Banca de DEFESA: MARTA FRANÇA SANTOS

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : MARTA FRANÇA SANTOS
DATE: 19/12/2022
TIME: 14:00
LOCAL: ENUFBA
TITLE:

PROTEIN SUPPLEMENT AND MORBIMORTALITY IN PATIENTS WITH CRITICAL ILLNESS: A COHORT STUDY

KEY WORDS:

Critical illness, nutritional therapy, protein, mortality, malnutrition

PAGES: 86
BIG AREA: Ciências da Saúde
AREA: Nutrição
SUMMARY:

Introduction: The acute phase of critical illness is characterized by intense protein catabolism and consequent loss of muscle mass, which is associated with worse clinical outcomes. Minimizing protein catabolism in the acute critical illness phase is the challenge of nutritional therapy. However, the ideal protein offer, as well as the best moment for this therapy to provide a better clinical response to patients, is still controversial. Objective: To evaluate the association between protein intake in the acute phase of critical illness and morbidity and mortality in intensive care patients. Method: This is a retrospective cohort study of patients admitted to a medical-surgical Intensive Care Unit (ICU), aged over 18 years, of both sexes, from January 2018 to June 2020. Demographic data were collected , clinical and nutritional supply until the seventh day of hospitalization, using the electronic medical records and nutritional monitoring software used in the Hospital. A protein target of 1.2g/KgWeight and a caloric target of 20-25Kcal/KgWeight were considered adequate. Six-month mortality data were collected from the Bahia Court of Justice website. Descriptive analysis of the variables was performed using measures of central tendency, frequency and prevalence and compared using the t-Studet, Mann Whitney and Pearson Chi Square tests. The association between protein intake and six-month ICU and hospital mortality was assessed by Cox multivariate regression, and the association between protein intake and length of stay in the ICU and hospital by negative binomial regression. Results: Of the 197 patients included in the study, 52.8% (n=104) died within 6 months. Patients who died had higher APACHE and SOFA scores (17 versus 15, p=0.028 and 6 versus 4, p=0.004, respectively), developed more sepsis during the ICU stay (81.7% versus 40 .9%, p < 0.001) and remained hospitalized longer (41 days versus 30.5 days, p=0.004) than survivors. Patients who died also had a higher frequency of nutritional risk (51.9% versus 34.4%, p=0.013). The 1g/KgWeight increase in mean protein intake on the seventh day reduced 6-month mortality by 65.0% (HR: 0.346, 95% CI: 0.133-0.903), ICU mortality by 64.4% (HR: 0.356 , 95% CI: 0.142-0.895) and 61.9% in-hospital mortality (HR: 0.381, 95% CI: 0.164-0.883). Considering nutritional risk, the reduction in mortality was even greater and only among patients at high nutritional risk: 81.5% 6-month mortality (HR: 0.185, 95% CI: 0.046-0.732), 78.5% ICU mortality (HR: 0.215, 95% CI: 0.061-0.75) and 82.7% hospital mortality (HR: 0.173, 95% CI: 0.051-0.587). For the length of stay in the ICU, the increase of 1g/KgWeight in mean protein intake on days 3 and 7 reduced by 32.0% (RR: 0.680, 95% CI: 0.498-0.928) and 28.4% (RR: 0.716, CI 95%: 0.533-0.961) respectively, the length of stay in the ICU. For patients at high nutritional risk, the reduction in ICU length of stay was 41.0% (RR: 0.590, 95% CI: 0.374-0.928) and 34.5% (RR: 0.655, 95% CI: 0.450- 0.954) respectively. Conclusion: Increasing mean protein intake on day 7 reduced 6-month mortality, ICU and hospital mortality, and length of ICU stay in critically ill patients. These results were even more evident in patients at high nutritional risk. Such findings reveal the importance of optimizing protein supply for patients with critical illness, particularly for patients at high nutritional risk, emphasizing the importance of nutritional screening for taking a more assertive nutritional approach.

COMMITTEE MEMBERS:
Externa à Instituição - WILZA ARANTES FERREIRA PERES - UFRJ
Interna - 2615563 - PRISCILA RIBAS DE FARIAS COSTA
Interna - 3315542 - RAQUEL ROCHA DOS SANTOS