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      Efficacy of Corrected Rapid Turnover Protein Increment Index (CRII) for Early Detection of Improvement of Nutrition Status in Patients with Malnutrition

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          Abstract

          Serum prealbumin level is useful for assessment of changes in nutritional status but it is markedly affected by the inflammation. In this study, we examined the efficacy of the corrected rapid turnover protein increment index (CRII) for prealbumin, which is calculated as [prealbumin level/C-reactive protein (CRP) level on the assessment day]/[prealbumin level/CRP level on the day of starting nutritional care], for prediction of improvement of nutritional status in patients with malnutrition. The subjects were 50 hospitalized patients with low albuminemia, who were receiving nutritional care. Serum concentrations of albumin, prealbumin and CRP were measured every week for 5 weeks. We defined patients whose serum albumin level was elevated by more than 0.2 g/dl after 5 weeks as those showing improved nutritional status. There was a significant difference in the prealbumin level between improved and unimproved patients at 5 weeks after the start of nutritional support. On the other hand, the prealbumin CRII value showed a significant difference between the groups at 1 and 2 weeks after the start of nutritional support. In conclusion, assessment of prealbumin CRII is useful for early prediction of improved nutritional status in patients with malnutrition.

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          Most cited references14

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          American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.

          (1992)
          To define the terms "sepsis" and "organ failure" in a precise manner. Review of the medical literature and the use of expert testimony at a consensus conference. American College of Chest Physicians (ACCP) headquarters in Northbrook, IL. Leadership members of ACCP/Society of Critical Care Medicine (SCCM). An ACCP/SCCM Consensus Conference was held in August of 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic variables by which a patient could be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods were recommended when dealing with septic patients as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.
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            Hepatic proteins and nutrition assessment.

            Serum hepatic protein (albumin, transferrin, and prealbumin) levels have historically been linked in clinical practice to nutritional status. This paradigm can be traced to two conventional categories of malnutrition: kwashiorkor and marasmus. Explanations for both of these conditions evolved before knowledge of the inflammatory processes of acute and chronic illness were known. Substantial literature on the inflammatory process and its effects on hepatic protein metabolism has replaced previous reports suggesting that nutritional status and protein intake are the significant correlates with serum hepatic protein levels. Compelling evidence suggests that serum hepatic protein levels correlate with morbidity and mortality. Thus, serum hepatic protein levels are useful indicators of severity of illness. They help identify those who are the most likely to develop malnutrition, even if well nourished prior to trauma or the onset of illness. Furthermore, hepatic protein levels do not accurately measure nutritional repletion. Low serum levels indicate that a patient is very ill and probably requires aggressive and closely monitored medical nutrition therapy.
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              Prealbumin: a marker for nutritional evaluation.

              Determining the level of prealbumin, a hepatic protein, is a sensitive and cost-effective method of assessing the severity of illness resulting from malnutrition in patients who are critically ill or have a chronic disease. Prealbumin levels have been shown to correlate with patient outcomes and are an accurate predictor of patient recovery. In high-risk patients, prealbumin levels determined twice weekly during hospitalization can alert the physician to declining nutritional status, improve patient outcome, and shorten hospitalization in an increasingly cost-conscious economy.
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                Author and article information

                Journal
                J Clin Biochem Nutr
                JCBN
                Journal of Clinical Biochemistry and Nutrition
                the Society for Free Radical Research Japan (Kyoto, Japan )
                0912-0009
                1880-5086
                July 2009
                30 June 2009
                : 45
                : 1
                : 44-48
                Affiliations
                [1 ]Department of Central Clinical Laboratory, Shimane University Hospital, Izumo-shi, Shimane 693-8501, Japan
                [2 ]Department of Clinical Nursing, Shimane University Faculty of Medicine, Izumo-shi, Shimane 693-8501, Japan
                [3 ]Department of Nutrition, Shimane University Hospital
                [4 ]Second Department of Internal Medicine, Shimane University Faculty of Medicine
                Author notes
                *To whom correspondence should be addressed. Tel: +81-853-20-2327 Fax: +81-853-20-2327 E-mail: kadachi@ 123456med.shimane-u.ac.jp
                Article
                jcbn08-244
                10.3164/jcbn.08-244
                2704326
                19590706
                cf091e48-3aba-4945-b3f1-3ffd1fcb2c9f
                Copyright © 2009 JCBN

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 October 2008
                : 16 December 2008
                Categories
                Original Article

                Biochemistry
                inflammation,c-reactive protein,prealbumin,nutritional assessment,rapid turn over protein

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