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P269 PHASE ANGLE: MORTALITY AND MORBIDITY PREDICTOR IN HEMODIALYSIS POPULATION?
144 resulting in an increased need for medical resources and economic expenses. The purpose of this study was to evaluate the relationship between nutritional status using subjective global assessment (SGA) and mortality in the elderly patients in ICUs. Methods: The elderly patients with an age >65 years were prospectively collected in the ICUs of a tertiary care hospital from July 2007 to November 2007. A nutritional assessment with SGA was completed within 24 hours of ICU admission. The demographic data, disease severity (APACHE II), laboratory test, the length of using mechanical ventilation days, the length of ICU and hospital days were recorded. The statistical comparative analysis was performed by Chi-square test with Yates’ correction for qualitative data. Student’s t test or Mann Whitney U test were used for quantitative data. P < 0.05 was considered statistically significant. Results: Fourty-seven of 67 patients (69.9%) were classified as malnourished patients (SGA B or C). Malnourished patients had significantly longer mechanical ventilation days (15.5±13.3 vs 5.9±7.7, p = 0.004) and ICU days (15.7±10.8 vs 8.0±6.8, p = 0.005). The BMI (20.4±4.2 vs 26.0±2.7, p < 0.001), albumin level (2.06±0.50 vs 2.59±0.35 g/dL, p < 0.001), prealbumin level (8.00±4.05 vs 12.77±4.25 mg/dL, p < 0.001) and percentage of lymphocyte count (6.3±5.4 vs12±8.7%, p = 0.002) were lower in malnourished patients. The mortality rate was significantly higher in malnourished patients (40.4 VS 10%, p = 0.014). Conclusion: The prevalence of malnourished elderly patients in the ICUs was high. Malnourished elderly patients had longer mechanical ventilation days and ICU stays, as well as higher mortality rate. Disclosure of Interest: None declared
P269 PHASE ANGLE: MORTALITY AND MORBIDITY PREDICTOR IN HEMODIALYSIS POPULATION? I. Saraiva1 , R. Araujo1 , C. Maximino1 . 1 Nutrition, Unidade de Dialise da Miseric´ ordia de Matosinhos, Matosinhos, Portugal Rationale: The morbidity and mortality rates in hemodialysis population remain high and the proteico-energy malnutrition is still one of its main causes. Few factors can foresee morbidi/mortality and those who are documented have various handicaps. The pursuit of a reliable index, of easily use, high relation cost/benefit, with good acceptance by the patients, and that serve as an early alert which allows an in time intervention, remains of clinical relevance. The trial’s purpose was to determine the phase angle’s prognostic value (given by bioelectric impedance) as an early morbidi/mortality index prior to others variables frequently used in the clinical practice. Methods: The following basal variables were collected: phase angle (PA), age, time in dialysis, vascular access, CRF etiology, comorbidities, blood albumin and Protein C reactive, dialysis dose (Kt/V) and nPCR. Prospectively and for a 3 months period, a register of every event major morbidity (hospitalization >24 hours) and mortality was undertaken.
Poster presentations Results: Of the 81 patients in HDF on-line evaluated: 56.8% were male and had a mean age of 65±12 years and a median time in dialysis of 15 months [3 167 months]. During this period, 13 patients met major morbidity criterions and 8 died morbidi/mortality group. The latter presents blood albumin (3.6±0.5 vs 3.9±0.5; p = 0.043) and PA (5.0±1.4 vs 6.0±1.2; p = 0.004) values significantly inferior to the remaining population. None of the others variables reached statistical significance. In logistic regression model, the PA was the only with a variable that reached statistical significance 5% significance level: women with a PA < 5.3º or men with a PA < 6.3º have a 5.6 fold morbidi/mortality risk compared to the same sex individual with an PA of equal or superior values. The PA had no strong correlation with any statistical variable: only a moderate association level with blood albumin (r = 0.585) and a weak one with Prot C reactive (r = 0.276), although both were significant. Conclusion: The PA reveled to be an important independent predictive morbidi/mortality factor, at short time. Our data suggest its inclusion on the routine assessment protocol for the TCRF patients in HD. References Pupim LB et al. Miner Electrolyte Metab 1999, 25:400 6. Pupim LB et al. Kidney Int 2004, 66(5):2054 60. Leavey SF et al. Am J Kidney Dis 1998, 31(6):997 1006. Disclosure of Interest: None declared
P270 EVALUATION OF THE DETERMINATION OF THE HEIGHT OF HOSPITALIZED INDIVIDUALS S.C. Coelho1 , V.M. Dias2 , T.N. Borges2 , J.A. Pandini2 . 1 Nutrition, Instituto Nacional do C, 2 ETENEP, Santa Casa da Miseric´ ordia, Rio de Janeiro, Brazil Rationale: The appropriate quantification of the height is an instrument that can be used to determine the needs of energy. When the height cannot be checked in orthostatic posture, some other methods should be used. To identify a better option to determine the height in hospitalized adults unable to be submitted to conventional measurement. Methods: 108 patients interned in the elective surgery infirmary of a general hospital, with average age 57±23 years, of both sexes, being 34.2% female and 65.7% males were evaluated. All the patients were submitted to three different kinds of evaluation to obtain the height, as described next: measure in bed, with the aid of a nonelastic ribbon extended from the heel to the top of the head of the patient lying in supine position at 180º; height of the knee, where also with the aid of a ribbon the distance from the heel to the knee of the left leg is measured according with the methodology described by Chumlea in 1985 with the individual in supine position, and prediction equations proposed by the same author in 1998 are used; and the chamfer method, where the distance between the breastbone of the thorax and the middle finger of one of the patient’s hands, whose arms are opened forming an angle of 90º with the body is measured and the value in cm is multiplied by 2. After the evaluations a comparison was made among the data obtained with each method.
