Associação entre a espessura do músculo adutor do polegar com estado nutricional e desfechos clínicos em pacientes grave

Abstract

Adductor pollicis muscle thickness (AMAP) is a proposed complementary anthropometric measurement in nutritional assessment, making it an interesting alternative because it is simple to perform, non-invasive and low-cost. EMAP has been tested in some clinical conditions and has been associated with nutritional status and clinical outcomes in hospitalized patients. However, the number of studies that evaluated EMAP in critically ill patients is small and with methodological inconsistencies that still do not allow robustly establishing the need for its use in hospital clinical practice. Thus, the objective of this observational, prospective and analytical study was to evaluate the association between EMAP with nutritional status and clinical outcomes in adult and elderly critically ill patients of both sexes admitted to an adult Intensive Care Unit (ICU) of a public hospital. Brazilian. The EMAP of both hands, skinfolds and body circumferences were measured within 48 hours after admission to the ICU, using standardized techniques. Clinical and laboratory data were obtained from the chart, including mortality (primary outcome). Nutritional status was determined by applying the Subjective Global Assessment (SGA). Patients were followed up until hospital discharge to assess outcomes. The p-value <0.05 was considered to determine statistical significance. A total of 28 participants of both sexes participated in the survey. Most were male (53.6%), with a mean age of 60.6 ± 17.2 years, with respiratory diseases (75.0%), with comorbidities (71.4%), used vasoactive drugs (60.7%), received invasive ventilatory support (57.1%), had a median length of stay in the ICU and hospital of 10 and 18 days, respectively, and was not to death (57.1%). In males, the EMAP of the dominant hand (EMAP(d)) showed moderate to strong and positive correlation (r > 0.5; p<0.05) with all analyzed anthropometric measurements. The EMAP of the non-dominant hand (EMAP(nd)) showed a moderate and positive correlation (r: 0.52; p<0.05) only with the circumference of the arm. In females, EMAP(d) showed moderate and positive correlation (r: 0.65; p<0.05) only with EMAP(nd). In both sexes, arm circumference, arm muscle circumference, corrected arm muscle area, calf circumference and triceps skinfold showed strong correlations with each other (r > 0.7; p<0.05). There was a significant difference between the mean values of non-adequate EMAP(nd) (< 5th percentile) of well-nourished participants in relation to those who were moderately or severely malnourished (mean difference of 3 mm; p = 0.016). Similarly, significant differences were observed between the mean values of EMAP(nd) in males, according to the length of hospital stay (< or ≥ 28 days; mean difference of 6 mm; p = 0.039). In conclusion, EMAP of the non-dominant hand was associated with nutritional status and length of hospital stay in critically ill patients, especially males, and its use in a complementary way to SGA in the first hours of admission of critically ill patients in ICU.