Perfil nutricional, tempo de perman?ncia e desfecho cl?nico de pacientes internados em Unidade de Terapia Intensiva de um hospital filantr?pico de Ouro Preto-MG.

Programa de P?s-Gradua??o em Sa?de e Nutri??o. Escola de Nutri??o, Universidade Federal de Ouro Preto.INTRODU??O: O estado nutricional do paciente hospitalizado ? um dos fatores que influenciam diretamente a resposta ao tratamento, tempo de perman?ncia e recupera??o. Para identificar o estado nutricional do paciente hospitalizado, v?rias ferramentas t?m sido propostas para triagem e avalia??o do estado nutricional. OBJETIVOS: Avaliar o perfil nutricional de pacientes internados em uma unidade de terapia intensiva a partir de m?todos para triagem e avali??o nutricional descritos na literatura, bem como tempo de perman?ncia e desfecho cl?nico. MATERIAL E M?TODOS: Estudo transversal, descritivo e observacional que consistiu em tr?s etapas: sele??o dos pacientes, triagem e avalia??o nutricional por diferentes m?todos, associa??o e correla??o entre os m?todos de avalia??o com o tempo de perman?ncia e desfecho cl?nico. Participaram do estudo 328 pacientes de ambos os sexos selecionados a partir de crit?rios de inclus?o. Foram aplicados os instrumentos: Risco Nutricional 2002, ?ndice de Risco Nutricional e ?ndice de Progn?stico Inflamat?rio Nutricional, al?m das medidas antropom?tricas, exames bioqu?micos, Avalia??o Nutricional Subjetiva Global e Avalia??o Nutricional. Foi realizado o teste de Kolmogorov-Smirnov, para verificar a distribui??o das vari?veis. Os resultados foram apresentados por meio de mediana e intervalos interquartis. As an?lises descritivas foram demonstradas por distribui??o de frequ?ncia absoluta e relativa e para as an?lises comparativas das m?dias dos grupos foi utilizado o teste Man-Whitney. Para verificar as associa??es entre os m?todos de avalia??o nutricional com o tempo de perman?ncia e com o desfecho cl?nico alta/?bito foi realizado a an?lise uni e multivariada pela regress?o de Poisson. As correla??es foram avaliadas usando o teste de Spearman. As an?lises estat?sticas foram efetuadas utilizando-se o programa Stata 10.0 e GraphPad Prism 5.0. Foi considerado o n?vel de signific?ncia estat?stica de 5%. RESULTADOS: Dos 328 pacientes, 55,5% eram do sexo masculino e idade mediana de 65 anos e a doen?a mais frequente foi acidente vascular encef?lico (14,3%). O tempo mediano de interna??o foi de 5 dias com preval?ncia de tempo de perman?ncia baixo. Os m?todos de triagem nutricional indicaram risco de desnutri??o e/ou desnutri??o. Nas avalia??es nutricionais os diagn?sticos mais prevalentes foram de desnutri??o, eutrofia e altera??es nos n?veis bioqu?micos. A an?lise de Poisson indicou que a preval?ncia de permanecer mais que 7 dias internados foi 1,43 vezes maior em pacientes que apresentaram n?veis de creatinina alterados, 1,39 vezes maior naqueles com n?veis de pot?ssio alterados e 1,49 vezes maior naqueles com desnutri??o diagnosticada pela Avalia??o Nutricional Instant?nea. Tamb?m, observou-se que a preval?ncia de ?bito foi 3,89 vezes maior em pacientes com leucopenia e 2,44 vezes maior em pacientes com deple??o moderada de contagem total de linf?citos. Al?m disso, pode-se verificar uma correla??o do estado nutricional obtidos pelos m?todos de triagem e avalia??o com o tempo de perman?ncia em dias. CONCLUS?O: Pode-se verificar o comprometimento nutricional nos pacientes internados por diferentes par?metros de rastreio e avalia??o do estado nutricional demonstrando interfer?ncia no tempo de perman?ncia e ?bito. Dessa forma as diferentes ferramentas contribuem aumentando a exatid?o do diagn?stico nutricional para obten??o de um melhor progn?stico cl?nico e nutricional em pacientes de unidade de terapia intensiva.INTRODUCTION: The nutritional status of hospitalized patients is one of the factors that directly influence the response to treatment, length of stay and recovery. To identify the nutritional status of the hospitalized patient, several tools have been proposed for nutritional screening and evaluation of nutritional status. OBJECTIVES: To evaluate the nutritional profile of hospitalized patients in an intensive care unit based on methods for nutritional screening and evaluation described in the literature, as well as the length of stay and clinical outcome. MATERIAL AND METHODS: A cross-sectional, descriptive and observational study consisting of three stages: patient selection, nutritional analysis and evaluation by different methods, association and correlation among the evaluation methods and length of stay and clinical outcome. Three hundred and twenty-eight patients of both sexes, selected by inclusion criteria, have participated in the study. The following instruments were applied: Nutrition Risk 2002, Nutrition Risk Index and Nutritional Inflammatory Prognosis Index, in addition to anthropometric measurements, biochemical tests, Global Subjective Nutrition Assessment and Nutritional Assessment. The Kolmogorov-Smirnov test was performed to verify the distribution of the variables. The results were presented by means of median and interquartile ranges. The descriptive analyzes were demonstrated by absolute and relative frequency distribution and the Man-Whitney test was used to the comparative analysis of the averages of the groups. In order to verify the associations among the methods of evaluation, with both the time of permanence and the clinical outcome of discharge/death, a multivariate analysis was performed by means of the Poisson regression. Correlations were assessed by the Spearman test. Statistical analyzes were performed by Stata 10.0 and GraphPad Prism 5.0 softwares. The level of statistical significance of 5% was considered. RESULTS: Of the 328 patients, 55.5% were males, the median age was 65 years, and the most frequent disease was a cerebrovascular accident (14.3%). The median time of hospitalization was 5 days with a prevalence of low residence time. Nutritional screening methods have indicated risk of malnutrition and/or malnutrition. About the nutritional assessments, the most prevalent diagnoses were malnutrition, eutrophy, and biochemical levels alteration. The Poisson analysis has indicated that the prevalence of remaining more than 7 days hospitalized was 1.43 times higher in patients with altered creatinine levels, 1.39 times higher in those with altered potassium levels and 1.49 times higher in those with malnutrition diagnosed by Instant Nutrition Assessment. In addition, it was observed that the prevalence of death was 3.89 times higher in patients with leukopenia and 2.44 times higher in patients with moderate total lymphocyte count depletion. Moreover, a correlation of the nutritional status obtained by the screening and evaluation methods with the residence time in days can be verified. CONCLUSION: Nutritional impairment can be verified in patients hospitalized by different evaluation parameters and evaluation of the nutritional status, which demonstrates interference in length of stay and death. In this way, different tools contribute to increase the accuracy of nutritional diagnosis to obtain a better clinical and nutritional prognosis in intensive care unit patients