Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos

Abstract

Introduction: Childhood overweight and obesity are considered a public health problem by the World Health Organization. However, little is known about the impact on the outcome of children who have undergone hospitalization in Intensive Care Units. Objective: Determine the impact of overweight in the admission and outcomes of children and adolescents in a Pediatric Intensive Care Unit. Methods: Retrospective cohort study with patients admitted to a PICU from 01/06/2013 to 31/01/2017. In order to evaluate and classification the nutritional status, Z-score of Body Mass Index (BMI) was calculated according to patient’s age and basedon WHO reference curves. Nutritional status was categorized according to BMI-for-age in “lowweight” (thinness and severethinness), “overweight”(overweight, obesity and severeobesity) and “appropriateweight” (overweightrisk and eutrophy). Pediatric Index of Mortality 2, presence of complex chronic conditions, lactate levels and C-reactive protein were considered as severity variables at admission. The outcomes evaluated were: mortality, presence of infection, need for mechanical ventilation, hospitalization time at PICU, organic dysfunction during hospitalization and multiple organ dysfunction syndrome. Pearson’s chi-squared test and Kruskall-Wallis, with Bonferroni correction were used to compare nutritional status categories. We developed a modelo acyclic causal diagram with further Poisson logistic regression, adjusted to the variables suggested on the diagram in order to analyze nutritional status and mortality association. All guidelines for ethic al aspects of research with human beings were followed. Results: In thepresentstudy, 1,407 patient’s hospital admissions were included. As for nutritional status categories’ distribution in the total sample, weobserved 956 (68.5%) as “appropriate weight”, 228 (16.2%) as “over weight” and 223 (15.8%) as “low weight”. Significant difference in median age was observed among all the categories. In relation to the outcomes, most of the variables that presented association belonged to the category “lowweight” and similar characteristics were observed in thecategories“appropriateweight” and “overweight”. There was no association between nutritional status and mortality in any of the categories analyzed. Conclusion: Inadequacies of nutritional status are representative in patients admitted to Pediatric Intensive Care Units. There was no association between overweight and worse outcomes in the study population. It is suggested to consider overweight as a potential risk for worse outcomes, a risk conferred by physiological aspects inherent to adipose tissue.