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Purpose: The purpose of our meta-analysis was to look at the impact of modified nutrition risk in the critically ill (mNUTRIC) on mortality in patients with critical illness. Materials and methods: Literature relevant to this meta-analysis was searched in PubMed, Web of Science, and Cochrane Library till 26 August 2023. Prospective or retrospective studies, patients >18 years of age, studies that reported on mortality and mNUTRIC (mNUTRIC cut-off score) were included. The QUIPS tool was used to evaluate the risk for bias in prognostic factors. Results: A total of 31 studies on mNUTRIC score, involving 13,271 patients were included. The summary area under the curve (sAUC) of 0.80 (95% CI: 0.76-0.83) illustrates the mNUTRIC score's strong discrimination. The pooled sensitivity was 0.79 (95% CI: 0.74-0.84) and pooled specificity was 0.68 (95% CI: 0.63-0.73). We found no discernible variation in the mNUTRIC's prediction accuracy among cut-off values of <5 and >5 in our subgroup analysis and sAUC values were 0.82 (95% CI: 0.78-0.85) and 0.78 (95% CI: 0.74-0.81), respectively. Conclusion: We observed that mNUTRIC can discriminate between critically ill individuals and predict their mortality. Prospero: CRD42023460292. How to cite this article: Prakash J, Verma S, Shrivastava P, Saran K, Kumari A, Raj K, et al. Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(5):495-503.
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INTRODUCTION: Hepatitis C is a global health burden with significant morbidity and mortality. It primarily affects the liver and causes acute hepatitis, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Common modes of transmission of hepatitis C virus (HCV) infection are blood transfusion, needlestick injury, and mother-fetus transmission, among which transmission, blood transfusion is one of the most important causes. Blood transfusion is one of the pillars in the management of patients that saves lives and improves morbidity. Blood donation in India is done by voluntary and replacement blood donors of both sexes. The aim of this study is to determine the seroprevalence of HCV among blood donors in the Jharkhand state, a tribal-preponderant region of India, and to see the trend over the years. MATERIAL AND METHODS: This is a nine-year retrospective observational study from 2015 to 2023 that screened for anti-HCV antibodies (third-generation kit: Abbott Diagnostics) using the chemiluminescence technique. RESULTS: In this study, in total, 249,461 units of blood were collected, of which the majority of donations were by male and replacement donors (RDs) comprising 230,757 (92.50%) and 188,047 (75.38%), respectively. The mean number of blood donations by replacement and male donors (MDs) was more than for voluntary donors (VDs) and female donors (FDs) (20894.11 ± 3041.71 RDs vs. 6823.77 ± 2332.96 VDs, p < 0.0001 and 25639.66 ± 2810.08 MDs vs. 2078.22 ± 828.16 FD, p < 0.0001), respectively. The overall prevalence of HCV was 0.63%, and all seropositive donors were male. CONCLUSION: Replacement blood donation contributes to the major part of blood donation and is primarily done by males in this tribal population-dominant region of India. Seroprevalence of HCV is high in the population of this part of India, and there is a constant or slightly upward trend in hepatitis C infection among individuals.
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Background and aim The type of fluid which is administered to patients is very crucial and important. In this study normal saline is compared with PlasmaLyte A in patients undergoing craniotomy for supratentorial brain tumors. Generally normal saline is used in neurosurgical patients; it is seen to be associated with hyperchloremic acidosis. A balanced crystalloid, e.g. PlasmaLyte A, maintains a better metabolic status than normal saline. This study was planned to study the metabolic effects of using PlasmaLyte A as compared with normal saline as intravenous fluids in patients undergoing supratentorial brain tumour surgeries. Methods This is a prospective, randomized, double-blinded study in patients undergoing craniotomy for supratentorial brain tumors. Written informed consent was taken from patients and they were divided into two groups, Group A and B of 40 patients each by computer-generated random numbers. Group A received PlasmaLyte A and Group B received normal saline intra-operatively as maintenance fluid. Heart rate, mean arterial pressure, total fluid administered, serum sodium, serum potassium, chloride, lactate, pH, serum urea, serum creatinine, osmolarity, and urine output were assessed at different time intervals in both groups. Blood urea and creatinine were assessed to see acute kidney injury. Results There was no difference in mean values of serum sodium, potassium, lactate, serum urea, creatinine and serum osmolarity in both groups throughout the study period. However there was a rise in serum chloride and a low pH was noted in Group B. The urine output was also similar in both groups. The metabolic status of patients receiving PlasmaLyte was better than those receiving normal saline. Conclusion Normal saline may cause hyperchloremic metabolic acidosis which may be avoided by using balanced crystalloids. The use of balanced crystalloids should be preferred to normal saline in neurosurgical patients to ensure a better metabolic status and good clinical outcome.
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Background and aim A variety of medications have been studied to reduce the hemodynamic response to laryngoscopy and intubation. Dexmedetomidine has been used intravenously in many studies to reduce the hemodynamic response to laryngoscopy and intubation. In high-risk patients, this pressor response can increase morbidity and mortality. As dexmedetomidine has a good bioavailability via the nebulisation route, we formulated this study to evaluate the effect of nebulised dexmedetomidine on the hemodynamic response to laryngoscopy and endotracheal intubation. Methods This is a prospective, randomised controlled trial conducted on 100 patients with the American Society of Anesthesiologists grade I and II. The primary objective of the study was to see if nebulised dexmedetomidine at a dose of 1 microgram/kg could reduce the stress reaction to laryngoscopy and intubation. The secondary objective was to study the dose sparing effect of nebulised dexmedetomidine on the amount of propofol used during induction of general anaesthesia. The study population was randomly divided into two groups: group A (n = 50) included patients nebulised with dexmedetomidine 1 microgram/kg and group B (n = 50) included patients nebulised with 5 ml saline 30 minutes before induction of anaesthesia in a sitting position. Results The demographics were similar in both groups. Following laryngoscopy and intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate showed a significant increase in the control group B as compared to the treatment group A. In group A, there was attenuation in SBP (one minute = 113.2 ± 14.503, P < 0.001; five minutes = 109.86 ± 8.342, P < 0.001; 10 minutes = 114.24 ± 7.797, P = 0.010), DBP (one minute = 73.72 ± 10.986, P = 0.011; five minutes = 71.62 ± 9.934, P = 0.005; 10 minutes = 76.1 ± 8.006, P = 0.009), MAP (one minute = 86.80 ± 11.86, P = 0.001; five minutes = 84.44 ± 8.97, P = 0.006; 10 minutes = 88.72 ± 7.44, P = 0.018), and heart rate (one minute = 83.34 ± 12.325, P = 0.001; five minutes = 81.56 ± 13.33, P = 0.003; 10 minutes = 80.16 ± 14.086, P = 0.013) following laryngoscopy and intubation. Induction dose of propofol was significantly lower in the dexmedetomidine group (73 ± 19.509, P < 0.001). Conclusion Nebulised dexmedetomidine effectively blunts the hemodynamic response to laryngoscopy and intubation and also has a dose sparing effect on the induction dose of propofol.