Power of mortality prediction in patients awaiting liver transplantation according to the Global Leadership Initiative on Malnutrition criteria and Subjective Global Assessment and Royal Free Hospital Global Assessment scores.

OBJECTIVES: This study aimed to analyze the performance of the Global Leadership Initiative on Malnutrition (GLIM) criteria and Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) scores in predicting 12-mo mortality in patients awaiting liver transplantation. METHODS: This is a longitudinal observational study, carried out between March 2019 and November 2021. Clinical data were collected and nutritional assessment was performed through anthropometry and application of validated instruments, such as the SGA, GLIM criteria, and RFH-GA. A Cox regression model was carried out, in which the dependent variable was mortality in 1 y, and the independent variables were the classifications of nutritional status by the different methods. RESULTS: The sample consisted of 126 patients, most of them male (56.35%). Malnutrition was diagnosed in 85.71% of the patients according to the RFH-GA, 62.70% according to the SGA, and 56.31% according to the GLIM criteria. Malnutrition assessed by GLIM was related to a 3.79-fold increase in the chance of mortality over time in patients awaiting liver transplantation. Moreover, the GLIM criteria had good discriminatory power in identifying mortality in patients awaiting liver transplantation, compared with the initial and final SGA and RFH-GA scores and the Model for End-stage Liver Disease-Sodium (MELD-Na) index. CONCLUSIONS: The GLIM criteria were a good predictor of increased risk of mortality in malnourished patients with chronic liver disease awaiting liver transplantation, compared with the SGA and RFH-GA scores and the MELD-Na index.

Estado nutricional e qualidade de vida de pacientes em tratamento crônico de hemodiálise em lista de espera de um centro de transplante renal em Fortaleza, Ceará / Nutritional status and quality of life in patients under chronic hemodialysis on a waiting list from a kidney transplantation center in Fortaleza, Ceará, Brazil

Objetivo: Investigar a associação entre o estado nutricional e a qualidade de vida de pacientes dialíticos em lista de espera para Transplante Renal (TxR) de um centro de transplante em Fortaleza, Ceará. Métodos: Estudo caráter transversal analítico, realizado entre agosto a outubro de 2018, no qual foram avaliados o estado nutricional (EN) e a qualidade de vida (QV), utilizando a versão brasileira do questionário SF-36, em 52 pacientes de um centro de TxR de um hospital universitário da rede pública de saúde. Resultados: Observou-se que a maioria dos pacientes eram eutróficos de acordo com os parâmetros índice de massa corporal (59,6%), circunferência do braço (48,1%) e circunferência muscular do braço (75,0%); no entanto, de acordo com prega cutânea triciptal, 59,6% da amostra encontrava-se desnutrida. Com relação às dimensões de QV, verificou-se que os "Aspectos Físicos" e "Estado Geral de Saúde" tiveram os piores escores, mas apresentaram associação significativa com o sexo feminino (p=0,046) e com o IMC (p=0,010), respectivamente. Já a dimensão "Capacidade Funcional" apresentou associação significativa com a população masculina (p=0,045). Conclusão: Observou-se comprometimento em algumas das dimensões de QV, as quais sugeriram guardar relação com o sexo e o EN. Assim, ressalta-se a importância da realização periódica do diagnóstico nutricional e da avaliação da QV, visto que os pacientes renais dialíticos listados merecem atenção especial, pois apresentam diversas fragilidades físicas, sociais e emocionais, que podem comprometer aspectos importantes no EN e na QV durante o cuidado antes e após o TXR e impactar no tratamento da doença. (AU)

Objective: To investigate the association between nutritional status and quality of life in patients under hemodialysis from a kidney transplantation center in Fortaleza, Ceará waiting for kidney transplantation. Methods: Cross-sectional analytical study carried out from August to October 2018, in which the patients' nutritional status and quality of life were evaluated using the Brazilian version of the SF-36 questionnaire. A total of 52 patients from a kidney transplantation center belonging to a public university hospital participated. Results: It was observed that most patients were eutrophic according to the body mass index (59.6%), arm circumference (48.1%), and arm muscle circumference (75.0%) parameters; however, based on the tricipital skin-fold measurement, 59.6% of the sample was malnourished. Regarding the quality of life dimensions, the "physical role functioning" and "general health perceptions" had the worst scores, but a significant association with female gender (p = 0.046) and body mass index (p=0.010), respectively. The "physical functioning" dimension, on the other hand, was significantly associated with male gender (p=0.045). Conclusion: Compromise was observed in some quality of life dimensions, and the findings suggest a relationship between quality of life and sex and nutritional status. Patients under hemodialysis deserve special attention as they present several physical, social, and emotional weaknesses that can compromise important nutritional aspects and quality of life before and after transplantation, affecting the treatment of the disease. Thus, the importance of periodic nutritional diagnosis and quality of life assessment is emphasized. (AU)