Nutritional risk assessment in critically ill cancer patients: systematic review.
OBJECTIVE
To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature.


METHODS
The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words "nutritional risk assessment", "critically ill" and "cancer".


RESULTS
Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found.


CONCLUSIONS
None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that their use is simple, feasible and useful in such cases.
Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Ana Valéria Gonçalves
AV
Fruchtenicht
Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Aline Kirjner
AK
Poziomyck
Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Geórgia Brum
GB
Kabke
Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BR.
Sérgio Henrique
SH
Loss
Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Jorge Luiz
JL
Antoniazzi
Departamento de Nutrição, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Thais
T
Steemburgo
Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Luis Fernando
LF
Moreira
D016638:Critical Illness; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology; D009369:Neoplasms / Q000473:pathology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D013534:Survival; D015431:Weight Loss / Q000502:physiology