Nutritional and Morphofunctional Assessment of Post-ICU Patients with COVID-19 at Hospital Discharge: NutriEcoMuscle Study.

This paper presents baseline results from the NutriEcoMuscle study, a multicenter observational study conducted in Spain which focused on changes in nutritional status, body composition, and functionality in post-intensive care unit (ICU) COVID-19 patients following a nutritional intervention. Assessments at hospital discharge included Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, the Barthel index, handgrip strength (HGS) and the Timed Up-and-Go test, bioelectrical impedance analysis (BIA), and nutritional ultrasound (US). The study involved 96 patients (71.9% male, mean age 58.8 years, mean BMI 28.8 kg/m2, 36.5% obese). All patients were malnourished at discharge according to GLIM and SGA. Functional status declined from admission up to hospital discharge. A total of 33.3% of patients had a low fat-free mass index (FFMI) and 29.5% had a low phase angle (PhA). Myosteatosis was observed in 83.7% of the population. There was a positive correlation between rectus femoris cross-sectional area, PhA, FFMI, and HGS. In conclusion, post-critically ill COVID-19 patients commonly suffer from malnutrition and reduced muscle mass, causing a loss of independence at hospital discharge. BIA and US could be valuable tools for assessing body composition in these patients. The NutriEcoMuscle study highlights the need for a thorough nutritional and morphofunctional status assessment of post-ICU patients.

Effects of Immunonutrition on Cancer Patients Undergoing Surgery: A Scoping Review.

INTRODUCTION: There is a large body of evidence about immunonutrition formulas; however, there are still doubts about their usefulness in routine clinical practice as compared with standard formulas. In the age of personalized medicine, new studies appear every year regarding several types of patients; therefore, an updated point of view on these formulas is necessary. METHODS: The Embase database was searched from 2016 to 14 March 2022. Our criteria were articles published in English and Spanish. The evidence quality was evaluated using GRADEpro, and the review was developed according to the PRISMA statement. RESULTS: In this review, a total of 65 unique records were retrieved; however, 36 articles did not meet the inclusion criteria and were thus excluded. In total, 29 articles were included in the final analysis. In the last few years, many meta-analyses have attempted to identify additional existing studies of surgical patients with certain pathologies, mainly oncological patients. Immunonutrition prior to oncological surgery was shown to cause a decrease in inflammatory markers in most of the studies, and the main clinical events that changed were the infectious complications after surgery. The length of stay and mortality data are controversial due to the specific risk factors associated with these events. CONCLUSIONS: The use of immunonutrition in patients who have undergone oncological surgery decreases the levels of inflammatory markers and infectious postoperative complications in almost all localizations. However, more studies are needed to assess the use of immunonutrition based on Enhanced Recovery After Surgery (ERAS) protocols.

Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

Mortality risk factors after percutaneous gastrostomy: Who is a good candidate?

BACKGROUND: The percutaneous gastrostomy tube (PG) is an effective and safe way for the delivery of enteral nutrition. The aim of this study was to identify predictive factors for mortality after PG placement. MATERIAL AND METHODS: An observational and analytical cohort study was conducted. All endoscopic or radiological percutaneous gastrostomy tubes placed between January 2009 and July 2016 were evaluated. Mortality was the dependent variable. Initial clinical and analytical patient features and the development of complications during follow-up were recorded. Cox regression models were used to evaluate the risk of mortality associated to the studied variables. Hazard ratios with the corresponding 95% confidence intervals were retrieved from these models. RESULTS: A total of 289 patients underwent PG placement (57% male). The mean age was 70.1 (SD 13.6) years. The median follow-up period was 8.7 (IQR 18) months. One hundred and seventy-four patients died during the follow-up period. The overall mortality rate was 4.8 per 100 patients-month. The highest mortality rate was during the first month after PG placement (13.2 per 100 patients-month), subsequently decreasing. Multivariate regression analysis showed that age (HR1year = 1.01; p = 0.015), Charlson comorbidity index ≥4 (HR = 1.69; p = 0.011), the presence of degenerative neurological disease (HR = 1.69; p = 0.012) or malignancy (HR = 2.02; p = 0.012) and the development of aspiration pneumonia during the follow-up period (HR = 3.29; p = 0.001) were statistically significant independent predictive risk factors associated with mortality. A model to predict survival probability prior to placing the PG was developed from the variables of the multivariate analysis. CONCLUSION: Mortality after PG placement is high. Older age, higher comorbidity and the development of aspiration pneumonia are predictive factors for mortality. A more careful selection of candidates for PG placement should be done to improve the patient prognosis after the procedure.

