1
|
Roncon-Albuquerque R, Gaião S, Vasques-Nóvoa F, Basílio C, Ferreira AR, Touceda-Bravo A, Pimentel R, Vaz A, Silva S, Castro G, Veiga T, Martins H, Dias F, Pereira C, Marto G, Coimbra I, Chico-Carballas JI, Figueiredo P, Paiva JA. Authors reply in response to a letter on "Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study". Ann Intensive Care 2023; 13:120. [PMID: 38041789 PMCID: PMC10693533 DOI: 10.1186/s13613-023-01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal.
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | | | - Rodrigo Pimentel
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Ana Vaz
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Guiomar Castro
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Tiago Veiga
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Hélio Martins
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Francisco Dias
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Catarina Pereira
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Gonçalo Marto
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | - Isabel Coimbra
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
| | | | - Paulo Figueiredo
- Department of Infectious Diseases, São João University Hospital Centre, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Roncon-Albuquerque R, Gaião S, Vasques-Nóvoa F, Basílio C, Ferreira AR, Touceda-Bravo A, Pimentel R, Vaz A, Silva S, Castro G, Veiga T, Martins H, Dias F, Pereira C, Marto G, Coimbra I, Chico-Carballas JI, Figueiredo P, Paiva JA. Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study. Ann Intensive Care 2023; 13:86. [PMID: 37723384 PMCID: PMC10506998 DOI: 10.1186/s13613-023-01185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Extubation during extracorporeal oxygenation (ECMO) in severe acute respiratory distress syndrome (ARDS) has not been well studied. Despite the potential benefits of this strategy, weaning from ECMO before liberation from invasive mechanical ventilation remains the most frequent approach. Our aim was to evaluate the safety and feasibility of a standardized approach for extubation during ECMO in patients with severe ARDS. RESULTS We conducted a prospective observational study to assess the safety and feasibility of a standardized approach for extubation during ECMO in severe ARDS among 254 adult patients across 4 intensive care units (ICU) from 2 tertiary ECMO centers over 6 years. This consisted of a daily assessment of clinical and gas exchange criteria based on an Extracorporeal Life Support Organization guideline, with extubation during ECMO after validation by a dedicated intensive care medicine specialist. Fifty-four (21%) patients were extubated during ECMO, 167 (66%) did not reach the clinical criteria, and in 33 (13%) patients, gas exchange precluded extubation during ECMO. At ECMO initiation, there were fewer extrapulmonary organ dysfunctions (lower SOFA score [OR, 0.88; 95% CI, 0.79-0.98; P = .02] with similar PaO2/FiO2) when compared with patients not extubated during ECMO. Extubation during ECMO associated with shorter duration of invasive mechanical ventilation (7 (4-18) vs. 32 (18-54) days; P < .01) and of ECMO (12 (7-25) vs. 19 (10-41) days; P = .01). This was accompanied by a lower incidence of hemorrhagic shock (2 vs. 11%; P = .05), but more cannula-associated deep vein thrombosis (49 vs. 31%; P = .02) and failed extubation (20 vs. 6%; P < .01). There were no increased major adverse events. Extubation during ECMO is associated with a lower risk of all-cause death, independently of measured confounding (adjusted logistic regression OR 0.23; 95% confidence interval 0.08-0.69, P = .008). CONCLUSIONS A standardized approach was safe and feasible allowing extubation during ECMO in 21% of patients with severe ARDS, selecting patients who will have a shorter duration of invasive mechanical ventilation, ECMO course, and ICU stay, as well as fewer infectious complications, and high hospital survival.
