Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/8901 |
Resumo: | 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. |
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Garcia, Pedro Celiny Ramoshttp://lattes.cnpq.br/0761993714239641http://lattes.cnpq.br/4194185073945093Costa, Caroline Abud Drumond2019-10-01T13:00:54Z2018-12-19http://tede2.pucrs.br/tede2/handle/tede/8901Introduction: 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.Introdução: A obesidade e excesso de peso infantil são considerados um problema de saúde pública pela Organização Mundial de Saúde. No entanto, pouco se sabe sobre o impacto nos desfechos de crianças submetidas à internação em unidades de terapia intensiva. Objetivo: Determinar o impacto do excesso de peso, nos desfechos de crianças e adolescentes admitidos em uma Unidade de Terapia Intensiva Pediátrica. Métodos: Estudo de coorte retrospectivo com pacientes que internaram em uma unidade de terapia intensiva pediátrica no período de 01/06/2013 a 31/01/2017. Para avaliação e classificação do estado nutricional foi calculado o escore-z do índice de massa corporal para Idade, com base nas curvas da Organização Mundial de Saúde. Categorizamos o estado nutrcional, segundo índice de massa corporal para idade, em “baixo peso” (magreza e magreza acentuada), “excesso de peso” (sobrepeso, obesidade, obesidade grave) e “peso adequado” (risco de sobrepeso e eutrofia).Como variáveis de gravidade na admissão consideramos, o escore Pediatric Index of Mortality 2, presença de condição crônica complexa, valores delactato e proteína c reativa. Os desfechos avaliados foram: mortalidade, necessidade de ventilação mecânica, tempo de internação na unidade de terapia intensiva pediátrica e síndrome da disfunção de múltiplos órgãos. A análise de comparação entre as categorias de estado nutricional foi realizada pelo teste Qui-quadrado de Pearson e Kruskall-Wallis, com corrreção de Bonferroni. Para análise de associação do estado nutricional com mortalidade, desenvolvemos modelo de diagrama causal acíclico, com posterior regressão logística de Poisson, ajustando para as variáveis sugeridas no diagrama. Os aspectos éticos de pesquisas com seres humanos foram respeitados. Resultados: Foram incluídas, 1407 admissões no estudo.Quanto à distribuição de categorias de estado nutricional na amostra total, tivemos 956 (68,5%) em “peso adequado”, 228 (16,2%) de “excesso de peso” e 223 (15,8%) de “baixo peso”. Houve diferença entre todas as categorias para mediana de idade. Para desfechos a maioria das variáveis com associção se atribuiu a categoria “baixo peso” e observou-se um comportamento semelhante das categorias “peso adequado” e “excesso de peso”. Não houve associação independente de estado nutricional com mortalidade em nenhuma das categorias. Conclusão: Inadequações de estado nutricional são representativas em pacientes admitidos em Unidades de Terapia Intensiva Pediátrica. Não houve associação entre excesso de peso e piores desfechos na população estudada. Sugere-se considerar o excesso de peso como potencial risco para piores desfechos, risco conferido por aspectos fisiológicos inerentes ao tecido adiposo.Submitted by PPG Pediatria e Saúde da Criança (pediatria-pg@pucrs.br) on 2019-09-18T11:16:54Z No. of bitstreams: 1 Tese Carol pos banca.pdf: 1628125 bytes, checksum: 88c8be66e2a7746145de723bfc344970 (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2019-10-01T12:55:44Z (GMT) No. of bitstreams: 1 Tese Carol pos banca.pdf: 1628125 bytes, checksum: 88c8be66e2a7746145de723bfc344970 (MD5)Made available in DSpace on 2019-10-01T13:00:54Z (GMT). No. of bitstreams: 1 Tese Carol pos banca.pdf: 1628125 bytes, checksum: 88c8be66e2a7746145de723bfc344970 (MD5) Previous issue date: 2018-12-19Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/176508/TES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina/Pediatria e Saúde da CriançaPUCRSBrasilEscola de MedicinaObesidadeEstado NutricionalUnidades de Terapia Intensiva PediátricaMortalidadePrognósticoObesityNutritional StatusIntensive Care UnitsPediatricMortalityPrognosisCIENCIAS DA SAUDE::MEDICINACLINICA MEDICA::PEDIATRIAImpacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho será publicado como artigo ou livro60 meses01/10/2024557290555552975733500500500600600-224747486637135387-969369452308786627-70271217037790659553590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.jpgTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.jpgimage/jpeg4085http://tede2.pucrs.br/tede2/bitstream/tede/8901/4/TES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.jpg1a4022c96f9de99ec848f1c24e1dcf2bMD54TEXTTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.txtTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.txttext/plain1724http://tede2.pucrs.br/tede2/bitstream/tede/8901/3/TES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.txt867971ef68dda9eb752f9aa905eaf5daMD53ORIGINALTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdfTES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdfapplication/pdf572894http://tede2.pucrs.br/tede2/bitstream/tede/8901/2/TES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdfdfab262a29b00005938e2c0cf88feb2bMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590http://tede2.pucrs.br/tede2/bitstream/tede/8901/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/89012019-10-01 12:01:44.485oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2019-10-01T15:01:44Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
title |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
spellingShingle |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos Costa, Caroline Abud Drumond Obesidade Estado Nutricional Unidades de Terapia Intensiva Pediátrica Mortalidade Prognóstico Obesity Nutritional Status Intensive Care Units Pediatric Mortality Prognosis CIENCIAS DA SAUDE::MEDICINA CLINICA MEDICA::PEDIATRIA |
title_short |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
title_full |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
title_fullStr |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
title_full_unstemmed |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
title_sort |
Impacto do excesso de peso nos desfechos de pacientes pediátricos criticamente enfermos |
author |
Costa, Caroline Abud Drumond |
author_facet |
Costa, Caroline Abud Drumond |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Garcia, Pedro Celiny Ramos |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/0761993714239641 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4194185073945093 |
dc.contributor.author.fl_str_mv |
Costa, Caroline Abud Drumond |
contributor_str_mv |
Garcia, Pedro Celiny Ramos |
dc.subject.por.fl_str_mv |
Obesidade Estado Nutricional Unidades de Terapia Intensiva Pediátrica Mortalidade Prognóstico |
topic |
Obesidade Estado Nutricional Unidades de Terapia Intensiva Pediátrica Mortalidade Prognóstico Obesity Nutritional Status Intensive Care Units Pediatric Mortality Prognosis CIENCIAS DA SAUDE::MEDICINA CLINICA MEDICA::PEDIATRIA |
dc.subject.eng.fl_str_mv |
Obesity Nutritional Status Intensive Care Units Pediatric Mortality Prognosis |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA CLINICA MEDICA::PEDIATRIA |
description |
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. |
publishDate |
2018 |
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2018-12-19 |
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2019-10-01T13:00:54Z |
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