Predictive value of the CONUT scale in the early detection of nutritional risk and its relationship with mortality in critically ill patients
DOI:
https://doi.org/10.56294/saludcyt2023339Keywords:
Nutrition in Critically Ill Patients, CONUT Scale, Nutritional Risk, MortalityAbstract
Introduction: Hospital malnutrition is a global health problem, and its prevalence has been estimated between 30 % y 60 %. Its early identification constitutes a pillar of the management and treatment of critically ill patients. Its usefulness has been shown both to improve the survival of these patients, as well as to reduce complications related to it, and reduce costs.
Objectives: apply the CONUT scale to assess nutritional risk and as a predictor of mortality. Relate it with causes of admission, stay in the ICU, time on mechanical ventilation, and the state at discharge from the ICU and determine the sensitivity and specificity of the CONUT scale as a predictor of mortality and its comparison with the APACHE II scale.
Methods: it was carried out in the ICU of the "Miguel Enríquez" Hospital for a period of 2 years. The variables applied were: age, sex, ICU stay, origin services, need for mechanical ventilation, discharge status, nutritional status classification according to CONUT and APACHE II.
Results: There was a predominance of males, the average stay was between 1-6 days, and mortality was low. More than 90 % of the patients were malnourished, the diagnosis at admission and the use of mechanical ventilation, and no association with mortality was demonstrated.
Conclusions: an association between nutritional status and ICU stay was demonstrated. According to the ROC curve, it was shown that the CONUT has a high sensitivity to predict nutritional risk and its relationship with mortality, compared to the APACHE scale it was low
References
1. Green CJ. Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention. Clin Nutr 1999;18:3-28.
2. Barker L, Gout B, Crowe T. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environm Res Public Health 2011;8:514-27.
3. Turner PL, Ilano AG, Zhu Y, Johnson SB, Hanna N. ACS-NSQIP criteria are associated with APACHE severity and outcomes in critically ill surgical patients. JAm Coll Surg 2015;212(3):287-294.
4. Freire AX, Bridges L, Umpierrez GE, Kuhl D, Kitabchi AE. Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population. Chest 2015;128(5):3109-3116.
5. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition- an ESPEN consensus statement. Clin Nutr 2015;34:335e40
6. Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, Pirlich M, Singer P; endorsed by the ESPEN Council. ESPEN expert statements and practical guidance for nutritional management of individuals. Clin Nutr. 2020;39(6):1631-1638. https://doi.org/10.1016/j.clnu.2020.03.022.
7. Quesada Castillo Y, León Pérez DO, Rosales García J, Palacios Téllez D. Estado nutricional de pacientes ingresados en una unidad de cuidados intensivos. Rev Cub Anest Rean. 2020; 19(1).
8. Altintas ND, Aydin K, Turkoglu MA, Abbasoglu O, Topeli A. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract 2011;26(3):322-329. https://doi.org/10.1177/0884533611405790
9. Bartz S, Mody A, Hornik C et al. Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality. J Clin Endocrinol Metab 2014;99(6):2128-2137.
10. de Ulibarri Perez JI. Clinical undernutrition in 2014; pathogenesis, early diagnosis and consequences; undernutrition and trophopathy. Nutr Hosp 2014;29(4):785- 796.
11. Flordelis Lasierra JL, Perez-Vela JL, Umezawa Makikado LD et al. Early enteral nutrition in patients with hemodynamic failure following cardiac surgery. JPEN J Parenter Enteral Nutr 2015;39(2):154-162.
12. Ulíbarri J, González A, González P, Fernández G,Rodríguez F, Mancha A. Nuevo procedimiento para la detección precoz y control de la desnutrición hospitalaria. Nutr Hosp. 2002;17(4):179-88.
13. Ulíbarri JI, González A, de Villar N, González P, González B, Mancha A. CONUT: A tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45.
14. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
15. Santana Porbén S. Estado de la desnutrición en los hospitales de Cuba: una actualización necesaria. Rev Cubana Aliment Nutr. 2015;25(2):356-70.
