RESUMEN
INTRODUCTION AND OBJECTIVES: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. MATERIALS AND METHODS: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver-kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998-2002, nâ¯=â¯488), era-2 (2003-2007, nâ¯=â¯889), era-3 (2008-2012, nâ¯=â¯703) and era-4 (2013-2018, nâ¯=â¯791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5â¯mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. RESULTS: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (Pâ¯<â¯0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (Pâ¯<â¯0.005) but not in era-3 or era-4 (Pâ¯=â¯0.13 and Pâ¯=â¯0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60â¯mL/min/1.73â¯m2 at LT to define renal dysfunction showed similar results. CONCLUSIONS: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era.
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Hepatopatías/complicaciones , Hepatopatías/mortalidad , Trasplante de Hígado , Insuficiencia Renal/complicaciones , Anciano , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Estimación de Kaplan-Meier , Hepatopatías/cirugía , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Diálisis Renal , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Factores de TiempoRESUMEN
RESUMEN Introducción: En el Hospital General Docente "Dr. Agostinho Neto", de Guantánamo, no se ha caracterizado la problemática del daño renal agudo en la unidad de terapia intensiva. Objetivo: caracterizar esta afección en pacientes ingresados en la citada unidad en el periodo 2018-2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, aprobado por el comité de ética. El universo de estudio se constituyó por el total de pacientes con este diagnóstico según la clasificación Acute Kidney Injury Network (AKIN). Se estudiaron las características de los pacientes (edad, sexo, comorbilidad, etiología, estadía en la unidad de terapia intensiva, necesidad de hemodiálisis, estado al egreso) y del daño renal agudo (estadio según los criterios de la escala AKIN). Resultados: En el 35,6 % de los pacientes se diagnosticó esta enfermedad, sobre todo en hombres (56,7 %) y con edad de 66,3 ± 24,3 años. El 41,4 % padeció hipertensión arterial sistémica. En el 48,9 % la enfermedad se presentó un en estadio 1, y en el 69,4 % la sepsis fue la principal causa. La mortalidad al egreso hospitalario fue de 16,4 %, y a los 30 días fue de 25,4 %. Se realizó hemodiálisis al 13,8 % de los pacientes, en los que el riesgo de muerte fue superior. Conclusiones: En la unidad de terapia intensiva es elevada la proporción de pacientes con daño renal agudo y resulta útil la escala que se utilizó para el diagnóstico y la evaluación de la gravedad y el pronóstico de los pacientes afectados.
ABSTRACT Introduction: Acute kidney injury in the intensive care unit in the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo has not been characterized. Objective: To characterize this disease in patients in the intensive care unit in the mentioned institution in the period 2018-2019. Method: A descriptive, retrospective and longitudinal study was undertaken, all approved by the ethics committee. The study population was made out of the total amount of the patients diagnosed according to the classification of the Acute Kidney Injury Network (AKIN). The variables taken into account were: age, gender, comorbidity, etiology, time in the intensive care unit, requirement for hemodialysis and status of the patient at the time of discharge, plus the stages of the acute kidney injury according to the AKIN scale. Results: Acute kidney injury was diagnosed in the 35.6% of the patients, especially in male patients (56.7%) with ages between 66.3 ± 24.3 years. 41.4% of the patients suffered of systemic arterial hypertension. Stage 1 was found in the 48.9% of the cases, and sepsis was the main cause in 69.4%. Mortality at the time of discharge represented the 16.4%; and after the following 30 days went up to 25.4%. Hemodialysis was required in the 13.8% of the patients; in wich the risk of death was significatively higher. Conclusions: There is a high number of patients with acute kidney injury in the intensive care unit, and it was really useful the scale implemented for diagnosis and evaluation of the severity of the condition and the prognosis of the patients.
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Humanos , Morbilidad , Insuficiencia Renal/mortalidad , Enfermedad Aguda , Epidemiología Descriptiva , Estudios Retrospectivos , Estudios Longitudinales , Unidades de Cuidados IntensivosRESUMEN
INTRODUCTION: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. OBJECTIVE: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. METHOD: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. RESULTS: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). CONCLUSIONS: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.
