Constipation in a cohort prospective in adult critically ill patients: How much occurs and why?

OBJECTIVE

To assess the incidence and factors associated with constipation in adult critical care patients.

DESIGN

Prospective cohort study.

SETTING

Intensive care unit (ICU) of a high-complexity hospital from November 2015 to October 2016.

PATIENTS

Adults who were hospitalized for at least 72h in the ICU were followed from their admission to the ICU until their departure.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In the 157 patients followed up, the incidence of constipation was 75.8%. The univariate analysis showed that constipated patients were younger, used more sedation and showed more respiratory and postoperative causes for hospitalization, while non-constipated patients were hospitalized more for gastrointestinal reasons. The use of vasoactive substances, mechanical ventilation and haemodialysis was similar between the constipated and non-constipated patients. Multivariate analysis, days of use of docusate+bisacodyl (HR: .79; 95% CI: .65-.96) of omeprazole or ranitidine (HR: .80; 95%CI: .73-.88) and lactulose (HR: .87; 95%CI: .76-.99) were independent protection factors for constipation.

CONCLUSION

Constipation has a high incidence among adult critical care patients. Days of drug use acting on the digestive tract (lactulose, docusate+bisacodyl and omeprazole and/or ranitidine) are able to prevent this outcome.

Comparison of NCHS, CDC and WHO growth charts in the nutritional assessment of hospitalized children up to five years old

AIMS

This study evaluated the agreement of growth charts proposed by the National Center for Health Statistics (NCHS/1977), Centers for Disease Control and Prevention (CDC/2000) and World Health Organization (WHO/2006).

METHODS

Were assessed children between 0 and 5 years old, hospitalized in the pediatric wards of a Brazilian school hospital. Z-score indexes: stature/age (S/A), weight/age (W/A) and weight/stature (W/S) was evaluated, in each of the three references (NCHS, CDC and WHO). ANOVA and test Bland & Altman and Lin plots were used in the comparison of the 3 charts. The agreement of the nutritional state categories was also evaluated, through kappa coefficient. The study was approved by the Institution's Research Ethics Committee.

RESULTS

The study analyzed 337 children, whose median age was 0.52 (IQR: 0.21-1.65) years, 65.3% of them were below 1 year old, 60.2% were male and 50% hospitalized due to acute respiratory disease. Lower Z-scores of W/A and S/A were obtained with the WHO charts and lower W/S with the CDC chart. High correlation and agreement were observed among the criteria, but more patients were classified as presenting shortness through the WHO criteria. CDC and WHO criteria were more rigorous than the NCHS criteria for the diagnosis of underweight (W/A) and malnutrition (W/S).

CONCLUSION

Despite the strong agreement of the 3 charts, the adoption of the WHO charts seems to be more helpful for the children's nutritional screening for admission, as it enables to detect a higher number of malnourished children or at nutritional risk, who will benefit from an early intervention.

Accuracy of nutritional assessment tools for predicting adverse hospital outcomes

BACKGROUND AND AIMS

The ability of nutritional status assessment methods to predict clinical outcomes in hospitalized patients has not been completely evaluated. This study compared the accuracy of traditionally used nutritional tools and parameters in predicting death, infection, and length of hospital stay (LOS) in hospitalized adults.

RESEARCH METHODS & PROCEDURES

Patients admitted at clinical and surgical wards were evaluated by body mass index, percentage of weight loss, Subjective Global Assessment, albumin, lymphocyte count, and followed until discharge. Clinical outcomes considered were in-hospital death, infection, and LOS. Overall accuracy of each method to predict these outcomes was assessed from ROC curves and C-statistic.

RESULTS

Among 434 patients evaluated, 51% had a prolonged LOS, 23% developed infection, and 7.8% died during hospitalization. In univariate analysis, serum albumin was the strongest predictive parameter for death (Cstatistic: 0.77; CI95%: 0.69-0.86) and hospital infection (C-statistic: 0.67; CI95%: 0.61-0.74). For longer stay, lymphocyte count (C-statistic: 0.60; CI95%: 0.55-0.65) emerged as the most predictive variable. After adjustment for non-surgical hospitalization and cancer diagnosis, weight loss > 5% (OR: 1.58; CI95%: 1.06-3.35), and serum albumin < 3.5 g/dL (OR: 2.40; CI95%: 1.46-3.94) were associated to LOS. Albumin was the only independent variable related to infection (OR: 5.01; CI95%: 3.06-8.18) and, for hospital death, albumin (OR: 7.20; CI95%: 3.39-15.32) adjusted for age (OR: 1.03; CI95%: 1.01-1.06).

CONCLUSIONS

Nutritional assessment methods evaluated were weakly predictors of hospital outcomes. Except for low serum albumin, isolated use of these methods adds little information in identifying the effect of nutritional status on clinically relevant outcomes.