Mortality in adolescents and young adults with chronic diseases during 16 years: a study in a Latin American tertiary hospital

Author(s):Show less -

Gabriel F. Ramos ^[1] ; Vanessa P. Ribeiro ^[2] ; Mariana P. Mercadante ^[3] ; Maira P. Ribeiro ^[4] ; Artur F. Delgado ^[5] ; Sylvia C.L. Farhat ^[6] ; Marta M. Leal ^[7] ; Heloisa H. Marques ^[8] ; Vicente Odone-Filho ^[9] ; Uenis Tannuri ^[10] ; Werther B. Carvalho ^[11] ; Sandra J. Grisi ^[12] ; Magda Carneiro-Sampaio ^[13] ; Clovis A. Silva ^[14]

Affiliation:Show less -

^[1] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[2] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[3] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[4] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[5] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[6] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[7] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[8] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[9] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[10] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[11] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[12] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[13] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[14] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

• Document type: Journal article
• Source: Jornal de Pediatria; v. 95, n. 6, p. 667-673, 2019-11-25.

Abstract

ABSTRACT Objectives: To evaluate mortality in adolescents and young adult patients with chronic diseases followed in a Latin American tertiary hospital. Methods: A cross-sectional retrospective study was performed in a tertiary/academic hospital in the state of São Paulo, Brazil. Death occurred in 529/2850 (18.5%) adolescents and young adult patients with chronic diseases, and 25/529 (4.7%) were excluded due to incomplete medical charts. Therefore, 504 deaths were evaluated. Results: Deaths occurred in 316/504 (63%) of early adolescent patients and in 188/504 (37%) of late adolescent/young adult patients. Further comparisons between early adolescents (n = 316) and late adolescent/young adult patients (n = 188) with pediatric chronic diseases at the last hospitalization showed that the median disease duration (22.0 [0-173] vs. 43.0 [0-227] months, p < 0.001) was significantly lower in early adolescents vs. late adolescent/young adult patients. The median number of previous hospitalizations was significantly lower in the former group (4.0 [1-45] vs. 6.0 [1-52], p < 0.001), whereas the last hospitalization in intensive care unit was significantly higher (60% vs. 47%, p = 0.003). Regarding supportive measures, palliative care was significantly lower in the younger group compared to the older group (33% vs. 43%, p = 0.02). The frequencies of renal replacement therapy (22% vs. 13%, p = 0.02), vasoactive agents (65% vs. 54%, p = 0.01), and transfusion of blood products (75% vs. 66%, p = 0.03) were significantly higher in the younger group. The five most important etiologies of pediatric chronic diseases were: neoplasias (54.2%), hepatic diseases/transplantation (10%), human immunodeficiency virus (5.9%), and childhood-onset systemic lupus erythematosus and juvenile idiopathic arthritis (4.9%). Autopsy was performed in 58/504 (11%), and discordance between clinical and postmortem diagnoses was evidenced in 24/58 (41.3%). Conclusions: Almost 20% of deaths occurred in adolescents and young adults with distinct supportive care and severe disease patterns. Discordance between clinical diagnosis and autopsy was frequently observed. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants