FLAVIA BARRETO GARCEZ CARVALHO

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LIM/66, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Fog ahead: delirium and post-discharge cognitive impairment in severe COVID-19.
    (2020) AVELINO-SILVA, T.; GARCEZ, F.; DIAS, M.; JACOB-FILHO, W.; ALIBERTI, M.
  • bookPart
    Delirium
    (2019) AVELINO-SILVA, Thiago Junqueira; CRENITTE, Milton Roberto Furst; CARVALHO, Flávia Barreto Garcez
  • article 15 Citação(ões) na Scopus
    Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study
    (2021) FERNANDEZ, Shirley Steffany Munoz; GARCEZ, Flavia Barreto; ALENCAR, Julio Cesar Garcia de; CEDERHOLM, Tommy; APRAHAMIAN, Ivan; MORLEY, John Edward; SOUZA, Heraldo Possolo de; SILVA, Thiago Junqueira Avelino da; RIBEIRO, Sandra Maria Lima
    Background & aims: Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). Methods: We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. Results: GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). Conclusion: GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
  • article 1 Citação(ões) na Scopus
    Accuracy of two prognostic indexes to predict mortality in older adults with advanced dementia
    (2022) LOPES, Beatriz Noele Azevedo; GARCEZ, Flavia Barreto; SUEMOTO, Claudia Kimie; MORILLO, Lilian Schafirovits
    ABSTRACT. Dementia is a cause of disability among older adults. Accessing advanced dementia prognosis is a challenge. Objective: The objective of this study was to evaluate the accuracy of the Charlson and Carey indexes in predicting 3-year survival of older adults with advanced dementia. Methods: This is a retrospective cohort study of 238 patients aged ≥60 years with advanced dementia from an outpatient clinic and classified as stage ≥6A by using the Functional Assessment Staging scale. We excluded patients with missing data. We reviewed the semi-structured interview (clinical, sociodemographic, and functional data) from the baseline visit. This information was used to calculate 3-year mortality risks according to the Charlson and Carey indexes. We used Cox proportional hazard models to evaluate the associations of all-cause mortality with both indexes, adjusted for sociodemographic variables. We used Harrell’s C measure to determine the discrimination. We calculated the absolute differences between observed and predicted 3-year mortality risks for each index for calibration. Results: In 238 patients, the average age was 80.5±7.8 years, with 36% being men. The median follow-up time was 1.8 years (0.05–3.0). The 3-year all-cause mortality rate was 50% (119 deaths). The Carey index was associated with mortality, with one point increase related to a 15% increase in the mortality risk (hazard ratio [HR]=1.15, 95% confidence interval (95%CI) 1.06–1.25, p=0.001), even after adjustment. Accuracy for the Charlson index and Carey index was 0.55 (95%CI 0.49–0.60) and 0.60 (95%CI 0.52–0.62), respectively, with no difference between them (p=0.44). Conclusions: Both indexes had poor discrimination and calibration performances in predicting 3-year mortality in patients with advanced dementia.
  • bookPart
    Delirium
    (2020) AVELINO-SILVA, Thiago Junqueira; GARCEZ, Flávia Barreto
  • article 5 Citação(ões) na Scopus
    Characterising neuropsychiatric disorders in patients with COVID-19
    (2020) OLDHAM, Mark A.; SLOOTER, Arjen J. C.; CUNNINGHAM, Colm; RAHMAN, Shibley; DAVIS, Daniel; VARDY, Emma R. L. C.; GARCEZ, Flavia B.; NEUFELD, Karin J.; CASTRO, Roberta Esteves Vieira de; ELY, E. Wesley; MACLULLICH, Alasdair
  • article 0 Citação(ões) na Scopus
    Last Word on Viewpoint: Nondyspnogenic acute hypoxemic respiratory failure in COVID-19 pneumonia-Breathing pattern in patients with SARS-CoV-2
    (2021) MOREIRA, Thiago S.; BARRETO-FILHO, Jose A.; SEABRA-GARCEZ, Juliane D.; GARCEZ, Flavia Barreto; DRAGER, Luciano F.
  • article 9 Citação(ões) na Scopus
    Nondyspnogenic acute hypoxemic respiratory failure in COVID-19 pneumonia
    (2021) BARRETO-FILHO, Jose Augusto; SEABRA-GARCEZ, Juliane Dantas; GARCEZ, Flavia Barreto; MOREIRA, Thiago S.; DRAGER, Luciano F.
  • article 0 Citação(ões) na Scopus
    Nondyspnogenic respiratory failure in patients with COVID-19: another example of myth-building in this new disease? Reply
    (2021) BARRETO-FILHO, Jose Augusto; SEABRA-GARCEZ, Juliane Dantas; GARCEZ, Flavia Barreto; MOREIRA, Thiago S.; DRAGER, Luciano F.
  • article 101 Citação(ões) na Scopus
    Delirium and Adverse Outcomes in Hospitalized Patients withCOVID-19
    (2020) GARCEZ, Flavia B.; ALIBERTI, Marlon J. R.; POCO, Paula C. E.; HIRATSUKA, Marcel; TAKAHASHI, Silvia de F.; COELHO, Venceslau A.; SALOTTO, Danute B.; V, Marlos L. Moreira; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    BACKGROUND Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19. OBJECTIVES To investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes. DESIGN Longitudinal observational study. SETTING Tertiary university hospital dedicated to the care of severe cases of COVID-19 in Sao Paulo, Brazil. PARTICIPANTS A total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020. MEASUREMENTS We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-Based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, and albumin). RESULTS Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization. CONCLUSION Delirium was independently associated with in-hospital death in adults aged 50 years and older with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients.