Validación del cribado nutricional CIPA mediante variables clínicas pronósticas en pacientes quirúrgicos hospitalizados / Validation of CIPA nutritional screening through prognostic clinical variables in hospitalized surgical patients

INTRODUCCIÓN: El cribado nutricional CIPA (Control de Ingestas, Proteínas, Antropometría) es positivo cumpliendo al menos una de las siguientes condiciones: control de ingestas en 48-72 h <5 0%; albúmina < 3 g/dl, índice de masa corporal < 18,5 kg/m2 o circunferencia del brazo ≤ 22,5 cm. Tras su validación en pacientes hospitalizados con patologías no quirúrgicas, se realiza el mismo proceso en pacientes quirúrgicos. OBJETIVOS: Validación del cribado CIPA en pacientes hospitalizados quirúrgicos mediante comparación con Valoración Global Subjetiva (VGS) y analizando el pronóstico clínico de los pacientes. MATERIAL Y MÉTODOS: Estudio prospectivo de pacientes quirúrgicos hospitalizados, valorando la prevalencia o riesgo de desnutrición a través de CIPA y VGS. Análisis de desnutrición hospitalaria a través de la asociación con las variables clínicas pronósticas estancia mediana, mortalidad y reingreso precoz. Concordancia entre ambos métodos de cribado mediante índice Kappa (κ), sensibilidad (S) y especificidad (E). RESULTADOS: Se analizan 226 pacientes. CIPA identifica una prevalencia de desnutrición o riesgo de padecerla del 35,40%, y VGS 30,08%. CIPA es capaz de detectar al paciente con mayor mortalidad hospitalaria (5% vs.0%, p = 0,006), a diferencia de la VGS (2,94% vs.1,27%, p = 0,385). CIPA también detectó aquellos con mayor estancia mediana (21 días [RIC 14-34 días] vs.14,5 días [RIC 9-27 días], p = 0,002) y reingresos precoces (25,3% vs.8,2%, p < 0,001). S y E de CIPA vs. VGS: 70,59% y 79,75%, respectivamente; κ = 0,479 (p < 0,001). CONCLUSIONES: Mediante el cribado nutricional CIPA la prevalencia de desnutrición o riesgo de padecerla en pacientes quirúrgicos es elevada, y estos cursan con peor evolución clínica, siendo válido y efectivo en este tipo de pacientes

INTRODUCTION: CIPA (Control of Food Intake, Protein, and Anthropometry) nutritional screening is positive when one of the following conditions is met: Control of Food Intake for 48-72h < 50 %; Albumin < 3 g/dL, Body Mass Index < 18.5 kg/m2 or Arm Circumference ≤ 22.5 cm. Following its validation in non-surgical inpatients, the same process was performed with surgical inpatients. OBJECTIVES: Validity of the CIPA screening tool in surgical inpatients by comparison with Subjective Global Assessment (SGA) and analysis of clinical outcomes. MATERIAL AND METHODS: A prospective study of hospitalized surgical patients, evaluating the prevalence or risk of malnutrition through CIPA and SGA. Analysis of hospital malnutrition according to CIPA screening and association with the clinical outcomes of median length of stay, mortality and early readmission. Concordance between both screening methods by Kappa Index (κ), sensitivity (S) and specificity (SP). RESULTS: A total of 226 patients were analysed. The prevalence of malnutrition or risk of malnutrition was identified by CIPA in 35.40% and by SGA in 30.08%. CIPA is capable of detecting patients at a greater risk of mortality during hospitalization (5% vs.0%, P = .006), unlike the SGA (2.94% vs.1.27%, P = .385). CIPA also detected patients with higher median length of stay (21 days [IQR 14-34 days] vs.14.5 days [IQR 9-27 days], P = .002) and rate of early readmissions (25.3% vs.8.2%, P < .001). S and SP of CIPA vs. SGA was 70.59% and 79.75%, respectively; Kappa index was 0.479 (P < .001). CONCLUSIONS: Using CIPA nutritional screening, the prevalence and risk of malnutrition in surgical patients is high, and they present poorer clinical outcomes, making CIPA valid and effective in this type of patients

Validation of CIPA nutritional screening through prognostic clinical variables in hospitalized surgical patients. / Validación del cribado nutricional CIPA mediante variables clínicas pronósticas en pacientes quirúrgicos hospitalizados.

INTRODUCTION: CIPA (Control of Food Intake, Protein, and Anthropometry) nutritional screening is positive when one of the following conditions is met: Control of Food Intake for 48-72h <50%; Albumin <3g/dL, Body Mass Index <18.5kg/m2 or Arm Circumference ≤22.5cm. Following its validation in non-surgical inpatients, the same process was performed with surgical inpatients. OBJECTIVES: Validity of the CIPA screening tool in surgical inpatients by comparison with Subjective Global Assessment (SGA) and analysis of clinical outcomes. MATERIAL AND METHODS: A prospective study of hospitalized surgical patients, evaluating the prevalence or risk of malnutrition through CIPA and SGA. Analysis of hospital malnutrition according to CIPA screening and association with the clinical outcomes of median length of stay, mortality and early readmission. Concordance between both screening methods by Kappa Index (κ), sensitivity (S) and specificity (SP). RESULTS: A total of 226 patients were analysed. The prevalence of malnutrition or risk of malnutrition was identified by CIPA in 35.40% and by SGA in 30.08%. CIPA is capable of detecting patients at a greater risk of mortality during hospitalization (5% vs. 0%, P=.006), unlike the SGA (2.94% vs. 1.27%, P=.385). CIPA also detected patients with higher median length of stay (21 days [IQR 14-34 days] vs. 14.5 days [IQR 9-27 days], P=.002) and rate of early readmissions (25.3% vs. 8.2%, P<.001). S and SP of CIPA vs. SGA was 70.59% and 79.75%, respectively; Kappa index was 0.479 (P<.001). CONCLUSIONS: Using CIPA nutritional screening, the prevalence and risk of malnutrition in surgical patients is high, and they present poorer clinical outcomes, making CIPA valid and effective in this type of patients.