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Gilda Aparecida Ferreirahttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4701209P6&tokenCaptchar=03AOLTBLRwePYiCh_9JeqPTHurA8DsM99Bdxo9KGBF1npyFfnd15OlrEz9gk6vSu9bCHgwPP89-WPr6fmKp2NO9jwKAn68HoCHmgqBHurdRUWozSoqfjiCorGT9vdKv6uBsPnCo84OZP2D9rmZvcXVnYzHAP76S35_ek0Arjps887whO9q0UOBtzjta1tUTu1jhkFEXh0C66d5y6zYkrrcqwbYam0FdyXtRRIvx0s98BqbPMCmG7-CEuLMhamLqXanAVtA3Fvs-m204hpiY86Z2lacg-5oZQWWjhRN8V51euRKoBkSSXGo4_XVmEqhpdLuI5uc1qxOBDZD9VAAAFkiJ1c-4Ug0OcN6EOPpD-qmO4VYKTPNutLyfcTxjaQ1dtNVddnaz8lMtxgJKiyKAlaxnqy82zf1OOc0m7_w3go5T77zhy-TKB0Exm1OtX8cztZSyVl0jVjvxcW965zUFOEYvgUzVUFxvHUscbCwK3dLxZsaek5v_6BJzpRiYFM-9Ly8c87WcWPl-vmnvwBoC550NNJaJtMUfOPqsobv4RhZfiPQBP7kRERXuAnRhL2cgPdJZaRjJlSTl5Q4Maria das Graças Carvalhohttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4787950T5&tokenCaptchar=03AOLTBLRvpGb3X59iMK7vGVh4nE41UpO4gsbWmkOX2UrsM-ZeXVUvnogtQugDHk-08M0DzpaHI-u7QUAOOnDBdJ7HFNzq_41N_mPwoytJGZC1_omRKpvffK10oYU-btDYd16kycRyK4h89VFKPX50pvMcOhPsImkJc7suVW_ZrxY8cZ_U0anHLcUD5LYl0B9mwhkYXgHiSiDqN7gJV4ylZbURoIgkM6jFULIkQNLenvDVJAob5xiQw_ifNlqhDkGIZoTMtp1rF0o7k3CejwSp1K4PqCMEUqQ4Xt37mA1uy0pR4X_iN1VaR6B1uByc0A3sTjDWlofRwLt3t4mpO6d4m8zWhrzd5cHTHEJDKeY2_eVWdH7mSqd_LwK0V1whMiHst5geI0zBjiheMOnO9SgViu4jyj_VqDU2v8s6Un6H-Zn_HX3IkYFzAUlGoArnLzryIvGcBeJjlcgjIHRqc4fDSxbHChMvj9Lblvf7FnMEX5O_8inAlB3JkVGZwCY19VO03bnU9WJUBQDeLJ0oEWE8tEIHM6Yy0LCEe5mb0yxy1mBxh1xb0f2L0FK9nYW4pQM7QZNBb4Sn2F43http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4480879J5&tokenCaptchar=03AOLTBLQorlFi6kDSyodDyigj5JzCWQPkK-VDiNcTPoOuW5fZI1B1I94vq_hCR5uTsYoFsiqin38bOqBpjSfM0AfkxfN770la5x5cErGDU0se4kFik_eKRUYTcRaMRIecvrzQJ4K3IwtafcMtIO9pBiRaq7XcEviJrNAe5dTx9aDIsY-gYBlS8NsLw_BqyeJ79i-51wcMhdhXJIFiduomWxy9yz2vPd-h4v6wWz_WYvKF1o3YwCFBTZJuIH3M-dscFyS9u1qPE4iKGv_U8YI5r3_hbykhyaCFaz0n_T_ISkZvGFtIu6TMojNqybv4GQcaGQGmZyzNIX422HPSVg3DoUWiVsYtDBRivmAxWrmcXVg2DzfTRuvAYFKwNnvBBeyZ9hrM2syPNXQTlPzbpNJD41-lpzQLGSCj4JPUIhIxsdIlPLMpeh0hMUG_Su3HAyYgJDTpJ77H-_AHwtOtThHceXUzg6_ZxOId2BrCFkHSYEY29E1v-ezZP9kfBCfeR_Cpt9SqfxMsbTioXYDt_ToxRJuz3NI6JSZseDEGdV11XMinn2c_h1U35QCMl4LPMe025D34n7ArEm7hJoana Starling de Carvalho2020-02-12T12:29:23Z2020-02-12T12:29:23Z2019-07-10http://hdl.handle.net/1843/32459Introdução: O Lúpus Eritematoso Sistêmico (LES) é uma doença com alta morbimortalidade. Cerca de 25% dos óbitos nessa população são secundários a complicações infecciosas. A identificação de infecção em pacientes com LES é um grande desafio na prática clínica por apresentar manifestações clínicas que se confundem com a própria doença em atividade. Os marcadores como proteína C reativa (PCR) e procalcitonina apresentaram limitações para diferenciar infecção de atividade da doença nesses pacientes. As razões neutrófilo-linfócito (RNL) e plaquetalinfócito (RPL) mostraram resultados promissores para avaliação de atividade nos pacientes com LES, mas ainda foram pouco explorados com a finalidade de diferenciar infecção de atividade da doença. O objetivo do presente estudo foi avaliar marcadores clínicos e o desempenho do PCR, RNL e RPL no diagnóstico de infecção em um grupo de pacientes brasileiros com LES admitidos em um Hospital Terciário. Metodologia: Cento e quatro internações de pacientes com LES foram avaliadas de forma retrospectiva e distribuídas em três grupos: infectados (26), infectados e com atividade da doença (41) e com atividade de doença sem infecção (37). Os grupos foram comparados em relação a variáveis clínicas e laboratoriais. A atividade de doença foi mensurada pelo escore SLEDAI-2K modificado. Resultados: Os grupos apresentaram diferença em relação à presença de febre, hipotensão e taquipneia, alterações observadas mais frequentemente nos pacientes infectados. Proteína C reativa (PCR), RNL e RPL também diferiram entre os grupos com valores mais altos sendo observados no grupo infectado, intermediários no grupo misto e inferiores no grupo com atividade isolada - PCR [56 (12 - 133) mg/dL vs 26 (3 - 59) mg/dL vs 15 (25 - 38) mg/dL, p = 0,002], RNL [7,9 (4,3 - 19,9) vs 4,0 (1,9 - 8,5) vs 3,1 (2,1 - 4,9), p = 0,005], RPL [270 (146 - 326) vs 227 (138 - 520) vs 134 (104 - 250), p = 0,025]. O valor do PCR de 20 mg/dl apresentou sensibilidade (S) de 67%, especificidade (E) de 67%, valor preditivo positivo (VPP) de 78% e valor preditivo negativo (VPN) de 53% para o diagnóstico de infecção, considerando a prevalência de infecção na amostra de 64%. A RNL e RPL apresentaram as seguintes medidas de acurácia para os pontos de coorte de 3,5 (S 65%, E 58%, VPP 73%, VPN 48%) e 151,4 (S 71%, E 53%, VPP 73% e VPN de 