RAMB - JUNHO 2017

amargo

LACR

548

ssoc

ras

2017; 63(6):543-549

Management of COPD aims to control symptoms

and comorbidities, and prevent exacerbations.

Hospital-

ization due to eCOPD does not necessarily occur in pa-

tients with more advanced disease

and, in our study, we

found that the patients had different grades of severity,

despite the fact that FEV

pre-bd was 44%±17%, and 22

(45%) patients used oxygen at home.

Mortality in eCOPD is high and we observed in our

study frequent readmissions that correlatedwith the outcome

of death, as described by Hurst,

Soriano,

and Teixeira,

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%.

The length of hospital stay was 18±17 days. We ob-

served the heterogeneity of clinical manifestations in

COPD patients through CAT variability and dyspnea as

measured by mMRC and VAS.

There is a correlation

between high CAT score and higher frequency of exacer-

bations, reflecting both severity and duration. CAT may

assist in assessing the severity of the exacerbation.

12,31

The prevalence of depression found in the sample was

35%. Coexistence of anxiety and/or depression with COPD

increases the number of exacerbations andhospitalizations.

8,32

Biomarkers are useful to monitor patients admitted

with eCOPD. The presence of eosinophilia > 2% indicates

a better response to steroid therapy,

and it was found

in 20% of the patients. CRP and BNP are useful biomark-

ers for monitoring, respectively, infectious exacerbations

and cardiopathies.

17,26,33

The seven deaths reported in our study were due to

respiratory failure (four patients) and cancer (three pa-

tients). Respiratory failure correlates with more severe

COPD, whereas lung cancer affects 9% of COPD patients,

regardless of staging.

The standardized analysis of age, CAT, FEV

and BMI

allowed grouping of patients into three clusters (Figure 2),

with different degrees of severity and no correlation with

the outcomes of hospitalization. In the first group there

were more women with lower FEV

, higher BMI, and CAT

displaying high scores. In the second group, there were

older patients with high CAT; and in the third group,

younger patients, with higher FEV

and lower CAT scores,

which indicates less severe COPD in this group with a

greater number of patients.

Readmissions due to eCOPD are a marker of poor

prognosis. The number of readmissions was high in our

study, which points to the need to adopt protocols for

hospital discharge and appointment scheduling soon

after discharge, with referral to a pulmonary rehabilita-

tion program.

The small number of patients included in the sample

was a limitation in our study, and was due to a high rate

of readmissions and failure to meet the inclusion criteria.

COPD exacerbation is an event that often requires

hospitalization and progresses with a high mortality rate.

Many times, COPD is under- or overdiagnosed, and one

reason is underutilization of spirometry. Thorough as-

sessment of these patients on admission, using labora-

tory tests, comorbidities assessment, and objective instru-

ments to quantify dyspnea and symptoms (mMRC, VAS

and CAT) is essential to reduce hospital stay, prevent

readmission and decrease mortality.

36,37

Patients admitted due to eCOPD are a heterogeneous

group that can be grouped into three clusters as described,

although we did not find an association between these

clusters and the outcomes of hospitalization. Studies

with a larger sample of patients are needed to confirm

the findings reported here and to relate them to the out-

comes of hospitalizations due to eCOPD.

esumo

Hospitalização por exacerbação da DPOC: desfechos da

“vida real”

Introdução:

As hospitalizações por exacerbação da doença

pulmonar obstrutiva crônica (eDPOC) podem indicar um

pior prognóstico. É importante conhecer o perfil dos

pacientes internados e os desfechos das internações para

personalizar e otimizar seu tratamento.

Método:

Avaliação dos pacientes hospitalizados por

eDPOC, com ≥ 10 anos/maços e ≥ 1 espirometria prévia

com obstrução ao fluxo aéreo no período de um ano em

um serviço de pneumologia de um hospital geral. Foram

utilizados: teste de avaliação da DPOC (CAT); mMRC e

Escala Analógica Visual (EAV) para aferição da dispneia;

escala hospitalar de ansiedade e depressão (HAD);

comorbidades pelos critérios de Divo e índice de Cote;

espirometria; e exames laboratoriais, eosinófilos no sangue,

proteína C reativa (PCR), brain natriuretic peptide (BNP).

Observamos evolução dos pacientes, duração da internação

e desfechos da hospitalização.

Resultados:

Ocorreram 75 (12%) internações por eDPOC,

sendo 27 reinternações, nove das quais com menos de 30

dias após a alta. Os principais desfechos foram: duração

da internação de 17±16,5 (2-75) dias; 30 (62,5%) altas

hospitalares; 18 (37,5%) altas/reinternações, oito pacientes

reinternarammais de uma vez; e sete (14,5%) óbitos, cinco

durante as reinternações. Analisamos 48 pacientes em sua

primeira internação. A amostra era um grupo heterogêneo