Prevalence, incidence, and complications of malnutrition in severely injured patients.

Suzan Dijkink, Pieta Krijnen, George C Velmahos, Ali Salim, Inger B Schipper, Jochem M Hoogendoorn, Esmee A H Verheul, Sesmu Arbous, Ron Peters, Daniel D Yeh

Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society 2025;51(1):72

PMID: 39856269

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Abstract

BACKGROUND

Severely injured patients may suffer from acute disease-related or injury-related malnutrition involving a marked inflammatory response. This study investigated the prevalence and incidence of malnutrition and its relation with complications in severely injured patients admitted to the intensive care unit (ICU).

METHODS

This observational prospective cohort study included severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU of five level-1 trauma centers in the Netherlands and United States. Malnutrition was defined as a Subjective Global Assessment score ≤ 5. Complications included systemic-, surgery-, and fracture-related complications, pneumonia, urinary tract infection, deep venous thrombosis, and pulmonary embolism. In-ICU and in-hospital mortality were recorded separately. The complication rate was compared between patients who had or developed malnutrition and patients who remained well-nourished, using multivariable logistic regression analysis.

RESULTS

Of 100 included patients, twelve (12%) were malnourished at admission. Of the 88 well-nourished patients, 44 developed malnutrition during ICU admission, (ICU incidence 50%, 95% confidence interval [CI] 40-60%). Another 18 patients developed malnutrition at the ward (overall in-hospital incidence 70%, 95% CI 61-80%). The 62 patients who developed malnutrition and 12 patients who were malnourished upon admission had more complications than the 26 patients who remained well-nourished (58% vs. 50% vs. 27% respectively; p = 0.03; Odds Ratio 3.4, 95% CI 1.2-9.6).

CONCLUSIONS

50% of severely injured patients developed malnutrition during ICU admission, increasing to 70% during hospital admission. Malnutrition was related to an increased risk of complications. Recognition of sub-optimally nourished severely injured patients and assessment of nutritional needs could be valuable in optimizing their clinical outcomes.

LEVEL OF EVIDENCE

Level III, Prognostic/Epidemiological.

Address: Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands. [email protected].; Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.; Department of General Surgery, Haaglanden Medical Center, The Hague, The Netherlands.; Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.; Acute Care Network West Netherlands, Leiden, The Netherlands.; Department of General Surgery, Haaglanden Medical Center, The Hague, The Netherlands.; Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.; Department of Intensive Care, Haaglanden Medical Center, The Hague, The Netherlands.; Department of Trauma Surgery, Massachusetts General Hospital, Boston, MA, USA.; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Department of Surgery, Denver Health Medical Center, Denver, CO, USA.; Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.

DOI: 10.1007/s00068-024-02711-8

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Full Text Sources:

https://doi.org/10.1007/s00068-024-02711-8

MeSH Terms: Humans, Malnutrition, Male, Female, Prospective Studies, Incidence, Prevalence, Netherlands, Middle Aged, Adult, Wounds and Injuries, Intensive Care Units, Injury Severity Score, Hospital Mortality, United States, Trauma Centers, Aged