Global leadership initiative on malnutrition criteria for undernutrition diagnosis in hospitalized patients: a validation study
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.206Keywords:
Length of hospital stay, Concurrent validity, Predictive validity, PG-SGA, NRS-2002Abstract
Introdução : A desnutrição é motivo de preocupação em ambientes hospitalares devido à sua alta prevalência e ao impacto dessa doença nos resultados do tratamento. Os critérios da Iniciativa Global de Liderança em Desnutrição (GLIM) foram propostos com o objetivo de padronizar o diagnóstico de desnutrição.
Objetivos: O presente estudo visa determinar a validade concorrente do GLIM e sua validade preditiva, por meio da associação com o tempo de internação hospitalar (TIH), em uma amostra de adultos e idosos hospitalizados.
Metodologia: Estudo observacional prospectivo, numa amostra de pacientes internados num Hospital Universitário do Porto. O Nutritional Risk Screening 2002 (NRS-2002) foi aplicado para o rastreio da desnutrição e a Avaliação Global Subjetiva Gerada pelo Paciente (PG-SGA) para o diagnóstico da desnutrição. A validade concorrente entre o GLIM e o PG-SGA foi avaliada através do cálculo da concordância, do coeficiente Kappa de Cohen, da sensibilidade e da especificidade. A validade preditiva foi estudada através da associação independente dos critérios do GLIM com o tempo de internação, utilizando a regressão de Cox.
Resultados: Esta amostra é composta por 430 pacientes internados (18-90 anos, 54,0% homens). De acordo com o GLIM, 222 (51,6%) não apresentavam desnutrição, 86 (20,0%) apresentavam desnutrição moderada e 122 (28,4%) apresentavam desnutrição grave. Comparado ao PG-SGA, o GLIM apresentou sensibilidade de 70,1% e especificidade de 79,4%; a concordância entre GLIM e PG-SGA foi de 58,4%, com kappa = 0,484. A desnutrição, segundo o GLIM, diminuiu a probabilidade de alta para o domicílio habitual: 0,564 (IC 95%: 0,431; 0,738) para desnutrição moderada e 0,639 (IC 95%: 0,505-0,809) para desnutrição grave.
Conclusão: O GLIM apresentou concordância moderada com o PG-SGA e especificidade satisfatória. Os resultados do presente estudo também demonstraram que a desnutrição, segundo os critérios do GLIM, tanto moderada quanto grave, diminui a probabilidade de alta para casa ou para o domicílio habitual, estando, portanto, associada a maior tempo de internação. Os critérios do GLIM podem ser utilizados na prática clínica para o diagnóstico de desnutrição em pacientes hospitalizados.
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