# Nutritional Status Disorders and Selected Risk Factors of
## 4 Discussion  
Ventilator-associated pneumonia (VAP) is a serious issue both clinically and epidemiologically for each ICU. It constitutes additional ailment to the already existing complications worsening the patient's clinical condition, which poses a huge risk of death. Considering the above, special attention has to be paid to actions preventing VAP, and in early diagnosis and the implementation of effective treatment. In the authors' own research conducted on a group of patients after experiencing injuries with diagnosed VAP, they were predominantly persons over 61 years of age (40.4%) and men (67.8%). The most frequent type of injury was multi-organ injury (45.5%). The study by [PERSON] et al., which included over 1200 patients mechanically ventilated, demonstrated that the largest VAP incidence occurred in the group with multi-organ injuries in the age range between 51 and 75 years [23]. The study by [PERSON] et al. on a group of 1097 patients demonstrated, in turn, that VAP developed mainly in males and patients after surgical procedures [37]. Other studies also confirm that an age of more than 60 years, male gender, and multi-organ injury are considered crucial risk factors for the contraction of VAP [38; 39]. Slightly different results were obtained by [PERSON] et al., who demonstrated that the highest risk of VAP contraction occurs in the post-trauma group at an average of 45 years [40]. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Variable** & **Day of Occurrence of Pneumonia** & **MEAN** & **U Test** & \(p\) \\ \hline \multirow{2}{*}{Number of risk factors} & Up to 4 days VAP & 6 & \multirow{2}{*}{1729} & \multirow{2}{*}{0.598} \\ \cline{2-2} \cline{5-5}  & From 5 th day VAP & 6 & \\ \hline \end{tabular} MEAN—arithmetical mean value; U test—non-parametric Mann–Whitney test \(p\) value—level of statistical significance.  
\end{table} 
Table 10: The influence of the risk factor number in studied patients on VAP occurrence time. One of important risk factors for VAP occurrence is abnormal nutritional conditions, especially under-nutrition. The entire study group obtained on the NRS-2002 scale a result which indicates the risk of under-nutrition and the necessity to implement nutritional treatment. The implementation of nutritional treatment is confirmed by ESPEN recommendations [41]. The results of our own research also exposed the fact that, after excluding patients with liver or renal failure features from the study, in 86% of patients, the parameter was below the norm threshold, with 37.2% below 25 g/L, and only 14% of the studied patients obtained the correct albumin level. Despite the more frequent remark that hypoalbumining ought not to be considered a result of under-nutrition, but rather as an indicator of the disease severity, inflammation, or hydration status of the organism, albumins are included in all prognostic-nutritional parameters, and their concentration in blood below 3.5 g/dL is pointed at as a factor of under-nutrition, and constitutes a bad probiotic factor, as well as serious risk for complications [42,43]. Of great importance for monitoring infections in ICUs are biomarkers: C-reactive protein (CRP) and procalcitonin (PCT) [44]. In our own research, 83.5% of patients obtained higher values of the CRP indicator, with the value of the parameter over 201 mg/L in 20.7% of cases, whereas in 68.6% of the studied patients, the level of leukocytes exceeded the norm (i.e., 10,000 / \(\upmu\)L), and 56.2% were indicated with a procalcitonin level over 0.5 \(\upmu\)/L. Studies by other authors demonstrate that, in patients subjected to mechanical ventilation, the daily monitoring of CRP was useful for VAP prognosis, whereas PCT turned out to be a poor marker for VAP prognosis [45]. The study by [PERSON] et al. [46] demonstrated a positive prognostic value of PCT increase in blood serum in the case of pulmonary or extrapulmonary infections, which justified immediate antibiotic administration. The study conducted by [PERSON] et al.