Risk factors that influence the prognosis of community-acquired pneumonia in hospitalized adults
Keywords:
Nutrition, Pneumonia, Prealbumin, RiskAbstract
Objective
The present study assessed the influence of nutritional parameters on the prognosis of community-acquired pneumonia in adults admitted to a general hospital.
Methods
A total of 61 individuals with community-acquired pneumonia were studied prospectively and the following data analyzed: sociodemographic variables, morbidity, life habits, anthropometric variables (body mass index, waist circumference, percentage of body fat, percentage of weight lost), biochemical variables (urea, creatinine, albumin on admission and 18 days later, prealbumin on admission and 4, 8 and 18 days later), and outcome (hospital stay shorter than 10 days, longer than 10 days and/or death).
Results
Anthropometric variables differed between genders but were not associated with poor outcome. Albumin and prealbumin levels were low on admission in 80.3% and 86.9% of the cases, respectively. Logistic regression showed that smoking (OR:1.23; CI:1.0-12.1), more than one finding or pleural effusion on chest radiographs (OR:1.4; CI:1.24-15.3) and low prealbumin on day 4 (OR:6.1; CI:1.7-22.5) predicted a poor outcome for patients with community-acquired pneumonia.
Conclusion
Nutrition-related biochemical markers, such as low prealbumin, smoking and more than one finding on chest radiographs, indicate severe pneumonia and are useful for deciding treatment strategy.
References
Corrêa RA, Lundgren LFC, Pereira-Silva JL, Silva RLF, Cardoso AP, Lemos ACM, et al. Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes: 2009. J Bras Pneumol. 2009; 35(6):574-601.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(44):243-50.
Brasil. Sistema Único de Saúde. Departamento de Informática do SUS. Morbidade Hospitalar do SUS: por local de residência - Brasil. Brasília: Ministério da Saúde [acesso 2010 jul]. Disponível em: <http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/mruf.def>.
Gomes L. Fatores de risco e medidas profiláticas nas pneumonias adquiridas na comunidade. J Pneumol. 2001; 27(2):97-113.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44(Suppl 2):27-72.
Calder PC, Samantha K. The immune system: a target for functional foods? Br J Nutr. 2002; 88: S165-76.
Katona P, Katona J.The interaction between nutrition and infection. Clin Infect Dis. 2011; 46(10): 1582-8.
Hedlund J, Hansson LO, Ortqvist A. Short and long term prognosis for middle-aged and elderly patients hospitalized with pneumonia: impact of nutritional and inflammatory factors. Scand J Infect Dis. 1995; 27(1):32-7.
Grant JP, Custer PB, Thurlow J. Current techniques of nutritional assessment. Surg Clin North Am. 1981; 61(3):437-63.
Sachs E, Bernstein LH. Protein markers of malnutrition status as related to sex and age. Clin Chem. 1986; 32:339-41.
Junqueira JCS, Soares EC, Correa Filho HR, Hoehr NF, Magro DO, Ueno M. Nutritional risk factors for postoperative complications in Brazilian elderly patients undergoing major elective surgery.Nutrition. 2003; 19:321-6.
Kurpad AV. The requirements of protein, and amino acid during acute and chronic infections. Indian J Med Res. 2006; 124:129-48.
Loeb MB. Community-acquired pneumonia in older people: the need for a broader perspective. JAGS. 2003; 51:539-43.
Riquelme RO, Riquelme MO, Rioseco MLZ, Cárdenas G, Torres C. Neumonía adquirida en la comunidad en el anciano hospitalizado: aspectos clínicos y nutricionales. Rev Méd Chile. 2008; 136:587-93.
Ingenbleek Y, van Den Schrieck HG, Nayer P, De Visscher M. Albumin, transferrin and the thyroxine- -binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition. Clin Chim Acta. 1975; 63:61-7.
Callaway CW, Chumlea WC, Bouchard C. Circunferences. In: Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.
Oliveira EXG, Travassos C, Carvalho MS. Acesso à internação hospitalar nos municípios brasileiros em 2000: territórios do Sistema Único de Saúde. Cad Saúde Pública. 2004; 20(Supl 2):298-309.
Heyward VH, Stolarczyk LM. Método de impedância bioelétrica. In: Heyward VH, Stolarczyk LM. Avaliação da composição corporal aplicada. São Paulo: Manole; 2000.
Bottoni A, Oliveira GPC, Ferrini MT, Waitzberg DL. Avaliação nutricional: exames laboratoriais. In: Waitzberg Dl. Nutrição oral, enteral e parenteral na prática clínica. 3ª ed. São Paulo: Atheneu; 2000.
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Vigitel Brasil 2009: vigilância de fatores de risco e proteção por doenças crônicas por inquérito telefônico. Brasília: MS; 2010.
Abrantes MM, Lamounier JA, Colosimo EA. Prevalência de sobrepeso e obesidade nas regiões Nordeste e Sudeste do Brasil. Rev Assoc Med Bras. 2003, 49(2):162-6.
Tavares EL, Anjos LA. Perfil antropométrico da população idosa brasileira. Resultados da Pesquisa Nacional sobre Saúde e Nutrição. Cad Saúde Pública. 1999; 15(4):759-68.
Gigante DP, Moura EC, Sardinha LMV. Prevalência de excesso de peso e obesidade e fatores associados, Brasil, 2006. Rev Saúde Pública. 2009; 43(Supl 2):83-89.
Borel JC, Roux-Lombard P, Tamisier R, Arnaud C, Monneret D, Arnol N, et al. Endothelial dysfunction and specific inflammation in obesity hypoventilation syndrome. PLoS One. 2009; 4(8):e6733. doi: 10.1371/journal.pone.0006733.
Bernstein L, Bachman T, Meguid M, Ament M, Baumgartner T, Kinosian B, et al. Measurement of visceral protein status in assessing protein and energy malnutrition: standard of care. Nutrition. 1995; 11:169-71.
Donalisio MR, Arca CHM, Madureira P. Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP. J Bras Pneumol. 2011; 37(2):200-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Maria Rita DONALISIO, Bertha Siqueira Bernardi de OLIVEIRA, Carlos Henrique Mamud ARCA, June Barreiros FREIRE, Daniela de Oliveira MAGRO
This work is licensed under a Creative Commons Attribution 4.0 International License.
