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Master's Dissertation
DOI
Document
Author
Full name
Rúbia Poliana Crisóstomo Miranda
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Dantas, Roberto Oliveira (President)
Bazan, Rodrigo
Felicio, Claudia Maria de
Pontes Neto, Octávio Marques
Title in Portuguese
Pneumonia no acidente vascular cerebral: frequência, preditores e desfechos associados
Keywords in Portuguese
Acidente vascular cerebral
Fatores de risco
Pneumonia
Prognóstico
Abstract in Portuguese
Introdução: Pneumonia é uma das complicações mais frequentes após Acidente Vascular Cerebral (AVC), com incidência variando de 2,3% a 47,3%. Nesse estudo, nosso objetivo foi identificar a frequência e os fatores associados com pneumonia após AVC e avaliar o impacto da pneumonia quanto ao óbito intra-hospitalar e quanto aos desfechos dependência funcional e óbito em três meses após o AVC. Métodos: Participaram do estudo pacientes que preencheram os critérios de inclusão (Idade maior que 18 anos de ambos os sexos e diagnóstico médico de AVC isquêmico ou hemorrágico agudo, confirmado por exames de neuroimagem) e nenhum dos critérios de exclusão (Ataque Isquêmico Transitório, Hemorragia Subaracnóidea, Trombose Venosa Cerebral, outros quadros clínicos em que não foi confirmado diagnóstico de AVC, ictus antigo, AVC hemorrágico de causa secundária por malformação arteriovenosa, aneurisma cerebral, neoplasia craniana, distúrbios da coagulação, entre outros; não concordância em participar do estudo ou não assinatura do Termo de Consentimento Livre e Esclarecido). Estes pacientes foram admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e incluídos no Registro de Acidente Vascular Encefálico (REAVER) no período de abril de 2015 a setembro de 2016. Os dados demográficos e clínicos foram coletados de forma prospectiva pelos coordenadores de pesquisa do REAVER. Quando possível, os pacientes foram submetidos à avaliação clínica da deglutição por três fonoaudiólogas. Os prontuários de todos os pacientes foram revisados por um infectologista para confirmar o diagnóstico de pneumonia. Resultados: Foram estudados 478 pacientes com AVC agudo. Considerando a amostra total do estudo, encontramos uma frequência relativa de 24% de pneumonia, 11,5% de óbito intra-hospitalar e 36,8% de dependência funcional ou óbito após três meses do AVC. Dos pacientes com pneumonia, 32,2% foram a óbito intra-hospitalar e 84,3% apresentaram dependência funcional ou óbito após três meses do ictus.Na análise multivariada por regressão logística para preditores de pneumonia após AVC, a gravidade do AVC (p=0,001), AVC hemorrágico (p=0,012) e disfagia (p=0,001) foram preditores independentes para pneumonia. Conclusão: Nosso estudo confirma que a pneumonia é uma complicação frequente após o AVC, sendo associada com gravidade do AVC, AVC hemorrágico e disfagia. Os pacientes com pneumonia apresentaram alta frequência de óbito intra-hospitalar e alta dependência funcional ou óbito após três meses do AVC.
Title in English
Pneumonia in stroke: frequency, predictors and associated outcomes
Keywords in English
Pneumonia
Prognosis
Risk factors
Stroke
Abstract in English
Introduction: Pneumonia is one of the most frequent complications after stroke, with an incidence varying from 2.3% to 47.3%. In this study, our goal was to identify the frequency and factors associated with post-stroke pneumonia and to assess the impact of pneumonia on in-hospital death, functional dependence outcomes and death at three months after stroke. Methods: Were included in the study, patients who met the criteria for participation (over 18 years old for both sexes and medical diagnosis of acute hemorrhagic or ischemic stroke, confirmed by neuroimaging exams) and none of the exclusion criteria (Transient Ischemic Attack, Subarachnoid Hemorrhage, Cerebral Venous Thrombosis, clinical conditions in which a diagnosis of stroke was not confirmed, not acute stroke, hemorrhagic stroke due to arteriovenous malformation, brain aneurysm, brain tumor, coagulation disorders, other diagnosis; non-agreement to participate in the study or non-signing of the Informed Consent Form). These patients were admitted to the University Hospital Emergency Unit of the Medical School of Ribeirão Preto (HCFMRP-USP) and included in the Registry of Stroke (REAVER) from April 2015 to September 2016. Demographic and clinical data were collected prospectively by the REAVER research coordinators. The patients underwent clinical evaluation of swallowing by three speech therapists whenever possible. The medical records of all patients were reviewed by an infectious disease specialist to confirm the diagnosis of pneumonia. Results: A total of 478 patients with acute stroke were included. Considering the total sample of the study, we found a relative frequency of 24% of pneumonia, 11.5% of in-hospital death and 36.8% of functional dependence or death after three months of stroke. Regarding the patients with pneumonia, 32.2% died in the hospital and 84.3% had functional dependence or death after three months of stroke. In the multivariate logistic regression analysis for predictors of poststroke pneumonia, the severity of stroke (p = 0.001), hemorrhagic stroke (p = 0.012), and dysphagia (p = 0.001) were independent predictors for pneumonia. Conclusion: Our study confirms that pneumonia is a common complication afterstroke and is associated with severity of stroke, hemorrhagic stroke and dysphagia. Patients with pneumonia had a higher frequency of in-hospital death and greater functional dependence or death after three months of stroke.
 
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Publishing Date
2019-08-14
 
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