Análise de sobrevida em pacientes críticos com suporte nutricional de acordo com o pontuação mNUTRIC
DOI:
https://doi.org/10.35454/rncm.v6n2.483Palavras-chave:
Escore mNUTRIC, Sobrevivência, Tempo de Internação, Cuidados Críticos, Nutrição EnteralResumo
Introdução: o pontuação mNUTRIC foi concebido para identificar pacientes internados em Unidades de Terapia Intensiva (UTI) que se beneficiariam de uma intervenção nutricional otimizada e intensiva. De acordo com várias diretrizes de prática clínica, o risco nutricional está relacionado à mortalidade e à permanência hospitalar.
Objetivos: analisar a associação entre sobrevida aos 30 dias e permanência na UTI com o pontuação mNUTRIC, ajustado para aporte calórico e protéico.
Metodos: foram incluídos 110 pacientes internados na UTI de um hospital público de Buenos Aires, com indicação de nutrição enteral exclusiva. Por meio de um desenho observacional, longitudinal, analítico e ambispectivo, foram realizadas análises de sobrevivência e modelos de regressão de Cox.
Resultados: de acordo com os modelos múltiplos, o risco de morte aumentou, em média, 4% para cada ano de aumento da idade (p = 0,002) e diminuiu em média 79% para cada grama adicional de proteína fornecida por quilo de peso corporal (p = 0,021). A probabilidade de alta da UTI diminuiu com o aumento da idade (p = 0,002). O mNUTRIC, sexo, ingestão calórica, obesidade e infecção por COVID-19 não foram associados às variáveis de desfecho.
Conclusão: o mNUTRIC não foi associado à mortalidade e permanência na UTI, e a infecção por COVID-19 poderia atenuar seu impacto. A ingestão de proteína foi um fator protetor contra a mortalidade, por conseguintes estratégias adicionais devem ser implementadas para otimizá-la.
Downloads
Referências
Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2022;46(1):12-41. doi: 10.1002/jpen.2267
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019;38(1):48-79. doi: 10.1016/j.clnu.2018.08.037
Castillo Pineda JC, Gómez García A, Velasco N, Díaz-Pizarro Graf JI, Matos Adámes A, Miján de la Torre A. Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables: The ENHOLA study. Nutrición Hospitalaria. 2016;33(3):655-62. doi: 10.20960/nh.275
Paez Candelaria Y, Romero García LI, Pereira Despaigne COL, Gondres Legró KM, Bacardí Zapata PA, Legró Bisset G. Factores predictivos de desnutrición en pacientes graves. Acta Colombiana de Cuidado Intensivo. 2018;18(1):10-21. doi: 10.1016/j.acci.2017.11.004
Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98. doi: 10.1007/s00134-016-4665-0
Correia MITD, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: A systematic review. Clin Nutr. 2017;36(4):958-67. doi: 10.1016/j.clnu.2016.06.025
Barritta RL, Villar Á, Bordalejo A, Nadal MA. Nutrición enteral en el paciente crítico: ¿cuánto es realmente administrado?. Rev Arg de Ter Int. 2019;36(2):p11-18. Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/564
Stewart ML. Interruptions in enteral nutrition delivery in critically ill patients and recommendations for clinical practice. Crit Care Nurse. 2014;34(4):14-21. doi: 10.4037/ccn2014243
Heyland DK, Dhaliwal R, Wang M, Day AG. The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’ critically ill patient: Results of an international, multicenter, prospective study. Clinical Nutrition. 2015;34(4):659-66. doi: 10.1016/j.clnu.2014.07.008
Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268. doi: 10.1186/cc10546
De Vries MC, Koekkoek W, Opdam MH, van Blokland D, van Zanten AR. Nutritional assessment of critically ill patients: validation of the modified NUTRIC score. Eur J Clin Nutr. 2018;72(3):428-35. doi: 10.1038/s41430-017-0008-7
Reis AM dos, Fructhenicht AVG, Moreira LF. NUTRIC score use around the world: a systematic review. Rev Bras Ter Intensiva. 2019;31(3):379-385. doi: 10.5935/0103-507X.20190061
Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study. Indian J Crit Care Med. 2017;21(5):253-256. doi: 10.4103/ijccm.IJCCM_24_17
Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland D. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study. J Crit Care. 2017;37:45-49. doi: 10.1016/j.jcrc.2016.08.001
Bernasconi Jose I, Leandro-Merhi VA, Mendonça JA, Braga de Aquino JL. The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit? Nutr Hosp. 2019;36(5):1027-36. doi: 10.20960/nh.02545
Riley RD, Ensor J, Snell KIE, Harrell FE, Martin GP, Reitsma JB, et al. Calculating the sample size required for developing a clinical prediction model. BMJ. 2020;368:m441. doi: 10.1136/bmj.m441
Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35(1):158-62. doi: 10.1016/j.clnu.2015.01.015
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. doi: 10.1177/0148607115621863
Bousie E, Van Blokland D, Lammers HJW, Van Zanten ARH. Relevance of non-nutritional calories in mechanically ventilated critically ill patients. Eur J Clin Nutr. 2016;70(12):1443-50. doi: 10.1038/ejcn.2016.167
Kleinbaum DG, Klein M. Survival analysis: a self-learning text. 3rd edition. New York: Springer; 2012.
