title: Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury.
abstract: BACKGROUND
  The association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients.
  
  
  METHODS
  In this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed.
  
  
  RESULTS
  At univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = -0.89), mid-arm muscle circumference (p = 0.050; beta = -1.29), hemoglobin (p = 0.04, beta -1.1) and albumin (p = 0.04, beta -7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ(2) test = 6.47).
  
  
  CONCLUSIONS
  Albumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.
authors.affiliation: Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy. tmontalcini@unicz.it.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Montalcini
authors.affiliation: Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy. martamoraca@hotmail.it.
authors.forename: Marta
authors.initials: M
authors.lastname: Moraca
authors.affiliation: Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy. ferro@unicz.it.
authors.forename: Yvelise
authors.initials: Y
authors.lastname: Ferro
authors.affiliation: Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy. romeo@unicz.it.|Department of Molecular and Clinical Medicine, Sahlgrenska Center for Cardiovascolar and Metabolic Research, University of Gothenburg, Gothenburg, Sweden. romeo@unicz.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Romeo
authors.affiliation: S.Anna Neurological Institute, Crotone, Italy. s.serra@istitutosantanna.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Serra
authors.affiliation: S.Anna Neurological Institute, Crotone, Italy. m.raso@istitutosantanna.it.
authors.forename: Maria Girolama
authors.initials: MG
authors.lastname: Raso
authors.affiliation: S.Anna Neurological Institute, Crotone, Italy. f.rossi@istitutosantanna.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rossi
authors.affiliation: S.Anna Neurological Institute, Crotone, Italy. wgs@dism.unige.it.
authors.forename: Walter G
authors.initials: WG
authors.lastname: Sannita
authors.affiliation: S.Anna Neurological Institute, Crotone, Italy. giulianodolce@libero.it.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Dolce
authors.affiliation: Clinical Nutrition Unit, Department of Medical and Surgical Science, University Magna Grecia, Viale S. Venuta, 88100, Catanzaro, Italy. pujia@unicz.it.
authors.forename: Arturo
authors.initials: A
authors.lastname: Pujia
mesh_terms: D000368:Aged; D000418:Albumins / Q000378:metabolism; D000886:Anthropometry; D001823:Body Composition; D001930:Brain Injuries / Q000150:complications / Q000401:mortality*; D003243:Consciousness; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D003668:Pressure Ulcer / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D011446:Prospective Studies; D012372:ROC Curve; D012709:Serum Albumin / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D006454:Hemoglobins; D012709:Serum Albumin