Nutritional indices may have prognostic value in elderly critically ill patients with sepsis

Year 2023, Volume: 6 Issue: 1, 145 - 151, 12.01.2023

Ömür İlban

https://doi.org/10.32322/jhsm.1217406

Abstract

Aim: Nutritional indicators are associated with adverse outcomes in critically ill elderly patients. In this study, we aimed to evaluate the prognostic potential of prealbumin and albumin in the prediction of mortality in elderly patients with sepsis.
Material and Method: A total of 108 patients who developed intensive care unit-acquired sepsis were divided into two groups: Survivors (n=72) and Non-survivors (n=36).
Results: Patients in the Non-survivors group were often older (68 vs 74) and presented lower prealbumin (15.1 vs 11), and higher Charlson index (4 vs 6), Sequential Organ Failure Assessment (SOFA) score (8.5 vs 10), C-reactive protein (CRP) (68.8 vs 91) and procalcitonin (PCT) (6 vs 8.4) (p< 0.05). The area under the curve of PCT was the highest at 0.74. Prealbumin presented the best sensitivity (75%) and 12 mg/dL cut-off value, while PCT had the best specificity (75%) and a cut-off value of 7 ng/mL. Although prealbumin was negatively correlated to SOFA score in a significant way (r=-0.226, p=0.019), White blood cells, CRP, and PCT were positively correlated to SOFA score (r=0.198, p=0.040; r=0.233, p=0.015; r=0.286, p=0.003, respectively). In addition, a weak negative correlation was observed between prealbumin and CRP and PCT (r=-0.203, p=0.037; r=-0.215, p=0.026, respectively). Multivariate analysis showed that a reduction in serum prealbumin levels compared to steady prealbumin greater than 4 mg/dL increased the risk of death by 85% (aHR: 1.85, 95% CI: 1.05-2.56, p=0.029).
Conclusion: Changes in serum prealbumin in the acute phase of sepsis may assist in determining the risk of mortality and in the administration of specific treatment in critically ill elderly patients. 

Keywords

Elderly, inflammation, mortality, prealbumin, sepsis

Supporting Institution

None

Project Number

None

Thanks

None

References

• Martín S, Pérez A, Aldecoa C. Sepsis and immunosenescence in the elderly patient: a review. Front Med 2017; 4: e1959.
• Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med 2006; 34: 15–21.
• Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH. Transthyretin as a marker to predict outcome in critically ill patients. Clin Biochem 2008; 41: 1126-30.
• Cabassi A, Champlain J, Maggiore U, et al. Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model: Results from a pilot study in elderly chronic heart failure patients. Int J Cardiol 2013; 168: 3334–9.
• Wang W, Pan Y, Tang X, et al. Serum prealbumin and its changes over time are associated with mortality in acute kidney injury. Sci Rep 2017; 7: 41493.
• Li W, Ding C, Yin S. Severe pneumonia in the elderly: a multivariate analysis of risk factors. Int J Clin Exp Med 2015; 8: 12463-75.
• Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis‑3). JAMA 2016; 315: 801-10.
• Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: guideline-based management. Cleve Clin J Med 2020; 87: 53-64.
• McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the rrovision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016; 40: 159-11.
• Xie Q, Zhou Y, Xu Z, et al. The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol 2011; 12: 30.
• Cheng V, Inaba K, Haltmeier T, et al. Serum transthyretin is a predictor of clinical outcomes in critically ill trauma patients. Surgery 2015; 158: 438-44.
• Barrés IA, Fernández RG, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019; 38: 743-6.
• Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340: 448-54.
• Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc 2004; 104: 1258-64.
• Dickson PW, Howlett GJ, Schreiber G. Metabolism of prealbumin in rats and changes induced by acute inflammation. Eur J Biochem 1982; 129: 289e93.
• Davis CJ, Sowa D, Keim KS, Kinnare K, Peterson S. The use of prealbumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. JPEN J Parenter Enteral Nutr 2012; 36: 197-204.
• Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr 2019; 43: 181-93.
• Johnson AM, Merlini G, Sheldon J, Ichihara K. Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med 2007; 45: 419–26.
• Lourenço P, Silva S, Friões F, et al. Low prealbumin is strongly associated with adverse outcome in heart failure. Heart 2014; 100: 1780-5.
• Buxbaum JN, Reixach N. Transthyretin: the servant of many masters. Cell Mol Life Sci 2009; 66: 3095–101.
• Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 2009; 37: 1649–54.
• Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud 2007; 44: 1036–54.
• Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis 2002; 2: 659e66.
• Qin X, Guo Q, Liu Y, et al. Prognostic value of procalcitonin and C-reactive protein combined with sequential organ failure assessment score in elderly patients with sepsis induced by pulmonary infection. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2019; 31: 562-5.
• Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev 2012; 25: 609-34.
• Rambod M, Kovesdy CP, Bross R, Kopple JD, Zadeh KK. Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis. Am J Clin Nutr 2008; 88: 1485-94.
• Nichols DC, Flannery AH, Magnuson BL, Cook AM. Prealbumin Is associated with in-hospital mortality in critically ill patients. Nutr Clin Pract 2020; 35: 572-7.