Collapse
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Rita Ferreira
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Rodrigo Pimentel
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Vaz
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Guiomar Castro
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Tiago Veiga
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hélio Martins
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisco Dias
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Catarina Pereira
- Department of Internal Medicine, São João University Hospital Centre, Porto, Portugal
| | - Gonçalo Marto
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Isabel Coimbra
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | | | - Paulo Figueiredo
- Department of Infectious Diseases, São João University Hospital Centre, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Ribeiro-Dias L, Fernandes J, Braga A, Vieira T, Madureira A, Hespanhol V, Coimbra I, Paiva JA, Santos L, Silva-Pinto A. Long-Term Sequelae of severe COVID-19: outpatient assessment of radiological and pulmonary function tests. Medicina Clínica Práctica 2023:100373. [PMCID: PMC10020040 DOI: 10.1016/j.mcpsp.2023.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Objective: Identify lung sequelae of COVID-19 through radiological and pulmonary function assessment. Design: Prospective, longitudinal, cohort study from March 2020 to March 2021. Setting: Intensive Care Units (ICU) in a tertiary hospital in Portugal. Patients: 254 patients with COVID-19 admitted to ICU due to respiratory illness. Interventions: A chest computed tomography (CT) scan and pulmonary function tests (PFT) were performed at 3 to 6 months. Main variables of interest: CT-scan; PFT; decreased diffusion capacity of carbon monoxide (DLCO). Results: All CT scans revealed improvement in the follow-up, with 72% of patients still showing abnormalities, 58% with ground glass opacities and 62% with evidence of fibrosis. PFT had abnormalities in 94 patients (46%): thirteen patients (7%) had an obstructive pattern, 35 (18%) had a restrictive pattern, and 58 (30%) had decreased DLCO. There was a statistically significant association between abnormalities in the follow-up CT scan and older age, more extended hospital and ICU stay, higher SAPS II and APACHE scores and invasive ventilation. Mechanical ventilation, especially with no lung protective parameters, was associated with abnormalities in PFT. Multivariate regression showed more abnormalities in lung function with more extended ICU hospitalization, chronic obstructive pulmonary disease (COPD), chronic kidney disease, invasive mechanical ventilation, and ventilation with higher plateau pressure, and more abnormalities in CT-scan with older age, more extended ICU stay, organ solid transplants and ventilation with higher positive end-expiratory pressure (PEEP). Conclusions: Most patients with severe COVID-19 still exhibit abnormalities in CT scans or lung function tests three to six months after discharge.
Collapse
Affiliation(s)
- Lúcia Ribeiro-Dias
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Joana Fernandes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - António Braga
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Tatiana Vieira
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - António Madureira
- Radiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Vencelau Hespanhol
- Pneumology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Isabel Coimbra
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - André Silva-Pinto
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Portugal,Corresponding author at: Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernani Monteiro, 4200 Porto, Portugal
| |
Collapse
|
4
|
Braga A, Martins S, Ferreira AR, Fernandes J, Vieira T, Fontes L, Coimbra I, Fernandes L, Paiva JA. Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors. J Intensive Care Med 2023:8850666231156782. [PMID: 36803155 PMCID: PMC9941006 DOI: 10.1177/08850666231156782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.
Collapse
Affiliation(s)
- A. Braga
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal,António José Falcão Peres Braga, Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - S. Martins
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A. R Ferreira
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - J. Fernandes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - T. Vieira
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - L. Fontes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - I. Coimbra
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - L. Fernandes
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal,Psychiatry Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - J. A Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João, Porto, Portugal,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Martins S, Ferreira AR, Fernandes J, Vieira T, Fontes L, Coimbra I, Paiva JA, Fernandes L. Depressive and Anxiety Symptoms in Severe COVID-19 Survivors: A Prospective Cohort Study. Psychiatr Q 2022; 93:891-903. [PMID: 35947293 PMCID: PMC9363264 DOI: 10.1007/s11126-022-09998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients' neuropsychiatric consequences. This study aims to describe the presence of depressive and anxiety symptoms in severe COVID-19 survivors and to identify associated baseline, in-hospital and post-discharge factors. This study is part of the MAPA longitudinal project conducted with severe COVID-19 patients admitted in Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ) in Porto, Portugal. Patients with ICMD length of stay ≤ 24 h, terminal illness, major auditory loss or inability to communicate at follow-up assessment were excluded. All participants were assessed by telephone post-discharge (median = 101 days), with a comprehensive protocol assessing depressive and anxiety symptoms, cognition, Intensive Care Unit (ICU) memories recall and health-related quality of life. Out of a sample of 56 survivors (median age = 65; 68% males), 29% and 23% had depressive and anxiety symptoms, respectively. Depressive and anxiety symptoms were significantly more prevalent among younger survivors and were associated with cognitive complaints, emotional and delusions ICU memories and fear of having COVID-19 sequelae, sleep problems and pain after discharge (all p < 0.05). An important proportion of these survivors suffers from depression and anxiety symptoms post-discharge, namely younger ones and those who reported more cognitive complaints, ICU memories, fear of having COVID-19 sequelae, sleep problems and pain. These findings highlight the importance of psychological consequences assessment and planning of appropriate and multidisciplinary follow-up care after hospitalization due to COVID-19.
