Are Visceral Proteins Valid Markers for Nutritional Status in the Burn Intensive Care Unit?

摘要

Nutrition plays an important role in improving outcomes for patients suffering from thermal injury.1,2 Resting energy expenditure (REE) increases twofold and protein loss increases threefold compared with preinjury levels.3,4 Providing adequate nutrition is essential to decrease infection rates and to promote wound healing.2 Monitoring nutritional adequacy is difficult for many reasons. Edema following fluid resuscitation limits the use of anthropometric measures. Nutritional markers are commonly used in majority of burn intensive care units, yet these are unreliable because of the inflammatory response. Production of hepatic proteins is reprioritized after thermal injury. Positive acute-phase reactant levels, such as C-reactive protein (CRP), haptoglobin, and -1-antitrypsin, are increased, whereas visceral protein levels (negative acute-phase reactants), such as albumin, prealbumin, transferrin, and retinolbinding protein, are decreased. Therefore, many researchers question the use of nutritional markers in trauma patients.5 In fact, their reliability in any disease process is considered controversial.6 Graves et al found that 85% of dietitians at burn care centers use visceral proteins for nutritional assessment,7 but the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition8 2009 guidelines state that visceral proteins have not been validated for use in nutritional assessment for critically injured patients.