Contributors: Service Médecine Intensive et Réanimation CHU Clermont-Ferrand (MIR); Pôle RHEUNNIRS CHU Clermont-Ferrand; CHU Gabriel Montpied Clermont-Ferrand; CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied Clermont-Ferrand; CHU Clermont-Ferrand-CHU Clermont-Ferrand; Service Nutrition Clinique CHU Clermont-Ferrand; Fédération de Médecine Translationnelle de Strasbourg (FMTS); Université de Strasbourg (UNISTRA); Nouvel Hôpital Civil de Strasbourg; Hôpitaux Universitaires de Strasbourg (HUS); Pôle Médecine Péri-opératoire CHU Clermont-Ferrand; CHU Clermont-Ferrand; Hospices Civils de Lyon (HCL); CHU Pitié-Salpêtrière AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Service Biostatistiques, Télématiques, Traitement de l’image CHU Clermont-Ferrand; CHU Clermont-Ferrand-CHU Clermont-Ferrand-Pôle Santé Publique CHU Clermont-Ferrand; Service Biochimie et Génétique Moléculaire CHU Clermont-Ferrand; CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing Clermont-Ferrand; CHU Clermont-Ferrand-Pôle Biologie médicale et Anatomie pathologique CHU Clermont-Ferrand; Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA); Nutrition, Métabolismes et Cancer (NuMeCan); Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Laboratoire Microorganismes : Génome et Environnement (LMGE); Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA); Unité de Nutrition Humaine (UNH); Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA); This study was supported by the CHU Clermont Ferrand, France, the DGOS (Direction Générale de l'offre de soins), and the SFNCM (Société Francophone Nutrition Clinique et Métabolisme), France. This study was also supported by a grant from Nestlé and Baxter S.A.S. However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
نبذة مختصرة : International audience ; BACKGROUND and AIMS: After a prolonged intensive care unit (ICU) stay patients experience increased mortality and morbidity. The primary aim of this study was to assess the prognostic value of nutritional status, body mass composition and muscle strength, as assessed by body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip (HG) test, and that of the biological features to predict one-year survival at the end of a prolonged ICU stay. METHODS: This was a multicenter prospective observational study. Survivor patients older than 18 years with ICU length of stay >72 h were eligible for inclusion. BIA and HG were performed at the end of the ICU stay. Malnutrition was defined by BMI and fat-free mass index (FFMI). The primary endpoint was one-year mortality. Multivariable logistic regression was performed to determine parameters associated with mortality. RESULTS: 572 patients were included with a median age of 63 years [53.5; 71.1], BMI of 26.6 kg/m(2) [22.8; 31.3], SAPS II score of 43 [31; 58], and ICU length of stay of 9 days [6; 15]. Malnutrition was observed in 142 (24.9%) patients. During the 1-year follow-up after discharge, 96 (18.5%) patients died. After adjustment, a low HG test score (aOR = 1.44 [1.11; 1.89], p = 0.01) was associated with 1-year mortality. Patients with low HG score, malnutrition, and Albuminemia <30 g/L had a one-year death rate of 41.4%. Conversely, patients with none of these parameters had a 1-year death rate of 4.1%. CONCLUSION: BIA to assess FFMI, HG and albuminemia at the end of ICU stay could be used to predict 1-year mortality. Their ability to identify patients eligible for a structured recovery program could be studied.
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