MARLON JULIANO ROMERO ALIBERTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina
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.conferenceObject Motoric Cognitive Risk Syndrome and Cognition: The Influence of Depression(2020) ALIBERTI, J.; SERRAGLIO, A.; ALIBERTI, M.conferenceObject Validating intrinsic capacity to measure healthy aging in a low to middle-income country: findings from the ELSI-Brazil(2020) ALIBERTI, M.; SUEMOTO, C.conferenceObject Mammalian target rapamycin inhibitor (mTOR) and cognition in the elderly after kidney transplantation(2020) FIGUEIREDO, C. S.; 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 Patient-centered outcomes: frailty and disability transitions after hospitalization for COVID-19(2020) ALIBERTI, M.; AVELINO-SILVA, T.conferenceObject Prevalence and Risk Factors for Motoric Cognitive Risk Syndrome in Middle-Aged and Older Adults: Evidence from the ELSI-Brazil(2020) SERRAGLIO, A.; ALIBERTI, J.; ALIBERTI, M.conferenceObject Frailty Modifies the Association of Blood Pressure with Cognition in Older Adults(2020) ALIBERTI, M.; SZLEJF, C.; SUEMOTO, C.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.