The Association Between Nutritional Risk Index and ICU Mortality Across Hematologic Malignancy Patients with Acute Respiratory Failure
CCCF ePoster library. Seeger R. 11/12/19; 283450; EP68
Rena Seeger
Rena Seeger
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Topic: Retrospective or Prospective Cohort Study or Case Series

Rena Seeger1, Michael D. Elfassy1, Dmitry Rozenberg2, Nanki Ahluwalia1, Michael E. Detsky1, Bruno Ferreyro1, Laveena Munshi1
1-Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Canada
2-Division of Respirology, University of Toronto, Toronto, Canada

Background: Acute respiratory failure requiring intensive care unit (ICU) admission is common across patients with hematologic malignancies (HM) and hematopoietic cell transplant (HCT). More attention is needed to identify modifiable determinants of ICU mortality given the persistently high mortality across this population (40-60%). Nutritional status is associated with the development of frailty – an important determinant of ICU mortality. Nutritional risk index (NRI) is a scoring system derived from albumin and weight, and reflects protein-energy malnutrition. NRI has been associated with worse outcomes across a series of populations including patients with acquired immunodeficiency syndrome, acute decompensated heart failure, and chronic kidney disease. Its reliability in the ICU setting in cancer patients has not be extensively evaluated. Albumin, as an acute phase reactant, may impact the association between NRI and malnutrition. However, NRI may still be associated with ICU outcome (either through NRI reflecting malnutrition or as a severity of illness maker).
Objectives: We wish to evaluate the association between NRI at ICU admission and all-cause ICU mortality in HM/HCT patients with acute respiratory failure.
Methods: We conducted a retrospective cohort study of all HM and HCT patients with acute respiratory failure requiring mechanical ventilation (invasive and non-invasive) for at least two hours at Mount Sinai Hospital between 2014-2018. We calculated NRI for all patients using their ICU-admission albumin and weight. NRI = (1.489 × serum albumin, g/L) + {41.7 × weight (kg)/ideal body weight(kg)}). Nutritional risk has been previously categorized as no risk (NRI >100), mild risk (97.5-100), moderate risk (83.5-97.5) and severe risk (<83.5). These risk categories have been associated with mortality across previous cohorts. Our primary outcome was ICU all-cause mortality.
Results: Two-hundred and eighty patients were admitted for acute respiratory failure requiring mechanical ventilation of which the median age was 62 (IQR 51-68) and 42% were female. The most common type of HM was acute leukemia (54%) and 40% of the cohort underwent HCT prior to admission to ICU. Median time between hospital and ICU admission was 15 days (IQR 7-26). Median BMI and albumin at the time of ICU admission was 25 (23-30) and 26 g/L (22-30) respectively. Median albumin 7 days prior to critical illness was 31 d/L (27-34). Median ICU admission sequential organ failure assessment (SOFA) score was 11 (9-14), 52% were neutropenic on admission to ICU and 34% were receiving corticosteroids. ICU mortality rate was 51% with a median duration of mechanical ventilation of 4 days (IQR 2-7). Median NRI across the cohort was 87 (79-99) at ICU and 89 (53-93) 7 days prior to ICU (median difference 0.87 (-8.91- 9.59)). According to the NRI severity scale, 40% were categorized as having severe risk of malnutrition, 32% moderate risk, 3% mild risk and 25% no risk. Mortality across those at severe risk of malnutrition (NRI <83.5) was 59% (65/111) compared to 46% (76/164) across those with moderate-no risk (p=0.047).

Conclusions: Our preliminary, exploratory analysis suggests an association between severe NRI risk score and ICU mortality across HM and HCT patients admitted with ARF requiring mechanical ventilation. Further research is ongoing to evaluate its role as a prognostic marker adjusting for important confounders.

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