INTRODUCCIÓN: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. OBJETIVO: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. MÉTODO: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. RESULTADOS: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). CONCLUSIONES: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.
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Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/epidemiología , Insuficiencia Renal/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Enfermedad Crónica , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Obesidad/epidemiología , Osteoartritis/epidemiología , Sobrepeso/epidemiología , Prevalencia , Insuficiencia Renal/etiología , Insuficiencia Renal/mortalidad , Factores Sexuales , Fumar/epidemiología , Adulto JovenRESUMEN
Resumen Introducción: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. Objetivo: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. Método: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. Resultados: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). Conclusiones: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.
Abstract Introduction: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. Objective: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. Method: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. Results: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). Conclusions: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Diabetes Mellitus Tipo 2/epidemiología , Insuficiencia Renal/epidemiología , Hipertensión/epidemiología , Osteoartritis/epidemiología , Fumar/epidemiología , Índice de Masa Corporal , Factores Sexuales , Enfermedad Crónica , Prevalencia , Estudios Transversales , Análisis Multivariante , Factores de Edad , Insuficiencia Renal/etiología , Insuficiencia Renal/mortalidad , Dislipidemias/epidemiología , Sobrepeso/epidemiología , México/epidemiología , Obesidad/epidemiologíaRESUMEN
BACKGROUND: The objective of the study is to report our experience with conventional surgery for juxtarenal abdominal aortic aneurysms (JRAs) by evaluating incidence of acute renal failure and perioperative mortality. Secondary objectives are to evaluate general morbidity and the need for permanent postoperative dialysis and to assess the influence on long-term survival of preoperative risk factors and deterioration of perioperative renal function. METHODS: A retrospective cohort study of 110 patients with JRA electively treated by open surgery between March 1992 and March 2018 was made. Data were obtained from clinical records, describing demographics, perioperative variables, and results. Acute kidney injury (AKI) was defined as 50% decrease in glomerular filtration rate or two-fold increase in serum creatinine. Multivariate analysis was performed by logistic regression to establish risk factors for renal failure. The influence of preoperative risk factors and deterioration of perioperative renal function on long-term survival was studied using Cox regression model. Descriptive and inferential statistics were used in the analysis. RESULTS: 110 consecutive patients were treated with an average age of 71 years, 82.7% male; 81% hypertensive and 41% active smokers. 46.3% had stage III or higher preoperative chronic kidney disease. Median diameter of the aneurysm was 5.7 cm. Interruption of bilateral renal flow was required in 73 patients (66.4%) and unilateral in 37 (33.6%). The average renal clamping time was 34.5 min. AKI occurred in 9 patients (8.2%). Two patients (1.8%) required postoperative dialysis, one of them permanent. Median hospital stay was 7 days. Thirty-three patients (30%) had at least one complication. Postoperative mortality was 2.7% (3 patients), two of them developed AKI. Multivariate analysis established a longer operative time and need for renal revascularization as independent risk factors for AKI. In the survival analysis, age, cerebrovascular disease, chronic obstructive pulmonary disease, and perioperative AKI were identified as risk factors for long-term mortality. CONCLUSIONS: JRA open surgical repair can be performed with low morbidity and mortality. Although transient acute renal dysfunction may be relatively frequent, the need for hemodialysis is low. Our study is a reference point to compare with endovascular repair.
