twelve (12%) were malnourished at admission. 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引用次数: 0
摘要
背景：严重损伤的患者可能患有急性疾病相关或损伤相关的营养不良，并伴有明显的炎症反应。本研究探讨重症监护病房（ICU）重症外伤患者营养不良的患病率、发生率及其与并发症的关系。方法：本观察性前瞻性队列研究纳入荷兰和美国5家一级创伤中心ICU收治的严重损伤患者（损伤严重程度评分≥16）。营养不良定义为主观总体评估得分≤5分。并发症包括全身、手术和骨折相关并发症、肺炎、尿路感染、深静脉血栓形成和肺栓塞。分别记录icu和住院死亡率。采用多变量logistic回归分析，比较营养不良患者和营养良好患者的并发症发生率。结果：在纳入的100例患者中，12例（12%）在入院时营养不良。88例营养良好的患者中，44例在ICU入院时出现营养不良（ICU发生率为50%，95%可信区间[CI] 40-60%）。另有18名患者在病房出现营养不良（住院总发生率为70%，95%可信区间为61-80%）。62名出现营养不良的患者和12名入院时营养不良的患者比26名营养良好的患者出现更多的并发症(分别为58%∶50%∶27%；p = 0.03；优势比3.4,95% CI 1.2-9.6)。结论：重症外伤患者在ICU住院期间出现营养不良的比例为50%，住院期间这一比例上升至70%。营养不良与并发症的风险增加有关。识别营养不良的严重受伤患者和评估营养需求可能对优化其临床结果有价值。证据等级：III级，预后/流行病学。
Prevalence, incidence, and complications of malnutrition in severely injured patients.
Background: Severely injured patients may suffer from acute disease-related or injury-related malnutrition involving a marked inflammatory response. This study investigated the prevalence and incidence of malnutrition and its relation with complications in severely injured patients admitted to the intensive care unit (ICU).
Methods: This observational prospective cohort study included severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU of five level-1 trauma centers in the Netherlands and United States. Malnutrition was defined as a Subjective Global Assessment score ≤ 5. Complications included systemic-, surgery-, and fracture-related complications, pneumonia, urinary tract infection, deep venous thrombosis, and pulmonary embolism. In-ICU and in-hospital mortality were recorded separately. The complication rate was compared between patients who had or developed malnutrition and patients who remained well-nourished, using multivariable logistic regression analysis.
Results: Of 100 included patients, twelve (12%) were malnourished at admission. Of the 88 well-nourished patients, 44 developed malnutrition during ICU admission, (ICU incidence 50%, 95% confidence interval [CI] 40-60%). Another 18 patients developed malnutrition at the ward (overall in-hospital incidence 70%, 95% CI 61-80%). The 62 patients who developed malnutrition and 12 patients who were malnourished upon admission had more complications than the 26 patients who remained well-nourished (58% vs. 50% vs. 27% respectively; p = 0.03; Odds Ratio 3.4, 95% CI 1.2-9.6).
Conclusions: 50% of severely injured patients developed malnutrition during ICU admission, increasing to 70% during hospital admission. Malnutrition was related to an increased risk of complications. Recognition of sub-optimally nourished severely injured patients and assessment of nutritional needs could be valuable in optimizing their clinical outcomes.
Level of evidence: Level III, Prognostic/Epidemiological.
期刊介绍：
The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries.
Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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