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Vol. 16. Issue 5.
Pages 759-777 (September - October 2010)
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Vol. 16. Issue 5.
Pages 759-777 (September - October 2010)
Artigo Original/Original Article
Open Access
Risco de reinternamento na doença pulmonar obstrutiva crónica – Estudo prospectivo com ênfase no valor da avaliação da qualidade de vida e depressão
Risk factors for readmission after hospital discharge in chronic obstructive pulmonary disease. The role of quality of life indicators
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Rui Carneiro1,
Corresponding author
ruicarneiro77@gmail.com

Correspondência/Correspondence to: Rui Carneiro, Hospital de Santo António, Serviço de Medicina Interna, Largo Prof. Abel Salazar, 4099-001 porto
, Cristiana Sousa1, Alexandre Pinto1, Fernanda Almeida2, Júlio R. Oliveira2, Nelson Rocha3
1 Interno Complementar de Medicina Interna/Resident, Internal Medicine
2 Assistente Hospitalar de Medicina Interna/Consultant, Internal Medicine
3 Chefe de Serviço de Medicina Interna/Head, Internal medicine Unit
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Resumo

O objectivo do estudo é identificar factores demográficos, clínico-funcionais e inerentes à qualidade de vida (QV) e depressão, com impacto na utilização do Serviço de Urgência (SU) e nos reinternamentos após alta hospitalar por agudização de doença pulmonar obstrutiva crónica (DPOC) num período de 66 semanas. A QV foi avaliada pelo St. George Respiratory Questionnaire (SGRQ). A Beck Depression Inventory avaliou a depressão.

Avaliámos prospectivamente 45 doentes (84,4% homens; mediana de idades: 73 anos; estádio IV:51%). A mediana do score total do SGRQ foi de 50,6, sendo maior o impacto dos sintomas, principalmente nos mais jovens (r:-0425; p:0,043), e da limitação à actividade do que o impacto emocional. Mais de metade encontravam-se deprimidos. Pior QV associou-se a depressão (R:0,699;p:0,02). Valores baixos do VEMS correlacionaram -se com a depressão (r=-0,46;p=0,054) mas não com QV. A prescrição de anticolinérgicos de longa acção ou corticóides inalatórios melhoraram a QV. Quase 85% dos doentes recorreram ao SU (25,8% por DPOC agudizada). A taxa de reinternamento por todos os motivos e por DPOC agudizada foi de 64,9% e 33,3% (por unidade de tempo). O número de reinternamentos (todos os motivos) correlacionou-se com a idade (R=0,48; p=0,003), cor pulmonale (R=-0,46; p=0,03) e com a QV (R=0,67 p=0,004). Doentes deprimidos (R=0,51; p=004), com VEMS baixo (R=-0,413; p=0,04) e com cor pulmonale (R=-046;p=0,005) estiveram mais dias internados por agudização da DPOC. A QV e a depressão são variáveis a considerar na avaliação e tratamento de doentes com DPOC, fazendo parte dum conjunto de dados clínicos, analíticos e funcionais que podem predizer o risco de reinternamento após alta por DPOC agudizada.

Rev Port Pneumol 2010; XVI (5): 759-777

Palavras-chave:
Doença pulmonar obstrutiva crónica
qualidade de vida
depressão
internamento
Abstract

Aims: To identify demographic, clinical, functional and inherent quality of life (QOL) and depression factors with impact on use of the Emergency Services (ES) or readmission after hospital discharge for acute exacerbation of chronic obstructive pulmonary disease (COPD) over a period of 66 weeks. QOL was evaluated by the St. George’s Respiratory Questionnaire (SGRQ). The Beck Depression Inventory assessed depression.

We prospectively evaluated 45 patients (84.4% male, median age 73 years, stage IV 51%). The median total SGRQ score was 50.6, with a greater impact on symptoms, especially in younger patients (r=-0.425; p=0.043), and activity limitation than emotional impact of the disease. More than half were depressed. Worse QOL meant depression (R=0.699; p=0.02). Low FEV1 correlated with depression (r=-0.46; p =0.05) but not with QOL. Long-acting anti-cholinergic bronchodilator and inhaled steroids improved QOL. Almost 85% of patients used ES (25.8% for exacerbated COPD). Rate of hospital readmission for all reasons and exacerbated COPD was 64.9% and 33.3%. The number of readmissions (all reasons) was correlated with age (R=0.48; p=0003), cor pulmonale (R=-0.46; p=0.03) and QOL (R=0.67; p=0.004). Depressed patients (R=0.51; p=004), with low FEV1 (R=-0413; p=0.04) and with cor pulmonale (R=-046, p=0.005) had more inhospital days for exacerbation of COPD.

QOL and depression are variables to consider in the evaluation and treatment of patients with COPD as part of a set of clinical and functional data that can predict the risk of readmission after hospital discharge for exacerbated COPD.

Rev Port Pneumol 2010; XVI (5): 759-777

Key-words:
Chronic obstructive pulmonary disease
quality of life
depression
admission to hospital
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Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
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