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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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Oliveira, Nelson Rocha" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Rui" "apellidos" => "Carneiro" "email" => array:1 [ 0 => "ruicarneiro77@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "Cristiana" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 2 => array:3 [ "nombre" => "Alexandre" "apellidos" => "Pinto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 3 => array:3 [ "nombre" => "Fernanda" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 4 => array:3 [ "nombre" => "Júlio R." "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 5 => array:3 [ "nombre" => "Nelson" "apellidos" => "Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Interno Complementar de Medicina Interna/Resident, Internal Medicine" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Assistente Hospitalar de Medicina Interna/Consultant, Internal Medicine" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Chefe de Serviço de Medicina Interna/Head, Internal medicine Unit" "etiqueta" => "3" "identificador" => "af0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência/<span class="elsevierStyleItalic">Correspondence to</span>:</span> Rui Carneiro, Hospital de Santo António, Serviço de Medicina Interna, Largo Prof. Abel Salazar, 4099-001 porto" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Risk factors for readmission after hospital discharge in chronic obstructive pulmonary disease. The role of quality of life indicators" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-04-10" "fechaAceptado" => "2010-05-25" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570261" "palabras" => array:4 [ 0 => "Doença pulmonar obstrutiva crónica" 1 => "qualidade de vida" 2 => "depressão" 3 => "internamento" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570260" "palabras" => array:4 [ 0 => "Chronic obstructive pulmonary disease" 1 => "quality of life" 2 => "depression" 3 => "admission to hospital" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">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 <span class="elsevierStyleItalic">Beck Depression Inventory</span> avaliou a depressão.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Avaliámos prospectivamente 45 doentes (84,4% homens; mediana de idades: 73 anos; estádio IV:51%). A mediana do <span class="elsevierStyleItalic">score</span> 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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0,46;p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,48; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003), <span class="elsevierStyleItalic">cor pulmonale</span> (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0,46; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,03) e com a QV (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,67 p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,004). Doentes deprimidos (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,51; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>004), com VEMS baixo (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0,413; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,04) e com <span class="elsevierStyleItalic">cor pulmonale</span> (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-046;p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>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.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (5): 759-777</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0.425; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.043), and activity limitation than emotional impact of the disease. More than half were depressed. Worse QOL meant depression (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.699; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). Low FEV1 correlated with depression (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0.46; p =<span class="elsevierStyleHsp" style=""></span>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<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.48; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0003), <span class="elsevierStyleItalic">cor pulmonale</span> (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0.46; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03) and QOL (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.67; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004). Depressed patients (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.51; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>004), with low FEV1 (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-0413; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.04) and with <span class="elsevierStyleItalic">cor pulmonale</span> (R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>-046, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005) had more inhospital days for exacerbation of COPD.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (5): 759-777</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0030">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Article information
ISSN: 08732159Original language: Portuguese
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