[Home and Ambulatory Artificial Nutrition (NADYA) Group Report. Home parenteral nutrition in Spain, 2018]. / Nutrición parenteral domiciliaria en España 2018. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

INTRODUCTION: Aim: to communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2018 Material and methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: there were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was "palliative cancer" (22.0%), followed by "others". In children it was Hirschsprung's disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: the number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN.

INTRODUCCIÓN: Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2018. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE del 1 de enero al 31 de diciembre de 2018. Resultados: se registraron 278 pacientes (54,7% mujeres), 23 niños y 255 adultos, procedentes de 45 hospitales españoles, lo que representa una tasa de prevalencia de 5,95 pacientes/millón de habitantes/año 2018. El diagnóstico más frecuente en adultos fue "oncológico paliativo" (22,0%), seguido de "otros". En niños fue la enfermedad de Hirschsprung junto con la enterocolitis necrotizante, con cuatro casos (17,4%). El primer motivo de indicación fue síndrome de intestino corto tanto en niños (60,9%) como en adultos (35,7%). El tipo de catéter más utilizado fue el tunelizado tanto en niños (81,0%) como en adultos (41,1%). Finalizaron 75 episodios, la causa más frecuente fue el fallecimiento (52,0%) y el paso a vía oral (33,3%). Conclusiones: el número de centros y profesionales colaboradores en el registro de pacientes que reciben NPD se mantiene estable, así como las principales indicaciones y los motivos de finalización de la NPD.

[Prevalence of malnutrition to income in a basic general hospital]. / Prevalencia de desnutrición al ingreso en un hospital general básico.

OBJECTIVE: The main objective has been to evaluate and quantify the prevalence of malnutrition at admission, the degree of severity and the correlation with the nutritional parameters in a basic general hospital of the first level. METHODS: Observational, transverse, and randomized study of 244 patients (59.8% male and 40.2% female) performed during the first 24 hours of hospital admission and with a nutritional assessment including nutritional screening (CONUT®), anthropometric parameters, other analytical parameters and a quantification of hospital stay. RESULTS: In this study, 60.7% of the sample has at least one criterion of malnutrition (anthropometric and/or analytical). When considering at least two altered nutritional parameters (one of them analytical type), the prevalence was 29.1%. Prealbumin and transferrin have been shown to be particularly sensitive to moderate to severe and mild malnutrition, respectively. CONUT® has detected nutritional risk of a mild nature in 39.8%. Malnourished patients have a longer stay, and are statistically significant in oncological versusnon-oncological patients. CONCLUSIONS: Anthropometric parameters, on their own, can generate some degree of controversy over the prevalence of malnutrition, so it is considered as appropriate to use two parameters, at least one of an analytical type. Prealbumin is the most sensitive and specific indicator, and CONUT® is an easy, quick and economical tool for nutritional screening. In order to greatly alleviate malnutrition at hospital admission, the objective of the study, it would be wise to strengthen its screening and treatment from Primary Health Care.

[Study of death with secondary diagnosis of malnutrition in a third level hospital]. / Estudio de los exitus con diagnóstico secundario de desnutrición en un hospital de tercer nivel.

BACKGROUND: Malnutrition is a major public health problems, according to WHO, is the leading cause of death, when it affects the group of hospitalized patients, making denominating separate entity "hospital malnutrition". OBJECTIVES: The overall objective is to quantify the main diagnoses frequently high, causing exitus, with secondary diagnosis of malnutrition. METHODS: This is a descriptive study, which included all hospital discharges in 2011 and first half of 2012, which have been exitus and whose secondary diagnosis of malnutrition, with the total of 33. We performed a descriptive analysis, effected the Mann-Whitney nonparametric test (p < 0.05). RESULTS: The most frequent main diagnoses among 33 analyzed are high sepsis (12.1%), liver metastases (9.1%), pneumonia (6.1%), acute respiratory failure (6.1%) and renal acute renal (6.1%). CONCLUSIONS: Although the most frequent primary diagnosis of sepsis, by grouping the diagnoses, the most frequent DRG is respiratory disease, so it has to make comprehensive and quality coding to adjust the relative weight of the same reality. It is essential to specify the source of clinical information used for coding, the degree of malnutrition, for greater specificity in the data.

Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los sujetos hospitalizados, toma entidad propia denominándose "desnutrición hospitalaria". Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos.

[Hospital malnutrition: relation between the hospital length of stay and the rate of early readmissions]. / Desnutrición hospitalaria: relación con la estancia media y la tasa de reingresos prematuros.

BACKGROUND AND OBJECTIVE: In hospitalized patients, malnutrition ranges between 30% and 55% and is associated with a higher rate of complications, prolonged hospitalization and increased cost of health services. Despite this, there is no awareness of the clinical and economic implications involving hospital malnutrition and its treatment. We analyzed the relationship between hospital malnutrition, average length of stay and early readmissions. MATERIAL AND METHODS: It is a prospective and dynamic cohort study, in which patients were observed from the time of their admission and throughout their hospitalization on a weekly basis. The selection was carried out using a systematic random method. Patients were all older than 18 and admitted to the services with an average stay 5 days. It was decided that a patient had malnutrition when some anthropometric (biceps circumference, tricipital, abdominal and subscapular skinfold thickness) or biochemical (albumin, prealbumin, and transferrin) parameter was below normal values. Early readmission was defined as a patient's return to hospital in a period < 31 days from the last date of discharge. Hospital entries were classified in relation to the average stay (hospital and services) and we analyzed the stays below and the stays above the average expected. Results have been expressed in average and standard deviation (X +/- SD) and frequency (%). Intergroup comparisons by Student's t test and chi(2), remain significant to P < .05. The risk and confidence intervals (CI) were applied to malnourished cohorts, with a significance level of 95%. RESULTS: The study included 817 patients (50.9 +/- 18.5 years), 62.9% men and 37.1% women. 45.9% (n = 375) of patients were malnourished, and malnutrition was most common in those with digestive diseases (22.5%), neoplasm (20.8%), circulatory (16.5%) and respiratory pathologies (11.6%). The average stay (hospital and services) and the premature readmission rate were higher in patients admitted to hospital with malnutrition. CONCLUSIONS: Nearly half of the patients presented some degree of malnutrition when they were admitted, increasing hospital stay and premature readmission rate. The high prevalence and incidence of malnutrition requires suggestions to develop mechanisms to determine its real scope and programs to solve it.