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Purpose: The purpose of our meta-analysis was to look at the impact of modified nutrition risk in the critically ill (mNUTRIC) on mortality in patients with critical illness. Materials and methods: Literature relevant to this meta-analysis was searched in PubMed, Web of Science, and Cochrane Library till 26 August 2023. Prospective or retrospective studies, patients >18 years of age, studies that reported on mortality and mNUTRIC (mNUTRIC cut-off score) were included. The QUIPS tool was used to evaluate the risk for bias in prognostic factors. Results: A total of 31 studies on mNUTRIC score, involving 13,271 patients were included. The summary area under the curve (sAUC) of 0.80 (95% CI: 0.76-0.83) illustrates the mNUTRIC score's strong discrimination. The pooled sensitivity was 0.79 (95% CI: 0.74-0.84) and pooled specificity was 0.68 (95% CI: 0.63-0.73). We found no discernible variation in the mNUTRIC's prediction accuracy among cut-off values of <5 and >5 in our subgroup analysis and sAUC values were 0.82 (95% CI: 0.78-0.85) and 0.78 (95% CI: 0.74-0.81), respectively. Conclusion: We observed that mNUTRIC can discriminate between critically ill individuals and predict their mortality. Prospero: CRD42023460292. How to cite this article: Prakash J, Verma S, Shrivastava P, Saran K, Kumari A, Raj K, et al. Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(5):495-503.
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BACKGROUND: Prediction of outcomes in severe COVID-19 patients using chest computed tomography severity score (CTSS) may enable more effective clinical management and early, timely ICU admission. We conducted a systematic review and meta-analysis to determine the predictive accuracy of the CTSS for disease severity and mortality in severe COVID-19 subjects. METHODS: The electronic databases PubMed, Google Scholar, Web of Science, and the Cochrane Library were searched to find eligible studies that investigated the impact of CTSS on disease severity and mortality in COVID-19 patients between 7 January 2020 and 15 June 2021. Two independent authors looked into the risk of bias using the Quality in Prognosis Studies (QUIPS) tool. RESULTS: Seventeen studies involving 2788 patients reported the predictive value of CTSS for disease severity. The pooled sensitivity, specificity, and summary area under the curve (sAUC) of CTSS were 0.85 (95% CI 0.78-0.90, I2 =83), 0.86 (95% CI 0.76-0.92, I2 =96) and 0.91 (95% CI 0.89-0.94), respectively. Six studies involving 1403 patients reported the predictive values of CTSS for COVID-19 mortality. The pooled sensitivity, specificity, and sAUC of CTSS were 0.77 (95% CI 0.69-0.83, I2 = 41), 0.79 (95% CI 0.72-0.85, I2 = 88), and 0.84 (95% CI 0.81-0.87), respectively. DISCUSSION: Early prediction of prognosis is needed to deliver the better care to patients and stratify them as soon as possible. Because different CTSS thresholds have been reported in various studies, clinicians are still determining whether CTSS thresholds should be used to define disease severity and predict prognosis. CONCLUSION: Early prediction of prognosis is needed to deliver optimal care and timely stratification of patients. CTSS has strong discriminating power for the prediction of disease severity and mortality in patients with COVID-19.
