Acceso usuarios
Yulia Wullur, Nurpudji Astuti Taslim, A.Yasmin Syauki, Raymond Lim, Rury L. Saptari, Haerani A. Rasyid, Aminuddin Aminuddin, Andi Faradillah
Introduction: The dynamic ICU environment requires theuse of accurate prognostic indicators to assess patient outcomes and guide clinical interventions. Nutritional status andi nflammation are important factors influencing patient outcomes in the ICU. Several prognostic indicators have been proposed to evaluate the prognostic value of NLR, PNI, and CRP to Albumin Ratio in predicting mortality in ICU patients with different levels of nutritional risk.
Methods: This observational retrospective cohort study was conducted in the ICU of Wahidin Sudirohusodo Hospital,Indonesia, from April 2022 to March 2023. All patients admitted to the ICU during the study period were considered. Data collected from medical records included patient demographics,clinical characteristics, prognostic indicators, and outcomes.Bivariate and multivariate regression analysis was used to evaluate the associations between prognostic indicators and mortality both in low-risk and high-risk subgroup. The resultswere presented as hazard ratios (HRs) with 95% confidenceintervals (CIs). To predict accuracy of prognostic biomarker, Receiver Operating Characteristic (ROC) curve analysis wa sconducted. The area under the ROC curve (AUC) was calculated to evaluate the discriminative ability of each biomarker.
Result: In a study of 1,106 ICU patients. The length ofstay in the ICU and hospital for survivors is shorter than fornon-survivors. Hazard ratio analysis showed that higher PNI significantly reduced the risk of death (un adjusted HR 0.914,adjusted HR 0.910), where as higher CAR and NLR were asociated with increased risk of death (CAR unadjusted HR1.020, adjusted HR 1.017; unadjusted NLR HR 1.018, ad-justed HR 1.014). This effect was less pronounced in patients at high nutritional risk, with non significant HR values. ROC curve analysis showed that CRP/Albumin (AUC: 0.696), NLR(AUC: 0.575), and PNI (AUC: 0.325).
Conclusion: NLR, PNI, and CAR are valuable prognostic indicators in ICU settings, providing crucial information on mortality risk especially in patients with low nutritional risk. The data supports their use in clinical assessments to tailor interventions that address inflammation and nutritional deficits.
