Risco e estado nutricional como preditores de mortalidade em pacientes críticos: um estudo de coorte prospectivo

Abstract

Malnutrition can alter the composition and functions of the body and is a prognostic indicator of clinical outcomes in hospitalized patients. Both risk and nutritional status should be assessed early in critically ill patients, as recommended by scientific societies worldwide inintensive care. Although there is no scientific consensus regarding the reference tools to assess the risk and nutritional status of critically ill patients, both the Nutrition Risk in Critically Ill (NUTRIC) and the Subjective Global Assessment (SGA) have been the most widely used in this population. In Brazil, some studies sought to identify the relationship between high nutritional risk, malnutrition and clinical outcomes in critically ill patients, only one of which was conducted in the central-west region. Thus, the objective of this prospective cohort study was to evaluate the ability of risk and nutritional status to predict mortality in critically ill adult and elderly patients of both sexes admitted to the Intensive Care Unit (ICU) of a public university hospital in the city of Dourados, largest city in the interior of the state of Mato Grosso do Sul. Sociodemographic and clinical data were collected through medical records and interviews. Anthropometric measurements were obtained within 48 hours after ICU admission, before risk and nutritional status assessment. The NUTRIC tools in their modified version (without IL-6) and ASG were used to determine risk and nutritional status,respectively. Patients were followed until death or hospital discharge, with mortality as the primary outcome. The Cox proportional hazard model was used to assess the associations between independent variables and ICU survival in a multivariate model. For all tests, the significance level adopted was 5%.A total of 153 individuals were included in the study. The majority were male (54.9%), the mean age was 62.4 ± 17.1 years, with respiratory system diseases (42.5%) as the main primary diagnosis at admission, with at least two comorbidities (61.4%), using vasoactive drugs (50.4%), receiving ventilatory support (67.6%) and the mortality rate was 32.7%. In total, 65 individuals had high nutritional risk (42.5%), 105 individuals had moderate or severe malnutrition (68.6%) and 50 individuals (32.7%) had both high nutritional risk and malnutrition. In the multivariate analysis, patients with high nutritional risk and malnutrition had a 104% higher risk of death when compared to the group with low nutritional risk and no malnutrition (HR 2.04; 95%CI 1.04-4.00). Approximately, for every three patients admitted to the ICU with high nutritional risk and malnutrition, one died (Number needed to cause harm (NNH) 3.4; 95% CI 2.3-6.4). In conclusion, the concomitant use of NUTRICm and ASG improved the predictive capacity for mortality in critically ill adults and elderly patients compared to the isolated use of these tools.