Associação entre estado nutricional e diagnóstico de sepse ou morte causada por sepse em adultos e idosos hospitalizados

Abstract

Introduction: Sepsis is defined as a dysregulated host response to an infection. It is currently recognized as a public health problem and is considered one of the main causes of morbidity and mortality in hospitalized patients. The association between nutritional status and diagnosis and death caused by sepsis is still not very well understood. Objective: To investigate the association between nutritional status and the diagnosis of sepsis and death caused by sepsis in hospitalized adults and elderly people, exploring the mediating effect. Methods: A documentary-based retrospective cohort study was carried out, including medical records of adult and elderly patients hospitalized between January 1, 2014 and December 31, 2016. All patients with clinical data, biochemical and status tests were included. complete nutritional information available in the electronic database. Deviations in nutritional status were considered to be patients with underweight and excess weight, classified according to BMI. To evaluate the association between deviations in nutritional status and diagnosis and death from sepsis, mediational analysis were carried out based on the KHB method proposed by Karlson, Holm and Breen using the length of hospital stay, multimorbidity and biochemical tests as mediators. Results: Of the 1,445 patients included, 26.9% were classified as malnourished and 33.4% as overweight. The frequency of sepsis diagnosis was 6.6% and death from sepsis was 3.3%. For those patients classified as malnutrition, a mediation percentage of 51.82% was found in the association (of risk) with the diagnosis of sepsis. There was no significant association between malnutrition and death caused by sepsis. In relation to patients classified as overweight, a percentage of mediation, 14%, was found in the (protective) association with the diagnosis of sepsis, but this effect explained only a part of the total effect of this association, as the direct effect was also significant. Furthermore, overweight patients also had a lower risk of dying from sepsis, but this association did not occur through the mediators of this study. Conclusion: Malnutrition had a risk association with the diagnosis of sepsis, while excess weight had a protective association with diagnosis and death from sepsis. Patients with malnutrition are at greater risk of sepsis with a high percentage of mediation, the opposite of being overweight, which demonstrated a low percentage of mediation for sepsis and death from sepsis, reducing the occurrence of these outcomes. These findings show the importance of identifying the nutritional status of hospitalized patients and thus recognizing patients at risk and carrying out the necessary interventions, reducing the frequency and mortality due to sepsis.