Associação entre índice prognóstico nutricional, estado nutricional e desfechos clínicos em pacientes cirúrgicos cardíacos

Barbara Giovanna Souza Silva Queiroz; Fabiana Nogueira Benedito da Silva; Andressa Maranhão de Arruda; Taisy Cinthia Ferro Cavalcante; Ana Célia Oliveira dos Santos; Amanda Alves Marcelino da Silva

doi:10.23925/1984-4840.2023v25a7

Authors

Barbara Giovanna Souza Silva Queiroz Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas https://orcid.org/0000-0002-9783-5404
Fabiana Nogueira Benedito da Silva Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas, Recife – PE, Brasil https://orcid.org/0000-0002-2091-4614
Andressa Maranhão de Arruda Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas
Taisy Cinthia Ferro Cavalcante Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas e Laboratório de Pesquisa do Sistema Nervoso e Metabolismo, Campus Petrolina, Petrolina- PE, Brasil
Ana Célia Oliveira dos Santos Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas, Recife – PE, Brasil
Amanda Alves Marcelino da Silva Universidade de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências Médicas https://orcid.org/0000-0002-5109-3900

DOI:

https://doi.org/10.23925/1984-4840.2023v25a7

Keywords:

Thoracic Surgery, Cardiovascular Diseases, Nutritional Status, Nutrition Assessment

Abstract

Introduction: The prognostic nutritional index (PNI) is a prognostic marker used for oncological surgeries and is currently being disseminated for cardiac surgeries. Nutritional status is a significant aggravating factor in this population, thus highlighting the importance of studying the association of these parameters. Objective: To evaluate the association between nutritional status, PNI and clinical outcomes in cardiac surgical patients. Methodology: Prospective cohort carried out with adults and elderly people, of both sexes, admitted to a university hospital that is a reference in cardiology, with surgical indication. Assessments were carried out preoperatively. Anthropometric measurements were taken and the PNI was calculated. The results were evaluated according to the established goals and were associated with the clinical outcome and postoperative (PO) complications. Results: A total of 75 patients with a median age of 60.00 (52.00-69.00) years, 37 (49.34%) patients experienced PO complications. Preoperatively, 52 (69.34%) patients had a poor prognosis according to the PNI. PNI and nutritional status did not differ significantly between patients who had PO complications and those who did not. Conclusion: Our study demonstrated that PNI and nutritional status are not associated with the clinical outcomes studied.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Avelino EB, Morais PSA, Santos AC, Bovi ACN. Fatores de risco para doença cardiovascular em adultos jovens. Braz J Dev. 2020;6(8):58843–4. doi: 10.34117/bjdv6n8-337.

World Health Organization. Noncommunicable diseases country profiles 2018 [Internet]. [acesso em: 13 set. 2023]. Disponível em em: https://iris.who.int/handle/10665/274512.

Lopez-Delgado JC, Muñoz-Del Rio G, Flordelís-Lasierra JL, Putzu A . Nutrition in adult cardiac surgery: preoperative evaluation, management in the postoperative period, and clinical implications for outcomes. J Cardiothoracic Vasc Anesth. 2019;33(11):3143-62. doi: 10.1053/j.jvca.2019.04.002.

Toledo DO, Piovacari SMF, Castro MG, Horie LM. Say no to hospital malnutrition: A Brazilian Society National Campaign. Clin Nutr. 2018;37:S250. doi: 10.1016/j.clnu.2018.06.1883

Hall R. Identification of inflammatory mediators and their modulation by strategies for the management of the systemic inflammatory response during cardiac surgery. J Cardiothoracic Vasc Anesth. 2013;27(5):983–1033.

Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160-7. doi: 10.1016/0002-9610(80)90246-9.

Rocha NP, Fortes RC. Total lymphocyte count and serum albumin as predictors as nutritional risk in surgical patients. ABCD Arq Bras Cir Digest. 2015;28(3):193-6.

Cuppari L. Nutrição clínica no adulto. 4ª ed. São Paulo: Manole; 2019.

Keskin M, İpek G, Aldağ M, Altay S, Hayıroğlu Mİ, Börklü EB, et al. Effect of nutritional status on mortality in patients undergoing coronary artery bypass grafting. Nutrition. 2018;48:82–6. doi: 10.1016/j.nut.2017.10.024.

Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign (IL): Human Kinetics Books; 1988.

Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34(11):2540-5. doi: 10.1093/ajcn/34.11.2540.a.

Blackburn GL, Thornton PA. Nutritional assessment of the hospitalized patient. Med Clin North Am. 1979;63(5):11103-5.