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Lesión Renal Aguda/etiología , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Insuficiencia Renal/etiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/mortalidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Diálisis Renal , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/mortalidad , Insuficiencia Renal/terapia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract Introduction: Renal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor. Objective: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients. Methods: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII: 1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6 mg/dL). Seven risk factors were then evaluated in each stratum. Results: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115 minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups. Conclusion: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Puente de Arteria Coronaria/mortalidad , Creatinina/sangre , Periodo Preoperatorio , Pronóstico , Valores de Referencia , Factores de Tiempo , Brasil , Modelos Logísticos , Estudios Retrospectivos , Factores de Riesgo , Medición de Riesgo , Insuficiencia Renal/mortalidad , Insuficiencia Renal/sangre , Tiempo de InternaciónRESUMEN
INTRODUCTION: Renal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor. OBJECTIVE: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients. METHODS: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII: 1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6 mg/dL). Seven risk factors were then evaluated in each stratum. RESULTS: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115 minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups. CONCLUSION: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.
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Puente de Arteria Coronaria/mortalidad , Creatinina/sangre , Periodo Preoperatorio , Anciano , Brasil , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Valores de Referencia , Insuficiencia Renal/sangre , Insuficiencia Renal/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
Objetivo: descrever a epidemiologia da morbimortalidade e custos públicos pela insuficiência renal entre 2012-2017. Método: trata-se de estudo quantitativo, ecológico e descritivo, com dados do Sistema de Informações Hospitalares. Selecionou-se as cinco regiões brasileiras como população de estudo e coletou-se as variáveis sexo, faixa etária, raça/cor, valores dos serviços hospitalares, internações, óbitos e taxa de mortalidade. Analisou-se os dados por meio de estatística descritiva simples (frequências absolutas e relativas) e apresentou-se em forma de tabelas construídas por meio do software Excel. Resultados: registrou-se 507.830 internações por insuficiência renal. Evidenciou-se maior prevalência no Sudeste (45,48%), no sexo masculino (56,47%), entre 60 a 64 anos (11,10%) e autodeclarados brancos (36,81%). Notificou-se, também 64.977 óbitos e mortalidade de 12,8%, com maior taxa na região norte (13,91%). Houve impacto financeiro superior a 1,4 bilhões de reais. Conclusão: conclui-se, que a insuficiência renal aflige em maior prevalência homens idosos e brancos quando o desfecho final é o óbito, implicando em mudanças na dinâmica e orçamento familiar, incremento de custos aos sistemas de saúde e redução da qualidade de vida.(AU)
Objective: to describe the epidemiology of morbidity-mortality and public costs of kidney failure between 2012-2017. Method: this is a quantitative, ecological and descriptive study, with data from the Hospital Information System. All five Brazilian regions were selected as study population, with the collection of gender, age and race/color variables, values of hospital services, hospitalizations, deaths and mortality rate. Data were analyzed by means of descriptive statistics (absolute and relative frequencies) and presented in the form of tables constructed through Excel software. Results: there were 507.830 hospitalizations due to kidney failure. The highest values were in the Southeast (45.48%), males (56.47%), aged 60 through 64 years (11.10%) and self-reported whites (36.81%). Furthermore, there were 64,977 deaths and mortality rate of 12.8%, with the highest rates in the northern region (13.91%). There was a financial impact exceeding R$ 1.4 billion. Conclusion: kidney failure affects, in greater prevalence, elderly and white men when the outcome is death, resulting in changes in the family dynamics and budget, increased costs to health systems and reduced quality of life.(AU)
