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PRONosTIC VALUE OF NUI'RITION-REXATRD VARIABLES IN ICU PATIENTS. B =O*, JM mL=*, M G?UW?E*, M DEFAYOLLE**, I? YOUI~U*, *$&vices de Reanimation &dicale et d'Imnunologie CHJ EREST, ** Institut MERIEUX LYON (F'RANB).

Protein calorie malnutrition, frequent in ICU patients, increases morbidity and mortality

rates. Several so called nutritional indices have been elaborated to predict the outcome of these patients but are limited to diagnosis-related groups or are uneasy to aF@Y cur- rently. we performed a prospective study to evaluate, among simply n-easurable nutritio- nal variables, which are the best predictive parameters of morbidity. The latter was d&i- ned as secondary severe sepsis and/or post operative complications. Patients and r~thcds 4C0 unselected ICU patients were included, 252 men and 148 Wn, mean age 57 years (18-84 years) ; 74 patients underwent operative procedures. They were all under meohanical ventilation and received early artificial nutrition, enteral and/or parenteral, within standard reccxmnandations. Variables tested were : % ideal body,weight, midarm muscle circumference, triceps skinfold thickness, creatinine height index, serum albumin (Alb), transferrin (Tr), thyroxin binding prealbumin (TBPA), retinol binding pro- tein (REP) and total lymphocyte count (Ly).Statistical analysis included multifactorial analysis, predictive values calculation, ROC curves and segmentatin determination. Results 128 patients (32 %) experienced severe secondary complications ; among the 74 surgical patients, 37 (42 %) had post operative complications. Only Alb, Tr and Ly were significantly lmr in the ccmplications group an$the highest_,pred&;l;v vva$e. The res-

&"d ive predictive cut-off

ination of at least 2 of sp ints were 420 umOl.1 I,65 g-1 ese variables was highl; predictive'of morbidity

. The corn : sensitivi-

ty 71 %, specificity 60 %, positive predictive value 59 %, negative predictive value 71 %. Moreover ccmplications wefe significantly more frequent in patients with at least two a- normal variables (p < 10 ). These results, validated in a prospective serie of 203 unselected patients proved reliable whatever the patient's age, sexe and primary illness.'Ihasevariables are simple to obtain on admission at a very low cost and prove to be reliable to select high risk patients for whom nutritional assistance must be optimum.

CONVENTIONAt NUTRITIONAL PARAMETERS, SOMATOMEDIN-C/INSULIN-LIKE GROWTH FACTOR-I (Sin-C/ IGF-I) AN0 BODY c0MP0sITI0N PRIOR TO AND FOLLOWING ~ILIOPANCREATIC DIVERSION (BPD). Barreca A.*, Adami G.F., Fortini P.*, Castagnola M., Scopin$ro N., Minuto F.* Patologia Chirurgica - Cattedra di Endocrinologia *, Universita di Genova

Thirty subjects (7 males) were studied prior to, three months (3M) and one year (IV) following BPD. Serum albumin (A) and trasferrin (TF) concentration, daily urinary crea- tinine excretion (CE) and circulating acidextractable Sm-C/IGF-I were determined. Body composition was evaluated from Total Body Water (TBW) and Total Body Sodium (TBNa), measu red by isotope dilution. Total Body Potassium (TBK) was indirectly calculated from TBW - and TBNa. Fifteen healthy volouteers (4 males) served as controls for body composition studies. At 3M, the loss of weight was accounted for by a reduction of both lean (from 79 kg to 68 kg, p < .005) and fat sector size (from 45 kg to 28 kg, p <.01) while the fur- ther decrease of body weight was mainly due to a reduction of fat (from 28 kg to 12 kg, P <.Ol). At this time, body composition became similar to the controls, A negative linear relationship (p (0.05) between TBNa/TBW and TF was evidenced, while Sm-C/IGF-I was positL vely correlated with both CR (p <.Ol) and TBK (p <.05) and negatively correlated with TBNaITBK (p c.05). Thus, both TF and Sm-C/IGE-I reflect body composition and have to be considered as reliable nutritional parameters.The positive correlation between Sm-C/IGF-I and TBK and CR which reflects the size of body cell mass is in a@eement with an ubiquita rius synthesis of this peptide. Within the first postoperative year, 4 patients (13%) de- veloped a frank malnutrition, with both lower than normal A, TF and Sm-C/IGF-I and higher TBNa/TBW and TBNa/TBK ratio. In five patients, in spite of normal A and TF, circulating Sm-C/IGF-I was more than 2 s.d. below standard values in our laboratory (1.14 + .07) and TBNWBK ratio was significantly (p <.Ol) higher than in controls. This suggests that circulating Sm-C/IGF-I can detect mild malnutritional conditions which are not evidenced by the conventional parameters,

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