RESUMEN
Acute kidney injury is a common complication of cirrhosis, occurring in up to 20% of patients hospitalized with cirrhosis. This field is rapidly changing, with significant advances in classification, biomarkers and therapy over the last few years. On the behalf of the Brazilian Society of Hepatology, a panel of experts in Hepatology and Nephrology reviewed published evidence to integrate findings and develop the recommendations presented in this manuscript.
Asunto(s)
Lesión Renal Aguda/terapia , Síndrome Hepatorrenal/terapia , Cirrosis Hepática/complicaciones , Lesión Renal Aguda/diagnóstico , Brasil , Creatinina/sangre , Manejo de la Enfermedad , Síndrome Hepatorrenal/diagnóstico , HumanosRESUMEN
BACKGROUND: This study aimed to identify predictors of early (7-day) mortality in patients with septic acute kidney injury (AKI) who required continuous renal replacement therapy (CRRT). METHODS: Prospective cohort of 186 septic AKI patients undergoing CRRT at a tertiary hospital, from October 2005 to November 2010. RESULTS: After multivariate adjustment, five variables were associated to early mortality: norepinephrine utilization, liver failure, medical condition, lactate level, and pre-dialysis creatinine level. These variables were combined in a score, which demonstrated good discrimination, with a C-statistic of 0.82 (95% CI = 0.76-0.88), and good calibration (χ 2 = 4.3; p = 0.83). SAPS 3, APACHE II and SOFA scores demonstrated poor performance in this population. CONCLUSIONS: The HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) score outperformed tested generic models. Future studies should further validate this score in different cohorts.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Sepsis/diagnóstico , Sepsis/mortalidad , Índice de Severidad de la Enfermedad , Lesión Renal Aguda/complicaciones , Anciano , Femenino , Humanos , Masculino , Estudios Prospectivos , Terapia de Reemplazo Renal , Factores de Riesgo , Sepsis/complicacionesRESUMEN
The aim of the study was to assess the clinical utility of lactate measured at different time points to predict mortality at 48 hours and 28 days in septic patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).Consecutive critically ill patients with septic AKI requiring CRRT were prospectively studied. Variables were collected at initiation of CRRT and 24âhours later.In total, 186 patients were analyzed. Overall mortality at 48âhours was 28% and at 28 days was 69%. Initial lactate, lactate at 24âhours and the proportion of patients with a lactate clearance superior to 10% were different between survivors at 28 days [2.0 mmol/L, 1.95 mmol/L and 18/45 (40%)] and nonsurvivors [3.46 mmol, 4.66 mmol, and 18/94 (19%)]. Multivariate analysis demonstrated that lactate at 24âhours and lactate clearance, but not initial lactate, were independently associated to mortality. Area under the ROC curves for 28-day mortality was 0.635 for initial lactate; 0.828 for lactate at 24âhours and 0.701 for lactate clearance.Lactate clearance and lactate after 24âhours of CRRT, but not initial lactate, were independently associated with mortality in septic AKI patients undergoing CRRT. Serial lactate measurements may be useful prognostic markers than initial lactate in these patients.
Asunto(s)
Lesión Renal Aguda/terapia , Enfermedad Crítica , Ácido Láctico/metabolismo , Terapia de Reemplazo Renal/métodos , Sepsis/metabolismo , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/mortalidad , Anciano , Biomarcadores/metabolismo , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Curva ROC , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/mortalidad , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
A coleta de dados foi feita no período de 20 a 23 setembro de 1995. Foram aplicados 497 formulários, preenchidos pelos próprios professores. Classificaram-se as escolas: pequena (10 a 20 profs.), média (21 a 49 profs.), e grande (50 ou mais profs.). As principais queixas com relação às condições de trabalho foram: presença de poeira (pó de giz), ritmo acelerado de trabalho, esforço físico e ambiente intraquilo e estressante. Referentes à situação de saúde foram: cansaço mental, dor de garganta, dor nas costas e dor nas pernas. Mais da metade dos professores (51,4 por cento) apresentava distúrbios psíquicos menores (DPM), investigados através do SRQ-20 ("self-report questionnaire"). A experiência adquirida por meio desse estudo permitirá um aperfeiçoamento do seu método, de modo a evitar distorções de seleção e de aferição em estudos subseqüentes.