Guía de práctica clínica para el tamizaje y manejo de adultos con desnutrición o riesgo de desnutrición en el seguro social del Perú (EsSalud)

Introduction: This article summarizes the clinical practice guide (CPG) for the screening and management of malnourished patients or patients at risk of malnutrition in the Social Security of Peru (EsSalud). Objective: To provide clinical recommendations based on evidence for the screening and management of malnourished patients or patients at risk of malnutrition in EsSalud. Methods: A CPG for the screening, management and monitoring of malnourished patients or patients at risk of malnutrition in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 9 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in Pubmed and CENTRAL during 2021. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of screening and management. Finally, the CPG was approved with Resolution No. 128-IETSI-ESSALUD-2021. Results: This CPG addressed 9 clinical questions, divided into three topics: screening, management and monitoring of malnourished patients or patients at risk of malnutrition. Based on these questions, 6 recommendations (3 strong recommendations and 3 weak recommendations), 39 points of good clinical practice, and 2 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the screening, management and monitoring of malnourished patients or patients at risk of malnutrition in EsSalud.Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y manejo de los pacientes desnutridos o en riesgo de desnutrición del Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el tamizaje y manejo de pacientes desnutridos o en riesgo de desnutrición en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó profesionales de la salud y metodólogos. El GEG formuló 9 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y cuando fue considerado pertinentes estudios primarios. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y los flujogramas de tamizaje y manejo. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2021. Resultados: La presente GPC abordó 9 preguntas clínicas, divididas en tres temas: tamizaje, manejo y monitoreo de pacientes desnutridos o en riesgo de desnutrición. En base a dichas preguntas se formularon 6 recomendaciones (3 recomendaciones fuertes y 3 condicionales), 39 puntos de buena práctica clínica, y 2 flujogramas. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el tamizaje, manejo y monitoreo de pacientes desnutridos o en riesgo de desnutrición en EsSalud

Score Malnutrición Inflamación (MIS) como predictor de mortalidad en pacientes con enfermedad renal crónica terminal en cuatro centros de diálisis de lima en el 2016

TesisIntroduction and objective. It has been confirmed that there is a relationship between malnutrition - inflammation and increased mortality among patients who were dialyzed. The score of malnutrition and inflammation (MIS) is a 10 components score, with an interval between 0 and 30 points, the highest score indicates worse prognosis. Our objective was to determine the Score of malnutrition inflammation (MIS) as predictor of mortality in patients with Terminal Chronic Renal Disease in four centers of dialysis in the city of Lima in the period January - February 2016. Material and methods. Transversal descriptive study. Evaluated 265 patients with Terminal chronic renal failure (IRCT) on hemodialysis who applied this instrument "Score malnutrition inflammation MIS". Version 14 program STATA was applied to the analysis of data. A descriptive statistics like frequency, central tendency measures and dispersion was conducted. Results Included 265 patients, mean age was 61±14.5 years. The highest percentage of patients with chronic kidney disease on dialysis over 70 years of age. 56% were male. The causes of chronic kidney disease was hypertension (55.8%) and Diabetes Mellitus (30.9%). For the PCR 1.5% presents a high risk of mortality and 54% average risk of mortality. The average MIS in total population is 8.1 (50%), mild malnutrition and a minimum of 2 and a maximum of 24 as score MIS. The values of TIBC were 150-199 mg/dl values considered to be below the recommended values. The Pearson correlation between MIS and PCR was low positive Conclusion. According to MIS 1% of the population has serious risk of mortality and 31% are at moderate risk. The average of MIS in four clinics were similar to being 8.1 average MIS. was obtained a slight positive correlation between the PCR and values of MIS There was no relationship between the causes or Comorbidities of the ERC with the classification MIS