Excesso de peso e sepse em pacientes críticos pediátricos

Abstract

Introduction: Childhood obesity is a serious public health problem. Little is known about the impact of this condition in critically ill pediatric patients. Sepsis is one of the major causes of admission and mortality of children in Pediatric Intensive Care Units (PICU), and few studies relate nutritional status with unfavorable outcomes in this condition. Objective: To determine the impact of excess weight on the outcomes of patients diagnosed with sepsis admitted to a PICU. Methods: Retrospective cohort study. Patients aged between 1 month and 18 years who were admitted to the PICU of a university hospital between 2013 and 2017 and who had a diagnosis of sepsis were included. The classification of nutritional status was performed using the Body Mass Index for Age. The severity at admission was assessed using the Pediatric Index of Mortality 2 (PIM 2) and the presence of a Complex Chronic Condition was observed. The outcomes analyzed were: mortality, length of stay in the PICU and hospital, need and days free of mechanical ventilation, Multiple Organ Dysfunction Syndrome and need and time of use of vasoactive and inotropic drugs. Inflammatory markers ferritin, c-reactive protein and leukocytes were also measured. Results: 456 subjects were included in the study. Regarding nutritional status, 385 individuals were eutrophic (84.4%) and 42 were overweight (9.2%). Obesity represented 6.4% of the sample (29 patients, 24 obese and 5 severely obese). As for the outcomes, an independent association between obesity and the need for NIV was found (RR=3.30 - CI 1.64 – 6.65). Conclusion: An independent association between the presence of obesity and a greater need for NIV was found in critically ill pediatric patients with sepsis.