Objetivo: describir la epidemiología de la morbimortalidad y costes públicos por insuficiencia renal entre 2012-2017. Método: se trata de un estudio cuantitativo, ecológico y descriptivo, con datos del Sistema de Información Hospitalaria. Fueron seleccionadas las cinco regiones brasileñas como población de estudio y recogidas las variables sexo, edad, raza/color, valores de los servicios hospitalarios, hospitalizaciones, muertes y tasa de mortalidad. Los datos fueron analizados mediante estadística descriptiva (frecuencias absolutas y relativas) y se presentan en forma de tablas construidas mediante software Excel. Resultados: se registraron 507,830 hospitalizaciones por insuficiencia renal. Mayor prevalencia en el sureste (45.48%), el sexo masculino (56.47%), entre 60 y 64 años (11,10%) y auto-declarados blancos (36.81%). También se notificaron 64,977 muertes y tasas de mortalidad del 12,8%, con tasas más altas en la región norte (13.91%). Hubo un impacto superior a los 1.400 millones de reales. Conclusión: Se concluye que la insuficiencia renal aflige, en la mayor prevalencia, hombres ancianos y blanco cuando el resultado final es la muerte, resultando en cambios en la dinámica y el presupuesto familiar, aumento de costes para los sistemas de salud y la reducción de la calidad de vida.(AU)
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Brasil , Salud Pública , Insuficiencia Renal , Insuficiencia Renal/mortalidad , Insuficiencia Renal/epidemiología , Insuficiencia Renal Crónica , Gasto Público en Salud , Epidemiología Descriptiva , Estudios Ecológicos , Sistemas de Información en SaludRESUMEN
INTRODUCTION: Berardinelli-Seip Congenital Lipodystrophy (BSCL) is a rare autosomal recessive disease that affects the development of adipocytes and leads to an inability to store fat in adipocytes. This study aimed to evaluate the life expectancy and the causes of death of patients with BSCL. METHOD: We analyzed death certificates, and medical records of BSCL patients who died between 1997 and 2017. If the death certificate was incomplete or unavailable, we reviewed the medical records, and if they were not available too, we collected information from the patient's relatives to understand how the death happened. We calculated the potential years of life lost as a result of premature death. RESULTS: Twenty patients (12 female and 8 male) died between 1997 and 2017. The mean age at the time of death was 27.1±12.4 years (women 25.2±12.5 vs. men 29.9±12.6 years, p = 0.41). Life expectancy for the study population was 62.9±4.8 years. The potential number of years of life lost was 35.6±16.6 years. The causes of deaths were divided into three major groups: infections (7 patients, 35%), liver disease (7 patients, 35%), and other causes (acute pancreatitis, one patient; renal failure, three patients; sudden death/myocardial infarction, two patients). Three patients had pulmonary fibrosis. CONCLUSION: BSCL led to premature death, cutting the patients' lifespan by 30 or more years. The majority of these young patients died of liver disease or infection. Other studies are needed to understand better the mechanisms that predispose to infections, as well as to assess whether new therapies can alter the natural history of this disease.
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Causas de Muerte , Esperanza de Vida , Lipodistrofia Generalizada Congénita/mortalidad , Enfermedades Raras/mortalidad , Adolescente , Adulto , Femenino , Humanos , Infecciones/mortalidad , Lipodistrofia Generalizada Congénita/complicaciones , Lipodistrofia Generalizada Congénita/genética , Hepatopatías/etiología , Hepatopatías/mortalidad , Masculino , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Pancreatitis/mortalidad , Fibrosis Pulmonar/etiología , Fibrosis Pulmonar/mortalidad , Enfermedades Raras/complicaciones , Enfermedades Raras/genética , Insuficiencia Renal/etiología , Insuficiencia Renal/mortalidad , Adulto JovenRESUMEN
INTRODUCTION: Preoperative renal insufficiency is an independent predictor of mortality after coronary artery bypass graft (CABG) surgery. However, there are few reports aimed to evaluate the impact of mild preoperative renal insufficiency on long-term follow-up outcomes after isolated CABG surgery. This study investigates the effect of mild preoperative renal insufficiency on long-term follow-up outcomes of patients after CABG. METHODS: Five hundred eighty-four patients' data that underwent CABG between 1 January 2009 and 1 December 2016 were retrospectively analyzed. They were divided into two groups: normal group [Estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2, n=304] and mild group (eGFR ranges from 60 to 89 ml/min/1.73 m2, n=280). Clinical material and long follow-up outcomes were compared inthe two groups. RESULTS: Two groups had similar baseline and intraoperative data except eGFR. Six (0.01%) patients died in hospital, 15 in normal group and 28 in mild group during the long-term follow-up, which had statistical significance (P<0.05). Univariate factor analysis displayed that the two groups had similar in-hospital outcomes. Kaplan-Meier curves showed a better long-term survival in patients with normal preoperative renal function compared to mild preoperative renal insufficiency (x 2=4.255, P=0.039). Cox proportional model presented the hazard ratio of long-term mortality in patients with mild preoperative renal insufficiency compared to normal preoperative renal function was 1.79 (95% CI 1.17-2.88, P=0.027). CONCLUSIONS: Patients with mild preoperative renal insufficiency had a higher mortality rate than normal patients in long-term survival, whereas no evidence of worse in-hospital mortality rate was found. Patients with mild preoperative renal insufficiency showed a higher mortality rate than other studies.
