RESUMO
OBJECTIVES: To evaluate health-related quality of life (HRQoL) and associated clinical, demographic and socioeconomic factors in a cohort of Ecuadorian patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: A cross-sectional descriptive study evaluating (HRQoL) with the Spanish version of the Quality of Life Rheumatoid Arthritis (QoL-RA) instrument in patients diagnosed with RA according to the criteria of the American College of Rheumatology and the European League Against Rheumatism. In addition, the following data were obtained: age, sex, marital status, socioeconomic stratum, comorbidities, disease duration, medication, rheumatoid factor positivity, disease activity using the simplified disease activity index and physical functionality measured with the modified Health Assessment Questionnaire (MHAQ). RESULTS: A total of 163 patients were assessed, the mean score of the QoL-RA scale was 6.84±1.5 points. The highest measurements were obtained in the domains of interaction (8.04±1.9) and support (8.01±2). The factors that were associated with the overall quality of life assessment were: functionality measured with MHAQ (r=-0.70; P<.001); disease duration in years (r=-0.178; P<.05); and disease activity (mean difference of 1.5; 95%CI: 1.09 to 1.91). CONCLUSION: The patients evaluated had a good to moderate HRQoL. The domains related to support and social life were those with the highest scores and the lowest scores were related to pain and nervous tension. Functionality, duration, and disease activity were statistically associated with HRQoL.
Assuntos
Artrite Reumatoide , Relações Interpessoais , Qualidade de Vida , Apoio Social , Fatores Etários , Análise de Variância , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/psicologia , Comorbidade , Estudos Transversais , Equador , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
Introducción: La mortalidad relacionada a la neutropenia febril puede ser muy alta en ciertas poblaciones de alto riesgo. El objetivo del presente estudio fue identificar factores predictores tempranos de mortalidad en una cohorte de pacientes oncológicos con neutropenia febril admitidos en una unidad de cuidados intensivos (UCI). Métodos: Estudio observacional retrospectivo en pacientes con neutropenia febril mayores de 18 años ingresados en la UCI del Hospital Oncológico Solón Espinosa Ayala de Quito. Se recogieron variables sociodemográficas, clínicas, de laboratorio y microbiológicas de los registros clínicos al ingreso. Con dichas variables se construyeron modelos predictivos de mortalidad mediante análisis de regresión logística para identificar predictores de muerte. Resultados: Se registraron 107 pacientes con episodios de neutropenia febril, el 53.3 % de los casos presentaron neutropenia severa y en un 29.9 % de los casos la neutropenia duró más de 10 días. La prevalencia de bacteriemia fue del 34.6 %. El 34.6 % de los pacientes murieron (n=37), de estos el 22.4 % falleció en la UCI. Edad superior de 40 años, valores de procalcitonina superiores a 4 ng/ml, puntuaciones altas en APACHE II y la necesidad de apoyo ventilatorio se asociaron con mayor riesgo de muerte en el modelo multivariado; el valor predictivo en la validación interna tuvo una precisión de 81.3 %; sensibilidad de 63.6 %; especificidad de 90.5 %; valor predictivo positivo de 77.8 %; valor predictivo negativo de 82.6 %; área bajo la curva de 0.87. Conclusión: Factores como la edad mayor de 40 años, procalcitonina > 4 ug/ml al ingreso, valores de APACHE II y necesidad de ventilación mecánica están asociados con mayor riesgo de muerte.
Introduction: The mortality related to febrile neutropenia may be very high in certain populations. The aim of the present study was to identify early predictors of mortality in a cohort of oncologic patients with febrile neutropenia admitted to an intensive care unit (ICU). Methods: Retrospective observational study in patients with febrile neutropenia older than 18 years admitted to the intensive care unit of the "Solon Espinosa Ayala" Oncology Hospital in Quito. Sociodemographic, clinical, laboratory and microbiological variables were collected from clinical records at admission. With these variables, predictive mortality models were constructed usingclogistic regression analysis to identify predictors of death. Results: There were 107 episodes of febrile neutropenia, 53.3 % had severe neutropenia, and in 29.9 % of the cases neutropenia lasted more than 10 days. The prevalence of bacteremia was 34.6 %. 34.6 % of the patients died (n = 37), of which 22.4 % died in the ICU. A higher age of 40 years, procalcitonin values higher than 4 ng / ml, high APACHE II scores and the need for ventilatory support were associated with an increased risk of death in the multivariate model; The predictive value in the internal validation had an accuracy of 81.3 %; Sensitivity of 63.6 %; Specificity of 90.5 %; Positive predictive value of 77.8 %; Negative predictive value of 82.6 %; Area under the curve of 0.87. Conclusion: Factors such as age greater than 40 years, procalcitonin at admission > 4 ug/ml, APACHE II and requirement of mechanical ventilation support are associated with a higher risk of death.