Assessment of Nutritional Status and Prognosis in Surgical Intensive Care Unit: The Prognostic and Inflammatory Nutritional Index (PINI)

Background Malnutrition is an independent factor of morbidity and mortality in patients at intensive care unit. The prognostic inflammatory and nutritional index (PINI) is frequently used as a marker of malnutrition but this scoring system was not studied in surgical intensive care units. The purposes of this study were to assist nutritional status with biomarkers and to search for a correlation between biological markers and prognosis, using the PINI. Methods A prospective, observational study was performed in the intensive care unit, started in July 2013. Twenty surgical patients, spent at least seven days at the intensive care unit were enrolled. An early nutritional care was given (first 24 hours). The patients were evaluated each week clinically and biologically (Albumin, Prealbumin, Orosomucoid, C-reactive protein) in order to establish the prognostic inflammatory and nutritional index (PINI = C-reactive protein x Orosomucoid / Albumin x Prealbumin). The correlation between variables was calculated, the Spearman rank-order correlation was used. Results The average age was 56+/-11 years, IGS II score was 48+/-17, APACHE II score was 25+/-12 and MODS ratio was 6+/-4. The mean duration of stay was 40+/-25 days, the mortality rate was 35%. The average calorie intake was 2300+/- 600 kcal. There was a weight gain and an increase of the Body Mass Index either in surviving and dead patients. There was an initial increase of the C-reactive protein and the orosomucoid rate during the acute phase of aggression followed by a progressive decrease. The nutritional proteins (albumin, prealbumin, retinol binding protein) were always low, despite a progressive increase. The PINI was initially high and decreased progressively but remained high (> 20).The Albumin and Prealbumin rate were correlated with the MODS ratio. There was a correlation between the orosomucoid rate and the organ failure. The PINI was correlated to the MODS ratio and to the IGS II but not with mortality. Conclusions The malnutrition in surgical patients at intensive care unit has an early onset and is always severe. Biological markers and PINI are correlated with organ failure but not with mortality.