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Advisor(s)
Abstract(s)
Introdução: A Doença Pulmonar Obstrutiva Crónica (DPOC) é uma doença
comum, evitável e tratável, que constitui a terceira causa de morte a nível global,
estimando-se que em Portugal afete cerca de 14,2% dos portugueses com mais de 40
anos. As exacerbações agudas da DPOC (EADPOC) fazem parte da história natural da
doença, e são responsáveis por um agravamento significativo do estado de saúde do
doente, podendo ter efeitos prolongados a nível do estado de saúde, da probabilidade
de hospitalização e de readmissão, da qualidade de vida e declínio da função pulmonar.
De acordo com o Relatório GOLD 2023, os principais fatores de risco associados a
EADPOC são história de EADPOC prévias, tabaco, inalação de fumo, poluição
ambiental, infeções respiratórias, nível de obstrução das vias aéreas ou severidade dos
sintomas da DPOC subjacente, eosinofilia periférica, e ainda outras comorbilidades
como diabetes, insuficiência cardíaca e Doença do Refluxo Gastroesofágico. A
determinação dos fatores de risco para exacerbações parece ser um elemento crucial
para a otimização da gestão dos doentes, uma vez que as intervenções preventivas e
terapêuticas devem ser adequadas e personalizadas individualmente. Há também um
grande interesse em identificar os fatores clínicos que aumentam o risco de
recorrências e readmissões hospitalares em doentes com DPOC, nomeadamente fatores
de risco modificáveis e modificadores de resposta ao tratamento com implicações no
prognóstico.
Objetivos: Avaliar a relação entre FEV1, eosinofilia periférica, IMC e uso de CI
e a frequência de exacerbações, número de internamentos, probabilidade de
internamento, tempo de internamento e duração de internamentos em contexto de
EADPOC. Perceber se existe relação entre a eosinofilia periférica e a carga tabágica dos
doentes com EADPOC.
Materiais e Métodos: Numa primeira fase, foi realizado um estudo
observacional, longitudinal e retrospetivo de doentes que recorreram ao SU da ULSG
entre 1 de novembro de 2022 e 31 de março de 2023 com EADPOC, previamente
diagnosticados com DPOC ou com episódio inaugural da doença. Os registos clínicos
destes doentes foram consultados, nomeadamente os registos de SU, internamento e
consulta externa, através do S. Clínico®. Foram colhidas as seguintes variáveis: género,
idade, terapêutica inalatória no domicílio, OLD/VNI no domicílio, IMC, eosinofilia do
sangue periférico, PCR, PFR, hábitos tabágicos, exposição ocupacional de risco
respiratório, vacinas, comorbilidades, número de exacerbações, número de
internamentos, e dias de internamento. Os doentes foram também alocados a diferentes grupos quanto ao seu valor de FEV1 de acordo com a classificação GOLD,
eosinofilia periférica (<0,1x109/L, entre 0,1 e 0,3x109/L, e =0,31x109/L), IMC, como
tendo exacerbações infrequentes (1 exacerbação) ou exacerbações frequentes (=2
exacerbações), e ainda, tendo tido ou não internamentos no período considerado. De
seguida, considerando os valores de FEV1, eosinofilia do sangue periférico e IMC como
potenciais fatores influenciadores de EADPOC, procurámos perceber se há relação
entre estas variáveis e a frequência de exacerbações e internamentos, bem como a
duração dos últimos, utilizando para este efeito regressões lineares, logísticas,
correlação de Pearson, correlação de Spearman e o teste do Qui quadrado. Por último,
procurámos perceber se há relação entre o valor de UMAs e a contagem de eosinófilos
do sangue periférico dos doentes da amostra, através de correlações de Pearson e
Spearman.
Resultados: No presente estudo 65,0% dos doentes tiveram uma exacerbação,
e 47,5% não tiveram nenhum internamento, sendo a duração média dos internamentos
de 12,9 dias (desvio-padrão 7,5). Foi encontrada uma relação negativa estatisticamente
significativa entre o número de eosinófilos dos doentes e o número de hospitalizações,
probabilidade de hospitalização, e duração de hospitalização, quando considerando
todos os doentes. Não foram encontradas relações estatisticamente significativa entre o
FEV1, IMC e uso de CI no domicílio e os outcomes analisados. Neste estudo, a
obesidade não demonstrou ser um fator protetor para EADPOC e a sua severidade. Não
foi encontrada uma relação estatisticamente significativa entre a carga tabágica (em
UMAs) e a eosinofilia Periférica (x109/L) dos doentes.
