Admission factors associated with nutritional status deterioration and prolonged PICU stay in critically ill children: PICU-ScREEN multicenter study.

BACKGROUND Early identification of patients in the Pediatric Intensive Care Unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. AIM To identify factors associated with NS deterioration and prolonged PICU stay. METHODS In a prospective cohort study in eight Brazilian PICUs, we enrolled children 72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutritional variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight-for-age, body mass index-for-age or mid-upper arm circumference-for-age z-score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. RESULTS We enrolled 363 eligible patients, median age 11.3 months (IQR:3.1-45.6) and 46% had at least one Complex Chronic Condition (CCC). NS deterioration was observed in 23% and was associated with CCC (OR:2.71, 95%CI:1.44-5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay (33% of the cohort) was associated with age 10%) over first 72 hours (OR:2.66, 95%CI:1.50-4.73) and hypoalbuminemia (<3.0 g/dL) (OR:2.05, 95%CI:1.12-3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. CONCLUSIONS CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutritional screening tool for critically ill children. This article is protected by copyright. All rights reserved.