0.39 MALNUTRITION AND SEVERITY OF ILLNESS ON ICU PATIENT’S OUTCOME. M. Giner, L. Chelluri, M.M. Meguid. SUNY Health Science Center, Syracuse NY, USA. Nutritional support is provided to patients unable to spontaneously meet their requirements. However, this therapy is expensive. Our study purposes were: i) to test the patient’s adverse effect of malnutrition according to severity of illness and ii1 to identify those patients who ax-e more likely to benefit from nutritional support. METHOD: 129 consecutive ICU patients entered the study. Upon admj ssion, patients were classified into well-nourished (W;n=74) and mal-nourished (M;n=55). Malnutrition was defined by a serum albumin <3.5g/dl or‘ a weight/height ratio <lOO%. The therapeutic intervention scoring system (TISS) was used to assess severity of illness and according to this, patients were classified as TISS-I&II (<19 points; n=42) and TISS-III&IV (220 points; n-87). Then, patients were followed clinically and their outcome recorded as ICL! and r;ard length of stay, complications and death. BBSULTS: TISS !L:i TISS III&IV Y H TOTAL Y I4 TOTAL Hunk? IIii %9 ;ii3lia 42 45 4%\4Bi 8: ECUstag' 2.513 3.5t4.2 2.9:3.3b $.sc?.: d.ltll 7.ltj.4 ward stay' iC.a~i1.l iR.9;!8.6 12.3i.1.2 13.1<11.3 13.2;kz 13.5i5.1 ~;on~licat~snaZ 4114; 4iSli 11191c :GIcal 26:62) SZIEli Deatbs’f; u 3(%3] 3’7 c 15 33 14123) 19133i <[lags L 50 (deatns excluded). *Patients u;ti; 1 or more. SI~IC vs. TiSS IIIdIV p(O.015, O.lJ$i, O.CllU5 CONCLUSIONS: M did worse than W. Incidence of M was higher among sicker patients (TISS-III&IV) than in TISS-I&II. However, by comparing W versus M in both groups, malnutrition in TISS-I&II affected patient's outcome more adversely than in TISS III&IV. Malnutrition unevenly affects Outcome in different groups of patients and an effort should be made to identify those patients more likely to benefit from OUL‘ theraputic resources. 0.40 The role of nitrogen source in septic patients receiving nephrotoxic agents. M. Van den Enden, M. Vandewoude, G. Ieven, I. De Leeuw Department of Nutrition, University of Antwerp, Belgium The use of Total Parenteral Nutrition (TPN), based on essential amino acids (EAA) as unique nitrogen source, in patients with renal insufficiency is controversial. To evaluate the effect of TPN with EAA versus TPN with EAA and non-EAA on renal kinetics, a randomized prospective study was undertaken. Twenty septic patients with hematological malignancies and borderline renal function, receiving nephrotoxic drugs, were included. During aplasia, when oral intake was stopped, they were at random assigned to receive isocaloric (1800 non-prot. Kcal/d), isonitrogenous (8.4 g N2/d) TPN with EAA or with EAA/non-EAA. Nutritional (weight, prealbumin, retinol binding protein, transferrin) and biochemical parameters were followed during the study period (14 days). Significant differences were observed for the change in blood urea and nitrogen balance between groups. Group Blood urea N-balance Transferrin Prealbumin ______________________~~~~~~_____________(g_/p)_______________~~g~~~____-________~~~!~!~____ EAA - 8.9 EAA/non-EAA + 17.9 ** * p < 0.05; ** p < 0.025 (Mann-Whitney) + 1.8 - 23.3 - 5.5 - 3.5 * - 23.5 - 7.8 No significant changes were observed in creatinine-clearance, creatininuria and nutritional indices, In summary, in septic TPN-patients receiving nephrotoxic agents, the use of essential AA as unique source of nitrogen, seems to prevent urea accumulation on a short term base, although the addition of non-EAA is not detrimental to renal function. 30

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Page 1: The role of nitrogen source in septic patients receiving nephrotoxic agents

0.39 MALNUTRITION AND SEVERITY OF ILLNESS ON ICU PATIENT’S OUTCOME. M. Giner, L. Chelluri, M.M. Meguid. SUNY Health Science Center, Syracuse NY, USA.

