ABSTRACT
We assessed the risk factors associated with death in patients hospitalized for juvenile systemic lupus erythematosus (JSLE) and evaluated the autopsy reports. A total of 57,159 hospitalizations occurred in our institution from 1994 to 2003, 169 of them involving 71 patients with JSLE. The most recent hospitalization of these patients was evaluated. Patients were divided into two groups based on mortality during hospitalization: those who survived (N = 53) and those who died (N = 18). The main causes of hospitalization were JSLE activity associated with infection in 52 percent and isolated JSLE activity in 44 percent. Univariate analysis showed that a greater risk of death was due to severe sepsis (OR = 17.8, CI = 4.5-70.9), systemic lupus erythematosus disease activity index (SLEDAI) ³8 (OR = 7.6, CI = 1.1-53.8), general infections (OR = 6.1, CI = 1.5-25), fungal infections (OR = 5.4, CI = 3.2-9), acute renal failure (OR = 5.1, CI = 2.5-10.4), acute thrombocytopenia (OR = 3.9, CI = 1.9-8.4), and bacterial infections (OR = 2.3, CI = 1.2-7.5). Stratified analysis showed that severe sepsis and SLEDAI ³8 were not confounder variables. In the multivariate analysis, logistic regression showed that the only independent variable in death prediction was severe sepsis (OR = 98, CI = 16.3-586.2). Discordance between clinical diagnosis and autopsy was observed in 6/10 cases. Mortality of hospitalized JSLE patients was associated with severe sepsis. Autopsy was important to determine events not detected or doubtful in dead patients and should always be requested.
Subject(s)
Adolescent , Female , Humans , Male , Hospital Mortality , Lupus Erythematosus, Systemic/mortality , Sepsis/mortality , Multivariate Analysis , Risk Factors , Severity of Illness IndexABSTRACT
Descreve atividades, problemas e resultados observados, por uma equipe multiprofissional no desenvolvimento de um projeto de educaçäo em saúde sobre a temática AIDS, junto aos alunos e professores de uma escola pública de primeiro grau. Mostra que a efetiva integraçäo entre profissionais das áreas de Saúde e Educaçäo permite a viabilizaçäo deste tipo de proposta, mesmo tratando de temas considerados tabu, o que dificulta ou até impede a sua abordagem junto aos alunos