Made available in DSpace on 2015-12-10T14:23:52Z (GMT). No. of bitstreams: 0
Previous issue date: 2015-02-27. Added 1 bitstream(s) on 2015-12-10T14:29:54Z : No. of bitstreams: 1
000851584.pdf: 1438887 bytes, checksum: f5b484c29744d12b5da935807b55f362 (MD5) / Introdução: O prognóstico da lesão renal aguda (LRA) é desfavorável, com mortalidade intra-hospitalar de 40% a 80% e em longo prazo entre 15 e 72%. O impacto negativo da desnutrição sobre a evolução em curto prazo dos pacientes com LRA tem sido recentemente confirmado por diferentes estudos, já a evolução nutricional após a alta hospitalar de pacientes críticos tem sido pouco estudada. O objetivo do estudo foi avaliar a evolução nutricional dos pacientes após episódio de LRA e identificar marcadores nutricionais associados ao óbito tardio destes pacientes. Materiais e métodos: Estudo tipo coorte prospectivo realizado com pacientes maiores de 18 anos, com diagnóstico de LRA renal ou pós-renal, acompanhados pelo Grupo da LRA da Disciplina de Nefrologia do Departamento de Clínica Médica da Faculdade de Medicina de Botucatu (FMB-UNESP) e submetidos à avaliação nutricional completa que incluiu a antropometria, a ingestão alimentar, a bioimpedância, os exames bioquímicos, a força de preensão manual, a anamnese e a avaliação subjetiva global; realizada em dois momentos durante a internação hospitalar (no momento da avaliação inicial e na alta do nefrologista) e em três momentos após a alta hospitalar (com 1 mês, 3 e 6 meses). Resultados: Foram incluídos 95 pacientes, que apresentaram idade de 62,3 ± 14,7 anos, prevalência de internação em enfermarias clínicas de 71,6%, índice de severidade da LRA (ATN-ISS) de 28%, sepse como principal etiologia (32,6%), mortalidade intra-hospitalar de 13,6% e tardia de 25,6%. Foram associados à mortalidade no ambiente hospitalar a gravidade da LRA (HR=1,89, IC95%= 1,48-3,46, p=0,04), a ausência de recuperação da função renal (HR=1,46, IC=1,02 - 2,16, p=0,03), a perda de peso grave (HR=1,95, IC95%= 1,19-3,3, p=0,02), a reactância no momento da avaliação do nefrologista (HR=1,51, IC95%=1,04-1,91, p=0,01) e o valor da albumina sérica no momento da última... / Introduction: The prognosis of Acute Kidney Injury (AKI) is poor, with early mortality rate from 40% to 80% and late mortality between 15 and 72%. The negative impact of malnutrition on the early outcome of AKI patients has recently been confirmed by various studies. However, nutritional evaluation after discharge of critically ill patients has not been studied. The aim of the study was to evaluate the nutritional status of patients after an episode of AKI and identify nutritional markers associated with late death in these patients. Methods: Prospective cohort study was performed with patients older than 18 years diagnosed with renal or post-renal AKI and followed up by AKI team, Department of Internal Medicine, Botucatu School of Medicine and underwent complete nutritional assessment that included anthropometry, food intake, bioimpedance, biochemical tests, handgrip, anamnesis and subjective global assessment. It was performed in two moments at hospitalization (at the beginning and end of nephrologist evaluation) and in three moments after hospital discharge (at 1 month, 3 and 6 months). Results: We included 95 patients, age of 62.3 ± 14.7 years, prevalence of hospitalization in medical wards of 71.6%, index of severity of AKI (ATN-ISS) of 28%, early and late mortality rates were 13.6 and 25.6%,respectively. Risk factors associated with early mortality were AKI severity (HR=1.89, 95%CI= 1.48-3.46, p=0.04), no recovery of renal function (HR=1.46, 95%IC=1.02 - 2.16, p=0.03), severe weigh loss (HR=1.95, 95%CI= 1.19-3.3, p=0.02), reactance at first moment of nephrologist evaluation (HR=1.51, 95%CI=1.04-1.91, p=0.01) and albumin at last nephrologist evaluation (HR=1.41, 95%CI=1.04-1.61, p=0.01). weight variation between time of first evaluation by a nephrologists and after 1 month of outpatient follow-up (71.10 ± 19.43 x 71.66 ± 21, p = 0.02) and with late mortality the number of comorbidities (HR=1.79, 95%CI=1.45-2.46, p=0.04), cancer ...
Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unesp.br:11449/132100 |
Date | 27 February 2015 |
Creators | Xavier, Patricia Santi [UNESP] |
Contributors | Universidade Estadual Paulista (UNESP), Ponce, Daniela [UNESP] |
Publisher | Universidade Estadual Paulista (UNESP) |
Source Sets | IBICT Brazilian ETDs |
Language | Portuguese |
Detected Language | English |
Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
Format | 90 f. |
Source | Aleph, reponame:Repositório Institucional da UNESP, instname:Universidade Estadual Paulista, instacron:UNESP |
Rights | info:eu-repo/semantics/openAccess |
Relation | -1, -1 |
Page generated in 0.0198 seconds