Risk factors for readmission after hospital discharge in chronic obstructive pulmonary disease. The role of quality of life indicators
Risco de reinternamento na doença pulmonar obstrutiva crónica – Estudo prospectivo com ênfase no valor da avaliação da qualidade de vida e depressão
Rui Carneiro1,
, Cristiana Sousa1, Alexandre Pinto1, Fernanda Almeida2, Júlio R. Oliveira2, Nelson Rocha3
Corresponding author
ruicarneiro77@gmail.com
Correspondence to/Correspondência: Rui Carneiro, Hospital de Santo António, Serviço de Medicina Interna, Largo Prof. Abel Salazar, 4099-001 porto
Correspondence to/Correspondência: Rui Carneiro, Hospital de Santo António, Serviço de Medicina Interna, Largo Prof. Abel Salazar, 4099-001 porto
1 Interno Complementar de Medicina Interna/Resident, Internal Medicine, Serviço de Medicina Interna/Internal medicine Unit, Hospital de Santo António, Centro Hospitalar do Porto
2 Assistente Hospitalar de Medicina Interna/Consultant, Internal Medicine, Serviço de Medicina Interna/Internal medicine Unit, Hospital de Santo António, Centro Hospitalar do Porto
3 Chefe de Serviço de Medicina Interna/Head, Internal medicine Unit, Serviço de Medicina Interna/Internal medicine Unit, Hospital de Santo António, Centro Hospitalar do Porto
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The role of quality of life indicators" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "759" "paginaFinal" => "777" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rui Carneiro, Cristiana Sousa, Alexandre Pinto, Fernanda Almeida, Júlio R. 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" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cristiana" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alexandre" "apellidos" => "Pinto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Fernanda" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Júlio R." 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QOL was evaluated by the St. George's Respiratory Questionnaire (SGRQ). The Beck Depression Inventory assessed depression.</p><p id="spar0020" 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=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>=<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="spar0025" 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>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" 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="spar0010" 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 en con travam-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=0,51; p=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>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Trabalho parcialmente apresentado no 15.° Congresso Nacional de Medicina Interna, em Março de 2009, e premiado como Melhor Comunicação Oral/<span class="elsevierStyleItalic">Work partly presented at the 15th National Congress of Internal Medicine, March 2009, and awarded the prize for Best Oral Communication</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Direcção-Geral da Saúde. 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| Year/Month | Html | Total | |
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