The impact of in-hospital nutritional status deterioration on treatment outcome of adult gastroenterological patients.

Background/Aim: In the current literature, data on impact of intrahospital changes in patients' nutritional status on the treatment outcome are limited. The aim of this study was to investigate the relationship between nutritional status deterioration and the treatment outcome among hospitalized gastroenterological patients. Methods: In 650 adult gastroenterological patients nutritional status on admission and at discharge was evaluated using the 6 nutritional status assessment parameters: body mass index, triceps skinfold thickness, mid-upper arm muscle circumference, serum albumin concentration, lymphocyte count and unintentional weight loss. The influence on treatment outcome was tested for the nutritional status on admission, nutritional status at discharge and intrahospital nutritional status deterioration. Results: The incidence of favorable outcome in the non-undernourished and undernourished patients on admission was in the range 93.4-97.3% and 81.2- 91.2%, respectively. The incidence of favorable outcome in the non-undernourished and undernourished patients at discharge was in the range 94-97.4% and 80.8-88.1%, respectively. Favorable outcomes were obtained in 95.6-98.9% of the patients without nutritional status deterioration and in 87.1-90.3% of the patients with nutritional status deterioration. Intrahospital nutritional status deterioration significantly influenced the outcome, no matter what assessment parameter had been used (p < 0.001 for all the applied parameters). Furthermore, only the deterioration of nutritional status was found to be an independent predictor of treatment outcome (multivariate analysis Forwald Wald, p £ 0.001; relative risk (RR) = 0.104-0.350; confidence intervals (CI) = 0.037-0.186/0.297-0.657). Conclusion: Deterioration of nutritional status is an independent predictor of adverse outcome.

Causes of rhabdomyolysis in acute poisonings.

BACKGROUND/AIM: Rhabdomyolysis (RM) is potentially lethal syndrome, but there are no enough published data on its frequency and characteristics in acute poisonings. The aim of this study was to determine the causes and severity of RM in acute poisonings. METHODS: Patients hospital charts were retrospectively screened during a one-year period in order to identify patients with RM among 656 patients treated due to acute poisonings with different agents. All the patients with RM were selected. Entrance criterion was the value of creatine kinase (CK) over 250 U/L. The severity of RM was assessed according to the Poison Severity Score. The patients were divided into three groups: the first one with mild RM (CK from 250 to 1,500 U/L), the second with moderate RM (CK from 1,500 to 10,000 U/L) and the third with severe RM (CK greater than 10,000 U/L). RESULTS: RM occurred in 125 (19%) of the patients with acute poisonings. It was mainly mild (61%), or moderate (36%), and only in 3% of the patients was severe RM. The incidence of RM was the highest in poisonings with opiates (41%), pesticides (38%), neuroleptics (26%), anticonvulsants (26%), ethyl alcohol (20%), and gases (19%). Psychotropic agents were the most common causes of poisoning, and consequently of RM. Fatal outcomes were registered in 32 (25.60%) of all RM patients. The incidence of fatal outcomes in poisonings with mild, moderate and severe RM was 19.73%, 31.11% and 75%, respectively. CONCLUSION: RM syndrome occurs at a relatively high rate in acute poisonings. Although agent's toxicity is crucial for the outcome, severe RM and its complications may significantly influence the clinical course and prognosis of poisoning. Routine analysis of CK, as a relevant marker for RM may indicate the development of RM in acute poisoning and initiate prompt therapeutic measures in preventing acute renal failure as the most frequent consequence of extensive rhabdomyolysis.