BIOCHEMICAL ASSESSMENT OF NUTRITIONAL-STATUS IN PATIENTS WITH CHRONICOBSTRUCTIVE PULMONARY-DISEASE AND ACUTE RESPIRATORY-FAILURE ON ADMISSION TO AN INTENSIVE-CARE UNIT

Although chronic obstructive pulmonary disease (COPD) is associated wi th weight loss and malnutrition, there is a paucity of relevant data o n COPD patients with acute respiratory failure (ARF). We studied 30 co nsecutive patients on the day of admission to our intensive care unit for ARF. In addition to a clinical work-up, the following biochemical parameters were determined: markers of nutritional status (albumin - A LB, transferrin - TRF, transthyretin - TTR, retinol binding protein - RBP, fibronectin), inflammation (C-reactive protein - CRP, alpha(1) gl ycoprotein acid - alpha(1)GPA) and catabolism (plasma phenylalanine - PHE, urinary 3-methylhistidine - 3-MH). Values were expressed as mean +/- SD and compared to those of 10 healthy subjects matched for age. C OPD-ARF patients had a poor protein status (ALB = 30 +/- 5 vs 42 +/- 3 g.l(-1); TTR = 118 +/- 75 vs 251 +/- 43 mg.l(-1); RBP = 23 +/- 12 vs 46 +/- 8 mg.l(-1) p < 0.001), were hypercatabolic (3-MH/Cr = 31 +/- 12 vs 22 +/-:7 mu mol.mmol Cr-1; PHE = 62 +/- 27 vs 46 +/- 10 mu mol.l(- 1); p < 0.001) and inflamed (CRP = 68 +/- 50 vs 12 +/- 5 mg.l(-1); alp ha(1)GPA = 1.2 +/- 0.4 vs 0.5 +/- 0.1 g.l(-1); p < 0.001). Severity of the disease correlated with short half-life proteins and protein cata bolism markers but not with inflammation markers. Considering ALB, TTR , RBP, the 3-MH/Cr ratio and PHE values, the 30 COPD patients fell int o 3 groups: chronic malnutrition (n = 7), acute malnutrition (n = 2), and acute + chronic malnutrition (n = 18). 3 patients had normal nutri tional status. We conclude that an assessment of nutritional status at admission to intensive care units could contribute towards 8 rapid fo rmulation of specific nutritional therapy.