Comparación del riesgo nutricional alto por tres variantes del puntaje NUTrICen pacientes críticos ventilados / High nutritional risk by three variants of NUTRIC score in critically ventilated patients

Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), conproteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional(RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr.Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba deKappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado.Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predo-minante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa= 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminarmortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significa-tivas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001).Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcadorinflamatorio, clasifica más pacientes como de RN alto.(AU)

Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), withC-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) incritical patients. However, the assessment of the high NR might not be uniform between these scores.Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr.Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa testand mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test.Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominanttraumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1(Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRI-Cpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showedsignificant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2(19.8 vs 9.8 %, p < 0.0001).Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker,classifies more patients as high nutritional risk.(AU)

[High nutritional risk by three variants of NUTRIC score in critically ventilated patients]. / Comparación del riesgo nutricional alto por tres variantes del puntaje NUTRIC en pacientes críticos ventilados.

Introduction: Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), with C-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) in critical patients. However, the assessment of the high NR might not be uniform between these scores. Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr. Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa test and mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test. Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominant traumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1 (Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRICpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showed significant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2 (19.8 vs 9.8 %, p < 0.0001). Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker, classifies more patients as high nutritional risk.

Introducción: Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), con proteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional (RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.. Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr. Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba de Kappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado. Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predominante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa = 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminar mortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significativas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001). Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcador inflamatorio, clasifica más pacientes como de RN alto.

Valor diagnóstico de la procalcitonina en la neumonía asociada a ventilación mecánica / Diagnostic value of procalcitonin in ventilator-associated pneumonia

Antecedentes y objetivo: La procalcitonina (PCT) puede ayudar al diagnóstico precoz de las infecciones bacterianas y estimar la respuesta obtenida. El objetivo es estudiar el valor de la PCT para el diagnóstico de la neumonía asociada a ventilación mecánica (NAV). Pacientes y método: Estudio prospectivo y observacional, realizado durante 18 meses, en una Unidad de Cuidados Intensivos (UCI) polivalente. Se incluyeron mayores de 18 años, con sospecha de neumonía luego de 48h de ventilación mecánica (VM). Se recogieron: datos demográficos, patología de ingreso, motivo de inicio de la VM, escalas de gravedad (APACHE II, SAPS II y SOFA), proteína C reactiva (PCR) y PCT. Al momento de la sospecha de NAV: precoz o tardía, severidad radiológica, presencia de shock séptico, SOFA, PCR, PCT y microbiología. Resultados: Se incluyeron 91 pacientes con sospecha de NAV. La media de edad fue de 42 (17,76) años y la de internación en la UCI fue de 18,59 (11,69) días. La NAV fue confirmada en 74 pacientes, de los cuales 19 (25,7%) presentaron shock séptico. La mortalidad fue del 28,4%. No hubo diferencias significativas de la PCT en los pacientes que presentaron NAV y los que no la presentaron (p=0,449). Cuando se compararon los pacientes sin NAV, con NAV y NAV con shock, la mediana de PCT fue de 0,38 (IC95%: 0,22-1,90), 0,56 (IC95%: 0,19-1,77) y 1,93 (IC95%: 0,38-10,07), respectivamente (p=0,169). Conclusiones: En nuestro trabajo la PCT no demostró utilidad para el diagnóstico de la NAV

Background and objective: Procalcitonin (PCT) can help the early diagnosis of bacterial infections and estimate the response obtained. The objective is to study the value of PCT for the diagnosis of ventilator-associated pneumonia (VAP). Patients and method: Prospective and observational study, carried out for 18 months, in a polyvalent Intensive Care Unit (ICU). Those included were over 18 years of age, with suspected pneumonia after 48h of mechanical ventilation (MV). Collected were demographic characteristics; admission pathology; reason for beginning MV; gravity scores (APACHE II, SAPS II and SOFA); C-reactive protein (CRP) and PCT. At the time of suspicion of VAP: early or late, radiological severity, presence of septic shock, SOFA, CRP, PCT and microbiology. Results: Ninety-one patients with suspected VAP were included. The mean age was 42 (17.76) and that of hospitalisation in the ICU was 18.59 (11.69) days. VAP was confirmed in 74 patients, of which 19 (25.7%) presented septic shock. The mortality was 28.4%. There were no significant differences of the PCT in the patients who presented VAP versus those who did not present VAP (P=.449). When patients without VAP, with VAP and VAP with shock, were compared, the PCT median was 0.38 (CI95%: 0.22-1.90), 0.56 (CI95%: 0.19-1.77) and 1.93 (CI95%: 0.38-10.07), respectively (P=.169). Conclusions: In our study, PCT did not prove useful for the diagnosis of VAP

