Correlação entre níveis séricos de 25-hidroxivitamina D, desenvolvimento de Dech e avaliação do estado nutricional em pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas

• Ano de defesa: 2019
• Autor(a) principal: Barban, Juliana Bernardo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Vitamin D; Hematopoietic Stem Cell Transplantation; Graft-Versus-Host Disease; Nutritional Status And Electrical Bioimpedance.; Vitamina D; Transplante De Células-Tronco Hematopoiéticas; Doença Do Enxerto Contra O Hospedeiro; Estado Nutricional E Bioimpedância Elétrica.
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7698143; https://repositorio.unifesp.br/handle/11600/59540

Objectives: Verify the prevalence of Vitamin D (VD) deficiency in patients submitted to Hematopoietic Stem Cell Transplantation (TCTH) before and after implementing the VD protocol. Check the 25-hydroxyvitamin D [25 (OH) D] levels variability during the first one hundred days. Investigate the nutritional status alterations throughout HSCT. Compare 25 (OH) D levels with graft versus host disease (GVHD) and mortality. Methods: Retrospective study consisting of adult patients that underwent allogeneic HSCT. The patients were divided in two groups: group 1, patients who underwent transplantation before protocol and group 2, patients who underwent transplantation after protocol. The VD levels were analyzed and compared with acute and chronic GVHD. In group 2, the data regarding VD variation was sampled in four different time series: baseline, D+15, D+60, and D+100. It was analyzed considering patient´s GVHD development, patient’s VD supplementation and nutritional status (BMI, phase angle, standardized phase angle, fat free mass and fat mass), using the bioelectrical impedance (BIA). Results: Sixty-five patients were evaluated, in which thirty-nine of the patients underwent transplantation before protocol (group 1) and twenty-six underwent transplantation after protocol (group 2). The mean age was 52,9±16,4 years and the most prevalent gender was male (58%). After implementing the protocol (group 2), a significant increase, 6.2 ng/mL (p=0.039), in VD levels at baseline were observed in comparison with group 1. During the follow-up, 63% of group 2 patients remained with sufficient VD (≥ 20 ng/mL), 21% of the initial deficient patients (<20 ng/mL) reached sufficient VD levels, and only 16% remained with deficient VD (p=0,045). In addition, a mean increase of 6,21 ng/mL in VD at D+100 was observed when compared to the baseline VD (p<0,001), in group 2. Both BMI and fat free mass showed a significant decrease (p<0.001) during the follow-up period. Moreover, VD levels had no correlation with previous fat free mass, BMI and GVHD development. However, a significant correlation was found between phase angle (PA) and mortality at D+100 (p=0,021) and D+365 (p=0,015). Therefore, patients with low PA had a higher mortality rate. Conclusion: The multidisciplinary team effort and the protocol implementation were extremely important to decrease the VD deficiency. The study showed that low PA at baseline is correlated with mortality up to one year. PA is an easy and practical tool to use with patients submitted to allogeneic HSCT. These findings reinforce the importance of nutritional assessment and monitoring before, during and after HSCT.