Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients?

Abstract

Background: The Subjective Global Assessment (SGA) is a validated nutrition assessment tool that is not commonly used to evaluate the nutritional status of patients admitted to the intensive care unit (ICU).

Objectives: The aims of this study were to determine the prevalence of malnutrition in critically ill medical patients using the SGA and to determine whether the SGA was predictive of patient outcome.

Materials and methods: A retrospective chart review was performed on 57 consecutive patients admitted to a single tertiary care medical ICU and requiring mechanical ventilation over a 6-month time period. All SGA assessments were performed by a single dietitian trained in this assessment technique. Multiple factors including patient demographics, severity of illness, length of mechanical ventilation, length of ICU stay, and mortality were abstracted from the charts.

Results: The prevalence of malnutrition on admission as assessed by the SGA was 35%. Severity of illness as determined by Acute Physiology and Chronic Health Evaluation II (APACHE II) score was not different between the SGA groups. Mortality rates were significantly higher in the moderately (45.5%) and severely malnourished (55.6%) groups than in the well-nourished group (10.8%; P = .004).

Conclusion: Malnutrition on admission is common in critically ill medical patients. Malnutrition, as assessed by SGA at admission to ICU, is associated with increased mortality and thus can serve as a valuable prognostic tool in the assessment of critically ill patients. Given that that the SGA is a simple bedside assessment, it should be considered for routine use in assessing critically ill patients.

Keywords: Subjective Global Assessment; critically ill; intensive care unit; malnutrition; mortality; nutrition assessment.