Wu S, Lou J, Xu P, Luo R, Li L. Early enteral nutrition improves the outcome of critically ill patients with COVID-19: A retrospective study. Asia Pac J Clin Nutr. 2019;30(2):192-8. doi: 10.6133/apjcn.202106_30(2).0002
Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105-22. doi: 10.1007/s00134-017-4867-0
Brascher JMM, Peres W a. F, Padilha PC. Use of the modified «Nutrition Risk in the critically ill» score and its association with the death of critically ill patients. Clin Nutr ESPEN. 2020;35:162-6. doi: 10.1016/j.clnesp.2019.10.005
Zhang P, He Z, Yu G, Peng D, Feng Y, Ling J, et al. The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr. 2021;40(2):534-41. doi: 10.1016/j.clnu.2020.05.051
Jeong DH, Hong SB, Lim CM, Koh Y, Seo J, Kim Y, et al. Relationship between Nutrition Intake and 28-Day Mortality Using Modified NUTRIC Score in Patients with Sepsis. Nutrients. 2019;11(8):1906. doi: 10.3390/nu11081906
Allingstrup M, Esmailzadeh N, Wilkens Knudsen A, Espersen K, Hartvig Jensen T, Wiis J, et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr. 2012;31(4):462-8. doi: 10.1016/j.clnu.2011.12.006
Chada RR, Chidrawar S, Goud BA, Maska A, Medanki R, Nagalla B. Association Between Nutrition Delivery, Modified Nutrition Risk In Critically III Score, and 28-Day Mortality. Nutr Clin Pract. 2021;36(5):1020-33. doi: 10.1002/ncp.10673
Silvah JH, de Lima CMM, Nicoletti CF, Barbosa AC, Junqueira GP, da Cunha SF de C, et al. Protein provision and lower mortality in critically ill patients with COVID-19. Clin Nutr ESPEN. 2021;45:507-510. doi: 10.1016/j.clnesp.2021.07.005
Mukhopadhyay A, Henry J, Ong V, Leong CSF, Teh AL, Van Dam RM, et al. Association of Modified Nutric Score with 28-Day Mortality in Critically Ill Patients. Clin Nutr. 2017;36(4):1143-8. doi: 10.1016/j.clnu.2016.08.004
Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 tools to assess nutrition risk in the intensive care unit. JPEN J Parenter Enteral Nutr. 2015;39(1):28-33. doi: 10.1177/0148607114532135
Wang N, Wang MP, Jiang L, Du B, Zhu B, Xi XM. Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study. BMC Anesthesiol. 2021 8;21(1):220. doi: 10.1186/s12871-021-01439-x
Liberti A, Piacentino E, Umbrello M, Muttini S. Comparison between Nutric Score and modified nutric score to assess ICU mortality in critically ill patients with COVID-19. Clinical Nutrition ESPEN. 2021;44:479-82. doi: 10.1016/j.clnesp.2021.04.026
Li G, Zhou CL, Ba YM, Wang YM, Song B, Cheng XB, et al. Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study. Clin Nutr. 2021;40(4):2154-2161. doi: 10.1016/j.clnu.2020.09.040
Osuna-Padilla IA, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Llamazares S. High nutritional risk using NUTRIC-Score is associated with worse outcomes in COVID-19 critically ill patients. Nutr Hosp. 2021;28(3):540-4. doi: 10.20960/nh.03440
Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, et al. Association of Obesity With COVID-19 Severity and Mortality: An Updated Systemic Review, Meta-Analysis, and Meta-Regression. Front Endocrinol (Lausanne). 2022;13:780872. doi: 10.3389/fendo.2022.780872
Paravidino VB, Leite TH, Mediano MFF, Sichieri R, Azevedo E Silva G, Cravo V, et al. Association between obesity and COVID-19 mortality and length of stay in intensive care unit patients in Brazil: a retrospective cohort study. Sci Rep. 2022;12(1):13737. doi: 10.1038/s41598-022-17197-w
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Ommi Acosta Sero, Micaela Di Iorio, Ailén Azul Perez
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
