Search

Introduction: Controversy 1: The role of albumin in nutritional assessment.

Introduction: CIPA (Control of Food Intake, Protein, and Anthropometry) nutritional screening is positive when one of the following conditions is met: Control of Food Intake for 48-72h <50%; Albumin <3g/dL, Body Mass Index <18.5kg/m 2 or Arm Circumference ≤22.5cm. Following its validation in non-surgical inpatients, the same process was performed with surgical inpatients., Objectives: Validity of the CIPA screening tool in surgical inpatients by comparison with Subjective Global Assessment (SGA) and analysis of clinical outcomes., Material and Methods: A prospective study of hospitalized surgical patients, evaluating the prevalence or risk of malnutrition through CIPA and SGA. Analysis of hospital malnutrition according to CIPA screening and association with the clinical outcomes of median length of stay, mortality and early readmission. Concordance between both screening methods by Kappa Index (κ), sensitivity (S) and specificity (SP)., Results: A total of 226 patients were analysed. The prevalence of malnutrition or risk of malnutrition was identified by CIPA in 35.40% and by SGA in 30.08%. CIPA is capable of detecting patients at a greater risk of mortality during hospitalization (5% vs. 0%, P=.006), unlike the SGA (2.94% vs. 1.27%, P=.385). CIPA also detected patients with higher median length of stay (21 days [IQR 14-34 days] vs. 14.5 days [IQR 9-27 days], P=.002) and rate of early readmissions (25.3% vs. 8.2%, P<.001). S and SP of CIPA vs. SGA was 70.59% and 79.75%, respectively; Kappa index was 0.479 (P<.001)., Conclusions: Using CIPA nutritional screening, the prevalence and risk of malnutrition in surgical patients is high, and they present poorer clinical outcomes, making CIPA valid and effective in this type of patients., (Copyright © 2020 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol ( n = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; p < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group ( p = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.

Introduction: the preliminary nutritional screening tool CIPA (food intake, proteins, anthropometry) is positive when it fulfills one of the following: control food intake (CI) 48-72 h < 50%, albumin < 3 g/dl, total protein < 5 g/dl, body mass index (BMI) < 18,5 kg/m2 or mid-upper arm circumference (MUAC) ≤ 22,5 cm. The use of two protein parameters increases costs and difficulty; one of them can be suppressed without affecting validity., Objectives: to evaluate the effectiveness of screening CIPA after exclusion of total protein., Method: prospective study of hospitalized patients; prevalence or risk of malnutrition was evaluated through CIPA and Subjective Global Assessment (SGA). Hospital malnutrition according to complete CIPA screening (with total proteins and albumin, [CIPAc] and without total proteins [CIPAw/p]) and concordance between both methods were analyzed, as well as the association of the positive screening result with clinical outcomes., Results: three hundred and forty-three patients were analyzed. The prevalence or risk of malnutrition identified by complete CIPA (c) was 38.19% (33.02-43.36); by CIPA without protein (w/p), 37.32% (32.17-42.46); and SGA was 29.15% (24.32-33.99). Kappa index: 0.981 between both CIPAs, p < 0.001. Both CIPA and SGA detect patients with higher mortality in hospital and one month after discharge. Early readmission was higher in positive CIPA, statistical significantly in CIPAw/p (screening with positive results 21.88% vs screening with negative results 13.49%, p = 0.044), SGA 20.01% vs 15.23%, p = 0.28. Length of stay was higher in patients with positive screening in CIPAc, CIPAw/p and SGA., Conclusions: CIPAw/p is equally or more effective than the previously validated full CIPA; therefore, it could replace the latter saving costs. The prevalence of malnutrition is high in both variants and they are able to predict which patient has worse clinical prognosis.

Background: Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system., Methods: The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m 2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention., Discussion: This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital., Trial Registration: Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.

Introduction: Malnourishment in hospitalized patients is very prevalent and therefore it is important to implement screening methods. A mixed nutritional screening method (CIPA) has been developed at our center; this method includes four parameters: (a) control of intakes for 72 h; (b) BMI; (c) proteins; and (d) albumin., Objectives: (1) To know the prevalence of malnourishment at the Internal Medicine Department of our Center; (2) To analyze the variables associated to higher prevalence of malnourishment., Materials and Method: The results of the nutritional screening tests carried out in 305 patients admitted to the Internal Medicine Department in the period of November of 2012-October of 2013 were retrospectively reviewed. The prevalence of hospital malnourishment was analyzed, as well as the association of a positive screening test (at least one positive item) with the following variables: BMI, age, gender, underlying disease, hospital staying, early re-admittance (< 1 month) and hospital mortality., Results: The test yielded a positive result in 23% of the patients. Patients with a positive screening test had lower BMI (24.9 ± 7.2 vs. 27.8 ± 6.4 kg/m; p = 0.002). Neoplastic and infectious pathologies were associated with greater positivity (35.3 and 28.9%, respectively; p = 0.006). Gender and age were not associated with a positive screening test. Patients with a positive screening test had longer mean hospital staying (26.7 ± 25 vs. 19.4 ± 16.5; p = 0.005), higher early re-admittance rates (18.6 vs. 6.8%; p = 0.003) and higher mortality (30 vs. 10.3%; p < 0.001)., Conclusions: The CIPA screening test can detect malnourished patients and predict worse clinical prognosis (mortality, mean hospital staying and early readmittance)., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool.Material and Methods: An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively; n = 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs).Results: The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days; p = 0.230). On the surgical ward, more patients from the control group moved to critical care units (p = 0.014); the other clinical variables did not vary. Quality of life at discharge was similar (p = 0.53), although slightly higher in the CIPA group at 3 months (p = 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective.Conclusions: The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients. [ABSTRACT FROM AUTHOR]

Introduction: There is no gold-standard method for hospital nutrition screening. The new screening tool termed Control of Food Intake, Protein, and Anthropometry (CIPA) gives positive results when at least one of the following parameters is met: control of food intake for 72 h < 50%, serum albumin < 3 g/dl, body mass index < 18.5 kg/m2 or mid-upper arm circumference ≤ 22.5 cm. This method was validated in comparison with Subjective Global Assessment (SGA) in hospitalized patients with non-surgical pathologies.Material and Methods: A prospective, longitudinal study was performed on 221 consecutively enrolled patients. Prevalence or risk of malnutrition was estimated with CIPA vs. SGA screening at hospital admission and the concordance (k index - K) between the two methods and their sensitivity (S) and specificity (SP) were studied. Mean length of stay (LOS), mortality, and rate of early readmission were analyzed.Results: The prevalence or risk of malnutrition identified by CIPA and SGA was 35.7% and 23.1%, respectively. K was 0.401 (p < 0.001); S and SP of CIPA vs. SGA were 72.5% and 75.3%, respectively. In contrast to SGA, CIPA-positive patients had an increased mean LOS compared to the negative ones (19.53 vs. 12.63 days, p < 0.001). Both methods detected a major risk of mortality in positive patients, but no difference in early readmission.Conclusions: The CIPA and the SGA screening tools detect patients with a higher risk of mortality, but only CIPA identifies patients with an increased mean LOS. CIPA screening proved valid for use in non-surgical inpatients. [ABSTRACT FROM AUTHOR]