FLAVIA BARRETO GARCEZ CARVALHO

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LIM/66, Hospital das Clínicas, Faculdade de Medicina

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Colaboração internacional: Estados Unidos ×

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  • 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 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 26 Citação(ões) na Scopus
    A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults
    (2021) ALIBERTI, Marlon Juliano Romero; COVINSKY, Kenneth E.; GARCEZ, Flavia Barreto; SMITH, Alexander K.; CURIATI, Pedro Kallas; LEE, Sei J.; DIAS, Murilo Bacchini; MELO, Victor Jose Dornelas; REGO-JUNIOR, Otavio Fortes Do; RICHINHO, Valeria de Paula; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    Background: Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability. Objective: This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients. Design: Cohort study. Setting: Large university hospital dedicated to providing COVID-19 care. Participants: Participants included are 1,428 consecutive inpatients aged =50 years. Methods: Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission. Results: The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models. Conclusions: Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.