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Exacerbações de Doença Pulmonar Obstrutiva Crónica num Serviço de Medicina Interna: Caracterização e Preditores de Prognóstico
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Abstract(s)
Introdução:
Em Portugal, a doença pulmonar obstructiva crónica (DPOC) afeta 14,2% daqueles com mais de 40 anos. A Medicina Interna tem um papel nos cuidados da exacerbação de DPOC hospitalizada. O nosso objetivo foi caracterizar as admissões por DPOC exacerbada num Serviço de Medicina Interna focando os preditores de mau prognóstico. Métodos:
Um estudo observacional retrospectivo recolheudados de três anos consecutivos. Para a análise univariada e multivariada foi assumido o evento morte intra-hospitalar
por qualquer causa. Resultados: A amostra integrou 280 casos. A média das
idades foi de 76,0 anos e 53,6% eram homens. À admissão, a depressão do estado de consciência foi evidente em 21,8% e hipotensão em 3,6%. etectou-se acidemia em 36% e hipercapnia em 64,3%. Hemoglobina abaixo de 10,0
g/dL verificou-se em 4,6%, eosinopenia em 20,4%, e creatininemia superior a 2,0 mg/dL em 6,0%. Dez porcentot inham fibrilhação auricular. Vinte e nove doentes faleceram no hospital (10,4%). Identificámos os seguintes preditores: admissão nos 90 dias prévios (OR ,47; p = 0,006), fibrilhação auricular (OR 5,0; p = 0,002), pressão sistólica < 100 mm Hg (OR 3,7; p = 0,023), eosinopenia (OR 2,7; p = 0,034), anemia (OR 5,1; p = 0,026) e disfunção renal (OR 3,8; p = 0,048). A ausência de preditores na admissão correspondeu a um perfil de baixo risco.Conclusão:
Comparado com a generalidade dos doentes com exacerbação com DPOC, aqueles admitidos num Serviço de Medicina Interna tendem a ser mais idosos e a ter mais comorbilidades. Os preditores identificados têm relação com a fisiopatologia da exacerbação da DPOC.
ntroduction: In Portugal, chronic obstructive pulmonary disease (COPD) affects around 14.2% of those older than 40 years. Internal Medicine plays a role in the hospital-ized CODP exacerbation patient care. Our objective was to characterize the COPD exacerbation patients admitted to an Internal Medicine ward focusing on adverse outcome predictors. Methods: An observational retrospective study retrieved data from three consecutive years. A univariate and mul-tivariate analysis was performed assuming the all-cause in-hospital death outcome. Results: The sample comprised 280 cases. The mean age was 76.0 years and 53.6% were male. At admission, de-pressed mental status was evident in 21.8% and hypoten-sion in 3.6%. Thirty six percent were acidemic and 64.3% were hypercapnic. A hemoglobin value below 10.0 g/dL was found in 4.6%, eosinopenia in 20.4%, and creatinine-mia above 2.0 mg/dL in 6.0%. Ten percent had atrial fibrillation. Twenty-nine patients died in the hospital (10.4%). We identified the following predictors: admission in the previous 90 days (OR 4.7; p = 0.006), atrial fibrillation (OR 5.0; p = 0.002), systolic blood pressure < 100 mm Hg (OR 3.7; p = 0.023), eosinopenia (OR 2.7; p = 0.034) and hemoglobin < 10 g/dL (OR 5.1; p = 0.026) and creatinine > 2.0 mg/dL (OR 3.8; p = 0.048). Absence of predictors at admission was linked to a low risk profile. Conclusion: Compared to the overall COPD exacerbation patient, those admitted to an Internal Medicine tend to be older and to have higher degree of comorbidity. The identified predictors can be linked to the COPD exacerbation pathophysiology.
ntroduction: In Portugal, chronic obstructive pulmonary disease (COPD) affects around 14.2% of those older than 40 years. Internal Medicine plays a role in the hospital-ized CODP exacerbation patient care. Our objective was to characterize the COPD exacerbation patients admitted to an Internal Medicine ward focusing on adverse outcome predictors. Methods: An observational retrospective study retrieved data from three consecutive years. A univariate and mul-tivariate analysis was performed assuming the all-cause in-hospital death outcome. Results: The sample comprised 280 cases. The mean age was 76.0 years and 53.6% were male. At admission, de-pressed mental status was evident in 21.8% and hypoten-sion in 3.6%. Thirty six percent were acidemic and 64.3% were hypercapnic. A hemoglobin value below 10.0 g/dL was found in 4.6%, eosinopenia in 20.4%, and creatinine-mia above 2.0 mg/dL in 6.0%. Ten percent had atrial fibrillation. Twenty-nine patients died in the hospital (10.4%). We identified the following predictors: admission in the previous 90 days (OR 4.7; p = 0.006), atrial fibrillation (OR 5.0; p = 0.002), systolic blood pressure < 100 mm Hg (OR 3.7; p = 0.023), eosinopenia (OR 2.7; p = 0.034) and hemoglobin < 10 g/dL (OR 5.1; p = 0.026) and creatinine > 2.0 mg/dL (OR 3.8; p = 0.048). Absence of predictors at admission was linked to a low risk profile. Conclusion: Compared to the overall COPD exacerbation patient, those admitted to an Internal Medicine tend to be older and to have higher degree of comorbidity. The identified predictors can be linked to the COPD exacerbation pathophysiology.
Description
Keywords
Doença Pulmonar Obstructiva Crónica complicações Hospitalização Medicina Interna Prognóstico. Madeira Island Portugal DPCO CODP exacerbation patients physiopathology fisiopatologia
Citation
Publisher
SPMI- Sociedade Portuguesa de Medicina Interna