Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Abstract

Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality. ResumoObjetivo: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. Métodos: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. Resultados: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29%, e essa foi a causa mortis de 22,6% dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95%: 1,26-2,95; p = 0,02) e acom...

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

“…Away from tuberculosis, three other papers deal with pulmonary and mediastinal infections. Martinelli et al85 determined the prevalence of nosocomial pneumonia in autopsies at a public university hospital in an attempt to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia and to determine whether patho-anatomical findings correlate with nosocomial pneumonia or aspiration pneumonia. They found a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths.…”

Estudio histopatológico comparativo del nervio frénico proveniente de cadáveres con enfermedad pulmonar obstructiva crónica y sin esta condición

“…La antracosis se encuentra con frecuencia en individuos con antecedentes de tabaquismo, pero también se puede observar en individuos expuestos a la quema de biomasa utilizado como fuente de energía (11,12) . El humo del cigarrillo provoca un reclutamiento grande y continuo de células inflamatorias que liberan enzimas proteolíticas en la matriz extracelular del parénquima pulmonar, causando patrones histopatológicos característicos como engrosamiento septal, agrandamiento de los espacios aéreos, reducción de colágeno y fibras elásticas y aumento de la cantidad de macrófagos alveolares (13) .…”