Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos
Ano de defesa: | 2018 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontif?cia Universidade Cat?lica do Rio Grande do Sul
|
Programa de Pós-Graduação: |
Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a
|
Departamento: |
Escola de Medicina
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | 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.Introdu??o: A obesidade e excesso de peso infantil s?o considerados um problema de sa?de p?blica pela Organiza??o Mundial de Sa?de. No entanto, pouco se sabe sobre o impacto nos desfechos de crian?as submetidas ? interna??o em unidades de terapia intensiva. Objetivo: Determinar o impacto do excesso de peso, nos desfechos de crian?as e adolescentes admitidos em uma Unidade de Terapia Intensiva Pedi?trica. M?todos: Estudo de coorte retrospectivo com pacientes que internaram em uma unidade de terapia intensiva pedi?trica no per?odo de 01/06/2013 a 31/01/2017. Para avalia??o e classifica??o do estado nutricional foi calculado o escore-z do ?ndice de massa corporal para Idade, com base nas curvas da Organiza??o Mundial de Sa?de. Categorizamos o estado nutrcional, segundo ?ndice 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 vari?veis de gravidade na admiss?o consideramos, o escore Pediatric Index of Mortality 2, presen?a de condi??o cr?nica complexa, valores delactato e prote?na c reativa. Os desfechos avaliados foram: mortalidade, necessidade de ventila??o mec?nica, tempo de interna??o na unidade de terapia intensiva pedi?trica e s?ndrome da disfun??o de m?ltiplos ?rg?os. A an?lise de compara??o entre as categorias de estado nutricional foi realizada pelo teste Qui-quadrado de Pearson e Kruskall-Wallis, com corrre??o de Bonferroni. Para an?lise de associa??o do estado nutricional com mortalidade, desenvolvemos modelo de diagrama causal ac?clico, com posterior regress?o log?stica de Poisson, ajustando para as vari?veis sugeridas no diagrama. Os aspectos ?ticos de pesquisas com seres humanos foram respeitados. Resultados: Foram inclu?das, 1407 admiss?es no estudo.Quanto ? distribui??o 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 diferen?a entre todas as categorias para mediana de idade. Para desfechos a maioria das vari?veis com associ??o se atribuiu a categoria ?baixo peso? e observou-se um comportamento semelhante das categorias ?peso adequado? e ?excesso de peso?. N?o houve associa??o independente de estado nutricional com mortalidade em nenhuma das categorias. Conclus?o: Inadequa??es de estado nutricional s?o representativas em pacientes admitidos em Unidades de Terapia Intensiva Pedi?trica. N?o houve associa??o entre excesso de peso e piores desfechos na popula??o estudada. Sugere-se considerar o excesso de peso como potencial risco para piores desfechos, risco conferido por aspectos fisiol?gicos inerentes ao tecido adiposo.Submitted by PPG Pediatria e Sa?de da Crian?a (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: 2018-12-19Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/176508/TES_CAROLINE_ABUD_DRUMOND_COSTA_CONFIDENCIAL.pdf.jpgporPontif?cia Universidade Cat?lica do Rio Grande do SulPrograma de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?aPUCRSBrasilEscola de MedicinaObesidadeEstado NutricionalUnidades de Terapia Intensiva Pedi?tricaMortalidadeProgn?sticoObesityNutritional StatusIntensive Care UnitsPediatricMortalityPrognosisCIENCIAS DA SAUDE::MEDICINACLINICA MEDICA::PEDIATRIAImpacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho ser? 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 pedi?tricos criticamente enfermos |
title |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos |
spellingShingle |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos Costa, Caroline Abud Drumond Obesidade Estado Nutricional Unidades de Terapia Intensiva Pedi?trica Mortalidade Progn?stico 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 pedi?tricos criticamente enfermos |
title_full |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos |
title_fullStr |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos |
title_full_unstemmed |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos criticamente enfermos |
title_sort |
Impacto do excesso de peso nos desfechos de pacientes pedi?tricos 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 Pedi?trica Mortalidade Progn?stico |
topic |
Obesidade Estado Nutricional Unidades de Terapia Intensiva Pedi?trica Mortalidade Progn?stico 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 |
dc.date.issued.fl_str_mv |
2018-12-19 |
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2019-10-01T13:00:54Z |
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por |
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Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a |
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