Collapse
Affiliation(s)
- Sónia Martins
- CINTESIS@RISE, Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Ana Rita Ferreira
- CINTESIS@RISE, Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Joana Fernandes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - Tatiana Vieira
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - Liliana Fontes
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - Isabel Coimbra
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University Porto (FMUP), Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Psychiatry Service, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
| |
Collapse
|
6
|
Silva B, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Anxiety symptoms in critically ill COVID-19 survivors and its association with post-discharge health concerns. Eur Psychiatry 2022. [PMCID: PMC9567653 DOI: 10.1192/j.eurpsy.2022.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery. Objectives To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery. Methods In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) ≤24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors’ post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19. Results Eighty-three patients were included (median age=63 years; 63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%; p=0.034), being re-infected (100% vs 79%; p=0.032) and having sequelae (94% vs 44%; p<0.001). Conclusions These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery. Disclosure No significant relationships.
Collapse
|
7
|
Martins S, Fontes L, Ferreira A, Fernandes J, Vieira T, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Depressive symptoms and health-related quality of life in critical COVID-19 survivors: Preliminary results of 1-year follow-up. Eur Psychiatry 2022. [PMCID: PMC9563347 DOI: 10.1192/j.eurpsy.2022.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction A higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients’ health-related quality of life (HRQoL). Objectives To identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL. Methods As part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record). Results A sample of 55 survivors (median age=66 years; 69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015; self-care:64%vs.27%, p=0.035; usual activities:91%vs.50%, p=0.017; pain/discomfort:100%vs.59%, p=0.010; anxiety/depression:100%vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010). Conclusions Even after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life. Disclosure No significant relationships.
Collapse
|
8
|
Chorão L, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Delirium and health-related quality of life in severe COVID-19 survivors. Eur Psychiatry 2022. [PMCID: PMC9562393 DOI: 10.1192/j.eurpsy.2022.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL). Objectives To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL. Methods In the context of the longitudinal MAPA project, we included adult patients (≥ 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients’ clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge. Results Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%; p=0.011) and considerably anxiety/depression (83%vs60%; p=0.032). Conclusions These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium long-term impacts. Disclosure No significant relationships.
Collapse
|
9
|
Silva J, Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Reis N, Braga A, Coimbra I, Paiva J, Fernandes L. Depression and health-related quality of life in critical COVID-19 survivors. Eur Psychiatry 2022. [PMCID: PMC9566138 DOI: 10.1192/j.eurpsy.2022.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on health-related quality of life (HRQoL), commonly used as an indicator of illness and treatment impact. Objectives To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains. Methods This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)≤24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project. Results Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%; p=0.029), pain/discomfort (86%vs49%; p=0.002), and anxiety/depression (96%vs54%; p<0.001). Conclusions These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients. Disclosure No significant relationships.
