Critical Care Unit, Hospital de Clínicas de Porto Alegre and Post-Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul Rua Ramiro Barcelos 2350, 90035-003, Porto Alegre-RS, Brazil.
Universidade Federal do Rio Grande do Sul, School of Medical Sciences, Rua Ramiro Barcelos 2400, 90035-003, Porto Alegre-RS, Brazil.
Clin Nutr ESPEN. 2023 Jun;55:151-156. doi: 10.1016/j.clnesp.2023.03.007. Epub 2023 Mar 15.
BACKCGROUND & AIMS: There in no data regarding outcomes after hospital discharge for underweight critically ill patients. This study aimed to assess long-term survival and functional capacity in underweight critically ill patients.
MATERIALS & METHODS: Prospective observational study that included underweight critically ill patients (BMI <20 kg/cm) followed-up one year after hospital discharge. To assess functional capacity, we interviewed patients or caregivers and performed Katz index (KI) and Lawton scale. Patients were divided into two groups: (1) poor functional capacity, if the patient had less points than the median of the Katz and IADL score, and (2) good functional capacity, if at least one score was above the median. Extremely low weight defined as less than 45 kg.
We assessed the vital status of 103 patients. Mortality was 38.8% (median 362 [136, 422] days of follow-up). We interviewed 62 patients or proxies. No difference was observed between survivors and non-survivors regarding weight and BMI at intensive care unit admission and nutritional therapy received in the first days of intensive care admission. Patients with poor functional capacity had lower admission weight (43.9 vs 52 ± 7.9 kg, p < 0.001) and BMI (17 ± 2.1 vs 18.2 ± 1.8 kg/cm, p = 0.028). In a multivariate logistic regression, weight under 45 kg was independently associated with poor functional capacity (OR = 13.6, 95%CI, 3.7 to 66.5) CONCLUSION: Underweight critically ill patients have high mortality and a persistent functional impairment, the last being more important in extremely low weight.
ClinicalTrials.gov number NCT03398343.
目前尚无关于危重症消瘦患者出院后结局的数据。本研究旨在评估消瘦危重症患者的长期生存和功能能力。
前瞻性观察研究，纳入出院后 1 年随访的消瘦危重症患者（BMI<20kg/cm）。为评估功能能力，我们对患者或照护者进行了访谈，并进行了 Katz 指数（KI）和 Lawton 量表评估。患者分为两组：（1）功能能力差，如果患者的 Katz 和 IADL 评分低于中位数；（2）功能能力良好，如果至少有一项评分高于中位数。极低体重定义为体重<45kg。
我们评估了 103 例患者的生命状态。死亡率为 38.8%（中位随访时间 362[136,422]天）。我们对 62 例患者或其代理人进行了访谈。幸存者和非幸存者在入住重症监护病房时的体重和 BMI 以及入住重症监护病房初期接受的营养治疗方面无差异。功能能力差的患者入院时体重（43.9 与 52±7.9kg，p<0.001）和 BMI（17±2.1 与 18.2±1.8kg/cm，p=0.028）较低。多变量逻辑回归显示，体重<45kg 与功能能力差独立相关（OR=13.6，95%CI，3.7 至 66.5）。
消瘦的危重症患者死亡率高，且持续存在功能障碍，在极低体重患者中，后者更为重要。
ClinicalTrials.gov 编号 NCT03398343。
