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Observational Study
. 2025 Jan 24;51(1):72.
doi: 10.1007/s00068-024-02711-8.

Prevalence, incidence, and complications of malnutrition in severely injured patients

Esmee A H Verheul  1 , Suzan Dijkink  2   3 , Pieta Krijnen  2   4 , Jochem M Hoogendoorn  3 , Sesmu Arbous  5 , Ron Peters  6 , George C Velmahos  7 , Ali Salim  8 , Daniel D Yeh  9 , Inger B Schipper  2
Affiliations
Observational Study

Prevalence, incidence, and complications of malnutrition in severely injured patients

Esmee A H Verheul et al. Eur J Trauma Emerg Surg. .

Abstract

Background: Severely injured patients may suffer from acute disease-related or injury-related malnutrition involving a marked inflammatory response. This study investigated the prevalence and incidence of malnutrition and its relation with complications in severely injured patients admitted to the intensive care unit (ICU).

Methods: This observational prospective cohort study included severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU of five level-1 trauma centers in the Netherlands and United States. Malnutrition was defined as a Subjective Global Assessment score ≤ 5. Complications included systemic-, surgery-, and fracture-related complications, pneumonia, urinary tract infection, deep venous thrombosis, and pulmonary embolism. In-ICU and in-hospital mortality were recorded separately. The complication rate was compared between patients who had or developed malnutrition and patients who remained well-nourished, using multivariable logistic regression analysis.

Results: Of 100 included patients, twelve (12%) were malnourished at admission. Of the 88 well-nourished patients, 44 developed malnutrition during ICU admission, (ICU incidence 50%, 95% confidence interval [CI] 40-60%). Another 18 patients developed malnutrition at the ward (overall in-hospital incidence 70%, 95% CI 61-80%). The 62 patients who developed malnutrition and 12 patients who were malnourished upon admission had more complications than the 26 patients who remained well-nourished (58% vs. 50% vs. 27% respectively; p = 0.03; Odds Ratio 3.4, 95% CI 1.2-9.6).

Conclusions: 50% of severely injured patients developed malnutrition during ICU admission, increasing to 70% during hospital admission. Malnutrition was related to an increased risk of complications. Recognition of sub-optimally nourished severely injured patients and assessment of nutritional needs could be valuable in optimizing their clinical outcomes.

Level of evidence: Level III, Prognostic/Epidemiological.

Keywords: Complications; Intensive care unit; Malnutrition; Severe injury; Severely injured.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Subjective Global Assessment rating form [8]
Fig. 2
Fig. 2
Distribution of severely injured patients according to their nutritional status based on the Subjective Global Assessment (SGA)
See this image and copyright information in PMC

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