Pereira Thainá Gattermann, da Silva Fink Jaqueline, Silva Flávia Moraes
Nutrition Service, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
Clin Nutr ESPEN. 2018 Apr;24:165-169. doi: 10.1016/j.clnesp.2017.10.013. Epub 2018 Feb 15.
BACKGROUNDS & AIMS: new techniques for assessment of nutritional status of critically ill and surgical patients have been investigated to overcome inherent limitations of conventional method. The current study aimed to evaluate the ability of thickness of the adductor pollicis muscle (TAPM) in detecting malnutrition and predicting morbidity and mortality in critically ill surgical patients.
cohort study of adult patients, assessed within the 48 h of admission to the surgical intensive care unit (ICU) of a public hospital. TAPM measurements of the non-dominant hand were performed with patients lying supine. TAPM values lower than the 5th percentile for age and sex were adopted to identify malnutrition. Patients were followed up until discharge for measurement of the following parameters: length of ICU stay, time on mechanical ventilation, length of hospital stay, and hospital mortality.
fifty-nine surgical ICU patients, with mean age of 60.0 ± 17.4 years were included in the current study. There was a positive, weak-to-moderate correlation between TAPM and anthropometric indicators (r = 0.338 to r = 0.579; p < 0.01). The ability of TAPM in identifying patients with malnutrition (diagnosed by global subjective assessment) was assessed by ROC curve analysis, and an area under the ROC curve of 0.611 (95%CI: 0.459-0.762; p = 0.151) was found. TAPM < p5 increased the risk of ICU length of stay >3 days (RR = 2.92; 95%CI 1.09-7.81; p = 0.032). Relative frequencies of malnourished and well-nourished patients according to TAPM were not different between survivors and non-survivors (p = 0.814).
TAPM showed unsatisfactory accuracy in predicting malnutrition. Although TAPM was not a good mortality predictor, reduced TAPM (< p5) values increased the risk of a prolonged ICU stay (>3 days).
为克服传统方法的固有局限性，人们对评估重症和外科手术患者营养状况的新技术进行了研究。本研究旨在评估拇收肌厚度（TAPM）检测重症外科手术患者营养不良以及预测发病率和死亡率的能力。
对成年患者进行队列研究，在一家公立医院的外科重症监护病房（ICU）入院48小时内进行评估。患者仰卧位时对其非优势手进行TAPM测量。采用低于年龄和性别的第5百分位数的TAPM值来识别营养不良。对患者进行随访直至出院，以测量以下参数：ICU住院时间、机械通气时间、住院时间和医院死亡率。
本研究纳入了59例外科ICU患者，平均年龄为60.0±17.4岁。TAPM与人体测量指标之间存在正相关，相关性较弱至中等（r = 0.338至r = 0.579；p < 0.01）。通过ROC曲线分析评估TAPM识别营养不良患者（通过整体主观评估诊断）的能力，发现ROC曲线下面积为0.611（95%CI：0.459 - 0.762；p = 0.151）。TAPM < p5增加了ICU住院时间>3天的风险（RR = 2.92；95%CI 1.09 - 7.81；p = 0.032）。根据TAPM划分的营养不良和营养良好患者的相对频率在幸存者和非幸存者之间没有差异（p = 0.814）。
TAPM在预测营养不良方面显示出不尽人意的准确性。虽然TAPM不是一个良好的死亡率预测指标，但TAPM值降低（< p5）会增加ICU住院时间延长（>3天）的风险。