P269 PHASE ANGLE: MORTALITY AND MORBIDITY PREDICTOR IN HEMODIALYSIS POPULATION? I. Saraiva1 , R. Araujo1 , C. Maximino1 . 1 Nutrition, Unidade de Dialise da Miseric´ ordia de Matosinhos, Matosinhos, Portugal Rationale: The morbidity and mortality rates in hemodialysis population remain high and the proteico-energy malnutrition is still one of its main causes. Few factors can foresee morbidi/mortality and those who are documented have various handicaps. The pursuit of a reliable index, of easily use, high relation cost/benefit, with good acceptance by the patients, and that serve as an early alert which allows an in time intervention, remains of clinical relevance. The trial’s purpose was to determine the phase angle’s prognostic value (given by bioelectric impedance) as an early morbidi/mortality index prior to others variables frequently used in the clinical practice. Methods: The following basal variables were collected: phase angle (PA), age, time in dialysis, vascular access, CRF etiology, comorbidities, blood albumin and Protein C reactive, dialysis dose (Kt/V) and nPCR. Prospectively and for a 3 months period, a register of every event major morbidity (hospitalization >24 hours) and mortality was undertaken.
Poster presentations Results: Of the 81 patients in HDF on-line evaluated: 56.8% were male and had a mean age of 65±12 years and a median time in dialysis of 15 months [3 167 months]. During this period, 13 patients met major morbidity criterions and 8 died morbidi/mortality group. The latter presents blood albumin (3.6±0.5 vs 3.9±0.5; p = 0.043) and PA (5.0±1.4 vs 6.0±1.2; p = 0.004) values significantly inferior to the remaining population. None of the others variables reached statistical significance. In logistic regression model, the PA was the only with a variable that reached statistical significance 5% significance level: women with a PA < 5.3º or men with a PA < 6.3º have a 5.6 fold morbidi/mortality risk compared to the same sex individual with an PA of equal or superior values. The PA had no strong correlation with any statistical variable: only a moderate association level with blood albumin (r = 0.585) and a weak one with Prot C reactive (r = 0.276), although both were significant. Conclusion: The PA reveled to be an important independent predictive morbidi/mortality factor, at short time. Our data suggest its inclusion on the routine assessment protocol for the TCRF patients in HD. References Pupim LB et al. Miner Electrolyte Metab 1999, 25:400 6. Pupim LB et al. Kidney Int 2004, 66(5):2054 60. Leavey SF et al. Am J Kidney Dis 1998, 31(6):997 1006. Disclosure of Interest: None declared
P270 EVALUATION OF THE DETERMINATION OF THE HEIGHT OF HOSPITALIZED INDIVIDUALS S.C. Coelho1 , V.M. Dias2 , T.N. Borges2 , J.A. Pandini2 . 1 Nutrition, Instituto Nacional do C, 2 ETENEP, Santa Casa da Miseric´ ordia, Rio de Janeiro, Brazil Rationale: The appropriate quantification of the height is an instrument that can be used to determine the needs of energy. When the height cannot be checked in orthostatic posture, some other methods should be used. To identify a better option to determine the height in hospitalized adults unable to be submitted to conventional measurement. Methods: 108 patients interned in the elective surgery infirmary of a general hospital, with average age 57±23 years, of both sexes, being 34.2% female and 65.7% males were evaluated. All the patients were submitted to three different kinds of evaluation to obtain the height, as described next: measure in bed, with the aid of a nonelastic ribbon extended from the heel to the top of the head of the patient lying in supine position at 180º; height of the knee, where also with the aid of a ribbon the distance from the heel to the knee of the left leg is measured according with the methodology described by Chumlea in 1985 with the individual in supine position, and prediction equations proposed by the same author in 1998 are used; and the chamfer method, where the distance between the breastbone of the thorax and the middle finger of one of the patient’s hands, whose arms are opened forming an angle of 90º with the body is measured and the value in cm is multiplied by 2. After the evaluations a comparison was made among the data obtained with each method.