El estado nutricional, la respuesta inflamatoria sistémica y la mortalidad en el anciano internado

Resumen La desnutricion en el anciano involucra un estado inflamatorio. Con el objetivo de evaluar en el paciente internado la relacion con la respuesta inflamatoria sistemica y la mortalidad desarrolla- mos un estudio de cohortes prospectivo en el que evaluamos un score nutricional (SGA), anos de instruccion, capacidad funcional, falla organica (Marshall), presencia de sepsis, comorbilidades (Charlson), estado cognitivo (MMSE), albumina, eritrosedimentacion y mortalidad. Se incluyeron 52 pacientes, 19 hombres (36.5%) y 33 mujeres (63.5%) con una mediana de edad de 80 (RI 12.5) anos. Los pacientes normonutridos fueron 29 (55.8%) y los desnutridos 23 (44.2%).El 53.8% de los pacientes desarrollaron sepsis al ingreso o en la internacion. La mortalidad intrahospitalaria en toda la muestra fue 7.7% (n = 4) y al ano fue del 31.8% (n = 14). En el analisis comparativo se evidencio mayor edad (80 vs. 78; p = 0.012), menos anos de instruccion (7 vs. 8; p = 0.027), un MMST menor (14 vs. 27; p = 0.017), menor capacidad funcional previa (21 vs. 32; p < 0.0001), menor valor de albumina (3 vs. 3.35; p = 0.014) y mayor score de falla organica de ingreso (3 vs. 1; p = 0.01) con mayor nume- ro de organos afectados (2 vs. 1; p = 0.003) en los desnutridos con respecto a los normonutridos. Tambien se observo mayor incidencia de sepsis -al ingreso o durante la internacion- (73.9% vs. 37.9%; p = 0.01) y niveles de sepsis mas graves en desnutridos. La mortalidad al ano fue significativamente mayor en los desnutridos (52.2% vs. 9.5%, log rank test = 0.002). En conclusion, los pacientes desnutridos presentaron mayor respuesta inflamatoria sistemica. Palabras clave: sindrome de respuesta inflamatoria sistemica, desnutricion, fragilidad en el anciano Abstract Nutritional status, systemic inflammatory response and mortality in the elderly hospitalized patient. In order to evaluate the relationship between systemic inflammatory response and mortal- ity in the older hospitalized patient, we developed a prospective cohort study in which we evaluated a nutritional score (SGA), years of instruction, functional status, organic failure (Marshall), presence of sepsis, comorbidities (Charlson), cognitive state (MMSE), albumin, erythrocyte sedimentation rate and mortality. Fifty two patients were included, 19 men (36.5%) and 33 women (63.5%), mean age was 80 (Interquartile Range 12.5) years. 29 (55.8%) patients were well-nourished and 23 (44.2%) malnourished, 53.8% of patients developed sepsis at admission or during hospitalization. Total nosocomial mortality was 7.7 % (n = 4) and one-year mortality was 31.8% (n = 14). Comparative analyses showed older age (80 vs. 78; p = 0.012), less years of instruction (7 vs. 8; p = 0.027), lower MMST (14 vs. 27; p = 0.017), lower previous functional status (21 vs. 32; p < 0.0001), lower albumin (3 vs. 3.35; p = 0.014) and higher organic failure score at admission (3 vs. 1; p = 0.01) with more number of affected organs (2 vs. 1; p = 0.003) in malnourished patients compared to well nourished ones. Higher incidence of sepsis -at admission or during hospitalization- (73.9% vs. 37.9%; p = 0.01) and more severe stages of sepsis were also observed in malnourished patients. One-year mortality was significantly higher in malnourished (52.2% vs. 9.5%, log rank test = 0.002). In conclusion, malnourished patients presented greater systemic inflammatory response.