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Published on: September 30, 2020
Functional assessment and mortality in underweight critically ill patients one year after hospital discharge: A
Marina V Viana1, Luiza A Gross2, Ana L Tavares2
1Critical Care Unit, Hospital de Clínicas de Porto Alegre and Post-Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul Rua Ramiro Barcelos 2350, 90035-003, Porto Alegre-RS, Brazil.
Insights
Underweight critically ill patients face high mortality and lasting functional decline post-discharge. Extremely low weight (<45 kg) significantly predicts poor functional capacity, highlighting a critical vulnerability.
Area of Science:
- Critical Care Medicine
- Nutritional Science
- Geriatric Medicine
Background:
- Limited data exists on outcomes for underweight critically ill patients after hospital discharge.
- Underweight status (BMI <20 kg/m²) in critical illness is associated with adverse events.
- Long-term survival and functional capacity are crucial metrics for this patient population.
Purpose of the Study:
- To evaluate long-term survival rates in underweight critically ill patients.
- To assess the functional capacity of these patients one year after hospital discharge.
- To identify factors associated with poor functional outcomes in this cohort.
Main Methods:
- Prospective observational study of underweight critically ill patients (BMI <20 kg/m²).
- One-year follow-up post-discharge, assessing survival status and functional capacity (Katz Index, Lawton Scale).
- Patients categorized into 'poor' or 'good' functional capacity based on median scores; extremely low weight defined as <45 kg.
Main Results:
- Overall mortality was 38.8% within a median follow-up of 362 days.
- Patients with poor functional capacity had significantly lower admission weight (<45 kg) and BMI.
- Weight under 45 kg was independently associated with poor functional capacity (OR = 13.6).
Conclusions:
- Underweight critically ill patients exhibit high mortality and persistent functional impairment.
- Extremely low body weight (<45 kg) is a strong predictor of poor functional capacity post-discharge.
- Nutritional status at ICU admission and early nutritional therapy did not differentiate survivors from non-survivors.
Backcground & Aims:
There in no data regarding outcomes after hospital discharge for underweight critically ill patients. This study aimed to assess long-term survival and functional capacity in underweight critically ill patients.
Materials & Methods:
Prospective observational study that included underweight critically ill patients (BMI <20 kg/cm2) followed-up one year after hospital discharge. To assess functional capacity, we interviewed patients or caregivers and performed Katz index (KI) and Lawton scale. Patients were divided into two groups: (1) poor functional capacity, if the patient had less points than the median of the Katz and IADL score, and (2) good functional capacity, if at least one score was above the median. Extremely low weight defined as less than 45 kg.
Results:
We assessed the vital status of 103 patients. Mortality was 38.8% (median 362 [136, 422] days of follow-up). We interviewed 62 patients or proxies. No difference was observed between survivors and non-survivors regarding weight and BMI at intensive care unit admission and nutritional therapy received in the first days of intensive care admission. Patients with poor functional capacity had lower admission weight (43.9 vs 52 ± 7.9 kg, p < 0.001) and BMI (17 ± 2.1 vs 18.2 ± 1.8 kg/cm2, p = 0.028). In a multivariate logistic regression, weight under 45 kg was independently associated with poor functional capacity (OR = 13.6, 95%CI, 3.7 to 66.5) CONCLUSION: Underweight critically ill patients have high mortality and a persistent functional impairment, the last being more important in extremely low weight.
Clinical Trial Registry:
ClinicalTrials.gov number NCT03398343.
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