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4 results

  • Prognostic value of different cut-off points of the NRS-2002 tool to identify nutritional risk in critically ill patients: a longitudinal study

  • Bruna Barbosa Stello, Aline Cattani, Danielle Silla Jobim Milanez, Elisa Loch Razzera, Júlia Lima, Flávia Moraes Silva
  • Journal:
    British Journal of Nutrition / Volume 130 / Issue 8 / 28 October 2023
    Published online by Cambridge University Press:
    17 February 2023, pp. 1357-1365
    Print publication:
    28 October 2023
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  • The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with Nutritional Risk Screening – 2002 (NRS-2002) ≥ 3 as NR and ≥ 5 as high NR. The present study evaluated the predictive validity of different NRS-2002 cut-off points in intensive care unit (ICU). A prospective cohort study was conducted with adult patients who were screened using the NRS-2002. Hospital and ICU length of stay (LOS), hospital and ICU mortality, and ICU readmission were evaluated as outcomes. Logistic and Cox regression analyses were performed to evaluate the prognostic value of NRS-2002, and a receiver operating characteristic curve was constructed to determine the best cut-off point for NRS-2002. 374 patients (61·9 ± 14·3 years, 51·1 % males) were included in the study. Of these, 13·1 % were classified as without NR, 48·9 % and 38·0 % were classified as NR and high NR, respectively. An NRS-2002 score of ≥ 5 was associated with prolonged hospital LOS. The best cut-off point for NRS-2002 was a score ≥ 4, which was associated with prolonged hospital LOS (OR = 2·13; 95 % CI: 1·39, 3·28), ICU readmission (OR = 2·44; 95 % CI: 1·14, 5·22), ICU (HR = 2·91; 95 % CI: 1·47, 5·78) and hospital mortality (HR = 2·01; 95 % CI: 1·24, 3·25), but not with ICU prolonged LOS (P = 0·688). NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.

  • Human Leukocyte Antigen Genotype as a Marker of Multiple Sclerosis Prognosis

  • Andreas P. Lysandropoulos, Gaetano Perrotta, Thibo Billiet, Annemie Ribbens, Renaud Du Pasquier, Caroline Pot Kreis, Pietro Maggi, Marie Théaudin
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 47 / Issue 2 / March 2020
    Published online by Cambridge University Press:
    02 December 2019, pp. 189-196
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  • Objective:

    In a previous pilot monocentric study, we investigated the relation between human leukocyte antigen (HLA) genotype and multiple sclerosis (MS) disease progression over 2 years. HLA-A*02 allele was correlated with better outcomes, whereas HLA-B*07 and HLA-B*44 were correlated with worse outcomes. The objective of this extension study was to further investigate the possible association of HLA genotype with disease status and progression in MS as measured by sensitive and complex clinical and imaging parameters.

    Methods:

    Hundred and forty-six MS patients underwent HLA typing. Over a 4-year period of follow-up, we performed three clinical and magnetic resonance imaging (MRI) assessments per patient, which respectively included Expanded Disability Status Scale, Multiple Sclerosis Severity Scale, Timed-25-Foot-Walk, 9-Hole Peg Test, Symbol Digit Modalities Test, Brief Visual Memory Test, California Verbal Learning Test-II, and whole-brain atrophy, fluid-attenuated inversion recovery (FLAIR) lesion volume change and number of new FLAIR lesions using icobrain. We then compared the clinical and MRI outcomes between predefined HLA patient groups.

    Results:

    Results of this larger study with a longer follow-up are in line with what we have previously shown. HLA-A*02 allele is associated with potentially better MS outcomes, whereas HLA-B*07, HLA-B*44, HLA-B*08, and HLA-DQB1*06 with a potential negative effect. Results for HLA-DRB1*15 are inconclusive.

    Conclusion:

    In the era of MS treatment abundance, HLA genotype might serve as an early biomarker for MS outcomes to inform individualized treatment decisions.

