Prealbumin Is Associated With In-Hospital Mortality in Critically Ill Patients.

BACKGROUND: Prealbumin (PAB) has been shown to be a useful index of nutrition status in clinically stable patients. In the setting of critical illness, however, PAB is a negative acute phase reactant and may also reflect severity of illness. The purpose of this study was to evaluate the relationship between PAB and clinical outcomes in critically ill patients. METHODS: This was a single-center, retrospective, nonrandomized cohort study of adult intensive care unit (ICU) patients. Baseline PAB and change in PAB were analyzed. The primary outcome was in-hospital mortality, and the secondary outcome was hospital length of stay (LOS). Data collected included PAB levels, Charlson Comorbidity Index, LOS, in-hospital mortality, and nutrition intake. Linear and logistic regressions were used to characterize the association between PAB levels and clinical outcomes. RESULTS: Our study included 926 patients. Patients expiring in hospital experienced a greater decrease in PAB over time, -1.3 vs -0.7 mg/dL (odds ratio 0.94 [0.9-0.98] in multivariable regression, P = .002). Baseline PAB was not associated with in-hospital mortality or LOS. Exploratory analyses demonstrated a weak correlation between nutrition and change in PAB. CONCLUSION: Our data demonstrate that change in PAB is associated with hospital mortality. Nutrition intake weakly correlated with change in PAB. PAB does not appear to be a robust marker of nutrition therapy but may have value as a prognostic indicator in the ICU setting.

Enteral nutrition and drug administration, interactions, and complications.

The enteral route has become the standard of care to deliver nutrition support for hospitalized acute care and ambulatory care patients. The same access device is increasingly being used to deliver medications, which provides cost savings but also creates new challenges. Cost savings can be negated if the concomitant administration of nutrition elicits a decrease in bioavailability due to incompatibilities that alter drug or nutrition therapy. Feeding tubes can deliver nutrients and drugs to the stomach, small bowel, or both, with optimal efficacy of medications depending on delivery to the appropriate segment of the gastrointestinal tract. Liquid preparations are often the preferred formulation for enteral administration. Obstruction of the enteral access device may occur when specialized medication formulations are altered inappropriately. Occasionally, the enteral formula should be changed to modify the content of free water, fiber, electrolytes, or vitamins that may interfere with the drug therapy. Intolerance to enteral nutrition such as abdominal distention and diarrhea may be the result of the medication, and the causative agent should be identified to improve patient comfort. This article will address optimal drug delivery via enteral access devices and possible complications associated with therapy.