SAMIA ZAHI RACHED
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity(2019) MARTINEZ-GARCIA, Miguel Angel; ATHANAZIO, Rodrigo; GRAMBLICKA, Giorgina; CORSO, Monica; LUNDGREN, Fernando Cavalcanti; FIGUEIREDO, Mara Fernandes de; ARANCIBIA, Francisco; RACHED, Samia; GIRON, Rosa; CARRO, Luis Maiz; CARRILLO, David de la Rosa; PRADOS, Concepcion; OLVEIRA, CasildaIntroduction: Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the ""frequent exacerbator patient"" with the best prognostic value and its relationship with the severity of bronchiectasis. Methods: A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. Results: The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the ""frequent exacerbator patient"" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69-0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. Conclusions: The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis.
- Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts(2017) ATHANAZIO, Rodrigo; PEREIRA, Monica Corso; GRAMBLICKA, Georgina; CAVALCANTI-LUNDGREN, Fernando; FIGUEIREDO, Mara Fernandes de; ARANCIBIA, Francisco; RACHED, Samia; ROSA, David de la; MAIZ-CARRO, Luis; GIRON, Rosa; OLVEIRA, Casilda; PRADOS, Concepcion; MARTINEZ-GARCIA, Miguel AngelBackground: The FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published. Methods: Retrospective and multicenter study conducted in six historical cohorts of patients from Latin America including 651 patients with bronchiectasis. Clinical, microbiological, functional, and radiological variables were collected, following the same criteria used in the original FACED score study. The vital status of all patients was determined in the fifth year of follow-up. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of the FACED score for all-cause and respiratory deaths and both number and severity of exacerbations. The discriminatory power to divide patients into three groups of increasing severity was also analyzed. Results: Mean (SD) age of 48.2 (16), 32.9% of males. The mean FACED score was 2.35 (1.68). During the follow up, 95 patients (14.6%) died (66% from respiratory causes). The AUC ROC to predict all-cause and respiratory mortality were 0.81 (95% CI: 0.77 to 0.85) 0.84 (95% CI: 0.80 to 0.88) respectively, and 0.82 (95% CI: 078-0.87) for at least one hospitalization per year. The division into three score groups separated bronchiectasis into distinct mortality groups (mild: 3.7%; moderate: 20.7% and severe: 48.5% mortality; p < 0.001). Conclusions: The FACED score was confirmed as an excellent predictor of all-cause and respiratory mortality and severe exacerbations, as well as having excellent discriminative capacity for different degrees of severity in various bronchiectasis populations.
- The annual prognostic ability of FACED and E-FACED scores to predict mortality in patients with bronchiectasis(2018) CARRILLO, David de la Rosa; ATHANAZIO, Rodrigo; MORENO, Rosa Maria Giron; CARRO, Luis Maiz; OLVEIRA, Casilda; GRACIA, Javier de; VENDRELL, Montserrat; SANCHEZ, Concepcion Prados; GRAMBLICKA, Georgina; PEREIRA, Monica Corso; LUNDGREN, Fernando; FIGUEIREDO, Mara Fernandes De; ARANCIBIA, Francisco; RACHED, Samia; MARTINEZ-GARCIA, Miguel-Angel
- Predicting high risk of exacerbations in bronchiectasis: the E-FACED score(2017) MARTINEZ-GARCIA, M. A.; ATHANAZIO, R. A.; GIRON, R.; MAIZ-CARRO, L.; ROSA, D. de la; OLVEIRA, C.; GRACIA, J. de; VENDRELL, M.; PRADOS-SANCHEZ, C.; GRAMBLICKA, G.; CORSO, Pereira M.; LUNDGREN, F. L.; FIGUEIREDO, M. Fernandes De; ARANCIBIA, F.; RACHED, S. Z.Background: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients. Objective: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality. Methods: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts. Results: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P < 0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED. Conclusion: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.