Nutritional assessment in head injured patients through the study of rapidturnover visceral proteins

Background & Aims: Nutritional monitoring of rapid turnover visceral protei n is important in the recognition of malnutrition in patients admitted to t he Intensive Care Unit (ICU). We studied prealbumin and retinol-binding pro tein in patients who received three different kinds of artificial nutrition in order to evaluate the appropriateness of artificial nutrition. Methods: 45 consecutive head injury patients received enteral (Group A), pa renteral (Group B) or both enteral and parenteral nutrition (Group C) at ra ndom. We considered these parameters: prealbumin, retinol binding protein a nd nitrogen balance before (T1), after 3 (T2), 7 (T3) and 11 (T4) days afte r the beginning of study. Statistical analysis was performed with Kruskal-W allis test and Bonferroni's t-test. Results: Plasma prealbumin and Retinol binding protein (RBP) showed an incr easing of basal values during the study period in all groups (< 0.0001) and more significantly in group A (Enteral nutrition P < 0.001 vs Total parent eral nutrition (TPN) and Enteral P < 0.01 vs Enteral and parenteral nutriti on). Conclusion: Data obtained in the present study indicate that a laboratory i s essential for monitoring nutritional assessment and for checking the appr opriateness of nutritional therapy. We found prealbumin to be the most sens itive measure and found it to be the test of choice for early assessment an d intervention.