WHO Consultation on Obesity‎; World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation [Internet]. Geneva: WHO; 1999 [acesso em: 27 dez. 2020]. Disponível em: https://iris.who.int/handle/10665/42330

Bragagnolo R, Caporossi FS, Dock-Nascimento DB, Aguilar-Nascimento JE. Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos. Rev Col Bras Cir. 2009;36(5):371–6. doi: 10.1590/S0100-69912009000500003

Hanley JA, Mcneil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.

Chaufour-André C, Bajard A, Fingal C, Roux P, Fiorletta I, Gertych W, et al. Conséquences nutritionnelles de la chirurgie en oncogériatrie. Étude descriptive et prospective. Nutr Clin Metabol. 2011;25:5–13. doi: 10.1016/j.nupar.2010.12.005.

Vegni R, Almeida GF, Braga F, Freitas M, Drumond LE, Penna G, et al. Complicações após cirurgia de revascularização miocárdica em pacientes idosos. Rev Bras Ter Intensiva. 2008;20(3):226–34. doi:10.1590/S0103-507X2008000300004.

Cheng YL, Sung SH, Cheng HM, Hsu PF, Guo CY, Yu WC, et al. Prognostic Nutritional Index and the risk of mortality in patients with acute heart failure. J Am Heart Assoc. 2017;6(6):e004876. doi: 10.1161/JAHA.116.004876.

Doi S, Iwata H, Wada H, Funamizu T, Shitara J, Endo H, et al. A novel and simply calculated nutritional index serves as a useful prognostic indicator in patients with coronary artery disease. Int J Cardiol. 2018;262:92–8. doi: 10.1016/j.ijcard.2018.02.039.

Okuno T, Koseki K, Nakanishi T, Sato K, Ninomiya K, Tomii D, et al. Evaluation of objective nutritional indexes as predictors of one-year outcomes after transcatheter aortic valve implantation. J Cardiol. 2019;74(1):34–9. doi: 10.1016/j.jjcc.2019.02.017.

Kurumisawa S, Kawahito K. Risk analysis using the prognostic nutritional index in hemodialysis-dependent patients undergoing cardiac surgery. J Artif Organs. 2018;21(4):443–9. doi: 10.1007/s10047-018-1056-z.

Felpel K, Palmese L, Urrutia L, Zhang Z, Shapero M, Esbenshade J, et al. Nutritional assessment and comparison of nutritional indices in predicting adverse outcomes in patients undergoing left ventricular assist device implantation. Nutrition. 2021;89:111287. doi: 10.1016/j.nut.2021.111287.

Montgomery TD, Cohen AE, Garnick J, Spadafore J, Boldea E. Nutrition assessment, care, and considerations of ventricular assist device patients. Nutr Clin Pract. 2012;27(3):352–62. doi: 10.1177/0884533612444537.

Yost G, Tatooles A, Bhat G. Preoperative nutritional assessment with the Prognostic Nutrition Index in patients undergoing left ventricular assist device implantation. ASAIO J. 2018;64(1):52–5. doi: 10.1097/MAT.0000000000000625.

Shibata K, Yamamoto M, Kameshima M, Fujiyama H, Sano T, Kagase A, et al. Impact of arm circumference on clinical outcomes in patients undergoing transcatheter aortic valve replacement. Int J Cardiol Heart Vasc. 2022;40:101049. doi: 10.1016/j.ijcha.2022.101049.

Sebe M, Tsutsumi R, Oyama T, Horikawa YT, Uemura Y, Kakuta N, et al. Assessment of postoperative nutritional status and physical function between open surgical aortic valve replacement and transcatheter aortic valve implantation in elderly patients. J Med Invest. 2020;67(1.2):139-44. doi: 10.2152/jmi.67.139.

Stavrou G, Tzikos G, Menni AE, Chatziantoniou G, Vouchara A, Fyntanidou B, et al. Endothelial damage and muscle wasting in cardiac surgery patients. Cureus. 2022;14(10):e30534. doi: 10.7759/cureus.30534.

Gonçalves LB, Jesus NMT, Gonçalves MB, Dias LC, Deiró TC. Preoperative nutritional status and clinical complications in the postoperative period of cardiac surgeries. Braz J Cardiovasc Surg. 2016;31(5):371-80. doi: 10.5935/1678-9741.20160077.

Junqueira JCS, Soares EC, Corrêa Filho HR, Hoehr NF, Magro DO, Ueno M. Nutritional risk factors for postoperative complications in Brazilian elderly patients undergoing major elective surgery. Nutrition. 2003;19(4):321–6.

World Health Organization. The World health report: 1995: bridging the gaps/report of the Director-General [Internet]. [acesso em 27 dez. 2023]. Disponível em: https://iris.who.int/handle/10665/41863.