Complicações infecciosas e mortalidade associada nos primeiros 100 dias pós-transplante de medula óssea, no Hospital Araújo Jorge, 2000-2005

• Autor(a) principal: Peleja, Edgar Berquó
• Data de Publicação: 2007
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/8538
• topic: Complicações infecciosas; Transplante; Medula óssea; Infectious complications; Transplantation; Bone marrow; CLINICA MEDICA::DOENCAS INFECCIOSAS E PARASITARIAS

Hematopoietic stem cell transplantation (HSCT) is a therapeutic modality used globally in several neoplastic and non-neoplastic diseases, with increasing progress and considerable progress in the last two decades. However, the important immunosuppression to which transplanted patients are subjected renders them vulnerable to multiple infections that contribute to unfavorable outcomes, including deaths. Objectives: To evaluate the clinicalepidemiological profile, infectious complications and mortality in the first 100 days posttransplantation (D100), in patients attending referral service in Goiás. Methodology: Retrospective cohort of all 143 patients submitted to HSCT, Hospital Araújo Jorge of the Association to Combat Cancer in Goiás, from 2000 to 2005. A structured questionnaire was developed and data extraction was carried out from the patients' medical and hospital records, containing information on: socio-demographic characteristics, type of transplantation, infectious complications and death to D100. Creation of computerized file (Microsoft Excel) and analysis of data using Epi Info and SPSS / PC for win programs. A descriptive analysis was performed for socio-demographic variables and for the main infectious complications. Univariate and multivariate analyzes according to the Cox proportional hazards model were used for factors associated with death and survival curves were constructed, according to Kaplan Meier. Statistical significance was defined as p <0.05. Results: We analyzed the records of 143 patients undergoing HSCT, 73 of which were autologous and 70 were allogeneic. There was a predominance of adults between the ages of 20 and 60 (65.1%), those with neoplastic diseases (84.6%), from Goiás (62.2%) and with treatment funded by the Unified Health System (70, 6%). The sources of cells used were peripheral blood (52.4%) and bone marrow (46.9%). Of the 136 patients, followed up to D100, 76 %% had at least one infectious episode, with predominance of bacterial infections (88.2%). Approximately half of the patients had at least one episode of bacteremia, predominantly Gram-positive. There was a statistically significant association between the presence of infection and having received bone marrow precursor cells or having developed graft disease against the host (p <0.05). Mortality in the first 100 days was 22.8%, being higher among patients submitted to allogeneic transplantation and in those who had pneumonia, even after adjusting for potential confounding variables (p <0.05). Conclusions: It was identified a high frequency of infectious complications, mainly bacterial, up to D100 post-transplantation. A worse prognosis was observed among patients who had pneumonia, suggesting the need for future studies to reduce infectious complications in this population.