الفهرس 
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Abstract
Summary
Introduction:
Patients admitted to the ICU suffer from acute critical illness. This induces major catabolic stress, which may result in severe muscle wasting and prolonged impaired functional outcomes. Providing adequate nutrition with essential nutrients may help to attenuate the consequences of the catabolic response. Hospital malnutrition can be prevented and treated. Early nutrition management can lower death rates, readmission rates, complication rates, hospital stay times, and cost of treatment.
Aim of the work:
This work aimed to detect the severity of malnutrition in critically ill patient by using Subjective Global Assessment score (SGA) and its association with mortality.
Methodology:
This was an observational, analytical, prospective, Cohort study that was conducted on 50 patients aged >18 years old. Patients were suffering from malnutrition and were admitted to critical care department at Beni-Suef university hospital in the period between May 2022 and Feb 2023.An informed consent was obtained before patients were enrolled into the study. All patients were subjected to: Careful medical history: Focusing on detailed dietary history, Full general examination, Caloric requirements were evaluated on admission, Routine laboratory investigations in the form of: CBC, liver profile, coagulation profile, kidney function tests, serum Na, K, and CRP, Subjective global assessment score, Mid arm circumference and subcutaneous fat at triceps area measurements, Hand grip strength, Daily screening for: Intensive care unit acquired weakness or infection, bedsores/ skin breaks and Duration of mechanical ventilation if the patient was intubated, Evaluation of outcome measures as primary outcome in the form of length of ICU stay, final ICU outcome (alive or dead) and secondary outcome in the form of hospital acquired infection, ICU acquired weakness, bedsores/skin breaks and duration of mechanical ventilation.
Results:
Our study revealed that:52.0% of patients were males while 48.0 % were females. The mean age of the studied patients was 55.9±19.9 years. 52% of cases had SGA score grade A, 34% had SGA score grade B, and 14% of cases of SGA had grade C. The mean hospital length of stay was 13.5±11.2 days. 36% of cases were in need to MV with mean ventilation days 10.7±7.1, and the mortality proportion 34%. There was no significant difference between the LOS and patient’s sex, cause of admission, hypertension but there was a significant longer LOS in non-diabetic patients.There was a significant association between the mortality and smaller TSF, mid arm circumference. In addition, the Hand grip strength was lower in mortality group but didn’t reach statistical significance.There was a significant association between the advanced grade of SGA (grade C) and mortality.There was a statistically significant association between the need to MV and smaller TSF, mid arm circumference.There was a significant association between the advanced grade of SGA (grade C) and need to MV.The mid arm circumference, hand gripstrength and triceps skin fold had a predictive role in prediction of mortality. At a cut off ≤29, ≤25, ≤22 of MAC, Hand grip and TSF respectively, had sensitivity 76.5%, 71.4%, 70.6%, specificity 75.8%, 60.9%, 66.7% and area under curve (AUC) 0.757, 0.736 and 0.784 for the three parameters, respectively.
In conclusion, our study demonstrated that the diagnosis of malnutrition based on SGA standardized diagnostic characteristics strongly predicts increased LOS and mortality rates compared with those in patients without severe malnutrition. The best predictive mortality measurement in ICU patients was mid arm circumference followed by triceps skin fold and hand grip.