Vulnerabilidade em saúde em indivíduos com doenças pulmonares intersticiais fibrosantes no Distrito Federal

Abstract

INTRODUCTION: Fibrotic interstitial lung diseases (FILD) are generally progressive respiratory disease associated with low quality of life and high mortality rate. Identification of those prone to functional decline and death, also known as vulnerable, is crucial. OBJECTIVES: We investigated the prevalence of health vulnerability in FILD patients and associated factors using the Vulnerable Elders Survey (VES-13). METHODS: Adult FILD patients diagnosed by multidisciplinary discussion, with reticulation and traction bronchiectasis with or without honeycomb in more than 10% of the lungs on high resolution chest tomography were evaluated in a cross-sectional study at the University Hospital of Brasilia, Brazil from May 2021 to June 2022. VES-13 was applied and those with three or more points classified as vulnerable. Sociodemographic and clinical were collected. Respiratory lung function and six-minute walk test were performed. These data were compared between vulnerable and non-vulnerable patients, and then multivariate logistic regression performed to identify associated risk factors. RESULTS: A total of 91 patients were included, 57 (63%) female, median (IQR) age 66 (53-74) years; the main causes were connective tissue diseases 37 (41%), idiopathic pulmonary fibrosis 24 (26%) and hypersensitivity pneumonitis 9 (10%). Vulnerability prevalence was 76% (n = 69), and median VES-13 score was 6 (3-7). Patients younger than 60 years also had high vulnerability prevalence (81%). The multivariate analysis revealed female sex (odds ratio [OR] 9.24, 95% CI 1.52-56.21, p = 0.016) and higher mMRC dyspnea scale (OR 5.15, 95% CI 2.07-12.81, p < 0.001) as vulnerability associated risk factors. CONCLUSION: Vulnerable patients are prevalent in FILD of all ages, and are associated with female sex and more severe dyspnea. This highlights their poor prognosis and suggests a more comprehensive evaluation of health vulnerabilities and interventions for better management