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Puente de Arteria Coronaria/mortalidad , Insuficiencia Renal/mortalidad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Puente de Arteria Coronaria/efectos adversos , Femenino , Tasa de Filtración Glomerular , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Masculino , Complicaciones Posoperatorias/mortalidad , Periodo Preoperatorio , Insuficiencia Renal/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract Introduction: Preoperative renal insufficiency is an independent predictor of mortality after coronary artery bypass graft (CABG) surgery. However, there are few reports aimed to evaluate the impact of mild preoperative renal insufficiency on long-term follow-up outcomes after isolated CABG surgery. This study investigates the effect of mild preoperative renal insufficiency on long-term follow-up outcomes of patients after CABG. Methods: Five hundred eighty-four patients' data that underwent CABG between 1 January 2009 and 1 December 2016 were retrospectively analyzed. They were divided into two groups: normal group [Estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m2, n=304] and mild group (eGFR ranges from 60 to 89 ml/min/1.73 m2, n=280). Clinical material and long follow-up outcomes were compared inthe two groups. Results: Two groups had similar baseline and intraoperative data except eGFR. Six (0.01%) patients died in hospital, 15 in normal group and 28 in mild group during the long-term follow-up, which had statistical significance (P<0.05). Univariate factor analysis displayed that the two groups had similar in-hospital outcomes. Kaplan-Meier curves showed a better long-term survival in patients with normal preoperative renal function compared to mild preoperative renal insufficiency (x 2=4.255, P=0.039). Cox proportional model presented the hazard ratio of long-term mortality in patients with mild preoperative renal insufficiency compared to normal preoperative renal function was 1.79 (95% CI 1.17-2.88, P=0.027). Conclusions: Patients with mild preoperative renal insufficiency had a higher mortality rate than normal patients in long-term survival, whereas no evidence of worse in-hospital mortality rate was found. Patients with mild preoperative renal insufficiency showed a higher mortality rate than other studies.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria/mortalidad , Insuficiencia Renal/mortalidad , Complicaciones Posoperatorias/mortalidad , Factores de Tiempo , Puente de Arteria Coronaria/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Causas de Muerte , Resultado del Tratamiento , Mortalidad Hospitalaria , Estadísticas no Paramétricas , Insuficiencia Renal/complicaciones , Estimación de Kaplan-Meier , Periodo Preoperatorio , Tasa de Filtración GlomerularRESUMEN
The use of very high doses of polymyxin B (PMB) against carbapenem-resistant Gram-negative bacilli has been addressed in in vitro experiments as a strategy to improve bacterial killing and suppress resistance emergence. However, the toxicities of very high doses in patients are unknown. We conducted a retrospective cohort study assessing patients receiving PMB at >3 mg/kg of body weight/day or a total dose of ≥250 mg/day. The main outcomes were severe infusion-related adverse events according to the Common Terminology Criteria for Adverse Events and the renal failure category of RIFLE criteria for acute kidney injury (AKI) during treatment. A total of 222 patients were included for analysis of infusion-related events. The mean PMB dose was 3.61 ± 0.97 mg/kg/day (median total dose/day = 268 mg). Severe infusion-related adverse events occurred in two patients, resulting in an incidence of 0.9% (95% confidence interval, 0.2 to 3.2%); one was classified as a life-threatening adverse event, and one was classified as a severe adverse event. Renal failure was analyzed in 115 patients, and 25 (21.7%) patients presented renal failure (54 [47.0%] developed any degree of AKI, categorized as risk [27.8%], injury [25.9%], and failure [46.3%]). Treatment with a vasoactive drug, concomitant treatment with nephrotoxic drugs, and baseline creatinine clearance were independent risk factors for renal failure. Neither the PMB daily dose scaled by body weight nor the total daily dose was associated with renal failure. The in-hospital mortality rate was 60% (134 patients): 26% of deaths (57 patients) occurred during treatment, and none occurred during infusion. Our data suggest that high-dose schemes have an acceptable safety profile and could be further tested in clinical trials assessing strategies to improve patient outcomes and minimize the emergence of PMB resistance.
