Jeyakumar Henry

Bio: Jeyakumar Henry is an academic researcher. The author has contributed to research in topics: Odds ratio & Body mass index. The author has an hindex of 2, co-authored 2 publications receiving 90 citations.

Higher BMI is associated with reduced mortality but longer hospital stays following ICU discharge in critically ill Asian patients.

Abstract: Summary Background & aims Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied. Methods We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014. Demographics, BMI, MV, comorbidities, ICU scores (Acute Physiology And Chronic Health Evaluation (APACHE) II and sequential organ failure assessment (SOFA)), use of vasopressor, renal replacement therapy and calorie supplementation were collected from the ICU database. BMI was categorized into four groups according to the World Health Organization's Asian BMI recommendation. Post-ICU LOS (days) was calculated from ICU discharge to hospital discharge in hospital survivors. We used multivariable logistic regression to identify factors associated with 28-day mortality and post-ICU LOS of more than 7 days. Results In a cohort of 273 patients (male 62%, mean age 58.4 ± 17 years), the prevalence of overweight/obesity was 53%. In the bivariate analysis, 28-day mortality was lower (p = 0.014) and post-ICU LOS longer (p = 0.01) in the overweight/obese groups. In the multivariable logistic regression analysis, APACHE II (Odds ratio, OR 1.10, CI 1.05–1.16), SOFA (OR 1.17, CI 1.05–1.31), duration of MV (days, OR 1.14, CI 1.05–1.25) were associated with increased and higher BMI groups (p Conclusion In multiethnic critically ill Asian patients, the prevalence of overweight/obesity was high. Although higher BMI was associated with reduced risk of 28-day mortality, obese patients stayed significantly longer in the hospital following ICU discharge.

Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults

Abstract: Beslenme desteği kritik yetişkin hastaların bakımında önemlidir. Fakat kritik hasta için uygun kalori hedefi net değildir. Hedeflenen kaloriye ulaşılması ile protein katabolizması ve malnutrisyonun iyileştirilmesi ve bununla ilişkili morbidite ve mortalitede azalma amaçlanmaktadır. Farklı kalori miktarına sahip enteral beslenme alımını inceleyen gözlemsel çalışmalar çelişkili sonuçlar ortaya koymuştur. Kritik hastalarda rutin enteral beslenme ile yüksek kalorili enteral beslenmeyi karşılaştıran iki randomize kontrollü çalışma (RKÇ) yüksek kalorili enteral beslenme ile mortalitede bir azalma göstermemiştir. Akut akciğer hasarı veya akut solunum yetmezlikli kritik hastalarda yapılan iki RKÇ mimimum ya da trofik enteral beslenme ile (hedeflenen kalorinin %15-25) standart enteral beslenmede (SEB) benzer sonuçlar göstermiştir. Mevcut kanıtlar erken kritik hastalık sırasında eş zamanlı kalori alımına bakılmaksızın belli bir düzeyde protein alımını desteklemesine rağmen protein dışı enerji kısıtlaması yapılan hastalarda protein ihtiyacının tamamının yerine konmasının sonuçlar üzerine etkisi bilinmemektedir. Sıçanlarda yapılan bir çalışma, glukoz verilmeden protein ile beslenmenin malnutrisyon ile azalmış olan mitokondriyal fonksiyonlarda düzelme sağladığını göstermiştir. Bu nedenle diyetle yeterli protein alımı sağlanırsa kalori kısıtlamasının yararlı olabileceği öne sürülmüştür. Bu çalışmanın hipotezi protein alımı korunurken protein dışı kalori kısıtlaması (permisif hipokalorik beslenme) yapılan kritik erişkin hastalarda, standart beslenme alan hastalara göre 90 günlük sağ kalımın daha iyi olduğunun gösterilmesidir.

