Complicações infecciosas e mortalidade associada nos primeiros 100 dias pós-transplante de medula óssea, no Hospital Araújo Jorge, 2000-2005
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2007-09-27
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Universidade Federal de Goiás
Resumo
Hematopoietic stem cell transplantation (HSCT) is a therapeutic modality used globally in
several neoplastic and non-neoplastic diseases, with increasing progress and considerable
progress in the last two decades. However, the important immunosuppression to which
transplanted patients are subjected renders them vulnerable to multiple infections that
contribute to unfavorable outcomes, including deaths. Objectives: To evaluate the clinicalepidemiological
profile, infectious complications and mortality in the first 100 days posttransplantation
(D100), in patients attending referral service in Goiás. Methodology:
Retrospective cohort of all 143 patients submitted to HSCT, Hospital Araújo Jorge of the
Association to Combat Cancer in Goiás, from 2000 to 2005. A structured questionnaire was
developed and data extraction was carried out from the patients' medical and hospital
records, containing information on: socio-demographic characteristics, type of transplantation,
infectious complications and death to D100. Creation of computerized file (Microsoft Excel)
and analysis of data using Epi Info and SPSS / PC for win programs. A descriptive analysis
was performed for socio-demographic variables and for the main infectious complications.
Univariate and multivariate analyzes according to the Cox proportional hazards model were
used for factors associated with death and survival curves were constructed, according to
Kaplan Meier. Statistical significance was defined as p <0.05. Results: We analyzed the
records of 143 patients undergoing HSCT, 73 of which were autologous and 70 were
allogeneic. There was a predominance of adults between the ages of 20 and 60 (65.1%),
those with neoplastic diseases (84.6%), from Goiás (62.2%) and with treatment funded by
the Unified Health System (70, 6%). The sources of cells used were peripheral blood (52.4%)
and bone marrow (46.9%). Of the 136 patients, followed up to D100, 76 %% had at least one
infectious episode, with predominance of bacterial infections (88.2%). Approximately half of
the patients had at least one episode of bacteremia, predominantly Gram-positive. There was
a statistically significant association between the presence of infection and having received
bone marrow precursor cells or having developed graft disease against the host (p <0.05).
Mortality in the first 100 days was 22.8%, being higher among patients submitted to
allogeneic transplantation and in those who had pneumonia, even after adjusting for potential
confounding variables (p <0.05). Conclusions: It was identified a high frequency of
infectious complications, mainly bacterial, up to D100 post-transplantation. A worse prognosis
was observed among patients who had pneumonia, suggesting the need for future studies to
reduce infectious complications in this population.
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PELEJA, E. B. Complicações infecciosas e mortalidade associada nos primeiros 100 dias pós-transplante de medula óssea, no Hospital Araújo Jorge, 2000-2005. 2007. 90 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2007.