Impacto do déficit calórico-proteico sobre tempo de internação e a mortalidade em pacientes críticos

Abstract

Critical patients generally present a nutritional deficit. Recent studies have shown that an increase in nutritional supply to critical patients is related to better clinical results. OBJECTIVE: To investigate the influence of caloric and protein deficit on mortality and length of hospital stay of critical patients using specialized nutrition therapy. METHOD: A cohort study in which 100 adult patients of both sexes, aged between 18 and 94, admitted to the ICU. The variables studied were: caloric deficit and protein deficit, and, for the effects of analysis, these were divided into critical caloric deficit (≥ 480 kcal) and non-critical caloric deficit (≤ 480 kcal); and critical protein deficit and (≥ 20 g) and non-critical protein deficit (≤ 20 g). The values found were correlated with hospital stay length and mortality as well as confusion variables such as: the nutrition therapy initiation, APACHE II, treatment types and nutritional state. RESULTS: The mortality rate during the study period was 33%. On 13.6% of the 1,772 days of clinical course there was no nutritional supplement for the patients. The patients received 65.4% of the caloric needs and 67.7% of their protein needs. In 72% of cases there was critical caloric deficit and in 70% there was critical protein deficit. There was a significant correlation between length of stay and accumulated caloric deficit (R=0.37; p<0.001) and protein deficit (R=0.28; p<0.001). The survival probability was greater in patients with non-critical caloric deficit (p < 0.001) and non- critical protein deficit (p = 0.002). The multivariate analysis showed critical protein deficit was associated with mortality in the 30 day study period. CONCLUSION: The incidence of caloric and protein deficit in the ICU is high, especially among the more serious and malnourished patients. Late initiation of nutrition therapy is associated with caloric and protein deficits and this increases the length of hospital stay, and protein deficit is an independent mortality factor in critical patients.