Associação entre perda de inserção periodontal, infecções relacionadas à assistência à saúde e mortalidade em pacientes hospitalizados em unidade de terapia intensiva: estudo transversal

Abstract

Healthcare-associated infections (HAIs) have a significant impact on patients admitted to intensive care units (ICUs), contributing to prolonged hospitalization, elevated healthcare expenditures, and increased mortality rates. Periodontitis has been associated with certain systemic diseases, since the inflammatory response is not limited to the periodontal tissues and can disseminate through the vascular system. In hospitalized patients, there is an higher risk of periodontal pathogen proliferation, potentially representing a critical step in the systemic dissemination of bacteria. The objective of this study is to evaluate the association between periodontal inflammation, HAIs and mortality in intubated patients, hospitalized in the ICU. Methodology: This is an observational cross-sectional study with a quantitative data analysis. Data collection was conducted in the ICU of a reference hospital at the Paraná’s western region. The included patients were under mechanical ventilation via an orotracheal tube, for a period ranging from 24 to 72 hours. The periodontal clinical examination and a gingival crevicular fluid collection were performed. Patient data and laboratorial test results were collected from the electronic medical record system, and the HAIs diagnoses were provided by the hospital. The data were presented through descriptive parameters. Continuous and discrete quantitative variables were analyzed using the Student’s t-test for unpaired samples. The variables that did not show a normal distribution (assessed by the Shapiro-Wilk test and Q-Q plot) were analyzed using the non-parametric Mann-Whitney test. Nominal qualitative variables related to sample characteristics, clinical conditions, and periodontal diagnosis were evaluated using the chi-square test. The logistic regression method was used to determine if periodontal variables and HAIs could predict the risk of mortality. The study sample comprised 50 patients. Results: The average age of patients who were discharged was of 48.3 ± 15.6 years old, while those who progressed to death had an average age of 61.1 ± 17.0 years old, with this difference being statistically significant. The loss of periodontal attachment in the 3-4 mm range was significantly greater in the group of patients who progressed to death (6 ± 7) compared to the group that was discharged (3 ± 7), with p = 0.021. The attachment level ≥ 3 mm was identified as a significant predictor for mortality. Conclusion: Mortality is associated with advanced age and with periodontal attachment loss of 3–4 mm, compared to younger patients with less periodontal involvement. Furthermore, the presence of HAIs and attachment loss ≥3 mm increase the risk of death.