Diagnostic value of procalcitonin in ventilator-associated pneumonia. / Valor diagnóstico de la procalcitonina en la neumonía asociada a ventilación mecánica.

BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) can help the early diagnosis of bacterial infections and estimate the response obtained. The objective is to study the value of PCT for the diagnosis of ventilator-associated pneumonia (VAP). PATIENTS AND METHOD: Prospective and observational study, carried out for 18 months, in a polyvalent Intensive Care Unit (ICU). Those included were over 18 years of age, with suspected pneumonia after 48h of mechanical ventilation (MV). Collected were demographic characteristics; admission pathology; reason for beginning MV; gravity scores (APACHE II, SAPS II and SOFA); C-reactive protein (CRP) and PCT. At the time of suspicion of VAP: early or late, radiological severity, presence of septic shock, SOFA, CRP, PCT and microbiology. RESULTS: Ninety-one patients with suspected VAP were included. The mean age was 42 (17.76) and that of hospitalisation in the ICU was 18.59 (11.69) days. VAP was confirmed in 74 patients, of which 19 (25.7%) presented septic shock. The mortality was 28.4%. There were no significant differences of the PCT in the patients who presented VAP versus those who did not present VAP (P=.449). When patients without VAP, with VAP and VAP with shock, were compared, the PCT median was 0.38 (CI95%: 0.22-1.90), 0.56 (CI95%: 0.19-1.77) and 1.93 (CI95%: 0.38-10.07), respectively (P=.169). CONCLUSIONS: In our study, PCT did not prove useful for the diagnosis of VAP.

[Relationship between the NUTRIC nutritional risk scale and protein hypercatabolism in critically ventilated patients]. / Relación entre la escala de riesgo nutricional NUTRIC y el hipercatabolismo proteico en pacientes críticos ventilados.

INTRODUCTION: the Nutrition Risk in Critically Ill (NUTRIC) score does not include a variable that objectively estimates protein hypercatabolism (PHC), one of the main metabolic changes experienced by critical patients. OBJECTIVE: to evaluate the correlation of the NUTRIC score with PHC in critically ventilated patients. MATERIALS AND METHODS: prospective, observational study. Mixed ICU. It included ventilated patients ≥ 18 years old, without anuria or chronic renal failure. The modified NUTRIC score, which replaces IL-6 for PCR, was obtained at admission and 24-hour urine was collected at the 2nd (T0) and 4th day (T1) to determine the total urinary nitrogen (TUN). RESULTS: a total of 69 patients were included. Average age: 43 years (± 17.01); 73% were males. Admission pathologies: trauma (39%) and sepsis (20%). APACHE II: 17 (± 6.66). Seventeen patients presented acute renal failure (ARF). NUTRIC score mean: 3.13 (± 1.94); 84% presented low nutritional risk. The Pearson correlation between NUTRIC and TUN in T0 and T1 was: -0.150 (p: 0.218) and -0.053 (p: 0.663). The mean length of staying in ICU and mechanical ventilation was: 13.35 (± 12.37) and 9.84 (± 10.82) days, respectively. Mortality in ICU: 36%. In the non-ARF subgroup with low risk according to NUTRIC score, 27% presented severe PHC at T0 and 52% at T1. The correlation was: 0.070 (p: 0.620) and 0.138 (p: 0.329), respectively. CONCLUSION: no correlation was found between the estimators of the stress metabolic response of the NUTRIC score and the PHC in critically ill patients ventilated; therefore, it would not be possible to substitute the measurement of the same in the assessment of the nutritional risk.