Subject(s)
COVID-19 , Humans , Tomography, X-Ray Computed , Prognosis , Patient AcuityABSTRACT
Background and Aims: Postoperative pain for patients having hip arthroplasty ranges from moderate to severe. Many regional anaesthesia procedures treat postoperative pain to improve functional ability and quality of life. Evidence comparing the analgesic effects of the pericapsular nerve group (PENG) block and fascia iliaca compartment block (FICB) remains unclear. The analgesic efficacies of PENG and FICB in hip arthroplasty were compared to determine which technique is associated with superior analgesia. Methods: The electronic databases (PubMed, Cochrane Library, Google Scholar and Web of Sciences) were searched for published randomised controlled trials (RCTs) till 5 April 2023 comparing PENG block vs. FICB following hip arthroplasty. The primary outcome was pain scores [numerical rating scale (NRS) or visual analogue scale (VAS)] between 0 and 10 at rest and during movement at 24 h. Secondary outcomes included pain scores at rest and during movement within 30 min, at 6 h and 12 h, time to first rescue analgesia and cumulative postoperative opioid use in 24 h. We assessed the risk of bias using the Cochrane Collaboration Risk-of-Bias 2 tool. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the certainty of the evidence was assessed. Subgroup analysis was performed to explore the source of heterogeneity. Results: We included 12 RCTs examining 644 patients. Pain scores at rest at 24 h (standardised mean differences (SMDs): 0.17; 95% confidence interval (CI): -0.90 to 1.23; P = 0.76, moderate certainty) and during movement at 24 h (SMD: -0.58, 95% CI: -1.53 to 0.38, P = 0.24, moderate certainty) were not different in both PENG block and FICB. Pain scores at rest and during movement within 30 min may be lower with PENG block than FICB. However, the pain score at rest and during movement at 6 h and the time to first rescue analgesia were not different between the two treatment arms. The mean opioid consumption in oral morphine equivalents (mg) in 24 h may be lower with PENG than FICB. Conclusion: We observed no difference between the PENG block and the FICB at 24 h for pain at rest and movement with a moderate degree of certainty. However, PENG block showed improved analgesia within 30 min at rest and during movement, and reduce postoperative opioid consumption in 24 h with moderate certainty of evidence. Further large-scale and high-quality RCTs are required to supplement the present findings.
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Background and Aims: Sepsis-induced immunosuppression appears to be reversible with immunomodulatory drugs. Mycobacterium indicus pranii (MIP) stimulates the Th1 type of immune response. This systematic review and meta-analysis of randomised controlled trials (RCTs) was aimed to find out if MIP is effective at improving clinical outcomes in sepsis patients. Methods: The databases (PubMed, Google Scholar, Web of Science, and Cochrane Library), along with preprint servers until June 2023, were searched. The methodology was evaluated using the 'Cochrane Collaboration risk of bias-2 tool' for RCT. The study included patients more than 18 years of age with sepsis within 48 h of first organ dysfunction. The primary outcome was 28-day mortality, and secondary outcomes were the length of stay in the intensive care unit (ICU), days on vasopressor support, ventilator-associated pneumonia (VAP), secondary infections, catheter-related bloodstream infections (CRBSI), and the delta sequential organ failure assessment (SOFA) score. Results: The meta-analysis included two studies with 252 participants. In a pooled analysis, mortality in the MIP group was 43% lower than in the control (RR: 0.57, 95%CI: 0.33-1); however, this difference was statistically not significant. We observed the days on a vasopressor day (standardised mean difference [SMD]: 0.38; 95%CI: -1.20 to 0.44), length of ICU stay (SMD: 0.46; 95%CI: -1.44 to 0.51), secondary infection (RR: 0.75; 95%CI: 0.19-3.01), VAP (RR: 0.6; 95%CI: 0.28-1.56), CRBSI (RR: 0.97, 95%CI: 0.14-6.98), delta SOFA score (SMD: 0.88, 95%CI: -1.66 to - 0.10) between the two groups. Conclusions: Our findings observed preliminary evidence in the trends for a positive association of MIP with better outcomes in sepsis patients.
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Background: Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration. The gold standard method for discriminating the causes of thrombocytopenia is bone marrow examination, but it is invasive and expensive. Therefore, an alternative method should be introduced as a first-line diagnostic procedure. Of late, the automated blood cell analyzer has made it possible to assess the cause of thrombocytopenia through various machine-derived parameters, known as platelet indices, which include the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are provided as a part of routine complete blood count. Objectives: The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia. Method: An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. The study group was classified into two groups: hypo-productive and hyper-destructive. Platelet indices were recorded and compared in the two groups along with the normal group. Results: The mean platelet count (10^3 µL) in the normal, hypo-productive, and hyper-destructive groups was 232.03 ± 74.84, 73.00 ± 36.52, and 68.28 ± 38.24, respectively. The MPV and mean PCT in the normal, hypo-productive, and hyper-destructive groups were 9.46 ± 1.68fL, 8.99 ± 1.49fL, and 11.35 ± 1.35fL and 0.22 ± 0.06%, 0.07 ± 0.04%, and 0.08 ± 0.05%, respectively. The mean PDW in the normal, hypo-productive, and hyper-destructive groups was 15.66 ± 1.76fL, 17.63 ± 1.01fL, and 18.32 ± 1.10fL, respectively. Conclusion: In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia.