  • Prognostic power of anaerobic threshold parameters in patients with transposition of the great arteries and systemic right ventricle

  • António V. Gonçalves, Tânia Mano, Ana Agapito, Sílvia A. Rosa, Lídia de Sousa, Pedro Rio, José Alberto, André Monteiro, Tiago P. da Silva, Rita I. Moreira, Rui Soares, Fátima Pinto, Rui C. Ferreira
  • Journal:
    Cardiology in the Young / Volume 29 / Issue 12 / December 2019
    Published online by Cambridge University Press:
    18 October 2019, pp. 1445-1451
  • Introduction:

    Both transposition of the great arteries (TGA) previously submitted to a Senning/Mustard procedure and congenitally corrected TGA (cc-TGA) have the systemic circulation supported by the morphological right ventricle, thereby rendering these patients to heart failure events risk. The aim of this study was to evaluate cardiopulmonary exercise test parameters for stratifying the risk of heart failure events in TGA patients.

    Methods:

    Retrospective evaluation of adult TGA patients with systemic circulation supported by the morphological right ventricle submitted to cardiopulmonary exercise test in a tertiary centre. Patients were followed up for at least 1 year for the primary endpoint of cardiac death or heart failure hospitalisation. Several cardiopulmonary exercise test parameters were analysed as potential predictors of the combined endpoint and their predictive power were compared (area under the curve).

    Results:

    Cardiopulmonary exercise test was performed in 44 TGA patients (8 cc-TGA), with a mean age of 35.1 ± 8.4 years. The primary endpoint was reached by 10 (22.7%) patients, with a mean follow-up of 36.7 ± 26.8 months. Heart rate at anaerobic threshold had the highest area under the curve value (0.864), followed by peak oxygen consumption (pVO2) (0.838). Heart rate at anaerobic threshold ≤95 bpm and pVO2 ≤20 ml/kg/min had a sensitivity of 87.5 and 80.0% and a specificity of 82.4 and 76.5%, respectively, for the primary outcome.

    Conclusion:

    Heart rate at anaerobic threshold ≤95 bpm had the highest predictive power of all cardiopulmonary exercise test parameters analysed for heart failure events in TGA patients with systemic circulation supported by the morphological right ventricle.

  • Depression and Anxiety Across the First Year After Ischemic Stroke: Findings from a Population-Based New Zealand ARCOS-IV Study

  • Suzanne Barker-Collo, Rita Krishnamurthi, Emma Witt, Alice Theadom, Nicola Starkey, P. Alan Barber, Derrick Bennett, Elaine Rush, Bruce Arroll, Valery Feigin
  • Journal:
    Brain Impairment / Volume 18 / Issue 3 / December 2017
    Published online by Cambridge University Press:
    29 June 2017, pp. 265-276

  • Background: Depression and anxiety are the two most frequently studied emotional outcomes of stroke. However, few previous studies have been carried out at a population level or beyond 6 months post stroke. The aim of this study was to describe depression and anxiety across the first year following incident ischemic stroke (IS), and identify predictive factors in a population-based study.

    Method: The Hospital Anxiety Depression Scale (HADS) was administered at baseline (within 2 weeks of onset), and again at 1-month, 6-months and 12-months after IS in a sample (N = 365) drawn from a population-based study.

    Results: Over 75% of those assessed experienced depression or anxiety symptoms below cut-offs for probable disorder across the year post stroke. Moderate to severe symptoms for anxiety were approximately twice as likely (range 4.1%–10.6%) as compared to depression (range 2.5%–5.0%) at each assessment. The greatest improvement in anxiety occurred within the first month post stroke. In contrast, the greatest reduction in depression occurred between 1- to 6-months post stroke.

    Conclusions: Anxiety symptoms in the moderate to severe range were twice as common as depression, and improved over the first month post stroke, whilst depression symptoms persisted for up to 6 months, indicating a need to target these two issues at different points in the recovery process.