INTRODUCCIÓN: la escala de riesgo nutricional NUTRIC no incluye una variable que estime en forma objetiva el hipercatabolismo proteico (HCP), una de las principales alteraciones metabólicas que experimentan los pacientes críticos. OBJETIVO: evaluar la correlación de la escala NUTRIC con el HCP en pacientes críticos ventilados. MATERIAL Y MÉTODOS: estudio prospectivo, observacional. UCI polivalente. Incluyó pacientes ≥ 18 años, ventilados, sin anuria ni insuficiencia renal crónica. La variante del NUTRIC, que remplaza la IL-6 por PCR se obtuvo al ingreso y se recolectó orina de 24 horas al segundo (T0) y cuarto día (T1) para determinar el nitrógeno urinario total (NUT). RESULTADOS: se incluyeron 69 pacientes. Edad media: 43 años (± 17,01); el 73% eran varones. Patologías de ingreso: trauma (39%) y sepsis (20%). APACHE II: 17 (± 6,66). Presentaron insuficiencia renal aguda (IRA) 17 pacientes. NUTRIC medio: 3,13 (± 1,94). El 84% presentó bajoriesgo nutricional. La correlación de Pearson entre NUTRIC y NUT en T0 y T1 fue de -0,150 (p: 0,218) y -0,053 (p: 0,663). La media de internación y ventilación mecánica fue de 13,35 (± 12,37) y 9,84 (± 10,82) días, respectivamente. Mortalidad en UCI: 36%. En el subgrupo sin IRA con bajo riesgo por NUTRIC el 27% presentó HCP severo en T0 y el 52% en T1. La correlación fue: 0,070 (p: 0,620) y 0,138 (p: 0,329), respectivamente. CONCLUSIÓN: no se halló correlación entre los estimadores de la respuesta metabólica de estrés de la escala NUTRIC y el HCP en pacientes críticos ventilados; por lo tanto, no se podría sustituir la medición real del mismo en la valoración del riesgo nutricional.

[Study of two variants of nutritional risk score "NUTRIC" in ventilated critical patients]. / Estudio de dos variantes de la puntuación de riesgo nutricional "NUTRIC" en pacientes críticos ventilados.

INTRODUCTION: The NUTRIC score was proposed to assess the risk of adverse events potentially modifiable through nutritional intervention in critically ill patients. This score uses interleukin-6 (IL-6), a biomarker not always available. OBJECTIVE: To study two variants of the score in patients with assisted mechanical ventilation (AMV): NUTRIC-1 without IL-6 and NUTRIC-2 with CRP as biomarker. METHODS: Observational prospective cohort with 368 patients with AMV >24 hours. The predictive capacity of both NUTRIC scores was studied by binary logistic regression. The significance level was set at 5%. RESULTS: mean age, 52 years; males 68%. Mean APACHE II score: 20.73 points. Death at the ICU: 196 (53%). Mean time on AMV of the survivals: 8.55 days. Mean NUTRIC-1 and NUTRIC-2 in the deceased-survivors: 4.23 - 3.06 (p = 0.000) and 4.68 -3.39 (p = 0.000). The mortality increased in relation to the score (p = 0.000). The calculated AUC for NUTRIC-1 and NUTRIC-2 were 0.671 (CI 0.617-0.726) and 0.679 (CI 0.624- 0.733). The mean CRP was higher in deceased patients: 13.07 mg/dL - 8.97 mg/dL (p = 0.001), the correlation improved with more days on AMV (p = 0.034 and p = 0.010) and the AUC increased in a similar way to IL-6 in the original work (0.008 and 0.007, respectively). CONCLUSION: The two studied variants of the NUTRIC score behaved similarly to the original NUTRIC score. The addition of the CRP improves the score performance and may be an alternative to IL-6, if it is not available.