title: Can Creatinine Height Index Predict Weaning and Survival Outcomes in Patients on Prolonged Mechanical Ventilation After Critical Illness?
abstract: OBJECTIVE
  Malnutrition is common in chronic critically ill patients on prolonged mechanical ventilation (PMV) and may affect weaning. The creatinine height index (CHI), which reflects lean muscle mass, is regarded as the most accurate indicator of malnutrition. The objective of this study was to determine the impact of CHI in comparison with other traditional nutritional indices on successful weaning and survival in patients on PMV after critical illness.
  
  
  METHODS
  Records of 167 patients on PMV following critical illness, admitted for weaning, were reviewed. Parameters studied included age, gender, body mass index (BMI), percentage ideal body weight (%IBW), total protein, albumin, prealbumin, hemoglobin (Hb), and cause of respiratory failure. Number successfully weaned and number discharged alive and time to wean and time to discharge alive were determined from records. The CHI was calculated from 24-hour urine creatinine using a standard formula. Unpaired 2-sample t test was performed to determine the association between the studied nutritional parameters and outcomes. Predictive value of studied parameters for successful weaning and survival was determined by multivariate logistic regression analysis to model dichotomous outcome of successful weaning and survival.
  
  
  RESULTS
  Mean age was 68 ± 14 years, 49% were males, 64% were successfully weaned, and 65.8% survived. Total protein, Hb, and CHI had a significant impact on successful weaning. Weight, %IBW, BMI, and CHI had a significant effect on survival. Of all parameters, CHI was most strongly predictive of successful weaning and survival.
  
  
  CONCLUSIONS
  The CHI is a strong predictor of successful weaning and survival in patients on PMV.
authors.affiliation: 1 Division of Pulmonary & Critical Care Medicine, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Debapriya
authors.initials: D
authors.lastname: Datta
authors.affiliation: 1 Division of Pulmonary & Critical Care Medicine, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Foley
authors.affiliation: 2 Biostatistics Center, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Wu
authors.affiliation: 2 Biostatistics Center, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: James
authors.initials: J
authors.lastname: Grady
authors.affiliation: 3 Division of Pulmonary & Critical Care Medicine, Hospital for Special Care, New Britain, CT, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Scalise
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001827:Body Height; D003404:Creatinine / Q000652:urine*; D016638:Critical Illness; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D056865:Ideal Body Weight; D008297:Male; D044342:Malnutrition / Q000378:metabolism*; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D011506:Proteins / Q000378:metabolism; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000378:metabolism / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D015300:Ventilator Weaning
chemical_list: D006454:Hemoglobins; D011228:Prealbumin; D011506:Proteins; D012709:Serum Albumin; D003404:Creatinine
keywords: creatinine height index; nutrition; prolonged mechanical ventilation; respiratory failure; survival; weaning