The value of malnutrition screening tool in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YU Yuheng , ZHOU Jing , XI Yin , NONG Lingbo , SANG Ling , HE Weiqun , LIU Xiaoqing ,  LI Yimin

Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institution of Respiratory Disease, Guangzhou, Guangdong 510120, P.R.China;

Corresponding author：

LI Yimin, Email: dryiminli@163.vip.vom

Keywords：

Malnutrition; Body mass index; Mechanical ventilation; Chronic obstructive pulmonary disease

DOI：

10.7507/1671-6205.201609042

Video：

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Objective To investigate the value of Malnutrition Screening Tool (MST) in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A single center retrospective observational study was conducted. The AECOPD patients who needed mechanical ventilation, admitted to ICU from January 2015 to June 2016 were enrolled in the study. They were divided into two groups according to the MST score, ie. a high risk malnutrition group (MST score≥2) and a low risk malnutrition group (MST score<2). The principle factors were analyzed including ICU mortality, in-hospital mortality, duration of invasive mechanical ventilation (IMV), length of ICU stay, and ICU readmission rate within 48 hours. Meanwhile the patients’ demographic and laboratory data were analyzed. Results A total of 101 patients were enrolled with 77 cases in the high risk malnutrition group and 24 cases in the low risk malnutrition group. The gender (χ²=1.882, P=0.172), age (t=1.091, P=0.33) and APACHE Ⅱ score (t=1.475, P=0.16) were similar in two groups. The high risk malnutrition group had significantly lower BMI (t=2.887, P=0.004) and lymphocyte count (t=3.402, P<0.001) than the low risk malnutrition group. Hemoglobin (t=0.817, P=0.36), albumin (t=0.706, P=0.44), pre-albumin (t=1.782, P=0.08) and procalcitonin (t=1.296, P=0.17) were similar in two groups. The high risk malnutritiongroup had significantly longer IMV duration (χ²=2.181, P=0.035) and length of ICU stay (χ²=2.364, P=0.02) than the low risk malnutrition group. While the ICU mortality (χ²=0.212, P=0.645), in-hospital mortality (χ²=0.212, P=0.645) and ICU readmission rate within 48 hours (χ²=1.656, P=1.0) were similar in two groups. Conclusion MST is a valuable tool in ICU to evaluated the nutrition status of ventilated AECOPD patients, and MST≥2 indicates longer IMV duration and length of ICU stay.

Citation： YU Yuheng, ZHOU Jing, XI Yin, NONG Lingbo, SANG Ling, HE Weiqun, LIU Xiaoqing, LI Yimin. The value of malnutrition screening tool in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(2): 137-141. doi: 10.7507/1671-6205.201609042 Copy

1.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
2.	Australian Institute of Health and Welfare. Who gets COPD?. Canberra: AIHW, 2016. Available from: http://www.aihw.gov. au/copd/prevalence/.
3.	Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology, 2016, 21(7): 1152-1165.
4.	胡国平, 钟南山, 冉丕鑫, 等. 中国的大气污染和 COPD. 中国胸心血管外科临床杂志, 2016, 23(2): 107-112.
5.	de Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, et al. Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012. Respirology, 2016, 21(3): 489-496.
6.	Schols AM, Slangen J, Volovics L, et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1998, 157(6): 1791-1797.
7.	Ferguson M, Capra S, Bauer J, et al. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 1999, 15(6): 458-464.
8.	中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者的机械通气指南(2007). 中华危重病急救医学, 2007, 19(9): 513-518.
9.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版). 中华结核和呼吸杂志, 2007, 30(1): 8-17.
10.	Wischmeyer PE. Are we creating survivorsor victims in critical care? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care, 2016, 22(4): 279-284.
11.	Vehe KL, Brown RO, Kuhl DA, et al. The prognostic inflammatory and nutritional index in traumatized patients receiving enteral nutrition support. J Am Coll Nutr, 1991, 10(4): 355-363.
12.	Jensen GL, Compher C, Sullivan DH, et al. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. J Parenter Enteral Nutr, 2013, 37(6): 802-807.
13.	White JV, Guenter P, Jensen G, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet, 2012, 112(5): 730-738.
14.	Collins PF, Elia M, Smith TR, et al. The impact of malnutrition on hospitalisation and mortality in outpatients with chronic obstructive pulmonary disease. Proc Nutr Soc, 2010, 69(13): 388-398.
15.	Nutrition Education Materials Online. Validated Malnutrition Screening and Assessment Tools: Comparison Guide: QLD Health. 2014. Available from: https://www.health.qld.gov.au/nutrition/ resources/hphe_scrn_tools.pdf.
16.	Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract, 2008, 23(4): 373-382.
17.	Neelemaat F, Meijers J, Kruizenga H, et al. Comparison of five malnutrition screening tools in one hospital inpatient sample. J Clin Nurs, 2011, 20(15): 2144-2152.
18.	Law S, Kumar P, Woods S, et al. Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes. Hosp Pract (1995), 2016, 44(4): 207-212.
19.	Anonymous. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Dietetics, 2009, 66(3): S1-34.
20.	Davis CJ, Sowa D, Keim KS, et al. The use of pre- albumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. J Parenter Enteral Nutr, 2012, 36(2): 197-204.
21.	Schols AM, Fredrix EW, Soeters PB, et al. Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr, 1991, 54(6): 983-987.
22.	Grönberg AM, Slinde F, Engström CP, et al. Dietary problems in patients with severe chronic obstructive pulmonary disease. J Hum Nutr Dietetics, 2005, 18(6): 445-452.
23.	Gan WQ, Man SFP, Senthilselvan A, et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax, 2004, 59(7): 574-580.
24.	Ezzell L, Jensen GL. Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nutr, 2000, 72(6): 1415-1416.
25.	Ferreira IM, Brooks D, White J, et al. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, 12(12): CD000998.
26.	Snider JT, Jena AB, Linthicum MT, et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD. Chest, 2015, 147(6): 1477-1484.
27.	Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med, 2009, 35(10): 619-635.

