Research paper Association of ‘‘Controlling Nutritional Status Index’’ and ‘‘Prognostic Nutritional Index’’ with intensive care unit survival in elderly patients M. Kos a, *, H. Titiz a , B. Onec b , T. Soysal a , A. Kutlucan c , S. Sahiner Emen d , L. Kutlucan e a Department of Internal Medicine, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey b Department of Hematology, Faculty of Medicine, Duzce University, Duzce, Turkey c Department of Hematology, Faculty of Medicine, Selcuk University, Konya, Turkey d Department of Internal Medicine, Cukurova Dr. Askım Tufekci State Hospital, Adana, Turkey e Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey 1. Introduction Nutritional support plays a vital role in patients admitted to the intensive care unit (ICU) due to various reasons. Losing body mass leads delayed functional recovery after discharge, and reduces the survival rate [1]. Therefore, nutritional status should be carefully assessed with proper tools. A consensus issued by the Academy of Nutrition and Dietetics (AND) and American Society for Parenteral and Enteral Nutrition (ASPEN) underscores the importance of inflammation in malnourished adults [2]. In this consensus, malnutrition was defined as the presence of 2 or more of the six (insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation that may sometimes mask weight loss and diminished functional status as measured by hand grip strength) predetermined components [2]. There is no special consensus recommendation for the ICU patients or the elderly patient group. Several indexes have been used to determine the nutritional status of ICU patients [3]. One of them is the ‘‘NUTrition Risk in Critically ill (NUTRIC) Score’’, which includes age, number of comorbidities, days from hospital to ICU admission, acute physiology and chronic health evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) Scores. NUTRI ˙ C score can be calculated with or without interleukin (IL)-6 values [4]. Subjective Global Assessment (SGA) comprises evaluation of the following: current weight, weight before illness and weight European Geriatric Medicine 7 (2016) 13–17 A R T I C L E I N F O Article history: Received 29 April 2015 Accepted 31 July 2015 Available online 28 August 2015 Keywords: Intensive Care Unit Elderly patient Nutritional Index Survival A B S T R A C T Objectives: Providing proper nutritional support for the intensive care unit (ICU) patients is only possible with assessment of malnutrition. In this study, we aimed to evaluate associations between nutritional indexes which were developed to assess malnutrition using blood parameters, and survival among elderly patients in the ICU. Patients and methods: Patients older than 65 years of age and monitored in the ICU, were retrospectively screened with nutritional indexes in order to assess the nutritional status. Each patient was evaluated with both ‘‘Controlling Nutritional Status Index’’ (CONUT) which includes albumin, total cholesterol, total lymphocyte counts, and ‘‘Prognostic Nutritional Index’’ (PNI) which includes only albumin beside total lymphocyte count. Results: Two hundred twenty five patients were enrolled in this study. Median age was 79 (range: 65– 100). One hundred and eleven (49.3%) patients died during intensive care follow-up. CONUT and PNI scores displayed significant differences between patients who died and who were discharged (P = 0.02 and P = 0.03, respectively). Kaplan–Meier analysis revealed that high CONUT (5) and low PNI (<40) scores were associated with intensive care unit survival but statistical significance was not provided for PNI (P = 0.04 and P = 0.06, respectively). Conclusion: Both CONUT and PNI indexes seems associated with survival but only CONUT score provides statistically significant prognostic information and may serve as a cost-effective nutritional assessment tool in elderly patients. Because this association did not retain its significance on multivariate analysis, the validity of this index in elderly patients should be further evaluated by prospective studies including larger samples. ß 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. * Corresponding author. Tel.: +90 5327 273356. E-mail address: mehmetkos@gmail.com (M. Kos). Available online at ScienceDirect www.sciencedirect.com http://dx.doi.org/10.1016/j.eurger.2015.07.007 1878-7649/ß 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.