Abstract
Several studies have attempted to define nutritional parameters that can be used to select undernourished hospitalized patients and identify those who present higher risk of postoperative septic complications. Nevertheless, the majority of these studies do not take into consideration the severity of infectious episodes. Systems for scoring the severity of illness are of critical importance in hospital practice and clinical research. In fact, they could be used for the following purposes: (a) a more correct stratification of patients in clinical studies; (b) monitoring the evolution of the infectious complication; (c) prediction of survival; (d) optimization of the criteria for admission to and discharge from intensive care units; and (e) evaluation of quality, quantity, and costs of nutritional therapy in critically ill patients. In this article, the authors present a critical review on the clinical relevance of the methods of nutritional assessment more commonly used in clinical practice; and, moreover they discuss the more recently proposed systems for scoring the severity of illness.
Résumé
Plusieurs études ont tenté de définir les paramètres nutritifs qui peuvent être employés pour sélectionner les malades dénutris et pour identifier ceux qui présentent des risques importants de complications infectieuses postopératoires mais la majorité de ces études ne prennent pas en considération la sévérité des épisodes infectieux. En fait les systèmes de marques qui permettent d'apprécier la gravité d'une maladie sont d'une importance capitale aussi bien en ce qui concerne la pratique clinique que la recherche. Ils doivent avoir pour but: (a) de déterminer les différents groupes de malades en fonction de la gravité de leur état; (b) de contrôler l'évolution des complications infectieuses; (c) de définir les chances de survie; (d) de préciser les critères d'admission et de départ dans les unités de soins intensifs; et (e) d'evaluer la qualité, la quantité et le coût du traitement nutritif chez le patient gravement malade. Dans cet article les auteurs présentent une revue critique de la valeur clinique des méthodes courantes employées pour assurer une nutrition satisfaisante et plus encore ils apprécient la valeur des différents systèmes de marques qui permettent de définir la gravité d'une maladie.
Resumen
Una variedad de estudios han sido diseñados para tratar de definir parámetros nutricionales que puedan ser utilizados en la identificación de pacientes hospitalizados en estado de desnutrición y de aquellos que se encuentran en alto riesgo de desarrollar complicaciones sépticas postoperatorias. Sinembargo, la mayoría de estos estudios no toman en consideración el grado de severidad de los episodios sépticos. Los sistemas para categorizar la gravedad de la enfermedad son de importancia crítica tanto en la práctica hospitalaria como en la investigación clínica, y son de utilidad para los siguientes propósitos: (a) una estratificación más precisa de los pacientes en estudios clínicos; (b) monitoría de la evolución de las complicaciones sépticas; (c) predicción de supervivencia; (d) optimización de los criterios para admisión y egreso de las unidades de cuidado intensivo; y (e) evaluación de calidad, cantidad y costos de la terapia nutricional en pacientes en estado crítico. En este artículo los autores presentan una revisión crítica sobre la pertinencia clínica de los métodos de valoración nutricional más comunmente usados en la práctica clínica, y, además, discuten los sistemas recientemente propuestos para categorizar la severidad de la enfermedad.
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Dionigi, R., Cremaschi, R.E., Jemos, V. et al. Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance. World J. Surg. 10, 2–11 (1986). https://doi.org/10.1007/BF01656084
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DOI: https://doi.org/10.1007/BF01656084