Características clínicas y de laboratorio en pacientes cirróticos asociada con desnutrición moderada o severa / Clinical and laboratory characteristics of cirrhotic patients associated with moderate and severe malnutrition

Context and objective: Protein-energy malnutrition is described Context and objective: Protein-energy malnutrition is described in 25-100% of patients with cirrhosis. The aim of this study was to evaluate the nutritional status of cirrhotic patients, to identify clinical and laboratory variables associated with moderate to severe malnutrition and to correlate them with cirrhosis prognostic factors (Child-Pugh Classification). Design and setting: This cross-sectional study evaluated cirrhotic individuals admitted to University Hospital from December 2011 to August 2012. Methods: Nutritional status was evaluated by Subjective Global Assessment (SGA), total lymphocyte count and serum albumin. Bivariate analysis was used to identify variables associated with Child C and with moderate to severe malnutrition in different nutritional classifications. Results: Sixty-seven patients were included (mean age 54.4 ± 11.7 years; 74.6% men). The mean MELD score was 14.5 ± 6.5, and almost 30% of the individuals were classified as Child C. With respect to nutritional status, 20.9% showed severe malnutrition by SGA, 14.9% malnutrition by total lymphocyte count, and 40.3% by albumin levels. In all methods employed, moderate to severe malnutrition was correlated with Child classification grade C. The rate of moderate to severe malnutrition by SGA was lower than that evidenced by laboratory methods. Nevertheless, SGA indicated a greater proportion of Child C patients with moderate to severe malnutrition. Conclusion: Due to the high prevalence of malnutrition and its correlation to the severity of cirrhosis, the nutritional evaluation ofcirrhotic patients is an essential step that can be performed through simple methods in routine hospital care.

Contexto y objetivo: la desnutrición proteico-calórica es reportada en 25 a 100 % de los pacientes con cirrosis. El objetivo de este estudio fue evaluar el estado nutricional de los pacientes cirróticos e identificar las variables clínicas y de laboratorio asociadas a la desnutrición moderada a severa y correlacionarlas con los factores de pronósticos de la cirrosis (clasificación de Child-Pugh). Diseño y montaje: Este es un estudio transversal que evaluó pacientes cirróticos ingresados en el Hospital Universitario de diciembre 2011 a agosto 2012. Métodos: El estado nutricional se consiguió mediante la Evaluación Subjetiva Global (ESG), recuento total de linfocitos (RTL) y albúmina sérica. Un análisis bivariado se utilizó para identificar las variables asociadas con el Child C y con la desnutrición Moderada-severa en diferentes clasificaciones nutricionales. Resultados: 67 pacientes fueron incluidos con una edad media de 54,4 ± 11,7 años, 74,6 % hombres. La media del registro MELD fue de 14,5 ± 6,5 y casi 30% de los individuos eran Child C. En cuanto al estado nutricional, el 20,9 % tenían desnutrición severa por ESG, 14,9 % por RTL, y el 40,3 % por albúmina. Para todos los métodos, la malnutrición moderada severa se correlacionó con Child C. La tasa de malnutrición moderada a grave detectada en la población por ESG fue más baja que la demostrada por los métodos de laboratorio. Sin embargo, el ESG indica una mayor proporción de pacientes Child C y con desnutrición moderada a severa. Conclusiones: Dada la alta prevalencia de desnutrición y su correlación con la gravedad de la cirrosis, la evaluación nutricional de los pacientes con cirrosis hepática es un paso esencial que se puede lograr a través de métodos simples y de rutina del hospital.

Identification of risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital / Identificação de grupos de risco para disfagia orofaríngea em pacientes internados em um hospital universitário

Purpose: To identify risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital. Methods: The study was design as an exploratory cross-sectional with quantitative data analysis. The researched population consisted of 32 patients admitted to the medical clinic at the university hospital. Patient history data were collected, followed by a universal swallowing screening which included functional feeding assessment, to observe clinical signs and symptoms of dysphagia, and assessment of nutritional status through anthropometric data and laboratory tests. Results: Of the total sample, the majority of patients was male over 60 years. The most common comorbidities related to patients with signs and symptoms of dysphagia were chronic obstructive pulmonary disease, systemic arterial hypertension, congestive heart failure, diabetes mellitus and acute myocardial infarction. The food consistency that showed higher presence of clinical signs of aspiration was pudding and the predominant sign was wet voice. Conclusion: There is a high incidence of risk for oropharyngeal dysphagia in hospitalized patients and an even higher rate of hospitalized patients with nutritional deficits or already malnourished. Hospitalized patients with respiratory diseases, chronic obstructive pulmonary disease, congestive heart failure and patients with xerostomia were indicated as risk group for oropharyngeal dysphagia. .

Objetivo: Identificar os grupos de risco para disfagia orofaríngea em pacientes internados em um hospital universitário. Métodos: O estudo foi transversal do tipo exploratório com análise quantitativa dos resultados. A população pesquisada foi formada por 32 pacientes internados nas clínicas médicas do hospital. Foram coletados dados da história do paciente e realizada a triagem universal de deglutição, avaliação funcional da alimentação para observação de sinais e sintomas de disfagia e avaliação do estado nutricional por dados antropométricos e exames laboratoriais. Resultados: Da amostra total, a maioria dos pacientes era homens acima de 60 anos. As comorbidades mais associadas a pacientes com sintomas e sinais de disfagia foram doença pulmonar obstrutiva crônica, hipertensão arterial sistêmica, insuficiência cardíaca congestiva, diabetes melitus e infarto agudo do miocárdio. A consistência alimentar em que foi observada a maior presença de sinal clínico de aspiração foi o pudim, e o sinal predominante, a voz molhada. Conclusão: Há grande incidência de risco para disfagia orofaríngea nos pacientes internados e um índice ainda maior de pacientes internados em comprometimento nutricional ou já desnutridos. Pacientes internados com doenças respiratórias, doença pulmonar obstrutiva crônica, insuficiência cardíaca congestiva e pacientes com xerostomia foram apontados como grupo de risco para disfagia orofaríngea. .