1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
2. Australian Institute of Health and Welfare. Who gets COPD?. Canberra: AIHW, 2016. Available from: http://www.aihw.gov. au/copd/prevalence/.
3. Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology, 2016, 21(7): 1152-1165.
4. 胡国平, 钟南山, 冉丕鑫, 等. 中国的大气污染和 COPD. 中国胸心血管外科临床杂志, 2016, 23(2): 107-112.
5. de Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, et al. Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012. Respirology, 2016, 21(3): 489-496.
6. Schols AM, Slangen J, Volovics L, et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1998, 157(6): 1791-1797.
7. Ferguson M, Capra S, Bauer J, et al. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 1999, 15(6): 458-464.
8. 中华医学会重症医学分会. 慢性阻塞性肺疾病急性加重患者的机械通气指南(2007). 中华危重病急救医学, 2007, 19(9): 513-518.
9. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版). 中华结核和呼吸杂志, 2007, 30(1): 8-17.
10. Wischmeyer PE. Are we creating survivorsor victims in critical care? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care, 2016, 22(4): 279-284.
11. Vehe KL, Brown RO, Kuhl DA, et al. The prognostic inflammatory and nutritional index in traumatized patients receiving enteral nutrition support. J Am Coll Nutr, 1991, 10(4): 355-363.
12. Jensen GL, Compher C, Sullivan DH, et al. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. J Parenter Enteral Nutr, 2013, 37(6): 802-807.
13. White JV, Guenter P, Jensen G, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet, 2012, 112(5): 730-738.
14. Collins PF, Elia M, Smith TR, et al. The impact of malnutrition on hospitalisation and mortality in outpatients with chronic obstructive pulmonary disease. Proc Nutr Soc, 2010, 69(13): 388-398.
15. Nutrition Education Materials Online. Validated Malnutrition Screening and Assessment Tools: Comparison Guide: QLD Health. 2014. Available from: https://www.health.qld.gov.au/nutrition/ resources/hphe_scrn_tools.pdf.
16. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract, 2008, 23(4): 373-382.
17. Neelemaat F, Meijers J, Kruizenga H, et al. Comparison of five malnutrition screening tools in one hospital inpatient sample. J Clin Nurs, 2011, 20(15): 2144-2152.
18. Law S, Kumar P, Woods S, et al. Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes. Hosp Pract (1995), 2016, 44(4): 207-212.
19. Anonymous. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Dietetics, 2009, 66(3): S1-34.
20. Davis CJ, Sowa D, Keim KS, et al. The use of pre- albumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. J Parenter Enteral Nutr, 2012, 36(2): 197-204.
21. Schols AM, Fredrix EW, Soeters PB, et al. Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr, 1991, 54(6): 983-987.
22. Grönberg AM, Slinde F, Engström CP, et al. Dietary problems in patients with severe chronic obstructive pulmonary disease. J Hum Nutr Dietetics, 2005, 18(6): 445-452.
23. Gan WQ, Man SFP, Senthilselvan A, et al. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax, 2004, 59(7): 574-580.
24. Ezzell L, Jensen GL. Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nutr, 2000, 72(6): 1415-1416.
25. Ferreira IM, Brooks D, White J, et al. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, 12(12): CD000998.
26. Snider JT, Jena AB, Linthicum MT, et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD. Chest, 2015, 147(6): 1477-1484.
27. Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med, 2009, 35(10): 619-635.

Chinese Journal of Respiratory and Critical Care Medicine

The value of malnutrition screening tool in ventilated patients with acute exacerbation of chronic obstructive pulmonary disease

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