RESUMO
Background: Comorbidities in idiopathic pulmonary fibrosis (IPF) affect quality of life, symptoms, disease progression and survival. It is unknown what are the comorbidities in patients with IPF in Latin America (LA) and if there are differences between countries. Our objective was to compare IPF comorbidities in four countries and analyze possible differences by altitude. Methods: Patients with IPF according 2012 ATS/ERS/JRS/ALAT guidelines, from two cities with an altitude of ≥2,250 m: Mexico City (Mexico) and Bogotá (Colombia) and from three at sea level: Buenos Aires (Argentina) and Lima and Trujillo (Peru). Comorbidities and pulmonary function tests were taken from clinical records. Possible pulmonary hypertension (PH) was defined by findings in the transthoracic echocardiogram of systolic pulmonary arterial pressure (sPAP) >36 mmHg or indirect signs of PH in the absence of other causes of PH. Emphysema as the concomitant finding of IPF criteria on chest tomography plus emphysema in the upper lobes. ANOVA or Kruskal Wallis and χ2-tests were used for comparison. Results: Two hundred and seventy-six patients were included, 50 from Argentina, 86 from Colombia, 91 from Mexico and 49 from Peru. There prevalence of PH was higher in Colombia and Mexico (p < 0.001), systemic arterial hypertension in Argentina (p < 0.015), gastro-esophageal reflux and dyslipidemia in Colombia and Argentina (p < 0.001) and diabetes mellitus in Mexico (p < 0.007). Other comorbidities were obesity (28.4%), coronary artery disease (15.2%) and emphysema (14.9%), with no differences between countries. There was more PH in the altitude cities than those at sea level (51.7 vs. 15.3%, p < 0.001). In patients from Bogotá and Mexico City, arterial oxygen pressure, saturation (p < 0.001) and carbon monoxide diffusing capacity (p = 0.004) were significantly lower than in cities at sea level. Conclusions: In this study with a significant number of patients, we were able to describe and compare the comorbidities of IPF in four LA countries, which contributes to the epidemiological data of this disease in the region. The main results were the differences in comorbidities between the countries and more PH in the subjects residing in the cities of higher altitude, a finding that should be validated in future studies.
RESUMO
BACKGROUND: The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. We measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities. METHODS: A cohort of adult patients admitted to the medical services of the Veterans Affairs Medical Center, Louisville, Kentucky, was retrospectively examined. A Kaplan-Meier survival curve was constructed to assess the effect of CAP admission status on patient survival. A Cox proportional hazards regression model included comorbidities as predictors and time to death as the outcome in the construction of a modified Charlson Comorbidity Index (mCCI). The mCCI was internally validated to evaluate the predictability of patient survival. The mCCI and age > 65 years were included as potential confounders in a final Cox proportional hazards regression model with CAP admission status as the main predictor and time to death as the outcome. RESULTS: CAP was identified in 624 (9%) out of 6,971 patients. The Kaplan-Meier survival curve showed a significantly shorter survival among patients with CAP than those without CAP (P < .0001). The internal validation of the mCCI showed that patients were more likely to die as the mCCI increased (P < .0001). The Cox proportional hazards regression modeling the association between time to death and CAP admission after adjusting for elderly age and the mCCI showed that hospitalization due to CAP was a statistically significant predictor of decreased survival (hazard ratio, 1.4; 95% CI, 1.2-1.5; P < .0001). CONCLUSION: There is a decreased long-term survival among hospitalized patients with CAP after adjusting for comorbidities and aging. Future research to understand the pathophysiology of the long-term CAP outcomes is necessary to develop treatment strategies.
