The assessment of changes in nutritional status and its effective factors over time in trauma patients in “Shahid Bahonar” Kerman Hospital.

Abstract

Background: Nutritional requirements are often escalated following major trauma. Underfeeding and adverse outcomes were seen in critically ill trauma patients. The aim of the study was to quantify actual amount of calories and protein intakes, and extent to which those clinical factors may affect adequate intake. Method: An observational study carried out in a medical intensive care unit (ICU) of Kerman University of Medical Sciences during April 2017 and December 2018. A total of 85 adult trauma patients with a 7 days ICU length of stay and who received Enteral nutrition (EN) were included in this study. The data on estimated and actual intake of energy and protein, severity of illness (i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), The Glasgow Coma Scale (GCS) and markers of nutritional status (i.e., serum albumin level and body mass index) were recorded at the first day of ICU admission. Results: In this study, sixty-six patients (77%) had inadequate energy intake. Results showed that only GCS possibly predict energy status. For every one-unit additional decrease in GCS scores, the odds of being underfed in terms of energy were increased by 1.32 times, after controlling for other factors (95% CI, 1.07 to 1.75, P-value = 0.044). No association was observed between nutritional status and clinical outcomes. There was an adverse association between APACHE Ⅱ Score and mean protein intake (95% CI, -0.74 to -0.06, β= -0.36, P-value = 0.046), and energy intake predict protein status significantly. Patient who had adequate intake of energy, were 16.54 times more likely for adequate protein intake than those who were underfed in term of energy. No association was observed between mean protein intake and m-Nutric Score, GCS, intubation time and albumin. Conclusion: The definite nutritional intake did not coverage the calculated requirements during ICU stay. In addition, the adverse association between some important clinical factors and mean energy and protein intake, showed that improvement of clinical status could prevent malnutrition or overload of protein intake during ICU stay.