MALNUTRITION AND CLINICAL OUTCOMES IN SURGICAL PATIENTS WITH COLORECTAL DISEASE

This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease.

METHODS:

This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis.

RESULTS:

Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively.

CONCLUSION:

Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.

HEADINGS:
Malnutrition; Electric impedance; Nutrition Assessment; Colorectal Surgery

Variable	M ± SD or N (%) or
	m (IQR: Q3-Q1)
Age (years)	59.4 ± 12.3
Gender
Male	19 (47.5)
Female	21 (52.5)
Diagnosis
Neoplasm	33 (82.5)
Crohn’s disease	03 (7.5)
Diverticular disease	03 (7.5)
Familial adenomatous polyposis	01 (2.5)
SGA
A	23 (57.5)
B or C	17 (42.5)
Clinical outcomes
Length of hospital stay (days)	04 (4 - 6)
Severe complications*	12 (30.0)
Death	02 (5.0)

Variable	Well-nourished	Malnourished	P value
	A (n=23)	B + C (n=17)
	M ± DP or m (IQR: Q3-Q1)
Weight (kg)	74.7 ± 12.2	65.4 ± 13.3	0.077
BMI (kg/m²)	28.0 ± 3.7	26.1 ± 5.0	0.328
Albumin (g/dl) ^#	4.2 (4.6-4.0)	3.9 (3.6-4.2)	0.012*
Hematocrit (%)	37.7 ± 4.8	34.7 ± 4.1	0.026*
PA (º)	6.5 ± 0.7	5.5 ± 0.9	0.002*
Resistance (ohm)	512.9 ± 82.6	550.8 ± 97.4	0.213
Reactance (ohm)	58.1 ± 9.7	52.7 ± 11.9	0.177
Fat free mass (%)	32.3 ± 3.9	29.8 ± 3.8	0.092
ECW/TBW (%)	46.3 ± 3.5	49.3 ± 3.8	0.047*
ECW/ICW ^#	0.8 (0.8-1.0)	1.0 (0.9-1.0)	0.019*
Length of hospital stay (days) ^#	4.0 (3.0-5.0)	5.0 (4.0-10.0)	0.051

	Severe postoperative		Total	OR (95% CI)
	complications N (%)
	Yes	No
Malnourished	10 (58.8)	07 (41.2)	17 (100)	15.0 (2.6-86.7)
Well-nourished	02 (8.7)	21 (91.3)	23 (100)	P=0.001*
Total	12 (30.0)	28 (70.0)	40 (100)

Variable	B (coefficient)	Exp (B)	95% CI for Exp(B)	P value
Malnourished (SGA)	2.708	15.000	2.626-85.681	0.002
Constant	-2.351	0.095		0.001

	AUC (95% CI)	Cut-off	S (%)	E (%)	PPV (%)	NPV (%)	P value
Phase	0.82	6.0º	76.5	87.0	81.3	83.4	0.001
angle	(0.65-0.95)

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: João Gomes Netinho. Orcid: https://orcid.org/0000-0003-0264-1883. E-mail: jgnetinho30@gmail.com