Conclusões: O nosso estudo parece concordar com a bibliografia no que toca à
influência da eosinofilia periférica nas EADPOC, não sendo possível retirar outras
conclusões devido ao reduzido tamanho da amostra. Sugerimos a realização de uma
análise mais alargada, para uma amostra mais representativa da realidade.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease, which is thought to be the third leading cause of death worldwide. It is estimated to affect around 14.2% of Portuguese individuals over the age of forty. Acute exacerbations of COPD (AECOPD) are part of the natural history of the disease and significantly worsen a patient's health status, leading to prolonged effects on health state, likelihood of hospitalization and readmission, quality of life, and decline in lung function. According to the GOLD Report 2023, the main risk factors associated with AECOPD include a history of previous AECOPD, smoking, exposure to smoke, environmental pollution, respiratory infections, degree of airway obstruction or severity of underlying COPD symptoms, blood eosinophilia, as well as other comorbidities such as diabetes, heart failure, and Gastroesophageal Reflux Disease (GERD). Identifying risk factors for exacerbations appears to be a crucial element in optimizing patient management, as preventive and therapeutic interventions should be individually tailored and appropriate. There is also significant interest in identifying clinical factors that increase the risk of recurrence and hospital readmissions in COPD patients, particularly modifiable risk factors and treatment response modifiers. Objectives: To assess the relation between FEV1, blood eosinophils, BMI, and ICS use with the frequency of exacerbations, number of hospitalizations, likelihood of hospitalization, length of hospital stay and duration of hospitalizations in the context of AECOPD. To investigate if there is a relation between blood eosinophils and the smoking history (in pack-years of smoking) of AECOPD patients. Materials and Methods: In the initial phase, an observational, longitudinal, retrospective study of patients who presented to the Emergency Department of the ULSG between November 1, 2022, and March 31, 2023, with AECOPD, previously diagnosed with COPD or experiencing the inaugural episode of the disease, was conducted. The clinical records of these patients were reviewed, including Emergency Department, hospitalization, and outpatient clinic records, accessed through the S. Clínico® system. The following variables were collected: gender, age, outpatient inhalation therapy, long-Term oxygen therapy/non-invasive ventilation (LTOT/NIV), body Mass Index (BMI), blood eosinophils, C-reactive protein (CRP), pulmonary function tests (PFTs), smoking history, occupational exposure, vaccinations, comorbidities, number of exacerbations, number of hospitalizations, and length of hospital stay. Patients were also categorized into different groups based on their FEV1 value according to the GOLD classification, blood eosinophils (<0,1x109/L, between 0,1 and 0,3x109/L, and =0,31x109/L), BMI, as having infrequent exacerbations (1 exacerbation) or frequent exacerbations (=2 exacerbations), and as having had or not had hospitalizations during the considered period. Next, considering FEV1, blood eosinophil count, and BMI as potential Influencing Factors of AECOPD, we sought to understand the relation between these variables and the frequency of exacerbations and hospitalizations, as well as the duration of the latter, using linear and logistic regressions, Pearson correlation, Spearman correlation, and Chi-square test. Lastly, we aimed to understand the relation between the values of smoking pack-years and the blood eosinophil count of the patients in the sample, through Pearson and Spearman correlations. Results: In this study, 65,0% of patients presented one exacerbation, and 47,5% didn’t have any hospitalization during the time period considered, with an average length of hospital stay being 12,9 days (standard deviation 7.5). A statistically significant negative relation between the number of eosinophils in patients and the number of hospitalizations, likelihood of hospitalization, and length of hospital stay when considering all patients was found. No statistically significant relations were found between FEV1, BMI, and outpatient ICS use and the analyzed outcomes. In our study, obesity did not demonstrate to be a protective factor for AECOPD and its severity. In our sample, no statistically significant relation was found between smoking history (in pack-years) and blood eosinophils. Conclusions: Our findings seem to support current evidence regarding the influence of eosinophilia on AECOPD, with higher values being associated with a better treatment response, resulting in a reduced need for hospitalization. However, due to the small sample size, we are unable to draw further conclusions. We suggest that a more extensive analysis be conducted with a larger and more representative sample to better understand these relations.