Impacto da internação hospitalar sobre o estado nutricional e força muscular de pacientes com doença hepática internados em um hospital universitário

Abstract

Introduction: Chronic liver disease (CLD) has a strong connection with nutritional and functional deficits associated with a worse clinical prognosis and greater morbidity and mortality. In addition to the pathophysiological impact inherent in CLD, hospitalization can worsen the nutritional and functional status of patients, leading to malnutrition and sarcopenia. It is therefore crucial to diagnose changes in the nutritional and functional status of individuals with CLD at an early stage in order to establish assertive approaches that will have a positive impact on their clinical evolution and also reduce the length of hospital stays. Objective: To assess the impact of hospitalization on the nutritional status and muscle strength of patients with CLD admitted to a university hospital. Methods: The study involved patients of both sexes, aged 18 or over, diagnosed with CLD and hospitalized for at least 5 days in the medical clinic of the Professor Alberto Antunes University Hospital, from April 2023 to April 2024. Data collection included socioeconomic information, anthropometric data, nutritional screening, disease severity (MELD-Na and Child-Pugh scores), functional capacity (using SARC-F, SARC-CALF and handgrip strength), phase angle, and food intake. The data was tabulated in Microsoft ExcelⓇ version 365 and statistical analysis was carried out using SPSSⓇ version 26.0 software, with Mann-Whitney, Spearman, and McNemar tests, adopting a significance level of p<0.05. Results: 40 patients were initially included, 35 of whom remained in the study after the diagnosis of CLD was confirmed. Of these, 15 were reassessed at hospital discharge. Most of the patients were male (71.4%) and aged ≥ 60 years (51.4%), with low levels of education and a vulnerable socio-economic situation. The vast majority of those assessed were nutritionally and functionally compromised on admission, with 85.7% at high nutritional risk according to the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), 88.6% malnourished according to the Royal Free Hospital-Global Assessment (RFH-GA), 71.4% at risk of sarcopenia, and 58.1% with low muscle strength. The median length of stay was 19 days (16) and the number of deaths among those assessed was high (25.7%). Nutritional and functional reassessment was carried out on only 42.9% of those initially included. There was no worsening in the nutritional and functional status of the patients who were reassessed, indicating the effectiveness of the nutritional and clinical treatment established. In addition, the risk of sarcopenia identified by the SARC-F showed a moderate positive correlation with length of stay (r=0.445; p=0.007). Conclusion: Patients with CLD showed significant impairment in their clinical, nutritional, and functional status when hospitalized and remained hospitalized for a long period, especially those diagnosed with a risk of sarcopenia. However, the clinical and nutritional treatment established in the hospital, despite not promoting positive changes in nutritional and functional status, was effective in stabilizing these patients and did not increase the prevalence of nutritional and functional deficits in those who were able to have their condition revealed before hospital discharge.