Collapse
|
10
|
Paulino MC, Pereira IJ, Costa V, Neves A, Santos A, Teixeira CM, Coimbra I, Fernandes P, Bernardo R, Póvoa P, Granja C. Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. Rev Bras Ter Intensiva 2022; 34:227-236. [PMID: 35946653 DOI: 10.5935/0103-507x.20220020-pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. METHODS A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. RESULTS A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. CONCLUSION The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
Collapse
Affiliation(s)
- Maria Carolina Paulino
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Isabel Jesus Pereira
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Vasco Costa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Aida Neves
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Anabela Santos
- Serviço de Medicina Intensiva/Anestesiologia, Centro Hospitalar Trás-os-Montes - Alto Douro, Portugal
| | - Carla Margarida Teixeira
- Departamento de Anestesiologia e Medicina Intensiva, Centro Hospitalar Universitário do Porto - Porto, Portugal
| | - Isabel Coimbra
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Paula Fernandes
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Ricardo Bernardo
- Departamento de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Cristina Granja
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| |
Collapse
|
11
|
Martins S, Ferreira AR, Fernandes J, Vieira T, Fontes L, Coimbra I, Paiva JA, Fernandes L. Delirium in Patients with Severe COVID-19: Preliminary Results of the MAPA Longitudinal Study. ACTA MEDICA PORT 2022; 35:228-230. [PMID: 35320075 DOI: 10.20344/amp.17522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/18/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Sónia Martins
- Clinical Neurosciences and Mental Health Department. Faculty of Medicine. University of Porto. Porto; Center for Health Technology and Services Research (CINTESIS). Faculty of Medicine. University of Porto (FMUP). Porto. Portugal
| | - Ana Rita Ferreira
- Clinical Neurosciences and Mental Health Department. Faculty of Medicine. University of Porto. Porto. Center for Health Technology and Services Research (CINTESIS). Faculty of Medicine. University of Porto (FMUP). Porto. Portugal
| | - Joana Fernandes
- Intensive Care Medicine Department. Centro Hospitalar Universitário São João (CHUSJ). Porto. Portugal
| | - Tatiana Vieira
- Intensive Care Medicine Department. Centro Hospitalar Universitário São João (CHUSJ). Porto. Portugal
| | - Liliana Fontes
- Intensive Care Medicine Department. Centro Hospitalar Universitário São João (CHUSJ). Porto. Portugal
| | - Isabel Coimbra
- Intensive Care Medicine Department. Centro Hospitalar Universitário São João (CHUSJ). Porto. Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department. Centro Hospitalar Universitário São João (CHUSJ). Porto. Department of Medicine. Faculty of Medicine. University of Porto (FMUP). Porto. Portugal
| | - Lia Fernandes
- Clinical Neurosciences and Mental Health Department. Faculty of Medicine. University of Porto. Porto. Center for Health Technology and Services Research (CINTESIS). Faculty of Medicine. University of Porto (FMUP). Porto. Psychiatry Service. Centro Hospitalar Universitário São João (CHUSJ). Porto. Portugal
| |
Collapse
|
12
|
Paulino MC, Pereira IJ, Costa V, Neves A, Santos A, Teixeira CM, Coimbra I, Fernandes P, Bernardo R, Póvoa P, Granja C. Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. Rev Bras Ter Intensiva 2022. [PMID: 35946653 PMCID: PMC9354111 DOI: 10.5935/0103-507x.20220020-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice. Methods A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices. Results A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%. Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients. Conclusion The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
Collapse
Affiliation(s)
- Maria Carolina Paulino
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Isabel Jesus Pereira
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Vasco Costa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Aida Neves
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Anabela Santos
- Serviço de Medicina Intensiva/Anestesiologia, Centro Hospitalar Trás-os-Montes - Alto Douro, Portugal
| | - Carla Margarida Teixeira
- Departamento de Anestesiologia e Medicina Intensiva, Centro Hospitalar Universitário do Porto - Porto, Portugal
| | - Isabel Coimbra
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| | - Paula Fernandes
- Departamento de Medicina Intensiva, Centro Hospitalar de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Ricardo Bernardo
- Departamento de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Unidade de Terapia Intensiva Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Cristina Granja
- Departamento de Medicina Intensiva, Centro Hospitalar Universitário de São João - Porto, Portugal
| |
Collapse
|
13
|
Martins S, Ferreira AR, Fernandes J, Vieira T, Fontes L, Coimbra I, Paiva JA, Fernandes L. Old critically ill COVID‐19 survivors: Patient and in‐hospital factors associated with cognitive dysfunction. Alzheimers Dement 2021. [PMCID: PMC9011607 DOI: 10.1002/alz.054107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sónia Martins
