A associação do nursing activity score centrado no paciente como preditor de mortalidade em unidade de terapia intensiva : estudo de coorte retrospectivo

Abstract

To evaluate the association between variations in the Nursing Activities Score (NAS) during the hospitalization of adult patients in intensive care units (ICUs) and 30-day mortality outcomes. The specific objectives were: to describe the nursing workload using the NAS in six ICUs; to assess the correlation between NAS at admission and mortality; and to analyze changes in NAS throughout hospitalization in relation to patient death. Methods: A prospective cohort study was conducted between September and November 2023 in two tertiary hospitals in southern Brazil. A total of 435 adult patients admitted to six ICUs were included. NAS was recorded daily, considering the admission score, the average score during the ICU stay, and its trajectory over time. The primary outcome was 30-day mortality. Cox regression models were used, adjusted for clinical, physiological, and sociodemographic variables. Results: NAS at admission, as a continuous variable, was not significantly associated with mortality. However, patients with NAS scores >100% had a significantly higher risk of death (adjusted HR = 4.69; p = 0.001). The average NAS during hospitalization was also associated with mortality, particularly among those with scores between 80 100% (adjusted HR = 2.37; p = 0.041). An increasing NAS trajectory (>3%) was the strongest predictor, associated with a 3.4-fold higher risk of death (HR = 3.43; p < 0.001). Conclusion: Changes in NAS throughout the ICU stay proved to be strong predictors of mortality in critically ill patients, surpassing the isolated admission score. Continuous monitoring of NAS may support early detection of clinical deterioration and contribute to safer and more effective care decisions. [resumo fornecido pelo autor]