Association of Subjective Global Assessment with outcomes in the intensive care unit: A retrospective cohort study

Aims: This retrospective audit was conducted to investigate the association between outcome and protein-energy malnutrition diagnosed using Subjective Global Assessment (SGA), to evaluate the predictive validity of Subjective Global Assessment in adults admitted to intensive care.

Methods: The audit analysed the medical records of 1034 consecutive adult patients who had nutrition assessment on admission to the intensive care unit between January 2017 and July 2018. Extracted data included patient demographics, nutritional status, outcomes, and Acute Physiology and Chronic Health Evaluation II score. Regression was used to explore the association between Subjective Global Assessment and outcomes.

Results: The prevalence of protein-energy malnutrition was 39.5% (342 patients SGA-B, and 75 patients SGA-C), and there was a significant independent association between Subjective Global Assessment and outcomes both in surgical and non-surgical patients. Compared with well-nourished patients, mortality was significantly higher in the malnourished, during the intensive care admission (p = 0.007), in hospital (p < 0.0001), at 90 days (p = 0.001) and at 180 days (p = 0.002). Pressure injuries were more common (p = 0.01). Length of stay was longer in intensive care (p = 0.001) and in hospital (p < 0.001), with increased readmission rate (p < 0.001).

Conclusion: Protein-energy malnutrition diagnosed by Subjective Global Assessment had a significant independent association with adverse clinical outcomes in critically ill patients. Subjective Global Assessment appears to have predictive validity in this patient population.