Background
Methods
Setting and patients
Data collection
Development of GLIMPSE
Validity of GLIMPSE as an assessment tool for nutritional support
Results
Patient characteristics | Enrolled patients (n = 440) | Survivors (n = 317) | Nonsurvivors (n = 123) | p value | Short-term ENS (≤ 6 days) (n = 106) | Longer-term ENS (≥ 7 days) (n = 146) | p value |
---|---|---|---|---|---|---|---|
Age (years) | 61.4 (15.7) | 59.3 (15.9) | 66.8 (14.1) | < 0.001 | 60.4 (16.9) | 59.5 (15.5) | 0.655 |
Male | 259 [58.9] | 192 [60.6] | 67 [54.5] | 0.244 | 63 [59.4] | 92 [63.0] | 0.564 |
BMI (kg/m2) | 24.4 [21.3, 28.2] | 24.4 [21.2, 28.0] | 24.2 [21.3, 28.6] | 0.955 | 24.5 [21.2, 29.5] | 24.6 [21.8, 28.4] | 0.726 |
Location before adm. | 0.003 | 0.976 | |||||
ED/HD/OT | 357 [81.1] | 268 [84.5] | 89 [72.4] | 88 [83.0] | 121 [82.9] | ||
Wards | 83 [18.9] | 49 [15.5] | 34 [27.6] | 18 [17.0] | 25 [17.1] | ||
Type of adm. | 0.006 | 0.001 | |||||
Medical | 293 [66.6] | 199 [62.8] | 94 [76.4] | 80 [75.5] | 79 [54.1] | ||
Surgery | 147 [33.4] | 118 [37.2] | 29 [23.6] | 26 [24.5] | 67 [45.9] | ||
Number of comorbidities | 2.0 [1.0, 4.0] | 2.0 [1.0, 4.0] | 3.0 [2.0, 4.0] | 0.069 | 3.0 [1.0, 4.0] | 2.0 [1.0, 3.0] | 0.002 |
LOS before ICU adm. (days) | 0.0 [0.0, 1.0] | 0.0 [0.0, 1.0] | 1.0 [0.0, 3.0] | 0.009 | 0.0 [0.0, 1.3] | 0.0 [0.0, 1.3] | 0.730 |
APACHE II | 24.5 (8.1) | 22.6 (7.4) | 29.5 (7.7) | < 0.001 | 25.4 (8.4) | 24.7 (7.6) | 0.543 |
SOFA | 8.7 (3.8) | 7.9 (3.5) | 10.7 (3.8) | < 0.001 | 9.2 (3.7) | 9.1 (3.8) | 0.909 |
mNUTRIC | 5.3 (2.1) | 4.8 (2.1) | 6.6 (1.5) | < 0.001 | 5.5 (2.3) | 5.3 (2.0) | 0.531 |
mNUTRIC ≥ 5 | 299 [68.0] | 187 [59.0] | 112 [91.1] | < 0.001 | 74 [69.8] | 100 [68.5] | 0.823 |
Malnutrition | 123 [28.0] | 72 [22.7] | 51 [41.5] | < 0.001 | 31 [29.2] | 35 [24.0] | 0.347 |
Admission reasons | < 0.001 | 0.020 | |||||
Cardiovascular | 82 [18.6] | 43 [13.6] | 39 [31.7] | 19 [17.9] | 18 [12.3] | ||
Respiratory | 84 [19.1] | 68 [21.5] | 16 [13.0] | 24 [22.6] | 21 [14.4] | ||
Sepsis | 105 [23.9] | 72 [22.7] | 33 [26.8] | 36 [34.0] | 39 [26.7] | ||
Trauma | 12 [2.7] | 12 [3.8] | 0 [0.0] | 4 [3.3] | 4 [2.7] | ||
Metabolic/renal | 8 [1.8] | 8 [2.5] | 0 [0.0] | 2 [1.9] | 2 [1.4] | ||
Gastrointestinal | 42 [9.6] | 29 [9.2] | 13 [10.6] | 3 [2.8] | 8 [5.5] | ||
