O impacto do desenvolvimento de novas morbidades durante o tratamento em unidade de terapia intensiva oncológica pediátrica no tempo e qualidade de vida do paciente
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Data
2024-02-20
Autores
Santos, Gabriela Maria Virgilio Dias [UNIFESP]
Orientadores
Caran, Eliana Maria Monteiro [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
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Objetivos: Sobreviventes de internação em UTIs pediátricas podem sofrer alterações funcionais. Investigamos os estados funcionais de crianças e adolescentes com câncer na admissão à UTI e na alta hospitalar, e o impacto no tempo de vida dos sobreviventes.
Métodos: coorte retrospectiva, em hospital oncológico de referência, de pacientes admitidos de 1º de abril de 2014 a 30 de abril de 2019. O instrumento FSS (Pediatric Functional Status Scale) foi avaliado na admissão à UTI e na alta hospitalar. A estatística envolveu as regressões: logística, de Cox e Weibull. Uma nova morbidade foi definida como aumento na FSS >= 3.
Resultados: Entre 1002 pacientes, houve 128 óbitos na internação hospitalar (12,7%). Foram analisados 855 sobreviventes, dos quais 194 (22,6%) faleceram até abril/2019; 45 (5,3%) apresentaram uma nova morbidade. As médias no domínio motor à admissão e alta eram 1,37 (Desvio padrão: 0,82) e 1,53 (DP 0,95), com p = 0,003 ao teste T. No domínio alimentação, as médias eram 1,19 (DP 0,63) e 1,30 (DP 0,76), p = 0,001; as médias globais eram 6,93 (DP 2,45) e 7,2 (DP 2,94), p = 0,03. As variáveis "Insuficiência respiratória aguda com necessidade de ventilação mecânica", "escore PRISM IV", "idade menor que 5 anos" e "tumor de sistema nervoso central" foram variáveis preditivas independentes de nova morbidade na análise multivariada. Uma nova morbidade correlacionou-se com probabilidades menores de sobrevivência (considerando todas as causas de óbito) após a alta hospitalar no teste logrank (P = 0,014), e foi preditiva de morte de forma independente (Cox hazard ratio = 1,98, 95% CI: 1,18-3,32), em relação aos diagnósticos de linfoma ou leucemia, recidiva de câncer, TCTH e desnutrição. As outras duas variáveis independentes foram a desnutrição e a recidiva do câncer. Em modelos de Weibull, foi estimado um encurtamento no tempo de vida de 14,2% (P = 0,014) para nova morbidade.
Conclusões: Riscos para novas morbidades estão relacionados à idade, gravidade à admissão e tumores cerebrais. Novas morbidades, por sua vez, se correlacionam com probabilidades menores de sobrevivência e um encurtamento no tempo de vida restante.
Objectives: Survivors of hospitalization in pediatric ICUs may experience physical and cognitive dysfunctions. We investigated the functional status of children and adolescents with cancer at ICU admission and at hospital discharge, and the impact on survivors' lifespan. Methods: retrospective cohort, in a referral cancer hospital, of patients admitted from 2014 to 2019. The FSS (Pediatric Functional Status Scale) was calculated at ICU admission and at hospital discharge. The statistics involved logistic, Cox and Weibull regressions. A new morbidity was defined as an increase in FSS > = 3. Results: Among 1002 patients, there were 128 deaths during hospitalization (12.7%). 855 survivors were analyzed, of which 194 (22.6%) had died by the end of the study; 45 (5.3%) had a new morbidity. Means in the motor domain at admission and discharge were 1.37 (Standard Deviation: 0.82) and 1.53 (SD 0.95), with p = 0.003 at the T-test. In the feeding domain, the means were 1.19 (SD 0.63) and 1.30 (SD 0.76), p = 0.001; global means were 6.93 (SD 2.45) and 7.2 (SD 2.94), p = 0.03. The variables "Acute respiratory failure requiring mechanical ventilation," "score PRISM IV," "age younger than 5 years" and "central nervous system tumor," were independent predictors of new morbidity in the multivariate analysis. New morbidity correlated with lower odds of survival (considering all causes of death) after hospital discharge in the logrank test (P = 0.014), and was independently predictive of death (Cox hazard ratio = 1.98, 95 % CI: 1.18–3.32), in relation to diagnoses of lymphoma or leukemia, cancer recurrence, HSCT and malnutrition. In Weibull models, shortening in the life span of 14.2% (P = 0.014) was estimated for new morbidity. Conclusions: Risks for new morbidities are related to age, disease severity at admission and brain tumors. New morbidities, in turn, correlate with lower probabilities of survival and shortening of the remaining life span.
Objectives: Survivors of hospitalization in pediatric ICUs may experience physical and cognitive dysfunctions. We investigated the functional status of children and adolescents with cancer at ICU admission and at hospital discharge, and the impact on survivors' lifespan. Methods: retrospective cohort, in a referral cancer hospital, of patients admitted from 2014 to 2019. The FSS (Pediatric Functional Status Scale) was calculated at ICU admission and at hospital discharge. The statistics involved logistic, Cox and Weibull regressions. A new morbidity was defined as an increase in FSS > = 3. Results: Among 1002 patients, there were 128 deaths during hospitalization (12.7%). 855 survivors were analyzed, of which 194 (22.6%) had died by the end of the study; 45 (5.3%) had a new morbidity. Means in the motor domain at admission and discharge were 1.37 (Standard Deviation: 0.82) and 1.53 (SD 0.95), with p = 0.003 at the T-test. In the feeding domain, the means were 1.19 (SD 0.63) and 1.30 (SD 0.76), p = 0.001; global means were 6.93 (SD 2.45) and 7.2 (SD 2.94), p = 0.03. The variables "Acute respiratory failure requiring mechanical ventilation," "score PRISM IV," "age younger than 5 years" and "central nervous system tumor," were independent predictors of new morbidity in the multivariate analysis. New morbidity correlated with lower odds of survival (considering all causes of death) after hospital discharge in the logrank test (P = 0.014), and was independently predictive of death (Cox hazard ratio = 1.98, 95 % CI: 1.18–3.32), in relation to diagnoses of lymphoma or leukemia, cancer recurrence, HSCT and malnutrition. In Weibull models, shortening in the life span of 14.2% (P = 0.014) was estimated for new morbidity. Conclusions: Risks for new morbidities are related to age, disease severity at admission and brain tumors. New morbidities, in turn, correlate with lower probabilities of survival and shortening of the remaining life span.
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Citação
SANTOS, Gabriela Maria Virgilio Dias. O impacto do desenvolvimento de novas morbidades durante o tratamento em unidade de terapia intensiva oncológica pediátrica no tempo e qualidade de vida do paciente. 2024. 86 f. Dissertação (Mestrado em Pediatria e Ciências Aplicadas à Pediatria) - Escola Paulista de Medicina, Univesidade Federal de São Paulo (UNIFESP). São Paulo, 2024.