THIAGO JUNQUEIRA AVELINO DA SILVA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor: AVELINO-SILVA, Thiago J. ×

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  • article 82 Citação(ões) na Scopus
    Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults
    (2014) AVELINO-SILVA, Thiago J.; FARFEL, Jose M.; CURIATI, Jose A. E.; AMARAL, Jose R. G.; CAMPORA, Flavia; JACOB-FILHO, Wilson
    Background: Comprehensive Geriatric Assessment (CGA) provides detailed information on clinical, functional and cognitive aspects of older patients and is especially useful for assessing frail individuals. Although a large proportion of hospitalized older adults demonstrate a high level of complexity, CGA was not developed specifically for this setting. Our aim was to evaluate the application of a CGA model for the clinical characterization and prognostic prediction of hospitalized older adults. Methods: This was a prospective observational study including 746 patients aged 60 years and over who were admitted to a geriatric ward of a university hospital between January 2009 and December 2011, in Sao Paulo, Brazil. The proposed CGA was applied to evaluate all patients at admission. The primary outcome was in-hospital death, and the secondary outcomes were delirium, nosocomial infections, functional decline and length of stay. Multivariate binary logistic regression was performed to assess independent factors associated with these outcomes, including socio-demographic, clinical, functional, cognitive, and laboratory variables. Impairment in ten CGA components was particularly investigated: polypharmacy, activities of daily living (ADL) dependency, instrumental activities of daily living (IADL) dependency, depression, dementia, delirium, urinary incontinence, falls, malnutrition, and poor social support. Results: The studied patients were mostly women (67.4%), and the mean age was 80.5 +/- 7.9 years. Multivariate logistic regression analysis revealed the following independent factors associated with in-hospital death: IADL dependency (OR= 4.02; CI= 1.52-10.58; p= .005); ADL dependency (OR= 2.39; CI= 1.25-4.56; p= .008); malnutrition (OR= 2.80; CI= 1.63-4.83; p< .001); poor social support (OR= 5.42; CI= 2.93-11.36; p< .001); acute kidney injury (OR= 3.05; CI= 1.78-5.27; p< .001); and the presence of pressure ulcers (OR= 2.29; CI= 1.04-5.07; p= .041). ADL dependency was independently associated with both delirium incidence and nosocomial infections (respectively: OR= 3.78; CI= 2.30-6.20; p< .001 and OR= 2.30; CI= 1.49-3.49; p< .001). The number of impaired CGA components was also found to be associated with in-hospital death (p< .001), delirium incidence (p< .001) and nosocomial infections (p= .005). Additionally, IADL dependency, malnutrition and history of falls predicted longer hospitalizations. There were no significant changes in overall functional status during the hospital stay. Conclusions: CGA identified patients at higher risk of in-hospital death and adverse outcomes, of which those with functional dependence, malnutrition and poor social support were foremost.
  • article 33 Citação(ões) na Scopus
    Malnutrition in Hospitalized Older Patients: Management Strategies to Improve Patient Care and Clinical Outcomes
    (2017) AVELINO-SILVA, Thiago J.; JALUUL, Omar
    Hospital malnutrition is estimated to affect as many as one in two patients at admission, while many others develop malnutrition throughout hospitalization. Despite being a common and long-standing problem among older adults, it is often unrecognized and associated with increased use of resources and negative outcomes such as increased complications, length of stay and mortality. Nutritional screening and assessment are readily available and inexpensive procedures that provide crucial information to develop nutrition care plans. These plans should determine the need for dietary modifications, enteral or parenteral nutrition, strategies for monitoring adverse events and therapeutic success, and parameters for therapy termination. Peculiarities of the geriatric context also need to be addressed, including the level of feeding assistance that will be required and the existence of conditions such as dementia, delirium and dysphagia. Providers should remain vigilant to potential adverse events that might result from nutritional interventions, working to prevent and correct them. Refeeding syndrome is of particular concern as a life-threatening condition. Finally, successful transition of care and adequate nutrition after discharge should also be a standing part of the nutrition care plan, and include patient/caregiver education.
  • article 3 Citação(ões) na Scopus
    Potentially inappropriate medications in older adults visiting a geriatric emergency department
    (2022) MARTINI, Isadora D.; CORREA, Fabiane G.; CASTELO, Pedro R.; MORINAGA, Christian V.; GIL-JUNIOR, Luiz A.; ALIBERTI, Marlon J. R.; CURIATI, Pedro K.; AVELINO-SILVA, Thiago J.
  • article 0 Citação(ões) na Scopus
    Reply to: Comment on: Potentially inappropriate medications in older adults visiting a geriatric emergency department
    (2022) MARTINI, Isadora D.; ALIBERTI, Marlon J. R.; AVELINO-SILVA, Thiago J.; CURIATI, Pedro K.
  • article 2 Citação(ões) na Scopus
    Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data
    (2023) AVELINO-SILVA, Vivian I.; AVELINO-SILVA, Thiago J.; ALIBERTI, Marlon J. R.; FERREIRA, Juliana C.; COBELLO JUNIOR, Vilson; SILVA, Katia R.; POMPEU, Jose E.; ANTONANGELO, Leila; MAGRI, Marcello M.; BARROS FILHO, Tarcisio E. P.; SOUZA, Heraldo P.; KALLAS, Esper G.
    Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic.Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores.Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.
  • article 6 Citação(ões) na Scopus
    The long and winding road of COVID-19 in survivors of hospitalisation: Symptoms trajectory and predictors of long COVID
    (2023) DIAS, Murilo B.; MEDEIROS, Ana Paula V.; MELO, Sarah S. de; FONSECA, Cecilia S.; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.; ALIBERTI, Marlon J. R.
  • article 6 Citação(ões) na Scopus
    Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors
    (2023) TANIGUCHI, Leandro U.; ALIBERTI, Marlon J. R.; DIAS, Murilo B.; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.
  • 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.
  • article 2 Citação(ões) na Scopus
    Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19
    (2022) ALMEIDA, Lyna Kyria Rodrigues; AVELINO-SILVA, Thiago J.; SILVA, Debora Carneiro de Lima e; CAMPOS, Bruna A.; VARELA, Gabriela; FONSECA, Cristina Mara Baghelli; AMORIM, Victor Lp; PIZA, Felipe Maia de Toledo; ALIBERTI JR., Marlon; DEGANI-COSTA, Luiza Helena
    Context. As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Objective. To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Methods. Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results. We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age >= 80 years, dementia, history of stroke or cancer, frailty, having a PaO2/FiO(2)<200 or a C-reactive protein >= 150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions. One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
  • article 4 Citação(ões) na Scopus
    The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study
    (2023) SEARA-MORAIS, Gabriel J.; AVELINO-SILVA, Thiago J.; COUTO, Marcia; AVELINO-SILVA, Vivian I.
    Background Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy.Methods In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term.Results Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters-0.11, 95% confidence interval [CI]-0.13 to-0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters-0.09, 95% CI-0.11 to-0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile).Conclusion Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.