Postoperation | 13 [3.0] | 12 [3.8] | 1 [0.8] | 4 [3.8] | 3 [2.1] | ||
Orthopaedics | 7 [1.6] | 6 [1.9] | 1 [0.8] | 1 [0.9] | 2 [1.4] | ||
Neurological | 87 [19.8] | 67 [21.1] | 20 [16.3] | 13 [12.3] | 49 [33.6] | ||
CPR before ICU adm. | 53 [12.1] | 17 [5.4] | 36 [29.3] | < 0.001 | 18 [17.0] | 18 [12.3] | 0.297 |
Length of MV (days) | 2.0 [1.0, 5.0] | 2.0 [1.0, 4.0] | 3.0 [2.0, 6.0] | < 0.001 | 3.0 [2.0, 4.0] | 7.0 [4.0, 13.0] | < 0.001 |
ICU LOS (days) | 2.0 [2.0, 5.0] | 2.0 [1.0, 4.0] | 3.0 [2.0, 6.0] | 0.001 | 3.0 [2.0, 4.0] | 7.0 [4.0, 12.0] | < 0.001 |
Hospital LOS (days) | 14.0 [7.0, 25.0] | 15.0 [9.0, 33.0] | 9.0 [4.0, 16.0] | < 0.001 | 8.0 [4.0, 15.3] | 24.0 [16.0, 45.0] | < 0.001 |
Nutritional parameters | All patients | Survivors | Nonsurvivors | p value |
---|---|---|---|---|
Short-term exclusive nutritional support (≤ 6 days) | ||||
Energy | ||||
Goal (kcal/kg) | 25.7 (5.8) | 25.5 (5.5) | 25.9 (6.3) | 0.680 |
Actual intake (kcal/kg) | 12.0 (6.6) | 10.0 (6.0) | 15.0 (6.4) | < 0.001 |
Actual intake (% goal/kg) | 48.0 (24.9) | 40.0 (22.4) | 59.2 (24.1) | < 0.001 |
Protein | ||||
Goal (g/kg) | 1.14 (0.23) | 1.14 (0.20) | 1.15 (0.26) | 0.779 |
Actual intake (g/kg) | 0.47 (0.29) | 0.39 (0.26) | 0.57 (0.30) | 0.001 |
Actual intake (% goal/kg) | 41.6 (25.0) | 34.7 (21.6) | 51.4 (26.4) | 0.001 |
Longer-term exclusive nutritional support (≥ 7 days) | ||||
Energy | ||||
Goal (kcal/kg) | 25.6 (4.4) | 25.9 (4.4) | 24.8 (4.3) | 0.166 |
Actual intake (kcal/kg) | 17.5 (5.3) | 17.7 (5.2) | 16.9 (5.7) | 0.389 |
Actual intake (% goal/kg) | 68.7 (18.2) | 68.8 (17.8) | 68.2 (19.5) | 0.857 |
Protein | ||||
Goal (g/kg) | 1.19 (0.22) | 1.20 (0.21) | 1.15 (0.26) | 0.281 |
Actual intake (g/kg) | 0.77 (0.25) | 0.79 (0.24) | 0.71 (0.28) | 0.125 |
Actual intake (% goal/kg) | 64.8 (19.1) | 66.1 (18.9) | 61.6 (19.4) | 0.206 |
Development of GLIMPSE
Validity of GLIMPSE as an assessment tool for nutritional support
Patient characteristics | Low-GLIMPSE (n = 188) | High-GLIMPSE (n = 252) | p value |
---|---|---|---|
Age (years) | 53.6 (16.0) | 67.2 (12.8) | < 0.001 |
Male | 115 [61.2] | 144 [57.1] | 0.396 |
BMI (kg/m2) | 25.5 (6.3) | 24.9 (5.8) | 0.262 |
Location before adm. | < 0.001 | ||
ED/HD/OT | 169 [89.9] | 188 [74.6] | |
Wards | 19 [10.1] | 64 [25.4] | |
Type of adm. | < 0.001 | ||
Medical | 104 [55.3] | 189 [75.0] | |
