Elaboração e validação de instrumento para avaliação do estado nutricional de pacientes em estado crítico

Abstract

Introduction: Malnutrition is a disease associated with unfavorable outcomes, with a high prevalence among critically ill patients. Objective: To compare the agreement between the Subjective Global Assessment (SGA) and Global Leadership Initiative on Malnutrition (GLIM) criteria in the assessment of the nutritional status of adult patients in critical condition, within the first 48 hours of admission to the ICU. In addition, the aim of the present study was to validate methods of assessing body composition to classify the nutritional status of critically ill patients, within the first 48 hours of admission to the ICU and to correlate nutritional status with the mortality of critically ill patients. Material and Methods: Prospective observational study, cohort type, with inclusion of critically ill clinical and surgical patients, ≥18 years old, mechanically ventilated. Nutritional status was assessed using the following methods: SGA; GLIM criteria; bioelectrical impedance (BIA), with analysis of the phase angle and skeletal muscle mass variables: and by ultrasound (USG), with analysis of the sectional area of the rectus femoris muscle, within the first 48 hours of admission to the ICU. Results: Article 1: Among the patients included (n=160), the prevalence of moderate and severe malnutrition demonstrated, in the first 48 hours of admission to the ICU, was 77.5% (124/160) and 14.4% (23/160) according to the SGA and GLIM criteria methods, respectively (p<0.001). Weak agreement was demonstrated between the SGA and GLIM criteria methods in the assessment of nutritional status in relation to the global diagnosis of malnutrition (κ=0.04; p=0.241) and the diagnosis of malnutrition according to subgroups (κ=0.05; p=0.073). The SGA (OR=1.39; p=0.506) and GLIM criteria (OR=1.87; 0.214) methods did not demonstrate a predictive power for mortality at 28 days. Article 2: Among the patients included (n=160), the non-survivors had lower values in relation to the survivors for the mean phase angle (4.4° ± 1.5 versus 4.9° ± 1.2; p=0.041) and sectional muscle area rectus femoris (6.1 ± 1.6 versus 7.4 ± 1.8; p=0.030). The cut-off values identified by means of the ROC curves were ≤4.4°, ≤19.2 kg/m2, and ≤5.9 cm2/m2 for the phase angle; skeletal muscle mass; and sectional area of the rectus femoris muscle, respectively. In multivariate logistic regression analysis, the sectional area of the rectus femoris muscle ≤5.9 cm2/m2 was the only independent predictor of 28-day mortality (OR=6.08; p=0.028). In the survival analysis, greater survival at 28 days was demonstrated for patients with phase angle >4.4º (p=0.020) and sectional area of the rectus femoris muscle >5.9 cm2/m2 (p=0.001). Malnourished patients had higher mortality than patients nourished according to the phase angle (31.5% versus 15.1%, respectively; p=0.015) and the area of the rectus femoris muscle (38.9% versus 6.3%, respectively; p=0.001). Conclusion: The SGA and GLIM criteria methods show low agreement in the diagnosis of malnutrition in critically ill adult patients, within the first 48 hours of admission to the ICU. USG of the rectus femoris muscle is an efficient method for classifying nutritional status at the time of admission to the ICU and assessing the prognosis of critically ill patients.