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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2020.tde-09032020-121655
Document
Author
Full name
Luiz Carlos Latorre
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 1997
Supervisor
Committee
Gotlieb, Sabina Lea Davidson (President)
Eluf Neto, Jose
Sato, Emilia Inoue
Souza, José Maria Pacheco de
Zerbini, Cristiano Augusto de Freitas
Title in Portuguese
Análise da sobrevida em pacientes com lúpus eritematoso sistêmico
Keywords in Portuguese
Estudos de Coortes
Grupos Étnicos
Hospitais Públicos
Lúpus Erimatoso
Abstract in Portuguese
Estudos epidemiológicos com análise multivariada de fatores prognósticos em pacientes com lúpus eritematoso sistêmico ainda não foram publicados no Brasil. Assim sendo, o objetivo deste trabalho foi analisar os fatores de risco para a mortalidade, bem como para a perda da função renal, em uma coorte de pacientes com lúpus eritematoso sistêmico (LES). Uma coorte de 253 pacientes foi acompanhada em um hospital público do Município de São Paulo, por um período de 17 anos (1978-1995), de acordo com protocolo padronizado. Foram realizadas duas análises de sobrevida: a primeira foi a análise até o óbito e, a segunda, a análise da sobrevida até o surgimento da insuficiência renal terminal. As variáveis independentes foram as características demográficas desses pacientes, bem como as alterações clínicas e laboratoriais mais comumente relacionadas ao LES. O teste de associação pelo X2 foi realizado com o objetivo de avaliar a associação entre as variáveis independentes e o óbito. As curvas de sobrevida foram calculadas utilizando o método de Kaplan-Meier e os fatores de risco foram estimados pelo modelo de riscos proporcionais de Cox. Os fatores prognósticos para o óbito dos pacientes com LES foram a presença de insuficiência renal terminal (razão de riscos-HR=2, 73), de envolvimento pulmonar isolado (HR=2,94) ou associado com envolvimento cardíaco (HR=3,77) e a utilização de imunossupressor (HR=0,45). Os fatores prognósticos para o óbito dos pacientes com nefrite lúpica foram a presença de insuficiência renal terminal (HR=2,75) e a utilização de imunossupressor (HR=0,24). Os fatores de risco para o desenvolvimento de insuficiência renal terminal dos pacientes com LES foram a idade no início da doença entre 7 e 15 anos (HR=3,61), a presença de hipertensão arterial sistêmica (HR=5,21) e a presença de anemia hemolítica (HR=9,35). O fator de risco para a perda da função renal dos pacientes com nefrite lúpica foi a presença de alteração hematológica do tipo anemia hemolítica (HR=3,64) ou plaquetopenia (HR=6,69).
Title in English
Not available
Keywords in English
Not available
Abstract in English
Epidemiological studies using multivariate analysis of risk factors in patients with systemic lupus erythematosus (SLE) have not yet been published in Brazil. The objective of this study was to analyse the risk factors of mortality and of end stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE) according to demographic, clinical, and laboratory variables. A cohort of 253 patients was followed over a 17-year period (from 1978 to 1995) according to a standard protocol in a single center. Two survival analyses were performed. The first analysis consisted of the survival time from the date of diagnosis of SLE to the last contact or death. The second analysis consisted of the survival time from the date of diagnosis of SLE to the occurrence of ESRD. The independent variables were the demographic characteristics, as well as clinical and laboratory information most commonly associated with SLE. The X2 test was performed in order to evaluate the association between the independent variables and the death or ESRD. The survival curves were calculated using the Kaplan-Meier method. The prognostic factors were estimated by the Cox proportional hazard model. The risk factors for death in patients with SLE were ESRD, lung involvement alone or associated with cardiac involvement and no use of immunossupressors. The risk factors for death in patients with lupus nephritis were ESRD and no use o f immunossupressors. The risk factors for ESRD in patients with SLE were age at onset of the disease between 7 and 15 years old, high blood pressure and haemolitic anemia. The risk factor for ESRD in patients with lupus nephritis were haemolitic anemia or plaquetopenia.
 
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Publishing Date
2020-03-09
 
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