- Faculty of Medicine, University Porto Porto Portugal
- Center for Health Technology and Services Research/CINTESIS Porto Portugal
| | - Ana Rita Ferreira
- Center for Health Technology and Services Research/CINTESIS Porto Portugal
- Faculty of Medicine ‐ University Porto Porto Portugal
| | | | | | | | | | - José Artur Paiva
- Faculty of Medicine, University Porto Porto Portugal
- Centro Hospitalar Universitário São João Porto Portugal
| | - Lia Fernandes
- Faculty of Medicine, University Porto Porto Portugal
- Centro Hospitalar Universitário de São João Porto Portugal
- CINTESIS – Center for Health Technology and Services Research Porto Portugal
| |
Collapse
|
14
|
Fernandes J, Fontes L, Coimbra I, Paiva JA. Health-Related Quality of Life in Survivors of Severe COVID-19 of a University Hospital in Northern Portugal. ACTA MEDICA PORT 2021; 34:601-607. [PMID: 34708687 DOI: 10.20344/amp.16277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Long-term health impairments are often experienced among survivors of critical illness, which may have a negative impact on their quality of life. The aim of this study was to characterize COVID-19 survivors of critical illness and to evaluate health-related quality of life and disability following hospital discharge. MATERIAL AND METHODS This is a retrospective case-series study that included COVID-19 survivors admitted to the Intensive Care Medicine Department of a University Hospital. Follow-up evaluation was performed between the 30th and the 90th day after discharge. Quality of life was explored using the five-level version of the EQ-5D instrument (EQ-5D-5L) and functionality using the 12-question World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS Forty-five survivors were enrolled, 28 (62.2%) men, median age 63.0 years. The EQ-5D-5L questionnaire showed moderate to extreme problems in some dimension in 29 patients (64.4%): mobility in six (13.3%), self-care in seven (13.3%), usual activities in 23 (51.1%), pain/discomfort in 14 (31.1%) and anxiety/depression in 17 (37.8%). When using the 12-question WHODAS 2.0 questionnaire, moderate to extreme disability was reported in some question in 37 patients (82.2%): 19 (42.2%) in standing for long periods, 18 (40.0%) in long-distance walking; 14 (31.1%) on taking care of household responsibilities and 17 (37.8%) in their day-to-day work; 23 (51.1%) felt emotionally affected by their health problems. DISCUSSION Based on COVID-19 survivors-reported outcomes after critical illness, mobility, pain/discomfort, and anxiety/depression were the main problems that persisted one to three months after hospital discharge. CONCLUSION An organized follow-up structure is crucial to improve health-related quality of life in critical COVID-19 survivors.
Collapse
Affiliation(s)
- Joana Fernandes
- Intensive Care Medicine Department. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Liliana Fontes
- Intensive Care Medicine Department. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - Isabel Coimbra
- Intensive Care Medicine Department. Centro Hospitalar Universitário de São João. Porto. Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department. Centro Hospitalar Universitário de São João. Porto. Portugal
| |
Collapse
|
15
|
Martins S, Ferreira A, Fernandes J, Vieira T, Fontes L, Coimbra I, Paiva J, Fernandes L. Post-discharge depressive symptoms and health-related quality of life of critical COVID-19 survivors. Eur Psychiatry 2021. [PMCID: PMC9528344 DOI: 10.1192/j.eurpsy.2021.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionSurvivors of critical illness stay frequently experience long-term mental health morbidity, suggesting that many critically ill patients with COVID-19 may also show a high prevalence of psychiatric conditions.ObjectivesTo describe depression in COVID-19 survivors 4-months post-hospital discharge and to examine its association with health-related quality of life (HRQoL).MethodsThis pilot study involved COVID-19 adult patients admitted in Intensive Care Medicine Service (ICMS) of a University Hospital. Exclusion criteria were: ICMS length of stay (LoS)≤24h, terminal illness, major sensory loss and inability to communicate at the time of assessment. All participants were evaluated at ICMS scheduled telephone follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EQ-5D-5L (HRQoL). Critical-illness severity was assessed with APACHE-II and SAPS-II.Results
Twenty patients were included with a median age of 62(range: 24-77) y.o., the majority male (75%) and married (70%). Median (range) APACHE-II and SAPS-II was 17 (5-34) and 32.5 (7-77), respectively, and LoS was 18 (4-58) days. Overall, 25% patients presented depression symptoms and most reported problems on EQ-5D-5L domains of pain/discomfort (65%), anxiety/depression (55%) and mobility (50%). Depression scores were higher in patients with problems in EQ-5D-5L domains of usual activities (median 4 vs 1.5; p=0.046), pain/discomfort (median 0 vs 4; p=0.004) and anxiety/depression (median 4 vs 0;p<0.001).ConclusionsThese preliminary findings show that depression is frequent in COVID-19 survivors and it is associated with worse HRQoL. This pilot study highlights the importance of psychological assessment and treatment of COVID-19 survivors, in order to minimize its negative impact on HRQoL, optimizing their recovery.
