THIAGO JUNQUEIRA AVELINO DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
2 resultados
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- Delirium and post-discharge dementia: results from a cohort of older adults without baseline cognitive impairment(2019) GARCEZ, Flavia Barreto; APOLINARIO, Daniel; CAMPORA, Flavia; CURIATI, Jose Antonio Esper; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago JunqueiraObjectives: to investigate the association between delirium occurrence in acutely ill older adults and incident dementia after hospital discharge. Methods: retrospective cohort study examining acutely ill older adults aged +60 years and consecutively admitted to the geriatric ward of a tertiary university hospital from 2010 to 2016. Inclusion criteria were absence of baseline cognitive decline on admission and documented clinical follow-up of +12 months after discharge. Admission data were collected from our local database, including results from a standardized comprehensive geriatric assessment completed for every patient. Pre-existing cognitive decline was identified based on clinical history, CDR and IQCODE-16. Delirium was diagnosed using short-CAM criteria, while post-discharge dementia after 12 months was identified based on medical records' review. We used competing-risk proportional-hazard models to explore the association between delirium and post-discharge dementia. Results: we included 309 patients. Mean age was 78 years, and 186 (60%) were women. Delirium was detected in 66 (21%) cases. After a median follow-up of 24 months, 21 (32%) patients who had experienced delirium progressed with dementia, while only 38 (16%) of those without delirium had the same outcome (P=0.003). After adjusting for possible confounders, delirium was independently associated with post-discharge dementia with a sub-hazard ratio of 1.94 (95%CI=1.10-3.44; P=0.022). Conclusion: one in three acutely ill older adults who experienced delirium in the hospital developed post-discharge dementia during follow-up. Further understanding of delirium as an independent and potentially preventable risk factor for cognitive decline emphasizes the importance of systematic initiatives to fight it.
- 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.