Nutrición Hospitalaria (Dec 2011)
Niveles de vitamina A y zinc en pacientes de cirugía gastroenterológica: Relación con la inflamación y la aparición de complicaciones postoperatorias Vitamin A and zinc levels in gastroenterological surgical patients: Relation with inflammation and postoperative complications
Abstract
Introducción: Se acepta que la depleción aún moderada de algunos nutrientes puede afectar la evolución del paciente quirúrgico. Objetivo: Evaluar la influencia de los niveles plasmáticos de retinol y de zinc preoperatorios sobre la evolución postoperatoria; evaluar la influencia de la inflamación sobre los niveles de ambos marcadores. Métodos: Se determinaron los niveles plasmáticos de retinol y zinc en 50 pacientes previo a ser sometidos a cirugías gastroenterológicas programadas. Para caracterizar el estado nutricional global de los pacientes se incluyeron el IMC y el porcentaje de pérdida de peso (%PP) previo a la cirugía. Se utilizó la Proteína C Reactiva (PCR) como marcador de inflamación. Durante el seguimiento se registraron las complicaciones postoperatorias. El presente análisis se realizó sobre 43 pacientes con información completa. Resultados: Se hallaron valores bajos de retinol (Introduction: It is accepted that even mild nutrient depletion may affect the evolution of the surgical patient. Objective: To evaluate the influence of preoperative levels of plasma retinol and zinc on postoperative evolution of surgical patients; to evaluate the influence of inflammation on both level markers. Methods: Plasma retinol and zinc were determined in 50 patients before programmed gastroenterological surgeries. To detect global malnutrition BMI and weight loss percentage (WL%) were included. C-reactive protein (CRP) was included as inflammation marker. During follow up postoperative complications were recorded. The present analysis was carried out in 43 patients with complete information. Results: Low retinol values (< 20 μg/dl) were founded in 3 cases and low Zn values (< 85 μg/dl) in 20 cases, being 9 of them indicative of severe deficiency (< 70 μg/dl). Postoperative complications were recorded in 17 patients; patients with complications presented lower values of plasma Zn (78.4 ± 25.8 vs. 87.8 ± 25.7 μg/dl) and retinol (36.9 ± 14.5 vs. 49.7 ± 20.6; P = 0.0318) than those with no complications; the number of patients with complications decreased when retinol and Zn ranges increased. No relation between BMI or WL% and appearance of complications was founded; patients with higher WL% were those with higher usual weight. Inflammation affected both markers: retinol dropped from 50.1 ± 17.2 to 44.0 ±20.8 and to 23.7 ± 4.0 μg/dl for CRP ranges of < 0.5, 0.5-3.9 and ≥ 4 mg/dl, respectively (p = 0.0193); levels of zinc fell from 90.1 ± 17.8 to 85.2 ± 29.9 and to 55.0 ± 25.9 μg/dl for the same CRP ranges (P = 0.0195). Zn level influenced retinol level, dropping to 33.1 ± 11.7 μg/dl of retinol in the Zn severe deficiency group (P = 0.0386). Conclusions: The obtained results confirm the influence of vitamin A and zinc on postoperative evolution of the surgical patient, while alert about the interrelationships among vitamin A, zinc and inflammation, which lead to difficulty to establish the real source of deficiencies. Beyond these difficulties, retinol and zinc plasma levels determine the nutrient availability for the body and appear as promissory markers of surgical risk.
