Abstract Objective: to investigate whether the caloric and protein deficits, the diagnosis and the NUTRIC score, behaved as risk factors associated to the survival time. Methods: prospective study with 82 critically ill patients in intensive care unit (ICU), with exclusive enteral nutritional therapy (EENT). We investigated the calorie and protein deficiencies of EENT, the NUTRIC score, and the inflammatory-nutritional index by the C-reactive protein-CRP/albumin. The data were analyzed using the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis, univariate and multiple Cox regressions and the Kaplan-Meyer method. Results: in the univariate Cox regression, one-year increase in age increased the risk of death by 4.1% (p=0.0009; HR=1.041) and one-day increase with intercurrent events, by 1.8% (p = 0.0485; HR = 1.018). In the multiple Cox regression, the clinical diagnosis (p = 0.0462, HR = 2.091) and the NUTRIC score ≥ 5 (p < 0.0001; HR = 5.740) were the variables that together were associated with the survival time. The critical caloric and protein deficits did not behave as death risk factors in this population. Kaplan-Meier curves showed that the probability of survival in 40 days was 28.1% with clinical diagnosis and 40.2% with surgical diagnosis. The mean survival time with NUTRIC score ≥ 5 was 17.4 days. The probability of survival at 40 days was 72.8% with NUTRIC score < 5 and 6.4% with NUTRIC score ≥ 5. Conclusion: caloric and protein deficits are not risk factors for mortality. Only the diagnosis and the NUTRIC score were considered risk factors associated with the survival time.

Resumen Objetivo: investigar si el déficit calórico y proteico, el diagnóstico y la puntuación nutricional se comportaron como factores de riesgo asociados al tiempo de supervivencia. Métodos: estudio prospectivo con 82 pacientes en estado crítico en la Unidad de Cuidados Intensivos (UCI), con terapia nutricional enteral exclusiva (EENT). Investigamos las deficiencias de calorías y proteínas de EENT, el puntuación NUTRIC y el índice inflamatorio-nutricional por la proteína C-reactiva-CRP / albúmina. Los datos se analizaron utilizando las regresiones de Chi-cuadrado, Fisher, Mann-Whitney, Kruskal-Wallis, univariadas y múltiples de Cox y el método de Kaplan-Meyer. Resultados: en la regresión de Cox univariada, el aumento de un año en la edad aumentó el riesgo de muerte en un 4,1% (p = 0,0009; HR = 1,041) y el aumento de un día con eventos intercurrentes, en un 1,8% (p = 0,0485; HR = 1,018). En la regresión múltiple de Cox, el diagnóstico clínico (p = 0,0462, HR = 2,091) y la puntuación nutricional ≥ 5 (p < 0,0001; HR = 5,740) fueron las variables que juntas se asociaron con el tiempo de supervivencia. Los déficits críticos de calorías y proteínas no se comportaron como factores de riesgo de muerte en esta población. Las curvas de Kaplan-Meier mostraron que la probabilidad de supervivencia en 40 días fue del 28,1% con diagnóstico clínico y del 40,2% con diagnóstico quirúrgico. El tiempo medio de supervivencia con puntuación NUTRIC ≥ 5 fue de 17,4 días. La probabilidad de supervivencia a los 40 días fue del 72,8% con una puntuación nutricional < 5 y del 6,4% con una puntuación NUTRIC ≥ 5. Conclusión: los déficits calóricos y proteicos no son factores de riesgo para la mortalidad. Solo el diagnóstico y la puntuación NUTRIC se consideraron factores de riesgo asociados con el tiempo de supervivencia.

RESUMO CONTEXTO: A terapia nutricional enteral (TNE) é a melhor via para a nutrição de pacientes críticos e com melhores impactos no tratamento clínico desses pacientes. OBJETIVO: Investigar a oferta energética e proteica da TNE em pacientes críticos, internados em uma unidade de terapia intensiva (UTI) de um hospital universitário. MÉTODOS: Um estudo prospectivo longitudinal foi conduzido com 82 pacientes críticos internados em uma UTI, recebendo TNE. Foram estudadas variáveis antropométricas, exames laboratoriais (albumina, PCR, relação PCR/albumina), NUTRIC-score e o Nutritional Risk Screening (NRS-2002), metas energéticas e proteicas e as inadequações e complicações da TNE. A análise estatística foi realizada utilizando-se os testes Qui-quadrado ou Fischer e o teste de Wilcoxon, com nível de significancia de P<0,05. RESULTADOS: Na avaliação pelo NUTRIC score, 48,78% apresentaram alto risco nutricional. Na relação PCR/albumina, 85,37% apresentaram alto risco de complicações. Verificou-se diferença estatisticamente significante (P<0,0001) para todas as comparações efetuadas entre a meta, prescrição e infusão da TNE, sendo infundido 72% do que foi prescrito tanto para caloria como para proteína. Observou-se que a diferença entre a prescrição e a infusão foi de 14,63% (±10,81) para caloria e de 14,21% (±10,5) para proteína, com diferença estatisticamente significante (P<0,0001). Na relação entre prescrição e infusão de calorias e proteínas, a única associação significativa foi a dos pacientes com alto risco para a relação PCR/albumina, destes; quase 94% receberam menos que 80% do volume energético e proteico prescrito (P=0,0111). CONCLUSÃO: A administração da TNE em pacientes graves, não supre suas reais necessidades energéticas e proteicas. A alta ocorrência de inadequações da infusão, comparadas à prescrição e às metas definidas podem gerar balanço nutricional negativo.

ABSTRACT BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.