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

Authors
  • Ramos, Gabriel F1
  • Ribeiro, Vanessa P1
  • Mercadante, Mariana P1
  • Ribeiro, Maira P1
  • Delgado, Artur F1
  • Farhat, Sylvia C L2
  • Leal, Marta M2
  • Marques, Heloisa H2
  • Odone-Filho, Vicente2
  • Tannuri, Uenis2
  • Carvalho, Werther B2
  • Grisi, Sandra J2
  • Carneiro-Sampaio, Magda2
  • Silva, Clovis A3
  • 1 Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Departamento de Pediatria, São Paulo, SP, Brazil. , (Brazil)
  • 2 Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Instituto da Criança, São Paulo, SP, Brazil. , (Brazil)
  • 3 Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Instituto da Criança, São Paulo, SP, Brazil. Electronic address: [email protected] , (Brazil)
Type
Published Article
Journal
Jornal de pediatria
Publication Date
Jul 19, 2018
Identifiers
DOI: 10.1016/j.jped.2018.06.006
PMID: 30030985
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To evaluate mortality in adolescents and young adult patients with chronic diseases followed in a Latin American tertiary hospital. 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. 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%). 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. Copyright © 2018. Published by Elsevier Editora Ltda.

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