Browsing by Author "Froes, F."
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- Diabetes hinders community-acquired pneumonia outcomes in hospitalized patientsPublication . Martins, M.; Boavida, J.M.; Raposo, J.F.; Froes, F.; Nunes, Baltazar; Ribeiro, R.T.; Macedo, M.P.; Penha-Gonçalves, C.Objectives: This study aimed to estimate the prevalence of diabetes mellitus (DM) in hospitalized patients with community-acquired pneumonia (CAP) and its impact on hospital length of stay and inhospital mortality. Research design and methods: We carried out a retrospective, nationwide register analysis of CAP in adult patients admitted to Portuguese hospitals between 2009 and 2012. Anonymous data from 157 291 adult patients with CAP were extracted from the National Hospital Discharge Database and we performed a DM-conditioned analysis stratified by age, sex and year of hospitalization. Results: The 74 175 CAP episodes that matched the inclusion criteria showed a high burden of DM that tended to increase over time, from 23.7% in 2009 to 28.1% in 2012. Interestingly, patients with CAP had high DM prevalence in the context of the national DM prevalence. Episodes of CAP in patients with DM had on average 0.8 days longer hospital stay as compared to patients without DM ( p<0.0001), totaling a surplus of 15 370 days of stay attributable to DM in 19 212 admissions. In-hospital mortality was also significantly higher in patients with CAP who have DM (15.2%) versus those who have DM (13.5%) ( p=0.002). Conclusions: Our analysis revealed that DM prevalence was significantly increased within CAP hospital admissions, reinforcing other studies’ findings that suggest that DM is a risk factor for CAP. Since patients with CAP who have DM have longer hospitalization time and higher mortality rates, these results hold informative value for patient guidance and healthcare strategies.
- Hospitalization direct cost of adults with community-acquired pneumonia in Portugal from 2000 to 2009Publication . Antunes, C.; Pereira, M.; Rodrigues, L.; Organista, D.; Cysneiros, A.; Paula, F.; Nunes, Baltazar; Barbosa, P.; Bárbara, C.; Escoval, A.; Diniz, A.; Froes, F.Introduction: Hospitalizations due to community-acquired pneumonia (CAP) in mainland Portugal from 2000 to 2009 accounted for 3.7% of all hospital admissions in population with 18 or more years of age. There is no direct-cost data regarding these admissions. Methods: In this observational descriptive study all adult hospitalizations associated with CAP diagnosis were retrospectively analyzed for the period between 2000 and 2009. Patients under 18 years old, those with pneumonia as secondary diagnosis, patients with tuberculous or obstructive pneumonia, and immunocompromised patients were excluded from the study. The direct cost of hospitalization was calculated according to the diagnosis-related groups (DRG), established for the respective year of hospitalization. Results: There were 294,026 hospital admissions with an average annual direct cost of 80 million Euros, which almost doubled between 2000 and 2009. The average direct hospitalization costs per admission, including wards and Intensive Care Units (ICU), amounted to €2,707, with an increasing trend. The average hospitalization cost was €2,515 for admissions resulting in live discharge, and €3,457 for the deceased. Conclusion: The average direct cost of adult hospitalizations associated with CAP amounted to €2,707 in mainland Portugal from 2000 to 2009, showing an increase of 37.5% in hospitalization cost of living and deceased patients. The economic impact of CAP-related hospital admissions justifies the need for better implementation of preventive measures.
- Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009Publication . Teixeira-Lopes, F.; Cysneiros, A.; Dias, A.; Durão, V.; Costa, C.; Paula, F.; Serrado, M.; Nunes, Baltazar; Diniz, A.; Froes, F.Introduction: Community-acquired pneumonia (CAP) remains a common and serious infection with wide variability in intra-hospital mortality. Methods: We performed a retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009. Results: The intra-hospital mortality rate was 20.4% with deaths in all age groups. The average age of deceased patients was 79.8 years, significantly higher than surviving patients with 71.3 years. Patients aged 50 or more presented a relative risk of death 4.4 times the risk of patients under this age group. Likewise, in patients aged 65 or more the risk of death was 3.2 times the risk of patients <65 years. Men died more at a younger age than women, the men who died were, on average, 4 years younger than women, 78.1 vs 82.1 years old. Relative risk of death in men was 17% higher than women after adjustment for year of admission and age. Conclusion: CAP remains an important cause of hospital mortality in all age groups.
- The typical presentation of an atypical pathogen during an outbreak of Legionnaires’ disease in Vila Franca de Xira, Portugal, 2014Publication . Dias, A.; Cysneiros, A.; Lopes, F.T.; von Amann, B.; Costa, C.; Dionísio, P.; Carvalho, J.; Durão, V.; Carvalho, G.; Paula, F.; Serrado, M.; Nunes, B.; Marques, T.; Froes, F.; Bárbara, C.Background: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires’ disease (LD). Methods: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department. Results: 60.5% were male, mean age was 56.1 ± 13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5 ◦C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30 mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases. Conclusions: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis