(449) Malnutrition in ICU Survivors: Quantifying Differences Between Survivor Clinic Care and Usual Care

Introduction: Nutritional status of ICU survivors is a key component of the physical health domain of Post Intensive Care Syndrome (PICS) but is often overlooked after hospital discharge. This is a Geisinger Commonwealth School of Medicine Summer Research Immersion Program project examining nutrition in ICU survivors at Geisinger.

Methods: Retrospective clinical research study conducted at a tertiary care hospital with adult medical, surgical, neuroscience, cardiovascular and trauma ICUs. Population is adult survivors of ICU eligible to participate in ICU Survivor Clinic (ICUSC) between November 1, 2016, and October 31, 2019. 282 adult patients are included, 95 (33.7%) received ICUSC care and 187 (66.3%) received usual care (UC). Data collected includes inpatient and outpatient weights up to 2 years post discharge, outpatient nutrition referrals and survival rates. Comparison between groups for categorical data was done with Pearson's Chi Square or Fisher's exact tests; for continuous data using t-tests or Wilcoxon rank-sum tests.

Results: Two years post-ICU discharge, 12.6% of ICUSC patients were deceased compared to 41.2% of UC patients. For patients who received outpatient nutrition consults, percent weight change was not significantly different between ICUSC and UC cohorts at 6 months (p = 0.48), 1 year (p = 0.80),
or 2 years (p = 0.35) post-discharge. In patients who did not receive outpatient nutrition consults, the ICUSC cohort had less average weight loss than the UC cohort at 6 months (-1.9% vs-4.9%, p = 0.04) and 1 year (-0.4% vs -4.0%, p = 0.04); however, they were comparable at 2
years (-0.2% vs -2.5%, p = 0.29) post-discharge. Percent weight change was comparable within each cohort regardless of outpatient nutrition consult (p > 0.05).

Conclusions: Participation in ICUSC, where nutrition support was discussed with most patients and caregivers and reinforced on follow up ICUSC visits and by ICUSC Nurse Case manager in telephone follow up, may promote more rapid recovery from acute malnutrition post hospital discharge as compared to usual care processes. More rapid recovery of nutritional health may be a factor in the reduced mortality rate seen in ICUSC cohort compared to UC cohort.