Análise de sobrevida e fatores de risco para óbito em pacientes adultos com bronquiectasias não fibrocísticas acompanhados em um ambulatório especializado

Abstract

Bronchiectasis is permanent dilatation of the airways due to various diseases that affect the lung. There is destruction of the bronchial wall and clinical manifestations may appear at any stage of life. In order to assess quality of life (QoL) and identify risk factors associated with mortality in patients with non-cystic fibrosis bronchiectasis (NCFB), the present thesis conducted a single-center, cohort study comprising 120 patients with NCFB followed regularly from January 2017 to June 2020. One hundred patients with NCFB were seen face-to-face, or by phone, every 3 months in the 1st year, and all were followed up for three years for the survival study. The EQ-5D-3L descriptive system and the visual analog scale (EQ-VAS) were applied at two time points in the study at the beginning and at the end of the 1st year. Variables such as exacerbation, emergency room visits, comorbidities, hemoptysis, airway colonization, hospitalizations, and others were noted at the 1st year of follow-up and analyzed after 3 years using the Cox proportional hazards model for survival. A thesis in the form of two scientific articles was produced as results. Of 100 patients, 99 completed the study, 72% were women. Health-related quality of life (HRQL) measured by the EQ-5D-3L was 0.545 and 0.589 at baseline and after one year, respectively. All-cause mortality was 10.8%. Adjusted multivariate analyses showed that the main predictors for mortality were female sex (aHR: 8.14; 95% CI: 2.39-27.78; p = 0.0001), smoking (aHR: 22.46; 95% CI: 2.03-74; p = 0.011), diabetes (aHR: 3.92; 95% CI: 1.09-14.10; p = 0.037), chronic obstructive pulmonary disease (aHR: 4.03; 95% CI:1.28-12.74; p = 0.018), emergency department visits (aHR: 36.77; 95% CI: 4.10-330.14; p = 0.001), antibiotic use for exacerbations (aHR: 11.17; 95% CI: 2.25-55.48; p = 0.003), sputum color change (aHR: 8.19; 95% CI: 2.45-27.38; p = 0.001 ), exacerbation (aHR: 3.78; 95% CI:1.05-13.65; p = 0.042), forced expiratory volume in 1st second (aHR: 6.51; 95% CI: 1.60-26.46; p = 0.009), forced vital capacity (aHR 36.17; 95% CI: 5.72-228.59; p = 0.0001), absence of physical therapy (aHR 41.32; 95% CI: 4.97-343.68; p = 0.001), absence of pneumococcal vaccination (aHR: 7.00; 95% CI: 2.90-24.48; p = 0.002), mobility (EQ-5D-3L) (aHR: 5.57; 95% CI: 1.46-21.21; p = 0.012), and self-rated health status (EQ-VAS) (aHR: 4.41; 95% CI: 1.33-14.59; p = 0.015). As conclusions, patients with NCFB have reduced quality of life and multiple factors may contribute unfavorably to clinical evolution, some of which can be identified early and treated preventively.