Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit

Artur F Delgado, Thelma S Okay, Claudio Leone, Buford Nichols, Gilda Maria Del Negro, Flávio Adolfo Costa Vaz, Artur F Delgado, Thelma S Okay, Claudio Leone, Buford Nichols, Gilda Maria Del Negro, Flávio Adolfo Costa Vaz

Abstract

Critical illness has a major impact on the nutritional status of both children and adults. A retrospective study was conducted to evaluate the incidence of hospital malnutrition at a pediatric tertiary intensive care unit (PICU). Serum concentrations of IL-6 in subgroups of well-nourished and malnourished patients were also evaluated in an attempt to identify those with a potential nutritional risk.

Methods: A total of 1077 patients were enrolled. Nutritional status was evaluated by Z-score (weight for age). We compared mortality, sepsis incidence, and length of hospital stay for nourished and malnourished patients. We had a subgroup of 15 patients with severe malnutrition (MN) and another with 14 well-nourished patients (WN). Cytokine IL-6 determinations were performed by enzyme-linked immunosorbent assay.

Results: 53% of patients were classified with moderate or severe malnutrition. Similar amounts of C- reactive protein (CRP) were observed in WN and MN patients. Both groups were able to increase IL-6 concentrations in response to inflammatory systemic response and the levels followed a similar evolution during the study. However, the mean values of serum IL-6 were significantly different between WN and MN patients across time, throughout the study (p = 0.043).

Discussion: a considerable proportion of malnourished patients need specialized nutritional therapy during an intensive care unit (ICU) stay. Malnutrition in children remains largely unrecognized by healthcare workers on admission.

Conclusions: The incidence of malnutrition was very high. Malnourished patients maintain the capacity to release inflammatory markers such as CRP and IL-6, which can be considered favorable for combating infections On the other hand, this capacity might also have a significant impact on nutritional status during hospitalization.

Figures

Figure 1
Figure 1
Therapeutic Intervention Scoring System (TISS) evolution in Mn and Wn patients during the period of study
Figure 2
Figure 2
IL-6 serum concentrations in malnourished and well-nourished patients during the period of the study

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