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Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children.
J Acad Nutr Diet. 2020 02; 120(2):219-229.JA

Abstract

BACKGROUND

There are few studies that assess the role of different nutritional assessment variables at pediatric intensive care unit (PICU) admission in predicting clinical outcomes.

OBJECTIVE

To identify nutritional variables in the first 4 days of PICU stay that predict 60-day mortality and time to discharge alive from the PICU.

DESIGN

Single-center prospective study in Southern Brazil, conducted between July 2013 and February 2016. At PICU admission, children with z scores <-2 for body mass index (BMI)-for-age, mid-upper arm circumference (MUAC)-for-age, and triceps skinfold thickness (TSF)-for-age were considered as undernourished.

PARTICIPANTS/SETTING

There were 199 patients, aged <15 years, with PICU stay >48 hours.

MAIN OUTCOME MEASURES

Sixty-day mortality and time to discharge alive from the PICU.

STATISTICAL ANALYSIS PERFORMED

Cox regression model was applied to determine predictors of 60-day mortality and time to discharge alive from the PICU.

RESULTS

Median age was 23.1 months (interquartile range=3.9 to 89.1), and 63% were male, with 18% prevalence of undernutrition at admission by BMI-for-age. Median PICU stay was 7 days (interquartile range=4 to 12), and 60-day mortality was 12%. After adjusting for sex, age, Pediatric Index of Mortality 2, and presence of complex chronic conditions, undernutrition based on BMI-for-age (hazard ratio [HR]=3.75; 95% CI=1.41 to 9.95; P=0.008), MUAC-for-age (HR=7.62; 95% CI=2.42 to 23.97; P=0.001), and TSF-for-age (HR=4.01; 95% CI=1.14 to 14.15; P=0.031) was associated with higher risk of 60-day mortality. Based on MUAC-for-age with the same adjustment model, undernourished children had longer time to discharge alive from the PICU (HR=0.45; 95% CI=0.21 to 0.98; P=0.045).

CONCLUSIONS

Undernutrition at PICU admission based on different anthropometric variables was predictive of 60-day mortality and longer time to discharge alive from the PICU.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31522971

Citation

Ventura, Julia Carvalho, et al. "Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children." Journal of the Academy of Nutrition and Dietetics, vol. 120, no. 2, 2020, pp. 219-229.
Ventura JC, Hauschild DB, Barbosa E, et al. Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet. 2020;120(2):219-229.
Ventura, J. C., Hauschild, D. B., Barbosa, E., Bresolin, N. L., Kawai, K., Mehta, N. M., & Moreno, Y. M. F. (2020). Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. Journal of the Academy of Nutrition and Dietetics, 120(2), 219-229. https://doi.org/10.1016/j.jand.2019.06.250
Ventura JC, et al. Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. J Acad Nutr Diet. 2020;120(2):219-229. PubMed PMID: 31522971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Undernutrition at PICU Admission Is Predictor of 60-Day Mortality and PICU Length of Stay in Critically Ill Children. AU - Ventura,Julia Carvalho, AU - Hauschild,Daniela Barbieri, AU - Barbosa,Eliana, AU - Bresolin,Nilzete Liberato, AU - Kawai,Kosuke, AU - Mehta,Nilesh M, AU - Moreno,Yara Maria Franco, Y1 - 2019/09/12/ PY - 2018/12/12/received PY - 2019/06/23/accepted PY - 2019/9/17/pubmed PY - 2020/10/2/medline PY - 2019/9/17/entrez KW - Length of stay KW - Malnutrition KW - Mortality KW - Nutritional status KW - Pediatric intensive care unit SP - 219 EP - 229 JF - Journal of the Academy of Nutrition and Dietetics JO - J Acad Nutr Diet VL - 120 IS - 2 N2 - BACKGROUND: There are few studies that assess the role of different nutritional assessment variables at pediatric intensive care unit (PICU) admission in predicting clinical outcomes. OBJECTIVE: To identify nutritional variables in the first 4 days of PICU stay that predict 60-day mortality and time to discharge alive from the PICU. DESIGN: Single-center prospective study in Southern Brazil, conducted between July 2013 and February 2016. At PICU admission, children with z scores <-2 for body mass index (BMI)-for-age, mid-upper arm circumference (MUAC)-for-age, and triceps skinfold thickness (TSF)-for-age were considered as undernourished. PARTICIPANTS/SETTING: There were 199 patients, aged <15 years, with PICU stay >48 hours. MAIN OUTCOME MEASURES: Sixty-day mortality and time to discharge alive from the PICU. STATISTICAL ANALYSIS PERFORMED: Cox regression model was applied to determine predictors of 60-day mortality and time to discharge alive from the PICU. RESULTS: Median age was 23.1 months (interquartile range=3.9 to 89.1), and 63% were male, with 18% prevalence of undernutrition at admission by BMI-for-age. Median PICU stay was 7 days (interquartile range=4 to 12), and 60-day mortality was 12%. After adjusting for sex, age, Pediatric Index of Mortality 2, and presence of complex chronic conditions, undernutrition based on BMI-for-age (hazard ratio [HR]=3.75; 95% CI=1.41 to 9.95; P=0.008), MUAC-for-age (HR=7.62; 95% CI=2.42 to 23.97; P=0.001), and TSF-for-age (HR=4.01; 95% CI=1.14 to 14.15; P=0.031) was associated with higher risk of 60-day mortality. Based on MUAC-for-age with the same adjustment model, undernourished children had longer time to discharge alive from the PICU (HR=0.45; 95% CI=0.21 to 0.98; P=0.045). CONCLUSIONS: Undernutrition at PICU admission based on different anthropometric variables was predictive of 60-day mortality and longer time to discharge alive from the PICU. SN - 2212-2672 UR - https://www.unboundmedicine.com/medline/citation/31522971/Undernutrition_at_PICU_Admission_Is_Predictor_of_60_Day_Mortality_and_PICU_Length_of_Stay_in_Critically_Ill_Children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-2672(19)30839-1 DB - PRIME DP - Unbound Medicine ER -