16. Campos Del PR, Palma MS, Garcia VN et al. Assessment of nutritional status in the healthcare setting in Spain. Nutr Hosp 2017;31(s03):196-208.
17. Villalobos Gamez JL, Garcia-Almeida JM, Guzman de Damas JM et al. [INFORNUT process: validation of the filter phase-FILNUT--and comparison with other methods for the detection of early hospital hyponutrition]. Nutr Hosp 2006;21(4):491-504.
18. Mezoff A, Gamm L, Konek S, Beal KG, Hitch D. Validation of a nutritional screen in children with respiratory syncytial virus admitted to an intensive care complex. Pediatrics 1996;97(4):543-546.
19. SwagataTripathy, JC. Mishra Assessing nutrition in the critically ill elderly patient: A comparison of two screening tools. Indian J CritCareMed. 2015 Sep; 19(9): 518–522
20. Hernandez Ruiz A, Delgado Fernández RI, Alcalde Mustelier GR, Collazo Ramos M, Garcia Collazo CM. Mortalidad en pacientes con ventilación mecánica ingresados en una Unidad de Cuidados Intensivos. Rev haban cienc méd. 2018;17(6).
21. Molina Soria JB, Lobo Támer G, Pérez de la Cruz AJ, Ruiz-López MD. Prevalencia de desnutrición al ingreso en un hospital general básico. Nutr Hosp. 2017;34:1390-98.
22. Casanova B, Casey JD, Gunasekera NS, Moromizato T, Rawn JD, et al. Nutritional status and mortality in the critically ill. Crit Care Med 2017;43:2605–2615.
23. Kogo M, Nagata K, Morimoto T. Enteral nutrition is a risk factor for airway complications in subjects undergoing noninvasive ventilation for acute respiratory failure. Respir Care. 2017;62(4):459-467.
24. Paez Candelaria Y, Romero García LI, Pereira Despaigne OL, Gondres Legró KM, Bacardí Zapata PA, Legró Bisset G. Factores predictivos de desnutrición en pacientes graves, Acta Colombiana de Cuidado Intensivo. 2018;18 (1):10-21. https://doi.org/10.1016/j.acci.2017.11.004
25. Manon CH de Vries, Koekkoek K, Opdam MH, van Blokland D, van Zanten A. Nutritional assessment of critically ill patients: validation of the modified NUTRIC score. European Journal of Clinical Nutrition. 2018. 72:428–435
26. Mogensen KM, Robinson MK, Casey JD, Gunasekera NS, Moromizato T, Rawn JD, et al. Nutritional status and mortality in the critically ill. Crit Care Med. 2015;43:2605–2615.
27. Magallanes Gamboa J, Ochoa Ramírez A, Notario Barba V, Gallegos Polonio A, Vizuete Calero A, Blanco Jarava y col. Indice CONUT: cribado de riesgo nutricional en un servicio de medicina interna de un hospital general. Rev Clin Esp. 2015; 215.
28. Álvarez Álvarez B, Rodríguez Mañero M, García Seara FJ, Abellas Sequeiros RM, González Melchor L, Fernández López A y col. Valor pronóstico del CONUT en pacientes con terapia de resincronización cardiaca. Eventos cardiovasculares y remodelado estructural. Rev Esp Cardiol. 2017; 70 (Supl 1):608.
29. Lima Rodriguez JM, Auza-Santiváñez JC, Guerra-Chagime R, Suárez López DE. Cuban Scientific Production on Intensive Care and Emergency Medicine in Scopus (2019-2021). Data & Metadata. 2022;1:3. https://doi.org/10.56294/dm20223
Published
Issue
Section
License
Copyright (c) 2023 Jhossmar Cristians Auza-Santivañez, Jorge Soneira Perez, David Orlando León, Nayra Condori-Villca, Juan Pablo Alvarez Loaces (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
