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Caracterização do estado nutricional de adultos submetidos a transplante hepático no Centro Hospitalar Lisboa Central - Hospital de Curry Cabral, através de duas ferramentas de rastreio nutricional
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Authors
Abstract(s)
Introdução: A desnutrição tem uma elevada prevalência nos doentes submetidos a transplante hepático. Este estudo teve como objetivo caracterizar o estado nutricional neste grupo de doentes.
Material e métodos: Este estudo, do tipo observacional e longitudinal, incluiu 47 doentes submetidos a transplante hepático, na Unidade de Transplante do Hospital de Curry Cabral, entre 27 de outubro de 2018 e 28 de junho de 2019. As ferramentas de rastreio nutricional aplicadas foram o Subjective Global Assessment (SGA) e o Nutritional Risk Screening (NRS). A avaliação foi complementada com Índice de Massa Corporal (IMC), parâmetros bioquímicos, composição corporal e perímetro abdominal. Foram realizadas duas avaliações após o transplante, a primeira na admissão na Unidade de Transplante e a segunda avaliação após 4 dias. A análise estatística foi realizada através do programa SPSS® Statistics (Statistical Package for Social Sciences) versão 26.0.
Resultados: O SGA revelou uma percentagem de indivíduos com desnutrição de 85,2% e 77,8% nas duas avaliações, respetivamente. Esta ferramenta revelou uma elevada sensibilidade (86,7%) no diagnóstico de desnutrição, no entanto tem uma baixa especificidade (16,7%). O NRS demonstrou que todos os indivíduos estavam em risco nutricional (100%), tendo uma elevada especificidade (75%) embora com uma baixa sensibilidade (20%). Na segunda determinação do SGA e do NRS obteve-se uma variabilidade de 33,3% e 14,8% no estado nutricional dos doentes, respectivamente. A análise da concordância nos dois momentos de avaliação de cada ferramenta demonstrou concordância de estado nutricional no referido periodo de tempo (Kappa=0.514, p=0.006 e Kappa=0.786, p<0.001, respectivamente).
Conclusões: A realização do rastreio nutricional a todos os doentes internados é crucial. O estudo demonstrou que o SGA é a ferramenta mais sensivel e adequada aos doentes submetidos a transplante hepático, embora não deva ser aplicada isoladamente.
Introduction: Malnutrition has a high prevalence in patients submitted to liver transplantation. This study aimed to evaluate the risk of malnutrition in this group of patients. Methods: This observational and longitudinal study included 47 patients submitted to liver transplant at Unidade de Transplante from Hospital de Curry Cabral, between 27th October 2018 and 28th June 2019. The nutritional screening tools applied were: Subjective Global Assessment (SGA) and Nutritional Risk Screening (NRS), which assess nutritional status and nutritional risk, respectively. The evaluation was complemented with Body Mass Index (BMI), biochemical measurements, body composition and waist circumference. Two evaluations were performed after transplantation, the first at the admission into the Transplant Unit and a second evaluation after four days. Results: The SGA revealed a percentage of individuals with malnutrition of 85.2% and 77.8% in the two assessments, respectively. This tool revealed a high sensitivity (86.7%) in the diagnosis of malnutrition, however it had a low specificity (16.7%). The NRS demonstrated that all individuals were at nutritional risk (100%), having a high specificity (75%), however showed low sensitivity (20%). In the second determination of the SGA and the NRS, a variation of 33.3% and 14.8% was documented in the nutritional status of the patients, respectively. An analysis of the agreement in the two moments of evaluation of each tool showed agreement of nutritional status in the referred period of time (Kappa = 0.514, p = 0.006 and Kappa = 0.786, p <0.001, respectively). Conclusions: The performance of nutritional screening for all hospitalized patients is crucial. The study showed that SGA is the most sensitivity and appropriate tool for patients undergoing liver transplantation, although it should not be applied in isolation.
Introduction: Malnutrition has a high prevalence in patients submitted to liver transplantation. This study aimed to evaluate the risk of malnutrition in this group of patients. Methods: This observational and longitudinal study included 47 patients submitted to liver transplant at Unidade de Transplante from Hospital de Curry Cabral, between 27th October 2018 and 28th June 2019. The nutritional screening tools applied were: Subjective Global Assessment (SGA) and Nutritional Risk Screening (NRS), which assess nutritional status and nutritional risk, respectively. The evaluation was complemented with Body Mass Index (BMI), biochemical measurements, body composition and waist circumference. Two evaluations were performed after transplantation, the first at the admission into the Transplant Unit and a second evaluation after four days. Results: The SGA revealed a percentage of individuals with malnutrition of 85.2% and 77.8% in the two assessments, respectively. This tool revealed a high sensitivity (86.7%) in the diagnosis of malnutrition, however it had a low specificity (16.7%). The NRS demonstrated that all individuals were at nutritional risk (100%), having a high specificity (75%), however showed low sensitivity (20%). In the second determination of the SGA and the NRS, a variation of 33.3% and 14.8% was documented in the nutritional status of the patients, respectively. An analysis of the agreement in the two moments of evaluation of each tool showed agreement of nutritional status in the referred period of time (Kappa = 0.514, p = 0.006 and Kappa = 0.786, p <0.001, respectively). Conclusions: The performance of nutritional screening for all hospitalized patients is crucial. The study showed that SGA is the most sensitivity and appropriate tool for patients undergoing liver transplantation, although it should not be applied in isolation.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Desnutrição Risco nutricional Ferramentas de rastreio nutricional Transplante hepático