Avaliação da fragilidade em pacientes com doença pulmonar obstrutiva crônica
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2020-04-24
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Universidade Federal de Goiás
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Introduction: Frailty has been recognized as a prognostic factor for chronic diseases, despite
being mostly age-related, in patients with Chronic Obstructive Pulmonary Disease (COPD), frailty
has been implicated in worse survival. Objectives: To assess the prevalence of frailty and
associated factors in patients with COPD. Methods: Cross-sectional study in COPD patients
registered for public access to pharmacological treatment. Data were collected in Goiânia, at the
High Cost Medication Center, from January to December 2018, after approval by the CEP.
Demographic data, lung function, medication in use for COPD were collected; number of
exacerbations, emergency consultations in the last 12 months; MRC, CAT, Charleston Index
(ICCI) and frailty was assessed by applying FRAIL-BR and classified as Frail (3 to 5 points), Pre-
Frail (1 or 2 points) and robust (0 points). A significance level of 5% was assigned. The
descriptions used proportion, median and interquartile range (IQR). The categorical variables: sex,
origin, race and drugs in use and the linear variables: medians of age and time in the program; were
analyzed using the Chi-square test and Mann-Whitney, respectively. For the correlations between
FRAIL and CAT, MRC and FEV1 variables, Spearman's correlation coefficient was used. Results:
153 patients were evaluated, predominantly elderly (83.0%), with a median age of 68 years (IIQ:
63-72) and male (54.9%). The prevalence of frailty in the sample was 50.3%, the pre-frail
corresponded to 35.3%, only 14.3% of the patients were normal. The fragile, pre-frail and normal
groups were similar with respect to age, sex, income, race / skin color, the presence of
comorbidities, BMI, the medications used, exacerbations in the last 12 months, current smoking,
hospitalizations, FEV (l) and vef1 / cvf (p-value> 0.05). The median of years of schooling was
statistically higher in the normal than in the frail group (6.5 versus 5.0; p-value = 0.011), frail
patients had worse lung function than normal patients with respect to FEV% (p- value = 0.011),
highest median mMRC and CAT score (p-value <0.001), (p-value <0.001) respectively, finally, the
groups were different regarding GOLD staging (p-value <0.001). GOLD A was more frequent in
normals, while GOLD D was more prevalent in pre-frail and frail. After ordinal regression, the
chances of frailty increased with increasing MRC (Model 1: ORaj = 1.94; p-value <0.001; Model
2: ORaj = 1.63; p-value <0.001), with the increase in CAT (ORaj = 1.12; p-value <0.001) and in
individuals GOLD B (ORaj = 3.42; p-value = 0.011) and D (ORaj = 4.74; p-value = 0.003) when
compared to A. Conclusion: Frailty is very prevalent in COPD patients, correlates with worse
symptoms of the disease and worse lung function.
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DIAS, L. S. Avaliação da fragilidade em pacientes com doença pulmonar obstrutiva crônica. 2020. 113 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2020.