Testes de função pulmonar e mortalidade após o transplante de células-tronco hematopoiéticas

Abstract

Objective: To determine whether the results of pulmonary function tests carried out in patients subsequently submitted to hematopoietic stem cell transplantation (HSCT) are associated with post-HSCT mortality. Methods: This was a prospective study involving patients older than 15 years of age who were submitted to allogenic HSCT between January of 2007 and March of 2008 at the Hospital das Clínicas da Universidade Federal de Minas Gerais, located in the city of Belo Horizonte, Brazil. Prior to HSCT, all of the patients underwent spirometry, determination of lung volumes, and determination of DLCO. Those same tests were repeated six months, one year, and two years after HSCT. Kaplan-Meier curves and two-tailed log-rank tests were used for survival analysis. The relative risk (RR) and 95% CI were calculated using the Cox proportional hazards model. The Cox regression model was used in the multivariate analysis. Results: The pre-HSCT pulmonary function results were normal in 40 (74.1%) of the 54 patients evaluated, 19 (35.2%) of whom died within the first 100 days after HSCT. By the end of the two-year follow-up period, 23 patients (42.6%) had died, the most common causes of death being septicemia, observed in 11 (47.8%), and septicemia-related respiratory insufficiency, observed in 10 (43.4%). The only variables significantly associated with post-HSCT mortality were alterations in spirometry results prior to HSCT (RR = 3.2; p = 0.016) and unrelated donor (RR = 9.0; p < 0.001). Conclusions: Performing spirometry prior to HSCT provides baseline values for future comparisons. Although alterations in spirometry results reveal a higher risk of post-HSCT mortality, such alterations do not contraindicate the procedure.Keywords: Hematopoietic stem cell transplantation/mortality; Respiratory function tests; Donor selection. ResumoObjetivo: Verificar se os resultados dos testes de função pulmonar realizados em pacientes submetidos a transplante de células-tronco hematopoiéticas (TCTH) estão associados com a mortalidade após o procedimento. Métodos: Estudo prospectivo no qual foram incluídos pacientes maiores de 15 anos submetidos a TCTH alogênico, entre janeiro de 2007 e março de 2008, no Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte (MG), e que realizaram espirometria, medida de volumes pulmonares e medida de DLCO antes do TCTH. Os testes foram repetidos seis meses, um ano e dois anos após TCTH. Para a análise de sobrevida, foram utilizados o método de Kaplan-Meier e testes de log-rank bicaudal. O risco relativo (RR) e IC95% foram calculados por meio do ajuste do modelo de riscos proporcionais de Cox. O modelo de regressão de Cox foi utilizado na análise multivariada. Resultados: Dos 54 pacientes incluídos, 40 (74,1%) apresentaram resultados normais de função pulmonar antes do TCTH. Ocorreram 23 óbitos (42,6%) em dois anos após o TCTH, sendo que 19 aconteceram antes de 100 dias. Dos 23 óbitos, 11 (47,8%) foram por septicemia e 10 (43,4%) por insuficiência respiratória aguda associ...

Evaluation of pulmonary complications in patients undergoing allogenic stem cell transplantation

“…In other studies about 35.2% of studied patients had died within first hundred days, and by the end of 2 years follow-up, the percentage had raised to 42.6%. The most common cause of delayed mortality was relapse of original disease and GVHD [ 37 ].…”

Avaliação Da Função Pulmonar Em Indivíduos Pós Covid-19 Atendidos No Ambulatório De Um Hospital Público Em Teresina-Piauí

“…No Brasil, os primeiros casos de COVID-19 ocorreram a partir de fevereiro de 2020 e, durante os meses seguintes, cada estado brasileiro apresentava elevados índices de infectados e morbimortalidade, entretanto também uma significativa presença de pessoas curadas que, dentre elas, apresentavam sequelas da doença (MANCUZO et al, 2021). Além da alta transmissibilidade, o estado de saúde de cada indivíduo influencia no grau e forma da patologia, isso porque a forma grave do COVID-19 alcança maior expressão em portadores de doenças crônicas a exemplo da hipertensão arterial sistêmica (HAS) e diabetes melito (DM), bem como de origem pulmonar, metabólica, cardiovascular e imunológica (ZHAO et al, 2020).…”

Prognostic implication of pre‐transplant FEV1 on long‐term outcomes following allogeneic hematopoietic stem cell transplantation

“…However, HCT continues to carry a significant risk of life‐threatening complications for the patient. Multiple studies have been published demonstrating that decreased pre‐transplant pulmonary function is associated with complications and mortality after HCT 2–5 . Of the metrics of the pulmonary function test (PFT), forced expiratory volume in the first second (FEV 1 ) and diffusion capacity of carbon monoxide (DLCO) 2,4–7 emerged as the major determinants of patient outcomes.…”