Prognostic nutritional index and mortality in children and adolescents underwent cardiac surgery / Índice nutricional prognóstico e mortalidade entre crianças e adolescentes submetidos à cirurgia cardíaca

Abstract Objectives: to analyze the prognostic nutritional index and factors associated with mortality in children and adolescents with heart disease who underwent cardiac surgery. Methods: this is a longitudinal, retrospective study that included 98 children and adolescents with heart disease from 0 to 14 years old, and assessed the prognostic nutritional index and nutritional status, through the body mass index for age, weight for height, weight for age and height for age. Multiple logistic regression analysis was performed. Results: malnutrition was present in 27 patients, 68 were categorized as having a low prognostic nutritional index and 16 died. In the adjusted analysis, malnutrition (OR=4.11; CI95%=1.26-13.40; p=0.019), the low body mass index for age (OR=4.14; CI95%=1.26-13.61; p=0.019), low weight for height (OR=4.15; CI95%=1.29-13.35; p=0.017) and low weight for age (OR=5.20; CI95%=1.39-19.43; p=0.014) were associated with mortality. Conclusions: malnutrition, low body mass index for age, weight for height and weight for age had shown a significant association with mortality. Despite being an easily applicable indicator of nutritional status, the findings suggest no association between the prognostic nutritional index and mortality in patients with congenital heart disease after cardiac surgery.

Resumo Objetivos: analisar o índice nutricional prognóstico e os fatores associados a mortalidade em crianças e adolescentescardiopatas submetidas à cirurgia cardíaca. Métodos: estudo longitudinal, retrospectivo, que incluiu 98 crianças e adolescentes cardiopatas entre zero a 14 anos e avaliou o índice nutricional prognóstico e o estado nutricional, através dos indicadores índice de massa corporal para idade, peso para estatura, peso para idade e estatura para idade. Foi realizada análise de regressão logística múltipla. Resultados: a desnutrição esteve presente em 27 pacientes, 68 foram categorizados como baixo índice nutricional prognóstico e 16 foram a óbito. Na análise ajustada, a desnutrição (OR=4,11; IC95%=1,26-13,40; p=0,019), o baixo índice de massa corporal para idade (OR=4,14; IC95%=1,26-13,61; p=0,019), o baixo peso para estatura (OR=4,15; IC95%=1,29-13,35; p=0,017) e baixo peso para idade (OR=5,20; IC95%=1,39-19,43; p=0,014) apresentaram associação com a mortalidade. Conclusão: desnutrição, baixo índice de massa corporal para idade, peso para estatura e peso para idade mostraram associação significativa com a mortalidade. Apesar de ser um indicador do estado nutricional de fácil aplicação não foi observada associação do índice nutricional prognóstico com a mortalidade em pacientes com cardiopatias congênitas após cirurgia cardíaca.

Agreement between nutritional risk screening tools and anthropometry in hospitalized pediatric patients.

BACKGROUND/OBJECTIVES: The use of malnutrition screening tools has been recommended to identify the risk of malnutrition among hospitalized children. The aim of this study was to evaluate the association between the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and anthropometric nutritional parameters to identify malnutrition in hospitalized children. SUBJECTS/METHODS: Data recorded in the nutrition sector for 672 pediatric patients hospitalized between 2019 and 2020 were used to complete the STRONGkids and STAMP tools. To test for associations, the chi-square test or Fisher-Freeman-Halton Exact Test were employed, accepting a p-value <0.05 as the threshold for significance. To determine agreement, the Kappa coefficient was applied. RESULTS: Patients with a mean age of 5 years and 7 months were classified as at high nutritional risk by STRONGkids and STAMP in 10.1% (n = 68) and 24.3% (n = 163) of cases, respectively. A significant association (p < 0.05) was identified between all parameters studied for both tools. For STRONGkids, the chi-square test were as follows: BMI/Age, 69.707; Height/Age, 37.730; Weight/Age, 72.202; and Weight/Height, 60.595, whereas for STAMP, they were BMI/Age, 79.620; Height/Age, 75.246; Weight/Age, 91.034; and Weight/Height, 57.227. When compared, the two tools showed significant moderate agreement (κ = 0.448; p < 0.001). CONCLUSIONS: STAMP classified a higher percentage of patients as being at high nutritional risk when compared with STRONGkids, and both tools had a significant association when compared with anthropometric parameters. Screening tools are easy to apply and can be used to identify the risk of malnutrition in this population.