Collapse
|
16
|
Cunha R, Maruza M, Montarroyos UR, Coimbra I, de B Miranda-Filho D, Albuquerque MDF, Lacerda HR, Ximenes R. Survival of people living with HIV who defaulted from tuberculosis treatment in a cohort, Recife, Brazil. BMC Infect Dis 2017; 17:137. [PMID: 28187753 PMCID: PMC5303219 DOI: 10.1186/s12879-016-2127-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/14/2016] [Indexed: 02/03/2023] Open
Abstract
Background Tuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment. Methods This was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz – HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations. Results From a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 < 200 cells/mm3 2.39 HR (95% CI 1.44 to 3.96); extrapulmonary tuberculosis 1.56 HR (95% CI 0.93 to 2.63); smoking 2.28 HR (95% CI 1.33 to 3.89); alcohol light 0.13 HR (95% CI 0.03 to 0.56). Conclusion The probability of death in people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.
Collapse
Affiliation(s)
- R Cunha
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil.
| | - M Maruza
- Hospital Correia Picanço - HCP - Health State Department, Rua Padre Roma, 149, Tamarineira, Recife, PE CEP: 52050-150, Pernambuco, Brazil
| | - U R Montarroyos
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - I Coimbra
- Hospital Universitário Oswaldo Cruz- HUOC- UPE, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - D de B Miranda-Filho
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - M de F Albuquerque
- Aggeu Magalhães Research Center/Fiocruz, Av Moraes Rego, s/n - Campos da UFPE - Cidade Universitária, Recife, PE CEP: 50670420, Pernambuco, Brazil
| | - H R Lacerda
- Post-Graduation Program in Tropical Medicine - Universidade Federal de Pernambuco, Hospital das Clínicas - Bl. A - Térreo do HC/UFPE, Av. Prof. Moraes Rego - s/n. - Cidade Universitária, Recife, PE CEP: 50670-901, Pernambuco, Brazil
| | - Raa Ximenes
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil.,Post-Graduation Program in Tropical Medicine - Universidade Federal de Pernambuco, Hospital das Clínicas - Bl. A - Térreo do HC/UFPE, Av. Prof. Moraes Rego - s/n. - Cidade Universitária, Recife, PE CEP: 50670-901, Pernambuco, Brazil
| |
Collapse
|
17
|
Maruza M, Albuquerque MFPM, Braga MC, Barbosa MTS, Byington R, Coimbra I, Moura LV, Batista JDL, Diniz GTN, Miranda-Filho DB, Lacerda HR, Rodrigues LC, Ximenes RAA. Survival of HIV-infected patients after starting tuberculosis treatment: a prospective cohort study. Int J Tuberc Lung Dis 2012; 16:618-24. [DOI: 10.5588/ijtld.11.0110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M. Maruza
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - M. C. Braga
- Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
| | - M. T. S. Barbosa
- Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. Byington
- Instituto Nacional do Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - I. Coimbra
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - L. V. Moura
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - J. D. L. Batista
- Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
| | - G. T. N. Diniz
- Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
| | | | - H. R. Lacerda
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | |
Collapse
|