Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Abstract

Objective: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. Methods: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). Results: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. Conclusions: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.Keywords: Pulmonary disease, chronic obstructive/mortality; Quality of life; Intensive care units. ResumoObjetivo: Determinar a taxa de mortalidade de pacientes com DPOC e avaliar o estado funcional dos sobreviventes dois anos após a alta da UTI. Métodos: Estudo de coorte prospectiva realizada nas UTIs de dois hospitais na cidade de Porto Alegre (RS) com pacientes com exacerbação aguda de DPOC e internados em UTI entre julho de 2005 e julho de 2006. Dois anos após a alta, os sobreviventes foram entrevistados via telefone. Os dados obtidos foram utilizados na determinação dos escores da escala de Karnofsky e de uma escala de atividades de vida diária (AVD). Resultados: Foram incluídos 231 pacientes. A mortalidade hospitalar foi de 37,7% e a mortalidade extra-hospitalar foi de 30,3%. Dos 74 sobreviventes, foram entrevistados 66 (89%). A média de idade dos pacientes no momento da internação na UTI era de 74 ± 10 anos e a do escore Acute Physiology and Chronic Health Evaluation II era de 18 ± 7. Tinham duas ou mais comorbidades 87,8% dos pacientes. Dos 66 entrevistados, 57 (86,3%) viviam em suas casas, 58 (87,8%) eram capazes de realizar seu autocuidado, 12 (18,1%) utilizavam oxigenoterapia, e 4 (6,1%) necessitavam suporte ventilatório. Houve uma significante redução na qualidade de vida e na autonomia, segundo os escores da escala de Karnofsky (85 ± 9 vs. 79 ± 11; p = 0,03) e de AVD (29 ± 5 vs. 25 ± 7; p = 0,01), respectivamente. Conclusões: A mortalidade desta amostra de pacientes foi muito elevada nos primeiros dois anos. Embora houvesse evidente redução do esta...

Hospitalization due to exacerbation of COPD: "Real-life" outcomes

“…Mortality in eCOPD is high and we observed in our study frequent readmissions that correlated with the outcome of death, as described by Hurst, 27 Soriano, 28 and Teixeira, 29 the latter in Brazil. Teixeira says that 87.8% of the patients hospitalized with COPD had two or more comorbidities, and hospital mortality due to eCOPD was 37.7%.…”

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

“…In the present study, we used the Katz index, which revealed a low degree of dependence in ADL, a finding that is consistent with those of other studies. (29,30) However, the Katz index was found to correlate negatively with the physical functioning and role-physical domains, i.e., lower scores on those domains translated to greater dependence in ADL. (29,30) The results of the present study allow us to conclude that this sample of COPD patients on LTOT had very low scores on the QoL domains of the SF-36, showing significantly impaired QoL.…”

Assessment of functional status in the ICU: instruments used in Brazilian settings

“…According to the results of this review, the Karnofsky/Performance Status Scale Scores is the most widely used tool among researchers in Brazil (15,16,17,18). It has been largely used to assess functional status in patients with incapacitating chronic disease, such as critically ill ICU patients.…”

“…Only one of the four studies that used this tool described how it assesses functional status and also reported that the researchers who administered it had been previously trained on the use of the scale (15). Two of the aforementioned studies just reported that the researchers had been trained to administer the scale (16,18).…”

“…According to the literature, the following tools are used to assess the physical functional status of ICU patients in Brazil: the Barthel scale (15), Karnofsky Performance Status Scale Scores (15,16,17,18), Functional Independence Measure (FIM) (19,20), Lawton Instrumental Activities of Daily Living (IADL) Scale (16), Eastern Cooperative Oncology Group Scale (21,22), the extended version of the Glasgow Outcome Scale (23), and a scale developed by Muramaki et al (24).…”