Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study / Associação entre mortalidade cardiovascular e pontuação do questionário STOP-Bang em uma coorte de pacientes hospitalizados: um estudo prospectivo

ABSTRACT Objective: Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. Methods: This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; ≥ 3 score, risk of OSA; and ≥ 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. Results: The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores ≥ 3 and ≥ 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score ≥ 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. Conclusions: In this cohort of hospitalized patients, STOP-Bang scores ≥ 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

RESUMO Objetivo: A apneia obstrutiva do sono (AOS) está associada a um risco maior de mortalidade e doenças cardiometabólicas. O questionário STOP-Bang é uma ferramenta para rastrear populações em risco de AOS e assim priorizar estudos complementares. Nosso objetivo foi avaliar a utilidade clínica desse questionário na identificação de pacientes com risco aumentado de mortalidade após a alta em uma coorte de pacientes hospitalizados. Métodos: Estudo de coorte prospectivo com pacientes consecutivos internados em uma unidade de medicina interna entre maio e junho de 2017 que foram reavaliados três anos após a alta. No momento basal, coletamos dados sobre comorbidades (hipertensão, obesidade, diabetes e perfil lipídico em jejum) e calculamos as pontuações no STOP-Bang, definindo o risco de OSA (pontuação 0-2, sem risco; pontuação ≥ 3, risco de AOS; e pontuação ≥ 5, risco de AOS moderada a grave), que determinou os grupos de estudo. Também registramos dados sobre mortalidade por todas as causas e mortalidade cardiovascular ao final do período de acompanhamento. Resultados: Foram incluídos 435 pacientes. Desses, 352 (80,9%) e 182 (41,8%) apresentaram pontuações no STOP-Bang ≥ 3 e ≥ 5, respectivamente. Quando comparados com o grupo com pontuação no STOP-Bang de 0-2, os outros dois grupos apresentaram prevalências mais elevadas de obesidade, hipertensão, diabetes e dislipidemia. A análise multivariada mostrou uma associação independente entre mortalidade cardiovascular e pontuação no STOP-Bang ≥ 5 (razão de risco ajustada = 3,12 [IC95%, 1,39-7,03]; p = 0,01). Além disso, doença coronariana prévia também foi associada à mortalidade cardiovascular. Conclusões: Nesta coorte de pacientes hospitalizados, pontuações no STOP-Bang ≥ 5 foram capazes de identificar pacientes com risco aumentado de mortalidade cardiovascular três anos após a alta.

Correlación entre características psicosociodemográficas con la tasa de mortalidad y letalidad por COVID-19 según región en Chile / Correlation between psycho-socio-demographic variables and COVID-19's mortality and case fatality rate for each region in Chile

INTRODUCCIÓN: El nuevo coronavirus, SARS-CoV-2, con su respectiva enfermedad, COVID-19, es la razón de la pandemia declarada el 11 de marzo 2020 por la Organización Mundial de la Salud. En Chile, hasta el 1° de mayo 2020, se tenía un total de 17.008 contagiados y 234 fallecidos por COVID-19. Sin embargo, esta cifra varía de región en región del mismo país. Además, cada una de ellas, ya era distinta antes de la pandemia, por sus características psicosociales. OBJETIVO: determinar la correlación entre características psicosociodemográficas con la tasa de mortalidad y letalidad por COVID-19 según región chilena durante marzo y abril 2020. METODOLOGÍA: Se realizó un estudio correlacional; la población y muestra correspondió a la población chilena proyectada para 2020 según Censo chileno 2017; se utilizó como fuente las bases de datos ministeriales chilenas; se tabularon y analizaron los datos calculando coeficiente de correlación de Pearson mediante Microsoft Excel® y XLSTAT®. Resultados: destacó que la variable con mayor correlación con la tasa de mortalidad fue el ingreso medio mensual de ocupados con coeficiente correlacional de 0,430; y con letalidad, fue la incidencia de pobreza en la población con coeficiente correlacional de 0,468. DISCUSIÓN: Es importante seguir investigando sobre determinantes sociales que inciden en la pandemia, tanto en contagiados como fallecidos, para finalmente poder establecer relaciones significativas y focalizar, tanto medidas de promoción de salud y prevención de COVID-19, como medidas de apoyo y protección psicosocial

INTRODUCTION: The newly discovered coronavirus, SARS-CoV-2, with its respective disease, COVID-19, is the cause of the pandemic that was declared on March 11, 2020, by the World Health Organization. On May 1st 2020, Chile exhibited a total of 17.004 confirmed cases and 234 deaths for COVID-19. However, these rates differ from one region of the country to another. Furthermore, due to their psychosocial characteristics, each region was already different before the pandemic. OBJECTIVE: This study aims to determine the correlation between psycho-socio-demographic variables and COVID-19's mortality and case fatality rate, for each chilean region, during March and April 2020. METHODOLOGY: A correlational study was carried out. The sample corresponded to the projected Chilean population of 2020, based on the 2017 Chilean Census. The sources of data were the Chilean ministerial databases. Through the use of Microsoft Excel® and XLSTAT®, this data was tabulated, analyzed, and then employed to calculate Pearson's correlation coefficient. RESULTS: One main find was that the average monthly income of the employed presented the highest correlation with the mortality rate, mounting to a correlation coefficient of 0,430. Regarding the case fatality rate, the most significant correlation was exhibited by the incidence of poverty in the population, with a correlation coefficient of 0,468. DISCUSSION: It is important to continue investigating about social determinants that affect the pandemic, regarding both infected and deceased people, in order to establish significant relationships that will help focalize health promotion and COVID-19 prevention efforts, as well as psychosocial support and protection measures.