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Antibacterianos/efectos adversos , Polimixina B/efectos adversos , Insuficiencia Renal/inducido químicamente , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/mortalidad , Adulto , Anciano , Antibacterianos/administración & dosificación , Estudios de Cohortes , Creatinina/metabolismo , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Polimixina B/administración & dosificación , Insuficiencia Renal/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Relatos de intoxicação por plantas toxicas são comuns no Brasil. Nesse trabalho foi relatado um caso de intoxicação em um bovino da raça Nelore, idade acima de 36 meses, lactante, devido ingestão de Enterolobium contortisiliquum, conhecido popularmente como orelha de negro, orelha de macaco, tamboril, tamborim, timbaúva, timbori, timboril. Na avaliação das alterações pós-mortem macro e micro demonstraram que a causa provável de morte foi disfunção hepática e renal com reflexo no mal funcionamento pulmonar.
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Animales , Bovinos , Fabaceae/envenenamiento , Insuficiencia Hepática/mortalidad , Insuficiencia Hepática/veterinaria , Insuficiencia Renal/mortalidad , Insuficiencia Renal/veterinaria , Enfermedades Transmitidas por los Alimentos/mortalidad , Enfermedades Transmitidas por los Alimentos/veterinariaRESUMEN
Relatos de intoxicação por plantas toxicas são comuns no Brasil. Nesse trabalho foi relatado um caso de intoxicação em um bovino da raça Nelore, idade acima de 36 meses, lactante, devido ingestão de Enterolobium contortisiliquum, conhecido popularmente como orelha de negro, orelha de macaco, tamboril, tamborim, timbaúva, timbori, timboril. Na avaliação das alterações pós-mortem macro e micro demonstraram que a causa provável de morte foi disfunção hepática e renal com reflexo no mal funcionamento pulmonar.(AU)
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Animales , Bovinos , Fabaceae/envenenamiento , Insuficiencia Hepática/mortalidad , Insuficiencia Hepática/veterinaria , Insuficiencia Renal/mortalidad , Insuficiencia Renal/veterinaria , Enfermedades Transmitidas por los Alimentos/mortalidad , Enfermedades Transmitidas por los Alimentos/veterinariaRESUMEN
Abstract Background: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. Objective: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. Methods: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. Results: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. Conclusion: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.
