Desfecho clínico e fatores associados em pacientes comCOVID-19 internados em uma Unidade de Terapia Intensiva / Clinical outcome and associated factors in patients with COVID-19 admittedto an Intensive Care Unit

Introdução: O Corona Virus Disease (COVID-19) é umainfecção de elevada transmissibilidade e está associada commaior suscetibilidade ao desenvolvimento de desnutrição.Desta forma, a terapia nutricional enteral deve estar inte-grada ao tratamento global deste agravo. Objetivo: Analisar os fatores clínicos, nutricionais e bioquí-micos associados ao desfecho clínico de pacientes com COVID-19 internados em uma Unidade de Terapia Intensiva (UTI). Métodos: Trata-se de uma série de casos, realizado no pe-ríodo de março a julho de 2020, com os dados registrados nasfichas de acompanhamento nutricional dos pacientes interna-dos com COVID-19. As variáveis analisadas foram: demográ-ficas (idade e sexo); clínicas (comorbidades, doença de basee desfecho), antropométricas, bioquímicas e de suporte nu-tricional. Resultados: A amostra foi composta por 102 pacientes,65,7% apresentaram síndrome respiratória aguda grave, aprincipal doença de base observada foi as doenças cardíacas(23,5%) e 69,3% dos pacientes evoluíram para a alta da UTI.Com relação às variáveis nutricionais, aproximadamente 50%dos pacientes receberam alimentação por via enteral e 73,3%iniciaram de forma precoce. No que se refere aos marcadores bioquímicos, os pacientes que foram a óbito, apresentarammaiores valores das razões proteína C reativa (PCR) /albu-mina (p=0,024) e das concentrações de PCR (p=0,012)quando comparado com os que evoluíram para alta da UTI.Além disso, observa-se que os idosos (HR ajustada =3,62;IC95% 1,19 – 10,97) e o início precoce da terapia nutricionalenteral (HR ajustada = 10,62; IC95% 2,41 – 46,87) foram fa-tores relacionados com a alta da UTI. Conclusão: O acompanhamento do processo inflamatórioatravés de diferentes marcadores parece ser um bom parâ-metro de evolução clínica desses pacientes. Além disso, osbenefícios da terapia de nutrição enteral precoce podem es-tar associados à melhor evolução clínica e redução de com-plicações durante internamento.(AU)

ntroduction: The Corona Virus Disease (COVID-19) is ahighly transmissible infection and is associated with greatersusceptibility to the development of malnutrition. Thus, en-teral nutritional therapy must be integrated into the globaltreatment of this condition. Objective: To analyze the clinical, nutritional and biochem-ical factors associated with the clinical outcome of patientswith COVID-19 admitted to an Intensive Care Unit (ICU). Methods: This is a case series, carried out from March toJuly 2020, with data recorded in the nutritional monitoringrecords of patients hospitalized with COVID-19. The variablesanalyzed were: demographic (age and sex); clinical (comor-bidities, underlying disease and outcome), anthropometric,biochemical and nutritional support. Results: The sample consisted of 102 patients, 65.7% hadthe severe acute respiratory syndrome, the main underlyingdisease observed was heart disease (23.5%) and 69.3% ofpatients were discharged from the ICU. Regarding nutritionalvariables, approximately 50% of patients received enteralfeeding and 73.3% started early. Concerning biochemicalmarkers, patients who died had higher C-reactive protein(CRP)/albumin ratios (p=0.024) and CRP concentrations(p=0.012) when compared to those who progressed to dis-charge from the ICU. In addition, it is observed that the eld-erly (adjusted HR = 3.62; 95%CI 1.19 – 10.97) and early ini-tiation of enteral nutritional therapy (adjusted HR = 10.62;95%CI 2.41 – 46 .87) were factors related to ICU discharge. Conclusion: Monitoring the inflammatory process usingdifferent markers seems to be a good parameter for theclinical evolution of these patients. In addition, the benefitsof early enteral nutrition therapy may be associated withbetter clinical outcomes and reduced complications duringhospitalization.(AU)

Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery.

INTRODUCTION: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. OBJECTIVE: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. METHODS: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. RESULTS: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). CONCLUSION: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence.

Introducción: El estado nutricional es el factor independiente que más influye en los resultados post-operacionales en las cirugías electivas. Objetivo: evaluar la influencia del estado nutricional en el periodo de hospitalización y en las complicaciones post-operatorias de los pacientes sometidos a cirugía abdominal. Métodos: Estudio prospectivo de 99 pacientes quirúrgicos mayores de 18 años de edad, sometidos a cirugía abdominal en el período de abril a octubre de 2013, en el Instituto de Medicina Integral Professor Fernando Figueira (IMIP). Todos los pacientes fueron sometidos a evaluaciones nutricionales antropométricos a través del índice de masa corporal (IMC), la circunferencia del brazo (CB) y el espesor del pliegue cutáneo tricipital (PCT). La evaluación bioquímica se llevó a cabo a partir de los resultados leucograma y albúmina sérica. La identificación de los pacientes candidatos a la terapia nutricional (TN) se llevó a cabo a través de la evaluación del riesgo nutricional (RN) utilizando el IMC, la pérdida de peso y la hipoalbuminemia. La información sobre las complicaciones postoperatorias, tiempo de hospitalización y diagnóstico clínico se recogió de los registros médicos. Programa SPSS versión 13.0 y nivel de significancia de 5 % se utilizaron para el análisis estadístico. Resultados: La malnutrición diagnosticada por el CB mostraron asociación positiva significativa con la presencia de complicaciones postoperatorias (p = 0,02) y con el período de hospitalización (p = 0,02). La presencia de RN fue mayor cuando se evaluó por la hipoalbuminemia (28,9 %), sin embargo, sólo el 4 % de la muestra llevó a cabo el TN en el período pre-operacional. El período de hospitalización fue mayor para los pacientes con neoplasia maligna (p < 0,01). Conclusión: El diagnóstico desnutrición de los pacientes sometidos a cirugía abdominal se asocia a un mayor riesgo de complicaciones post-operativas y más tiempo de permanencia de hospitalización.