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Experiencia de una consulta multidisciplinar de enfermedad pulmonar intersticial

Authors: Pedraja Ferreira, Lucía;

Experiencia de una consulta multidisciplinar de enfermedad pulmonar intersticial

Abstract

RESUMEN : Introducción: La evaluación multidisciplinar es actualmente la herramienta estándar para el diagnóstico, clasificación, seguimiento y tratamiento de los pacientes con enfermedad pulmonar intersticial difusa (EPID). Está constituida principalmente por neumólogos especializados en EPID, radiólogos torácicos y anatomopatólogos especializados en patología pulmonar, pudiendo incorporar otros especialistas como reumatólogos o cirujanos torácicos. Considerando sus beneficios, se recomienda la derivación de estos pacientes a un hospital de referencia que disponga de un equipo multidisciplinar. Objetivos: Describir las características y funcionamiento global de una unidad de EPID. Como objetivos secundarios, realizar sobre los pacientes de la unidad con neumonitis por hipersensibilidad crónica una descripción de su situación clínica en su primera consulta en la unidad y del tiempo transcurrido entre el inicio de los síntomas y dicha consulta; valorar la presencia de marcadores de mal pronóstico de evolución clínica; y hacer un análisis de su supervivencia, comparándolos con el resto de los pacientes con EPID, con los de Fibrosis Pulmonar Idiopática (FPI) y con los de EPID secundaria a conectivopatía. Material y métodos: Se realizó una descripción de las características de la unidad de EPID del Hospital Universitario Marqués de Valdecilla (HUMV) entre 2017 y 2021, y un estudio observacional retrospectivo que incluyó a los pacientes de la unidad con diagnóstico de neumonitis por hipersensibilidad crónica (n=51). Se comparó con el resto de la serie de la unidad de EPID (n=454) a efectos de supervivencia. Resultados: Entre 2017 y 2021 se atendieron en la unidad de EPID del HUMV a 704 pacientes, de los que 603 residían en Cantabria y 101 en otras Comunidades Autónomas, y se efectuaron un total de 4305 consultas. Se incluyeron 51 pacientes con diagnóstico de neumonitis por hipersensibilidad crónica, de los que 33 eran trasplantados (64,7%) y 18 no trasplantados (35,3%). No se encontraron diferencias en la supervivencia de los pacientes con neumonitis por hipersensibilidad crónica con respecto al resto de los pacientes con EPID ni a los pacientes con FPI. Se observaron diferencias en la supervivencia de los pacientes con neumonitis por hipersensibilidad y los pacientes con EPID secundaria a conectivopatía. Conclusiones: Las patologías más frecuentes de la unidad de EPID del HUMV fueron la FPI, la EPID secundaria a conectivopatía, la EPID inclasificable y la neumonitis por hipersensibilidad crónica, y casi un tercio de los pacientes atendidos pertenecieron a un Área de Salud diferente a Santander. Los pacientes con EPID secundaria a conectivopatía presentaron mayor supervivencia.

ABSTRACT : Background: Multidisciplinary team discussion is currently the standard reference used to diagnose, classify, treat, and follow up patients with interstitial lung disease (ILD). It is primarily composed by pneumologists specialized in ILD, thoracic radiologists and pathologists specialized in lung pathology, although it is possible to include other specialists such as rheumatologists or thoracic surgeons. Given its benefits, it is recommended to refer patients to a reference hospital with an ILD center. Purpose: To describe the features and global performance of an ILD unit. As secondary aims, to describe the time passed between the onset of symptoms and the first consultation, the clinical status of patients in the first consultation and the presence of poor-prognosis clinical markers in patients diagnosed with chronic hypersensitivity pneumonitis, as well as to perform a survival analysis comparing them with the rest of the patients in the ILD unit, with those diagnosed with idiopathic pulmonary fibrosis (IPF) and with those diagnosed with ILD associated with autoimmune diseases (AD-ILD). Methods: The description of the ILD unit in Hospital Universitario Marqués de Valdecilla (HUMV) was performed with data corresponding to years 2017 to 2021. An observational retrospective study was performed on patients diagnosed with chronic hypersensitivity pneumonitis (n=51). Those patients were compared to the rest of the series of patients in the ILD unit (n=454) for the survival analysis. Results: From 2017 to 2021, 704 patients were seen in HUMV’s ILD unit, out of which 603 lived in Cantabria and 101 in other Autonomous Communities; also, 4305 consultations were performed. A total of 51 patients with chronic hypersensitivity pneumonitis were included, out of which 33 had undergone lung transplantation (64,7%) and 18 had not (35,3%). No differences were found in survival of patients with chronic hypersensitivity pneumonitis compared to the rest of the series, nor to those diagnosed with IPF. Differences were found in survival of patients with chronic hypersensitivity pneumonitis compared to those with AD-ILD. Conclusions: The most common pathologies presented by patients in HUMV’s ILD unit were IPF, AD-ILD, unclassifiable ILD and chronic hypersensitivity pneumonitis, and almost a third of the patients in the series lived outside Santander Health Area. Patients with AD-ILD showed better results in survival.

Grado en Medicina

Keywords

Trasplante pulmonar, Supervivencia, Multidisciplinary, Lung transplantation, Survival, Multidisciplinar, Neumonitis por hipersensibilidad crónica, Interstitial lung disease, Chronic hypersensitivity pneumonitis, Enfermedad pulmonar intersticial difusa

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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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