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease, which is thought to be the third leading cause of death worldwide. It is estimated to affect around 14.2% of Portuguese individuals over the age of forty. Acute exacerbations of COPD (AECOPD) are part of the natural history of the disease and significantly worsen a patient's health status, leading to prolonged effects on health state, likelihood of hospitalization and readmission, quality of life, and decline in lung function. According to the GOLD Report 2023, the main risk factors associated with AECOPD include a history of previous AECOPD, smoking, exposure to smoke, environmental pollution, respiratory infections, degree of airway obstruction or severity of underlying COPD symptoms, blood eosinophilia, as well as other comorbidities such as diabetes, heart failure, and Gastroesophageal Reflux Disease (GERD). Identifying risk factors for exacerbations appears to be a crucial element in optimizing patient management, as preventive and therapeutic interventions should be individually tailored and appropriate. There is also significant interest in identifying clinical factors that increase the risk of recurrence and hospital readmissions in COPD patients, particularly modifiable risk factors and treatment response modifiers. Objectives: To assess the relation between FEV1, blood eosinophils, BMI, and ICS use with the frequency of exacerbations, number of hospitalizations, likelihood of hospitalization, length of hospital stay and duration of hospitalizations in the context of AECOPD. To investigate if there is a relation between blood eosinophils and the smoking history (in pack-years of smoking) of AECOPD patients. Materials and Methods: In the initial phase, an observational, longitudinal, retrospective study of patients who presented to the Emergency Department of the ULSG between November 1, 2022, and March 31, 2023, with AECOPD, previously diagnosed with COPD or experiencing the inaugural episode of the disease, was conducted. The clinical records of these patients were reviewed, including Emergency Department, hospitalization, and outpatient clinic records, accessed through the S. Clínico® system. The following variables were collected: gender, age, outpatient inhalation therapy, long-Term oxygen therapy/non-invasive ventilation (LTOT/NIV), body Mass Index (BMI), blood eosinophils, C-reactive protein (CRP), pulmonary function tests (PFTs), smoking history, occupational exposure, vaccinations, comorbidities, number of exacerbations, number of hospitalizations, and length of hospital stay. Patients were also categorized into different groups based on their FEV1 value according to the GOLD classification, blood eosinophils (<0,1x109/L, between 0,1 and 0,3x109/L, and =0,31x109/L), BMI, as having infrequent exacerbations (1 exacerbation) or frequent exacerbations (=2 exacerbations), and as having had or not had hospitalizations during the considered period. Next, considering FEV1, blood eosinophil count, and BMI as potential Influencing Factors of AECOPD, we sought to understand the relation between these variables and the frequency of exacerbations and hospitalizations, as well as the duration of the latter, using linear and logistic regressions, Pearson correlation, Spearman correlation, and Chi-square test. Lastly, we aimed to understand the relation between the values of smoking pack-years and the blood eosinophil count of the patients in the sample, through Pearson and Spearman correlations. Results: In this study, 65,0% of patients presented one exacerbation, and 47,5% didn’t have any hospitalization during the time period considered, with an average length of hospital stay being 12,9 days (standard deviation 7.5). A statistically significant negative relation between the number of eosinophils in patients and the number of hospitalizations, likelihood of hospitalization, and length of hospital stay when considering all patients was found. No statistically significant relations were found between FEV1, BMI, and outpatient ICS use and the analyzed outcomes. In our study, obesity did not demonstrate to be a protective factor for AECOPD and its severity. In our sample, no statistically significant relation was found between smoking history (in pack-years) and blood eosinophils. Conclusions: Our findings seem to support current evidence regarding the influence of eosinophilia on AECOPD, with higher values being associated with a better treatment response, resulting in a reduced need for hospitalization. However, due to the small sample size, we are unable to draw further conclusions. We suggest that a more extensive analysis be conducted with a larger and more representative sample to better understand these relations.
Description
Keywords
Dpoc Eosinofilia Exacerbação Aguda Fev1 Imc Preditores