WILSON JACOB FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina - Líder
7 resultados
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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.- 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.
conferenceObject The Prognostic Value of a 10-min Targeted Geriatric Assessment in Older Adults with Heart Failure: A Prospective Cohort Study(2020) MEYER, J. Ferreira; MOREIRA, F. Vecchi; CRENITTE, M. R. Furst; JACOB FILHO, W.; ALIBERTI, M.- Role of Gait Speed, Strength, and Balance in Predicting Adverse Outcomes of Acutely Ill Older Outpatients(2020) FORTES-FILHO, Sileno Queiroz; ALIBERTI, M. J. R.; APOLINARIO, D.; MELO-FORTES, J. A.; SITTA, M. C.; JACOB-FILHO, W.; GARCEZ-LEME, L. E.Aim To evaluate the ability of the Short Physical Performance Battery (SPPB) for predicting 1-year adverse outcomes of acutely ill older outpatients. Methods Prospective study with 512 acutely ill older outpatients (79.4 +/- 8.3 years, 63% female) in an acute care day hospital. The SPPB was administered at admission. Participants were classified as low (0-4 points), intermediate (5-8 points), or high (9-12 points) performance. Primary outcomes were new dependence in basic activities of daily living (ADL), hospitalization, and death at 1 year. Cox models tested whether the SPPB predicted outcomes after adjustment for sociodemographic factors, comorbidities and well-known geriatric conditions. We also estimated whether the chair-stand and balance tests improve the SPPB's ability to identify patients at high risk of adverse outcomes. Results Patients with intermediate or low SPPB performance were at higher risk of 1-year new ADL dependence (32% vs 13%: adjusted hazard ratio [aHR]=2.00; 95%CI=1.18-3.37; 58% vs 13%: aHR=3.40; 95%CI=2.00-5.85, respectively), hospitalization (43% vs 29%: aHR=1.56; 95%CI=1.04-2.33; 44% vs 29%: aHR=1.80; 95%CI=1.15-2.82), and death (18% vs 6%: aHR=2.54; 95%CI=1.17-5.53; 21% vs 6%: aHR=2.70; 95%CI=1.17-6.21). Use of all three components (versus gait speed alone) improved predictions of new ADL dependence (Harrell's C=0.73 vs 0.70;P=0.01), hospitalization (Harrell's C=0.60 vs 0.57;P=0.04), and death (Harrell's C=0.67 vs 0.62;P=0.04). Conclusions The SPPB is as a powerful tool for identifying acutely ill older outpatients at high-risk of adverse outcomes. The combination of the three components of the SPPB resulted in better predictive performance than gait speed alone.
- Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results(2020) SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; KHAZAAL, Eugenia Jatene Bou; ALIBERTI, Marlon Juliano Romero; AVELINO-SILVA, Thiago Junqueira; APOLINARIO, Daniel; SUEMOTO, Claudia Kimie; JACOB-FILHO, WilsonBackgroundThe demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in SAo Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population.MethodsThe ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years.ResultsWe included 1336 participants with a mean age of 828years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score >= 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk=0.6%; medium-risk=7.4%; high-risk=17.5%; P<0.001).Conclusion The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.
- Prognostic value of a rapid sarcopenia measure in acutely ill older adults(2020) ALIBERTI, Marlon J. R.; SZLEJF, Claudia; COVINSKY, Kenneth E.; LEE, Sei J.; JACOB-FILHO, Wilson; SUEMOTO, Claudia K.Background: Current recommendations to assess sarcopenia requiring specialized equipment hinder its use as a prognostic tool in busy acute settings. Aims: To investigate the prognostic value of a rapid sarcopenia measure in acutely ill older outpatients for 1-year adverse outcomes. Methods: Prospective study with 665 acutely ill older adults (mean age 78.7 +/- 8.3 years; 63% women) in need of intensive management to avoid hospital admission. Sarcopenia was screened upon admission, defined as the presence of both low muscle strength and low muscle mass. Low muscle strength was determined by handgrip strength according to the cutoffs of the Foundation for the National Institutes of Health (<16 kg for women and <26 kg for men). Low muscle mass was assessed by calf circumference, a validated surrogate measure of skeletal muscle mass, using previously established thresholds (<= 33 cm for women and <= 34 cm for men). Outcomes were time to hospitalization, new dependence in basic activities of daily living (ADL), worsening walking ability, and death. To investigate the association of sarcopenia and its components with outcomes we used hazard models, considering death as a competing risk, adjusted for sociodemographic factors, Charlson comorbidity index, cognitive impairment, depressive symptoms, and weight loss. Results: On admission, 203 (31%) patients had sarcopenia. Comparing 1-year adverse outcomes between older adults with and without sarcopenia, respectively, cumulative incidences for hospitalization were 46% vs 32% (adjusted sub-hazard ratio [sHR] = 1.53; 95% CI = 1.16-2.04), for new ADL dependence, 47% vs 24% (adjusted sHR = 1.78; 95% CI = 1.31-2.42), for worsening walking ability, 28% vs 13% (adjusted sHR = 1.93; 95% CI = 1.28-2.90), and for death, 22% vs 10% (adjusted HR = 1.69; 95% CI = 1.05-2.73). Low muscle strength alone was associated with all outcomes, and low muscle mass was associated with all outcomes except mortality. Conclusion: Sarcopenia was a strong predictor of 1-year adverse outcomes among acutely ill older outpatients. Combining handgrip strength with calf circumference may be a practical and efficient approach to screen for sarcopenia, and thereby identify high-risk older adults in busy clinical settings.
conferenceObject Geriatric Conditions Predict Mortality in Older Adults after Kidney Transplantation(2020) ALTONA, M.; DIAS, M. B.; AVELINO-SILVA, T. J.; ALIBERTI, M.; JACOB FILHO, W.