Resumo Fundamentos: Disfunção renal é preditor independente de morbimortalidade após cirurgia cardíaca. Para uma melhor avaliação da função renal, o cálculo do clearance de creatinina (CC) pode ser necessário. Objetivo: Avaliar objetivamente se o CC é melhor que a creatinina sérica (CS) para predizer risco nos pacientes submetidos à cirurgia cardíaca. Métodos: Análise em 3285 pacientes do Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) incluídos de forma prospectiva, consecutiva e mandatória entre novembro de 2013 e janeiro de 2015. Foram obtidos valores de CS, CC (Cockcroft-Gault) e do EuroSCORE II. Análise de associações da CS e do CC com morbimortalidade foi realizada mediante testes de calibração e discriminação. Por regressão logística múltipla, foram criados modelos multivariados independentes com CS e com CC para predição de risco de morbimortalidade após cirurgia cardíaca. Resultados: Apesar da associação entre a CS e morbimortalidade, essa não calibrou adequadamente os grupos de risco. Houve associação entre o CC e morbimortalidade com boa calibração dos grupos de risco. Na predição do risco de mortalidade, a CS ficou descalibrada com valores >1,35 mg/dL (p < 0,001). A curva ROC revelou que o CC é superior à CS na predição de risco de morbimortalidade. No modelo multivariado sem CC, a CS foi a única preditora de morbidade, enquanto que no modelo sem a CS, o CC foi preditor de mortalidade e o único preditor de morbidade. Conclusão: Para avaliação da função renal, o CC é superior que a CS na estratificação de risco dos pacientes submetidos a cirurgia cardíaca.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Medición de Riesgo/métodos , Creatinina/sangre , Insuficiencia Renal/mortalidad , Insuficiencia Renal/sangre , Tasa de Filtración Glomerular/fisiología , Procedimientos Quirúrgicos Cardíacos/mortalidad , Estándares de Referencia , Valores de Referencia , Calibración , Modelos Logísticos , Estudios Transversales , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de Riesgo , Morbilidad , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Renal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary. OBJECTIVE: To objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery. METHODS: Analysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery. RESULTS: Despite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor. CONCLUSION: Compared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.
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Procedimientos Quirúrgicos Cardíacos/mortalidad , Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Insuficiencia Renal/sangre , Insuficiencia Renal/mortalidad , Medición de Riesgo/métodos , Anciano , Calibración , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Prospectivos , Estándares de Referencia , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
Objetivo: conhecer a prevalência de internações e a correlação com a mortalidade infantil por insuficiência renal. Método: estudo ecológico, descritivo, realizado a partir de informações oriundas do banco de dados do Sistema de Informação em Saúde DATASUS, referentes às internações e à taxa de mortalidade por insuficiência renal, utilizando as variáveis: sexo, idade, internação e óbitos por insuficiência renal, nas cinco regiões do Brasil, no período de 2008 a 2014. Empregou-se amostragem não probabilística intencional e o coeficiente de correlação de Pearson. Resultados: foram registradas 11.802 internações por insuficiência renal no Brasil, com média de 8,4 a 13,8 dias. Predominou o sexo masculino e a faixa etária de cinco a nove anos. A região Nordeste apresentou maior número de internações e de mortalidade e a Norte a menor. Conclusão: a disparidade nas informações pode estar relacionada às características socioeconômicas e de atenção à saúde de cada região.
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Masculino , Femenino , Humanos , Recién Nacido , Lactante , Preescolar , Niño , Hospitalización , Insuficiencia Renal , Insuficiencia Renal Crónica , Insuficiencia Renal/mortalidad , Mortalidad del Niño , Salud Infantil , Epidemiología Descriptiva , Estudios Ecológicos , Estudios TransversalesRESUMEN
Objective: To characterize the clinical and epidemiological profiles of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (LAmB) and to identify prognostic factors for death from VL in 2008-2012 in the state of Minas Gerais, Brazil. Methods: A historical cohort study was conducted using data obtained from treatment requests forms, Brazilian Notifiable Disease Information System and the Mortality Information System. Case-fatality rates of patients with VL treated with LAmB were compared with patients treated with other therapies. Logistic regression analysis was used to identify prognostic factors for death. Results: The overall case-fatality rate of the 577 patients treated with LAmB was 19.4%. Prognostic factors for death from VL were age between 35 and 49 years (OR 2.7; 95% CI 1.3-5.4) and above 50 years (OR 2.6; 95% CI 1.3-4.9), jaundice (OR 2.2; 95% CI 1.2-3.7), kidney disease (OR 2.8; 95% CI 1.6-4.9), presence of other infections (OR 2.4; 95% CI 1.5-4.1), edema (OR 2.0; 95% CI 1.1-3.4), platelet count below 50.000/mm3 (OR 3.6; 95% CI 2.1-6.0), AST higher than 100 U/L (OR 2.2; 95% CI 1.3-3.8), and assistance in non-specialized institutions (OR 1.9; 95% CI 1.0-3.5). Conclusions: Case-fatality rates were higher than that observed among patients with VL treated with other therapies. Identification of prognostic factors of death from VL may allow early diagnosis of patients prone to such outcome and prompt an expeditious and appropriate management of VL to reduce fatality rates.