Development of hyponatremia in non-critical patients receiving total parenteral nutrition: A prospective, multicenter study.

BACKGROUND & AIMS: Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance. METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels. RESULTS: A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036). CONCLUSIONS: Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.

[Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report]. / Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos Nutritional support and parenteral nutritio.

BACKGROUND: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. OBJECTIVE: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. METHODS: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel's criteria, could generate greater controversy or doubt. RESULTS: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer Patients.

Predictive factors of hypertriglyceridemia in inhospital patients during total parenteral nutrition / Factores predictores de hipertrigliceridemia en pacientes hospitalizados con nutrición parenteral total

Introduction: Total parenteral nutrition (TPN) is a kind of nutritional support indicated for patients whose clinical situation makes it impossible to cover their nutritional requirements enterally. Despite the fact that TPN is a safe and effective therapy, some complications have been described. One of the most frequent is hypertriglyceridemia. The etiology of this metabolic complication is complex and multifactorial. Objetive: The aim of this work was to determine risk factors associated with the development of hypertrilgyceridemia in adult inhospital non critical patients who carry TPN for a short term. A secondary aim was to evaluate the effect that a lipid emulsion fortified with omega-3 poliunsaturated fatty acids causes on this metabolic complication. Material and methods: This is an observational retrospective cohort study, in which adult inhospital non critical patients have been included. Only those who needed TPN during more than seven days were included. Hypertriglyceridemia was defined as plasma triglycerides levels higher than 200 mg/dl. The lipid emulsions were composed whether by a combination of 50% long-chain (LCT) and medium-chain (MCT) triglycerides or 40% LCT/50% MCT/10% omega-3. Clinical, nutritonal and biochemical parameters were included. Analitical samples were obtained before starting TPN, and weekly until withdrawal. Multivariate logistic regression analysis was used to identify predictive factors of the appearance of hypertriglyceridemia. Results: One hundred and one patients were included (61.4% male). Thirty-three per cent of them developed hypertriglyceridemia. In the multivariate analysis the independent risk factors associated with the presence of hypertriglyceridemia were the initial plasmatic triglycerides levels, the body mass index (BMI) and an input of glucose in the TPN higher than 3.1 g/kg/day. The infusion of a lipid emulsion fortified with 3-omega fatty acids was associated with a nonsignificant reduction of the risk of appearance of hypertriglyceridemia. Conclusion: The patient's clinical metabolic situation, as well as the load of carbohydrates in the TPN are essential for the development of the TPN-associated hypertriglyceridemia. The administration of a lipid emulsion fortified with omega-3 fatty acids is safe, even though it was not associated with a signifi cant protective effect over the risk of appearance of this metabolic complication.

Introducción: la nutrición parenteral total (NPT) es una modalidad de soporte nutricional indicada en aquellas situaciones donde el enfermo no puede cubrir sus requerimientos nutricionales por vía enteral. A pesar de ser una terapia segura y eficaz, no está exenta de complicaciones, entre las que cabe destacar, por su frecuencia, la hipertrigliceridemia. La etiología de esta complicación metabólica es compleja y multifactorial. Objetivos: el objetivo de este trabajo fue determinar los factores de riesgo asociados al desarrollo de hipertrigliceridemia en pacientes adultos hospitalizados no críticos que reciben NPT a corto plazo y evaluar el efecto que una emulsión lipídica enriquecida en ácidos grasos poliinsaturados omega-3 ejerce sobre esta complicación metabólica. Material y métodos: estudio observacional retrospectivo de cohortes donde se ha incluido a pacientes hospitalizados adultos no críticos que precisaron NPT durante un periodo superior a siete días. Se consideró la presencia de hipertrigliceridemia cuando los niveles plasmáticos de triglicéridos fueron superiores a 200 mg/dl. Las emulsiones lipídicas empleadas fueron una mezcla al 50% de triglicéridos de cadena larga (LCT) y de cadena media (MCT) o una combinación al 40% LCT/50% MCT/10% omega-3. Se recogieron variables clínicas, nutricionales y bioquímicas. Las determinaciones analíticas se realizaron antes del comienzo de la NPT y semanalmente hasta su retirada. Los factores predictores de la aparición de hipertrigliceridemia fueron identificados mediante modelos de regresión logística multivariante. Resultados: fueron incluidos 101 pacientes (61,4% varones), de los cuales el 33% desarrolló hipertrigliceridemia. En el análisis multivariante los factores de riesgo independientes asociados a la presencia de hipertrigliceridemia fueron los niveles plasmáticos iniciales de triglicéridos, el índice de masa corporal (IMC) y un aporte de glucosa en la NPT superior a 3,1 g/kg/día. La infusión de una emulsión lipídica enriquecida con ácidos grasos omega-3 se asoció con un descenso no significativo del riesgo de aparición de hipertrigliceridemia. Conclusión: la situación clínica metabólica del paciente y la dosis de hidratos de carbono en la NPT resultan fundamentales en el desarrollo de la hipertrigliceridemia relacionada con la NPT. La administración de una emulsión lipídica enriquecida en ácidos grasos omega-3 es segura, aunque no se asoció a un efecto protector significativo sobre el riesgo de aparición de esta complicación metabólica.