Association between Malnutrition and 28-Day Mortality and Intensive Care Length-of-Stay in the Critically ill: A Prospective Cohort Study

Abstract: There is limited evidence for the association between malnutrition and mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with ≥ 24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients' nutritional status within 48 h of ICU admission. Multivariable regressions were conducted in two ways: (1) presence versus absence of malnutrition, and (2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and the 28-day mortality rate was 28.0%. Malnutrition was associated with an increased risk of 28-day mortality (adjusted Relative Risk 1.33 (95% Confidence Interval: 1.05-1.69)), and this risk increased with a greater degree of malnutrition (adjusted Relative Risk 1.08 (95% Confidence Interval: 1.00-1.16) for each 1-point decrease in the 7-point SGA). No significant association was found between malnutrition and ICU-LOS. The results of this study indicated a clear association between malnutrition and higher 28-day mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

Nutritional assessment of critically ill patients: validation of the modified NUTRIC score

Abstract: In order to identify critically ill patients with high nutritional risk the modified NUTrition Risk in the Critically ill (mNUTRIC)-score was developed. This score aims to identify patients that will benefit from nutritional interventions. Few data are available on its validity. In The Netherlands, the MUST-score, a nutritional assessment tool for non-ICU patients, is commonly used in the ICU. To validate the mNUTRIC-score in Dutch ICU patients and compare its prognostic performance with the MUST-score. A single-center retrospective cohort study among 475 mechanically ventilated patients. Prognostic performance of the mNUTRIC and MUST-scores were assessed and compared for discriminative abilities for 28-day mortality and prolonged mechanical ventilation (>2 days). The discriminative ability of the mNUTRIC-score for 28-day mortality is (ROC-AUC) 0.768 (95% CI 0.722–0.814) with an associated LR+ of 1.73 (95% CI 1.53–1.95) and LR− of 0.24 (95% CI 0.14–0.39) when comparing low with high (>4) scores. Comparing low with high MUST-scores (>1) a ROC-AUC of 0.513 (95% CI 0.445–0.587) and LR+ of 1.05 (95%CI 0.77–1.45) and LR− of 0.97 (95% CI 0.71–1.17) for mortality were found. The discriminative ability for prolonged ventilation was 0.666 (95% CI 0.616–0.716) and 0.532 (95% CI 0.469–0.594) for the mNUTRIC and MUST-scores, respectively. The prognostic performance of the mNUTRIC-score for 28-day mortality is fair and comparable to other validation studies. The association with prolonged ventilation was not confirmed by our results. The mNUTRIC-score has better performance than the commonly used MUST-score. Therefore, we suggest abandoning use of the MUST-score and to recommend introduction of the mNUTRIC-score for the nutritional risk assessment of critically ill patients.

Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations

Abstract: Obesity represents a global epidemic with serious implications in public health due to its increasing prevalence and its known association with a high morbidity and mortality burden However, a growing number of data support a survival benefit of obesity in critical illness This review summarizes current evidence regarding the obesity paradox in critical illness, discusses methodological issues and metabolic implications, and presents potential pathophysiologic mechanisms Data from meta-analyses and recent studies corroborate the obesity-related survival benefit in critically ill patients as well as in selected populations such as patients with sepsis and acute respiratory distress syndrome, but not trauma However, this finding warrants a cautious interpretation due to certain methodological limitations of these studies, such as the retrospective design, possible selection bias, the use of BMI as an obesity index, and inadequate adjustment for confounding variables Main pathophysiologic mechanisms related to obesity that could explain this phenomenon include higher energy reserves, inflammatory preconditioning, anti-inflammatory immune profile, endotoxin neutralization, adrenal steroid synthesis, renin-angiotensin system activation, cardioprotective metabolic effects, and prevention of muscle wasting The survival benefit of obesity in critical illness is supported from large meta-analyses and recent studies Due to important methodological limitations, more prospective studies are needed to further elucidate this finding, while future research should focus on the pathophysiologic role of adipose tissue in critical illness