Surgery | 84 [44.7] | 63 [25.0] | |
Number of comorbidities | 2.0 [1.0, 3.0] | 3.0 [2.0, 4.0] | < 0.001 |
LOS before ICU adm. (days) | 0.0 [0.0. 1.0] | 1.0 [0.0, 2.5] | < 0.001 |
APACHE II | 18.6 (5.2) | 29.0 (6.9) | < 0.001 |
SOFA | 6.4 (3.0) | 10.3 (3.4) | < 0.001 |
mNUTRIC | 3.4 (1.5) | 6.7 (1.2) | < 0.001 |
mNUTRIC ≥ 5 (high-mNUTRIC) | 55 [29.3] | 244 [96.8] | < 0.001 |
Malnutrition | 29 [15.4] | 94 [37.3] | < 0.001 |
Predicted mortality risk | 9.7 (5.0) | 41.6 (19.5) | < 0.001 |
Admission reasons | < 0.001 | ||
Cardiovascular | 22 [11.7] | 60 [23.8] | |
Respiratory | 39 [20.7] | 45 [17.9] | |
Sepsis | 26 [13.8] | 79 [31.4] | |
Trauma | 11 [5.9] | 1 [0.4] | |
Metabolic/renal | 3 [1.6] | 5 [2.0] | |
Gastrointestinal | 15 [8.0] | 27 [10.7] | |
Postoperation | 9 [4.8] | 4 [1.6] | |
Orthopaedics | 3 [1.6] | 4 [1.6] | |
Neurological | 60 [31.9] | 27 [10.7] | |
CPR before ICU adm. | 1 [0.5] | 52 [20.6] | < 0.001 |
Length of MV (days) | 2.0 [1.0, 4.0] | 2.0 [1.0, 5.0] | 0.039 |
ICU LOS (days) | 2.0 [2.0, 5.0] | 3.0 [2.0, 5.0] | 0.381 |
Hospital LOS (days) | 13.5 [7.0, 27.0] | 14.0 [7.0, 24.0] | 0.953 |
Parameters | Short-term ENS (≤ 6 days) | Longer-term ENS (≥ 7 days) | p value | |||
---|---|---|---|---|---|---|
Low-GLIMPSE* (n = 36) | High-GLIMPSE* (n = 70) | Low-GLIMPSE* (n = 64) | High-GLIMPSE* (n = 82) | |||
Energy intake | 0.793† | 0.035‡ | ||||
Each 10% of goal | 1.24 (0.70–2.20) | 1.60 (1.19–2.15) | 2.17 (0.75–6.26) | 0.83 (0.64–1.12) | ||
p = 0.462 | p = 0.002 | p = 0.150 | p = 0.228 | |||
GOF = 0.682 | GOF = 0.823 | GOF = 0.287 | GOF = 0.615 | |||
Protein intake | 0.904§ | 0.025** | ||||
Each 10% of goal | 1.20 (0.68–2.11) | 1.47 (1.12–1.86) | 1.23 (0.73–2.08) | 0.75 (0.57–0.99) | ||
p = 0.535 | p = 0.004 | p = 0.428 | p = 0.043 | |||
GOF = 0.685 | GOF = 0.530 | GOF = 0.455 | GOF = 0.335 | |||
7-point SGA-categories | 0.480†† | 0.633‡‡ | ||||
Well-nourished | ||||||
SGA-7 | 22 [61.1] | 34 [48.6] | 41 [64.1] | 34 [41.5] | ||
SGA-6 | 8 [22.2] | 11 [15.7] | 18 [28.1] | 18 [22.0] | ||
Mildly to moderately malnourished | ||||||
SGA-5 | 3 [8.3] | 8 [11.4] | 4 [6.3] | 14 [17.1] | ||
SGA-4 | 2 [5.6] | 7 [10.0] | 1 [1.6] | 9 [11.0] | ||
SGA-3 | 1 [2.8] | 5 [7.1] | 0 [0.0] | 5 [6.1] | ||
Severely malnourished | ||||||
SGA-2 | 4 [5.7] | 2 [2.4] | ||||
SGA-1 | 1 [1.4] | 0 [0.0] |