[Risk factors for catheter-related bloodstream infection in non-critical patients with total parenteral nutrition]. / Factores de riesgo de aparición de bacteriemia asociada al catéter en pacientes no críticos con nutrición parenteral total.

INTRODUCTION: Catheter-related bloodstream infection (CRBSI) is one of the most important complications in patients with a central venous catheter (CVC), due to its association with increased mortality, morbidity and health care cost. The administration of total parenteral nutrition (TPN) is considered a CRBSI risk factor. The aim of our study was to determine the incidence rate and risk factors of CRBSI in patients with TPN that were hospitalized at the medical-surgical wards. METHODS: This is a prospective observational study in non-critical patients who received TPN and were admitted at our hospital from January 2010 to November 2011. The clinical end point was the CRBSI. CRBSI incidence rate was calculated from episodes by every 1000 CVC-day. CRBSI independent risk factors were obtained from logistic regression analysis. RESULTS: A total of 331 patients were prescribed TPN during our study. The mean time of catheterization was 12.4 (DE 8.7) days and the mean TPN duration was 10.4 (DE 8.3) days. 47 cases of CRBSI were recorded, with an incidence rate of 11.4/1,000 CVC-day and of 13.7/1,000 NPT-day. Risk factors for CRBSI on univariante analysis included duration of catheterization more than 20 days (OR = 2.48; IC 95%: 1.16-5.26), TPN duration more than 2 weeks (OR= 4.63; IC 95%: 2.16-9.90) and the presence of fistulas (OR = 3.08; IC 95%: 1.24-7.63). At multivariate analysis, TPN duration (OR for a duration more than 14 days= 4.9; IC 95%: 2.2-10.9; p < 0.0001) was the only independent risk factor for CRBSI. CONCLUSION: In non-critical adult patients hospitalized at the medical-surgical wards, we have demonstrated that duration of TPN infusion increases the CRBSI risk. This risk increase is especially remarkable, being multiplied by 5, with a duration superior to 2 weeks.

Introducción: La bacteriemia asociada al catéter (BAC) es una de las complicaciones más importantes en pacientes portadores de un catéter venoso central (CVC) debido a su asociación con un incremento en la mortalidad, morbilidad y gasto sanitario. La administración de nutrición parenteral total (NPT) aumenta el riesgo de aparición de BAC. El objetivo de nuestro estudio fue determinar la tasa de incidencia y los factores de riesgo de BAC en pacientes con NPT hospitalizados en plantas médico-quirúrgicas. Métodos: Estudio observacional, analítico, retrospectivo donde se analizaron a todos los pacientes adultos no críticos que precisaron NPT desde enero de 2010 hasta noviembre de 2011. El punto final clínico fue la BAC. La tasa de incidencia de BAC se calculó en forma de episodios por cada 1.000 pacientes-día de cateterización. Los factores predictivos independientes de BAC se determinaron mediante regresión logística. Resultados: Durante el periodo de estudio precisaron NPT un total de 331 pacientes. La duración media del CVC fue de 12,4 (DE 8,7) días y la NPT fue infundida durante un periodo medio de 10,4 (DE 8,3) días. 47 pacientes presentaron BAC, con una tasa de incidencia de 11,4/1.000 pacientes- día de CVC y de 13,7/1.000 pacientes-día de NPT. Los factores predictores univariantes de aparición de BAC fueron la permanencia del CVC superior a 20 días (OR = 2,48; IC 95%: 1,16-5,26), la duración de la NPT superior a 2 semanas (OR = 4,63; IC 95%: 2,16-9,90) y la presencia de fístulas (OR = 3,08; IC 95%: 1,24-7,63). En análisis multivariante, el único predictor independiente de BAC fue la duración de la NPT (OR para una duración superior a 14 días = 4,9; IC 95%: 2,2-10,9; p < 0,0001). Conclusiones: En pacientes adultos hospitalizados en plantas diferentes a UCI, hemos demostrado que la duración de la infusión de la NPT incrementa el riesgo de BAC. El incremento de riesgo es especialmente marcado, llegando a multiplicarse por 5, con duraciones superiores a las 2 semanas.