Nutritional indices may have prognostic value in elderly critically ill patients with sepsis

Abstract

Aim: Nutritional indicators are associated with adverse outcomes in critically ill elderly patients. In this study, we aimed to evaluate the prognostic potential of prealbumin and albumin in the prediction of mortality in elderly patients with sepsis. Material and Method: A total of 108 patients who developed intensive care unit-acquired sepsis were divided into two groups: Survivors (n=72) and Non-survivors (n=36). Results: Patients in the Non-survivors group were often older (68 vs 74) and presented lower prealbumin (15.1 vs 11), and higher Charlson index (4 vs 6), Sequential Organ Failure Assessment (SOFA) score (8.5 vs 10), C-reactive protein (CRP) (68.8 vs 91) and procalcitonin (PCT) (6 vs 8.4) (p< 0.05). The area under the curve of PCT was the highest at 0.74. Prealbumin presented the best sensitivity (75%) and 12 mg/dL cut-off value, while PCT had the best specificity (75%) and a cut-off value of 7 ng/mL. Although prealbumin was negatively correlated to SOFA score in a significant way (r=-0.226, p=0.019), White blood cells, CRP, and PCT were positively correlated to SOFA score (r=0.198, p=0.040; r=0.233, p=0.015; r=0.286, p=0.003, respectively). In addition, a weak negative correlation was observed between prealbumin and CRP and PCT (r=-0.203, p=0.037; r=-0.215, p=0.026, respectively). Multivariate analysis showed that a reduction in serum prealbumin levels compared to steady prealbumin greater than 4 mg/dL increased the risk of death by 85% (aHR: 1.85, 95% CI: 1.05-2.56, p=0.029). Conclusion: Changes in serum prealbumin in the acute phase of sepsis may assist in determining the risk of mortality and in the administration of specific treatment in critically ill elderly patients.