Triagem para fragilidade em pacientes idosos hospitalizados utilizando marcadores inflamatórios na identificação do risco de mortalidade e fatores adversos à saúde.

Abstract

Frailty is characterized as a clinical syndrome and multidimensional nature, which precedes adverse health effects, such as fallings, inability to perform activities of daily life, hospitalizations and death outcomes. In the aging process called "Inflamm-Ageing" that has as markers inflammatory cytokines, among which stand out the C-reactive protein (CRP) and leukocytes by being involved in the embrittlement of the elderly. This paper aimed to determine the prevalence of frailty in hospitalized elderly people; to identify the relative risk of fragile elderly compared to nonfragile ones to adverse health factors (functional decline, fallings, medication use, hospitalizations and mortality) after 30 and 180 days of discharge; to estimate the predictive power and the criterion of discrimination of CRP and leukocytes to the risk of adverse health factors within 30 days after hospital discharge. Observational study, analytical-like type with prospective cohort design using methods of exploratory and blood biomarkers conducted in 135 hospitalized elderly people in medical and surgical clinics of the Hospital de Clinicas, Federal University of Triangulo Mineiro in the period April 2013 to September 2014. Data collection during the hospitalization period was performed by a questionnaire carried out in an individual interview with socioeconomic and demographic information, functional capacity and mental health. Frailty was assessed through changes in plasma concentrations of CRP and/or leukocytes, considering as references 2 mg/dL and 4.000-11.300 mm³, respectively. In the monitoring of elderly patients after 30 and 180 days of discharge, home assessment was conducted addressing the adverse health factors (re-hospitalization, amount of consumed medications, falling occurrences, disability in basic activities (ADL) and instrumental daily living (IADL) and mortality. For the analysis of the data were used descriptive statistics procedures (frequency, mean and standard deviation) and inferential (Chi-square, ROC curve and cross tabulation to estimate the relative risk), considering a value of p<0.05 and confidence interval (CI) of 95%. The prevalence of frailty was 35.6% with a higher proportion among men. Fragile patients presented a higher risk for readmissions, medication consumption > 2, IADL disability and mortality in the 30 days after discharge, functional disability in ADL and IADL after 180 days of discharge. The levels of plasma CRP concentrations > 2.4; ≥ 0.7; > 24.7 mg/dL and WBC ≥ 6.410; ≥ 8.690; > 8.310 mm³ were distinctive for readmission, falls and mortality at 30 days after hospital discharge, respectively. The outcomes of this research provide information that contributes to the formulation of interventional strategies aimed at maintaining the health of the elderly, prevention of adverse factors caused by their embrittlement through strategic and continuous monitoring in the period after hospitalization.