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Anfotericina B/uso terapéutico , Antiprotozoarios/uso terapéutico , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Estudios de Cohortes , Comorbilidad , Edema/mortalidad , Femenino , Infecciones por VIH/mortalidad , Cardiopatías/mortalidad , Humanos , Lactante , Ictericia/mortalidad , Leishmaniasis Visceral/tratamiento farmacológico , Leishmaniasis Visceral/fisiopatología , Fallo Hepático/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal/mortalidad , Factores de Riesgo , Adulto JovenRESUMEN
Fundamento: la hemodiálisis permite a más de dos millones de personas de todo el mundo vivir por muchos años; para ello es necesario garantizar la calidad de la misma que es igual a la suma de múltiples detalles que la integran y que a largo plazo determinan la calidad de vida del enfermo y su supervivencia.Objetivo: determinar el comportamiento de la mortalidad del adulto en el programa de hemodiálisis crónica.Métodos: se realizó un estudio observacional descriptivo retrospectivo para determinar el comportamiento de la mortalidad del adulto en el programa de hemodiálisis crónica en el servicio de Nefrología del Hospital Universitario Manuel Ascunce Domenech, provincia de Camagüey desde enero de 2003 hasta diciembre de 2012, donde fueron incluidos todos los pacientes fallecidos. Las variables seleccionadas fueron: edad, sexo, causas de IRC-T, acceso vascular, anemia, hipoalbuminemia, hipertensión, hipotensión arterial y causas de muerte. Los datos fueron obtenidos de los expedientes clínicos, registros de fallecidos, certificados de defunción e informes necrópsicos.Resultados: la mortalidad predominó en pacientes diabéticos masculinos, mayores de 60 años de edad quienes presentaron accesos vasculares transitorios para hemodiálisis.Conclusiones: las enfermedades cardiovasculares fueron responsables del mayor número de muertes(AU)
Background: hemodialysis gives two million people all over the world the opportunity of living for many years; that is why guaranteeing the quality of this procedure is necessary. This quality is equivalent to the combination of multiple details, which make it up and at long term determine the quality of life and survival of the patient. Nevertheless, there are some individual risk factors that modify the evolution of the patients in dialysis and impede improving the results of the treatment, presenting a high mortality and worse quality of life for patients.Objective: to determine how adult mortality behaves in the chronic hemodialysis program in the nephrology service in the Manuel Ascunce Domenech provincial hospital from January 2003 to december 2012.Methods: a descriptive observational retrospective study was carried out in order to determine the behavior of adult mortality in the chronic hemodialysis program in the nephrology service in the Manuel Ascunce Domenech provincial hospital from January 2003 to december 2012. All the deceased patients were included in the study. The variables related to the patient were age, sex causes of TCRD, vascular access, anemia, hypoalbuminemia, hypertension, hypotension, and causes of death. The data were obtained from clinical records, deceased records, death certificates, and necropsy records.Results: mortality predominated in diabetics patients (32, 3 percent), men (59 percent), and people older than 60 years old (49, 6 percent) who presented in 50, 3 percent transitory haemodialysis vascular accesses.Conclusions: cardiovascular pathology, followed by infections, predominated as direct cause of death(AU)
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Humanos , Adulto , Diálisis Renal/efectos adversos , Diálisis Renal/mortalidad , Terapia de Reemplazo Renal/mortalidad , Insuficiencia Renal/mortalidad , Insuficiencia Renal/terapia , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/terapia , Estudio Observacional , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days ( n = 216), 4-7 days ( n = 109), and ≥8 days ( n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min-1) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min-1, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min-1 (12% vs. 4% for creatinine clearance ≤and >60 mL min-1, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.