Nutritional support is provided to patients unable to spontaneously meet their requirements. However, this therapy is expensive. Our study purposes were: i) to test the patient’s adverse effect of malnutrition according to severity of illness and ii1 to identify those patients who ax-e more likely to benefit from nutritional support. METHOD: 129 consecutive ICU patients entered the study. Upon admj ssion, patients were classified into well-nourished (W;n=74) and mal-nourished (M;n=55). Malnutrition was defined by a serum albumin <3.5g/dl or‘ a weight/height ratio <lOO%. The therapeutic intervention scoring system (TISS) was used to assess severity of illness and according to this, patients were classified as TISS-I&II (<19 points; n=42) and TISS-III&IV (220 points; n-87). Then, patients were followed clinically and their outcome recorded as ICL! and r;ard length of stay, complications and death.

BBSULTS: TISS !L:i TISS III&IV

Y H TOTAL Y I4 TOTAL

Hunk? IIii %9 ;ii3lia 42 45 4%\4Bi 8:

ECU stag' 2.513 3.5t4.2 2.9:3.3b $.sc?.: d.ltll 7.ltj.4

ward stay' iC.a~i1.l iR.9;!8.6 12.3i.1.2 13.1<11.3 13.2;kz 13.5i5.1

~;on~licat~snaZ 4114; 4iSli 11191c :GIcal 26:62) SZIEli

Deatbs’f; u 3(%3] 3’7 c 15 33 14123) 19133i

<[lags L 50 (deatns excluded). *Patients u;ti; 1 or more. SI~IC vs. TiSS IIIdIV p(O.015, O.lJ$i, O.CllU5

CONCLUSIONS: M did worse than W. Incidence of M was higher among sicker patients (TISS-III&IV) than in TISS-I&II. However, by comparing W versus

M in both groups, malnutrition in TISS-I&II affected patient's outcome

more adversely than in TISS III&IV. Malnutrition unevenly affects Outcome

in different groups of patients and an effort should be made to identify those patients more likely to benefit from OUL‘ theraputic resources.

0.40 The role of nitrogen source in septic patients receiving nephrotoxic agents.

M. Van den Enden, M. Vandewoude, G. Ieven, I. De Leeuw Department of Nutrition, University of Antwerp, Belgium

The use of Total Parenteral Nutrition (TPN), based on essential amino acids (EAA) as unique nitrogen source, in patients with renal insufficiency is controversial. To evaluate the effect of TPN with EAA versus TPN with EAA and non-EAA on renal kinetics, a randomized prospective study was undertaken. Twenty septic patients with hematological malignancies and borderline renal function, receiving nephrotoxic drugs, were included. During aplasia, when oral intake was stopped, they were at random assigned to receive isocaloric (1800 non-prot. Kcal/d), isonitrogenous (8.4 g N2/d) TPN with EAA or with EAA/non-EAA. Nutritional (weight, prealbumin, retinol binding protein, transferrin) and biochemical parameters were followed during the study period (14 days). Significant differences were observed for the change in blood urea and nitrogen balance between groups.

Group Blood urea N-balance Transferrin Prealbumin

______________________~~~~~~_____________(g_/p)_______________~~g~~~____-________~~~!~!~____

EAA - 8.9

EAA/non-EAA + 17.9 **

* p < 0.05; ** p < 0.025 (Mann-Whitney)

+ 1.8 - 23.3 - 5.5

- 3.5 * - 23.5 - 7.8

No significant changes were observed in creatinine-clearance, creatininuria and nutritional indices, In summary, in septic TPN-patients receiving nephrotoxic agents, the use of essential AA as unique source of nitrogen, seems to prevent urea accumulation on a short term base, although the addition of non-EAA is not detrimental to renal function.