Background <p>Malnutrition is associated with poor prognosis in critically ill elderly patients with hemorrhagic cerebrovascular disease (HCVD), and in this study, the effectiveness of nutritional assessment tools such as Nutritional Risk Screening 2002 (NRS-2002), Controlling Nutritional Status (CONUT), and Geriatric Nutritional Risk Index (GNRI), as well as the severity-of-illness score Acute Physiology and Chronic Health Evaluation II (APACHE-II), was evaluated for predicting prognosis in this population.</p> Methods <p>This study was designed as a retrospective cohort study. Patients aged 65 years and older who were admitted to the intensive care unit from the emergency department with a diagnosis of HCVD between January 1, 2018, and June 30, 2024, were included. Patients with incomplete medical records and those with post-traumatic or mass-related intracranial hemorrhage were excluded. Clinical and laboratory findings and outcomes of all patients, were recorded. The NRS-2002 (3 parameters: nutritional status, disease severity, and age), APACHE-II (12 physiological parameters), CONUT (serum albumin, total cholesterol, and lymphocyte count), and GNRI (serum albumin and body mass index) scores were calculated. Statistical analysis was performed using the Chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Receiver Operating Characteristic (ROC) curve analysis was conducted to evaluate the predictive value of nutritional screening scores on mortality. A p-value of &lt; 0.05 was considered statistically significant.</p> Results <p>A total of 113 patients were included, with an overall mortality rate of 57.5%. The NRS-2002 showed weak predictive ability for mortality (AUC = 0.67, <i>p</i> = 0.002). The APACHE-II demonstrated very good predictive performance (AUC = 0.84, <i>p</i> &lt; 0.001). The CONUT score showed excellent discrimination (AUC = 0.92, <i>p</i> &lt; 0.01), while the GNRI also demonstrated very good predictive value (AUC = 0.83, <i>p</i> &lt; 0.001).</p> Conclusion <p>The CONUT score may serve as a valuable tool for assessing nutritional risk in patients with HCVD, both in the emergency department and in the intensive care unit.</p>

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The role of the nutritional screening tools in predicting clinical outcomes among older adults with hemorrhagic cerebrovascular disease

  • Ahmet Burak Urfalioglu,
  • Erdem Aksay,
  • Yeliz Simsek,
  • Onder Yesiloglu,
  • Mustafa Oguz Tugcan,
  • Saliha Dilek Oztoprak Hacioglu,
  • Begum Seyda Avci,
  • Adnan Kuvvetli,
  • Akkan Avci

摘要

Background

Malnutrition is associated with poor prognosis in critically ill elderly patients with hemorrhagic cerebrovascular disease (HCVD), and in this study, the effectiveness of nutritional assessment tools such as Nutritional Risk Screening 2002 (NRS-2002), Controlling Nutritional Status (CONUT), and Geriatric Nutritional Risk Index (GNRI), as well as the severity-of-illness score Acute Physiology and Chronic Health Evaluation II (APACHE-II), was evaluated for predicting prognosis in this population.

Methods

This study was designed as a retrospective cohort study. Patients aged 65 years and older who were admitted to the intensive care unit from the emergency department with a diagnosis of HCVD between January 1, 2018, and June 30, 2024, were included. Patients with incomplete medical records and those with post-traumatic or mass-related intracranial hemorrhage were excluded. Clinical and laboratory findings and outcomes of all patients, were recorded. The NRS-2002 (3 parameters: nutritional status, disease severity, and age), APACHE-II (12 physiological parameters), CONUT (serum albumin, total cholesterol, and lymphocyte count), and GNRI (serum albumin and body mass index) scores were calculated. Statistical analysis was performed using the Chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Receiver Operating Characteristic (ROC) curve analysis was conducted to evaluate the predictive value of nutritional screening scores on mortality. A p-value of < 0.05 was considered statistically significant.

Results

A total of 113 patients were included, with an overall mortality rate of 57.5%. The NRS-2002 showed weak predictive ability for mortality (AUC = 0.67, p = 0.002). The APACHE-II demonstrated very good predictive performance (AUC = 0.84, p < 0.001). The CONUT score showed excellent discrimination (AUC = 0.92, p < 0.01), while the GNRI also demonstrated very good predictive value (AUC = 0.83, p < 0.001).

Conclusion

The CONUT score may serve as a valuable tool for assessing nutritional risk in patients with HCVD, both in the emergency department and in the intensive care unit.