Desfecho terapêutico de pacientes em risco nutricional admitidos em um hospital universitário / Therapeutic outcome of patients at nutritional risk upon admission to a university hospital / Desenlace terapéutico de pacientes en riesgo de desnutrición ingresados en un hospital universitario

RESUMO

OBJETIVO: investigar a influência do risco nutricional, detectado ao início da internação, no desfecho terapêutico de pacientes.MÉTODOS: estudo de coorte prospectiva com 495 pacientes admitidos no pronto-atendimento de um hospital universitário, submetidos à triagem de risco nutricional com base no Nutritional Risk Screening, 2002. Ao final da internação, buscaram-se os prontuários para avaliação do desfecho, complicações e presença da terapia nutricional.RESULTADOS: do total de pacientes, 53,9% eram do sexo feminino, 71,3% tinham idade inferior a 60 anos e 11,7% evoluíram com cuidados paliativos/óbito. Segundo o índice de massa corporal, 15,5% dos pacientes foram classificados como desnutridos. O risco nutricional foi encontrado em 54,5% e associou-se fortemente ao desfecho terapêutico cuidados paliativos/óbito (HR 5,92; IC 95% 2,68-13,08), assim como seus componentes, estresse metabólico da doença (HR 3,33; IC 95°% 1,61-6,86) e estado nutricional prejudicado (moderado = HR 3,24; IC 95°% 1,31-8,00; grave = HR 6,45; IC 95% 2,36-17,63), após o ajuste por potenciais fatores de confusão.CONCLUSÃO: a prevalência de risco nutricional detectada foi alta e sua presença estava relacionada a pior desfecho terapêutico.

ABSTRACT

Objective: To investigate the influence of nutritional risk, detected upon being admitted to a hospital, on therapeutic outcomes in patients. Methods: This prospective cohort study was conducted with 495 patients admitted to the emergency clinic of a public hospital, where they were screened for nutritional risk based on the Nutritional Risk Screening 2002. At the end of hospitalization, the outcome, complications, and the presence of nutritional therapy were evaluated based on the medical records. Results: Of the total patients, 53.9% were female, 71.3% were less than 60 years of age, and 11.7% had the therapeutic outcome of palliative care / death. According to Body Mass Index (BMI), 15.5% of the patients were classified as malnourished. Nutritional risk was found in 54.5%, which correlated strongly with the therapeutic outcome of palliative care/death (HR 5.92, 95% CI 2.68 to 13.08) as well as their components of increased nutritional requirements (HR 3.33, 95% CI 1.61 to 6.86) and impaired nutritional status (HR = moderate 3.24, 95% CI 1.31 to 8.00, severe = HR 6.45, 95% CI 2.36 to 17.63) after adjustment for potential confounding factors. Conclusion: The prevalence of nutritional risk detected in the sample was high, and its presence was related to a poor therapeutic outcome.