Insufficient Nutrition and Mortality Risk in Septic Patients Admitted to ICU with a Focus on Immune Dysfunction

Kai-Yin Hung, Yu-Mu Chen, Chin-Chou Wang, Yi-Hsi Wang, Chiung-Yu Lin, Ya-Ting Chang, Kuo-Tung Huang, Meng-Chih Lin, Wen-Feng Fang, Kai-Yin Hung, Yu-Mu Chen, Chin-Chou Wang, Yi-Hsi Wang, Chiung-Yu Lin, Ya-Ting Chang, Kuo-Tung Huang, Meng-Chih Lin, Wen-Feng Fang

Abstract

Immune dysfunction is seen both in sepsis patients and in those with malnutrition. This study aimed to determine whether insufficient nutrition and immune dysfunction have a synergistic effect on mortality in critically ill septic patients. We conducted a prospective observational study from adult sepsis patients admitted to intensive care units (ICUs) between August 2013 and June 2016. Baseline characteristics including age, gender, body mass index, NUTRIC, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were recorded. Immune dysfunction, defined by human leukocyte antigen DR (HLA-DR) expression, was tested at days 1, 3, and 7 of ICU admission. The study included 151 patients with sepsis who were admitted to the ICU. The 28-day survivors had higher day 7 caloric intakes (89% vs 73%, p = 0.042) and higher day 1-HLA-DR expression (88.4 vs. 79.1, p = 0.045). The cut-off points of day 7 caloric intake and day 1-HLA-DR determined by operating characteristic curves were 65.1% and 87.2%, respectively. Immune dysfunction was defined as patients with day 1-HLA-DR < 87.2%. Insufficient nutrition had no influence on survival outcomes in patients with immune dysfunction. However, patients with insufficient nutrition had poor prognosis when they were immune competent. Insufficient nutrition and immune dysfunction did not have a synergistic effect on mortality in critically ill septic patients.

Keywords: HLA-DR; ICU; nutrition; sepsis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient recruitment and assignment.
Figure 2
Figure 2
(A) The ROC curve of day 1-HLA-DR for 28-day mortality prediction. The best cut-off point for day 1-HLA-DR determined using the ROC curve and Youden index was 87.2%. (B) The ROC curve of day 7 caloric meet for 28-day mortality prediction. The best cut-off point for day 7 caloric meets determined using the ROC curve and Youden index was 65.1%. PV: predictive value.
Figure 3
Figure 3
Impact of day 7 caloric meet on survival outcome in patients with or without immune dysfunction. Patients with higher day 7 caloric meet and normal immune status had the best prognosis. Patients with lower day 7 caloric meet and normal immune status had a worse prognosis.
Figure 4
Figure 4
Impact of day 7 caloric meet on survival outcome in patients with high or low NUTRIC score. Patients with a lower day 7 caloric meet had a poor prognosis both in those with (A) low nutritional risk (NUTRIC score 0–5) and (B) high nutritional risk (NUTRIC score 6–10).

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