The importance of high total body water/fat free mass ratio and serial changes in body composition for predicting hospital mortality in patients with severe pneumonia: a prospective cohort study

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Abstract

Purpose

This study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient.

Methods

We conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality.

Results

Multivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission.

Conclusions

The mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-024-03302-4.

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Most cited references 41

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Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Joshua Metlay, Grant Waterer, Ann C Long … (2019)

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

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Obesity in adults: a clinical practice guideline

Sean Wharton, David Lau, Michael Vallis … (2020)

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ICU-acquired weakness

Ilse Vanhorebeek, Nicola Latronico, Greet Van den Berghe (2020)

Critically ill patients often acquire neuropathy and/or myopathy labeled ICU-acquired weakness. The current insights into incidence, pathophysiology, diagnostic tools, risk factors, short- and long-term consequences and management of ICU-acquired weakness are narratively reviewed. PubMed was searched for combinations of “neuropathy”, “myopathy”, “neuromyopathy”, or “weakness” with “critical illness”, “critically ill”, “ICU”, “PICU”, “sepsis” or “burn”. ICU-acquired weakness affects limb and respiratory muscles with a widely varying prevalence depending on the study population. Pathophysiology remains incompletely understood but comprises complex structural/functional alterations within myofibers and neurons. Clinical and electrophysiological tools are used for diagnosis, each with advantages and limitations. Risk factors include age, weight, comorbidities, illness severity, organ failure, exposure to drugs negatively affecting myofibers and neurons, immobility and other intensive care-related factors. ICU-acquired weakness increases risk of in-ICU, in-hospital and long-term mortality, duration of mechanical ventilation and of hospitalization and augments healthcare-related costs, increases likelihood of prolonged care in rehabilitation centers and reduces physical function and quality of life in the long term. RCTs have shown preventive impact of avoiding hyperglycemia, of omitting early parenteral nutrition use and of minimizing sedation. Results of studies investigating the impact of early mobilization, neuromuscular electrical stimulation and of pharmacological interventions were inconsistent, with recent systematic reviews/meta-analyses revealing no or only low-quality evidence for benefit. ICU-acquired weakness predisposes to adverse short- and long-term outcomes. Only a few preventive, but no therapeutic, strategies exist. Further mechanistic research is needed to identify new targets for interventions to be tested in adequately powered RCTs.

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Author and article information

Contributors

Wen-Feng Fang: fangwf@hotmail.com , wenfeng@cgmh.org.tw

Journal

Journal ID (nlm-ta): BMC Pulm Med

Journal ID (iso-abbrev): BMC Pulm Med

Title: BMC Pulmonary Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2466

Publication date (Electronic): 27 September 2024

Publication date PMC-release: 27 September 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 470

Affiliations

[1 ]GRID grid.413804.a, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao Sung District, ; No. 123 Ta Pei Road, Kaohsiung, 83301 Taiwan

[2 ]GRID grid.413804.a, Department of Respiratory Therapy, , Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, ; Kaohsiung, 83301 Taiwan

[3 ]Department of Nutritional Therapy, Kaohsiung Chang Gung Memorial Hospital, ( https://ror.org/00k194y12) Kaohsiung, 83301 Taiwan

[4 ]Department of Nursing, Mei Ho University, Pingtung, 91202 Taiwan

[5 ]GRID grid.418428.3, Department of Respiratory Care, , Chang Gung University of Science and Technology, ; Chiayi, 61363 Taiwan

Article

Publisher ID: 3302

DOI: 10.1186/s12890-024-03302-4

PMC ID: 11437920

PubMed ID: 39333963

SO-VID: 40f77487-9129-4233-9db4-51788896e687

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 14 January 2024

Date accepted : 19 September 2024

Custom metadata

ScienceOpen disciplines: Respiratory medicine

Keywords: body composition,hospital mortality,severe pneumonia,nutrition

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ScienceOpen disciplines: Respiratory medicine

Keywords: body composition, hospital mortality, severe pneumonia, nutrition

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The importance of high total body water/fat free mass ratio and serial changes in body composition for predicting hospital mortality in patients with severe pneumonia: a prospective cohort study

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Abstract

Purpose

Methods

Results

Conclusions

Supplementary Information

Related collections

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Most cited references 41

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Obesity in adults: a clinical practice guideline

ICU-acquired weakness

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