51%), respectivamente. Febre, taquipneia, leucócito total e RPL foram associados de forma independente com infecção. O uso combinado de variáveis clínicas e laboratoriais apresentou acurácia superior ao uso isolado para diagnóstico de infecção em pacientes com LES. Conclusão: As razões estudadas, RNL e RPL, apresentaram desempenho inferior a PCR para o diagnóstico de infecção nos pacientes com LES. Porém, o uso combinado pelo fluxograma proposto, possui potencial para uso futuro na prática clínica, principalmente se considerarmos a acurácia satisfatória do método e o seu baixo custo e acessibilidade.Introduction: Systemic lupus erythematosus (SLE) is a disease with high morbidity and mortality. About 25% of deaths in this population are secondary to infectious complications. The identification of infection in SLE patients is a major challenge in clinical practice because it presents clinical manifestations that are confused with active disease. Markers such as C-reactive protein (CRP) and procalcitonin showed limitations in differentiating infection from disease activity in these patients. The neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios showed promising results for evaluation of disease activity, but they were still poorly explored in order to differentiate infection from disease activity. The objective of the present study was to evaluate clinical markers and the performance of CRP, NLR and PLR in the diagnosis of infection in a group of Brazilian patients with SLE admitted in a Tertiary Hospital. Methods: One hundred and four hospitalizations of SLE patients were retrospectively evaluated and allocated into three groups: infected (26), infected and disease activity (41), disease activity without infection (37). They were compared in relation to clinical and laboratory variables. The disease activity was measured by the modified SLEDAI2K score. Results: The frequency of fever, hypotension and tachypnea was higher in infected patients. CRP, NLR and PLR also differed among the groups with higher values observed in the infected group, intermediary in the mixed group and lower in the group with isolated activity - CRP [56 (12 - 133) mg / dL vs 26 (3 - 59) mg / dL vs 15 (25-38) mg / dL, p = 0.002], NLR [7.9 (4.3 - 19.9) vs. 4.0 (1.9 - 8.5 ) vs. 3.1 (2.14.9), p = 0.005], PLR [270 (146-616) vs. 227 (138-520) vs. 134 (104-250), p = 0.025]. The CRP value of 20 mg / dl showed a 67% sensitivity, 67% specificity (E), positive predictive value (PPV) of 78% and negative predictive value (NPV) of 53% for diagnosis of infection, considering 64% the prevalence of infection in the sample. The NLR and PLR presented the following measures of accuracy for the cohort points of 3.5 (S 65%, E 58%, PPV 73%, NPV 48%) and 151.4% (S 71%, E 53%, PPV 73% and NPV 51%), respectively. Fever, tachypnea, total leukocyte and PLR were independently associated with infection. The combined use of clinical and laboratory variables showed superior accuracy to the isolated use for diagnosis of infection in SLE patients. Conclusion: NLR and PLR presented inferior performance than CRP for the diagnosis of infection in patients with SLE. However, the combined use of the proposed flowchart has potential for future use in clinical practice, especially considering the satisfactory accuracy of the method and its low cost and accessibility.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMEDICINA - FACULDADE DE MEDICINALúpus Eritematoso SistêmicoInfecçãoNeutrófilosLinfócitosPlaquetasProteína C-ReativaLupus eritematoso sistemicoInfecçãoRazão neutrófilo-linfócitoRazão plaqueta-linfócitoProteína c reativaAtividade de doençaLúpus Eritematoso Sistêmico na Atenção Hospitalar Terciária: avaliação de fatores clínicos e laboratoriais associados à infecçãoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALJSCarvalho_dissertacao_15-7-19.pdfJSCarvalho_dissertacao_15-7-19.pdfapplication/pdf1522793https://repositorio.ufmg.br/bitstream/1843/32459/1/JSCarvalho_dissertacao_15-7-19.pdf7635d594ce2abcc519766b1c9020c3c5MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/32459/2/license.txt34badce4be7e31e3adb4575ae96af679MD52TEXTJSCarvalho_dissertacao_15-7-19.pdf.txtJSCarvalho_dissertacao_15-7-19.pdf.txtExtracted texttext/plain147210https://repositorio.ufmg.br/bitstream/1843/32459/3/JSCarvalho_dissertacao_15-7-19.pdf.txt7a974db4cc9820f93a3af69d6fac10beMD531843/324592020-02-13 03:24:40.123oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2020-02-13T06:24:40Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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