Association Between Nutritional Status, Energy-Protein-Micronutrient Intake, and Mortality in Critically Ill Patients Receiving Enteral Nutrition

Aim: Malnutrition is a common issue in the intensive care units (ICUs) and can lead to poor clinical outcomes if not managed with adequate nutritional support. This study aimed to examine the association between energy, protein, and micronutrient intake and mortality among malnourished and well-nourished critically ill patients. Study Design: This retrospective cohort study was conducted in a tertiary medical ICU. Patients were enrolled within the first 48 hours of ICU admission and categorized as either well-nourished (modified Nutrition Risk in the Critically Ill [mNUTRIC] score: 0-4) or malnourished (mNUTRIC score: 5-9). Daily energy, protein, and micronutrient intake of adult critically ill patients receiving enteral tube feeding was meticulously monitored during the first seven days in the ICU. Results: A total of 226 patients were included, with 137 classified as malnourished and 89 as well-nourished. The median age of the study population was 65.0 years (range: 47.8-74.0). Patients with malnutrition had lower energy adequacy (%) compared to well-nourished patients (median: 52.3 vs. 68.3, p=0.001). Malnourished patients also received significantly lower amounts of chromium, copper, iodine, iron, manganese, molybdenum, selenium, biotin, vitamin A, vitamin C, and vitamin D compared to well-nourished patients (p<0.05 for all). Multivariate Cox regression analysis revealed that the mNUTRIC score was a significant predictor of ICU mortality (Hazard Ratio (95% Confidence Interval): 1.235 (1.112-1.371), p<0.001). Kaplan-Meier analysis demonstrated that malnourished patients had a significantly lower probability of survival compared to well-nourished patients (median (95% CI): 29.0 (16.2-41.8) vs. 17.0 (15.0-19.0) days, p=0.001). Conclusions: Critically ill adult patients with malnutrition had significantly lower energy and selected micronutrient intake via the enteral route, along with a reduced probability of survival

Importance of Asprosin for Changes of M. Rectus Femoris Area during the Acute Phase of Medical Critical Illness: A Prospective Observational Study

Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients’ cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4–38.1) ng/mL on the first study day and 26.1 (23.4–32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = −0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass.</jats:p

Importance of Asprosin for Changes of M. Rectus Femoris Area during the Acute Phase of Medical Critical Illness: A Prospective Observational Study

Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients’ cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4–38.1) ng/mL on the first study day and 26.1 (23.4–32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = −0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass

Could serum intestinal fatty acid-binding protein and citrulline levels be predictive markers of mortality in critically ill COVID-19 patients?

INTRODUCTION: The global Coronavirus Disease 2019 (COVID-19) pandemic has been demonstrated to cause severe acute respiratory syndrome and is frequently associated with gastrointestinal (GI) manifestations. Intestinal fatty acid binding protein (IFABP) and citrulline have been identified as potential biomarkers of intestinal (dys)function. The present study was undertaken to ascertain the relationship between serum IFABP and citrulline concentrations and mortality in patients with COVID-19. METHODOLOGY: This observational study was conducted in the medical intensive care unit (ICU) and included adult patients diagnosed with PCR-confirmed cases of severe acute respiratory syndrome (SARS-CoV-2). Serum citrulline and IFABp concentrations were quantitatively analyzed using an enzyme-linked immunosorbent assay (ELISA) within the initial 24 hours following ICU admission. RESULTS: A total of 85 critically ill patients (mean age: 70.0 12.4 years) were recruited for this study. The mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 20.0 7.1. In comparison with survivors (n = 48 patients), non-survivors (n = 37 patients) exhibited significantly elevated serum IFABp concentrations (median (interquartile range, IQR): 13.27 [6.41-17.87] vs. 7.23 [3.26-12.25] ng/mL, p = 0.007) and diminished citrulline levels (median (IQR): 7.61 [4.37-8.52] vs. [4.67 (3.34-8.90] nmol/L, p = 0.043). Receiver operating characteristic (ROC) analysis revealed that the cut off value of serum IFABp and citrulline concentrations to predict ICU mortality was 8.15 ng/mL (AUC: 0.722, 95% Cl: 0.611-0.833, p = 0.001) and 5.99 nmol/L (AUC: 0.671, 95% Cl: 0.551-0.791, p = 0.009), respectively. CONCLUSIONS: The findings of this study indicate that serum IFABP and citrulline concentrations possess the potential to function as biomarkers for predicting mortality in critically ill patients with confirmed cases of SARS-CoV-2

The expression levels of miRNA-15a and miRNA-16-1 in circulating tumor cells of patients with diffuse large B-cell lymphoma.

MicroRNAs (miRNAs) have major roles in nearly all cellular process including gene expression, and may behave as oncogene or tumor suppressor gene by binding to complementary sequences in the target mRNA. The circulating microRNA-15a (miRNA-15a) and microRNA-16-1 (miRNA-16-1) of 15 healthy adults and of 40 untreated patients diagnosed with diffuse large B-cell lymphoma (DLBC) were recruited to investigate the expression levels. The expression levels of miRNA-15a, and miRNA-16-1 genes of the untreated DLBCL patients, and healthy individuals with matched age, sex and ethnicity were examined. MicroRNA expression profiles obtained from peripheral blood were investigated. The samples were collected from 40 patients diagnosed with DLBC patients, and from 15 healthy controls. Two miRNAs were selected, and expression profile was examined using a quantitative real-time polymerase chain reaction (qPCR) based on the previous studies. Statistically significant expression level differences (p0.05). On the contrary to the literature, miRNA-16-1 expression level was suppressed in DLBCL group in our study, however no whole gene silencing was performed. MicroRNA-16-1 might be suggested to behave as a tumor suppressor in DLBCL in our study

Wernicke's Encephalopathy: A Forgotton Disease

Wernicke's encephalopathy (WE) is an acute neurological condition characterized by ataxia, confusion, ocular findings, and impairment of consciousness due to thiamine deficiency. Although alcoholism is the most common reason, WE cases resulting from prolonged total parenteral nutrition (TPN) without multivitamin complex have been reported. Here we present a dramatic improvement in symptoms with high-dose thiamine in a patient who developed WE due to TPN after gastrointestinal surgery