RESUMO
BACKGROUND: Evaluate the association between serum urea at admission and during hospital stay with return of spontaneous circulation (ROSC) and in-hospital mortality in patients with in-hospital cardiac arrest (IHCA). METHODS: This retrospective study included patients over 18 years with IHCA attended from May 2018 to December 2022. The exclusion criteria were the absence of exams to calculate delta urea and the express order of "do-not-resuscitate". Data were collected from the electronic medical records. Serum admission urea and urea 24 hours before IHCA were also collected and used to calculate delta urea. RESULTS: A total of 504 patients were evaluated; 125 patients were excluded due to the absence of variables to calculate delta urea and 5 due to "do-not-resuscitate" order. Thus, we included 374 patients in the analysis. The mean age was 65.0 ± 14.5 years, 48.9% were male, 45.5% had ROSC, and in-hospital mortality was 91.7%. In logistic regression models, ROSC was associated with lower urea levels 24 hours before IHCA (OR: 0.996; CI95%: 0.992-1.000; p: 0.032). In addition, increased levels of urea 24 hours before IHCA (OR: 1.020; CI95%: 1.008-1.033; p: 0.002) and of delta urea (OR: 1.001; CI95%: 1.001-1.019; p: 0.023) were associated with in-hospital mortality. ROC curve analysis showed that the area under the ROC curve for mortality prediction was higher for urea 24 hours before IHCA (Cutoff > 120.1 mg/dL) than for delta urea (Cutoff > 34.83 mg/dL). CONCLUSIONS: In conclusion, increased serum urea levels during hospital stay were associated with worse prognosis in IHCA.
Assuntos
Parada Cardíaca , Mortalidade Hospitalar , Ureia , Humanos , Masculino , Feminino , Ureia/sangue , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Parada Cardíaca/sangue , Parada Cardíaca/mortalidade , Tempo de Internação/estatística & dados numéricos , Retorno da Circulação Espontânea , Prognóstico , HospitalizaçãoRESUMO
Células escamosas atípicas de significado indeterminado (ASC-US) é uma categoria bastante subjetiva, que abrange alterações morfológicas, as quais, qualitativamente ou quantitativamente, são insuficientes para definir uma lesão intraepitelial escamosa. Dados da literatura afirmam que aproximadamente 75% retornam à normalidade após repetição da citologia, porém, parte delas, na histologia, são lesões com alto potencial neo¬plásico. Objetivos: Avaliar o seguimento de mulheres com ASC-US e a adesão às condutas preconizadas. Métodos: Foi realizada busca dos exames posteriores das mulheres com resultado de ASC-US em 2015, atendidas no Núcleo de Anatomia Patológica do Instituto Adolfo Lutz. Foram avaliados o tempo médio de repetição, idade e exame posterior. Resultados: Das 675 mulheres participantes do estudo, 71,7% repetiram a citologia com intervalo médio de 9 meses e média de idade de 37 anos. Na citologia de repetição, 77,7% foram NILM. Dos exames de repetição alterados, 1,7% (8/484) foi HSIL na citologia, 13,3% (4/30) foram NIC e 3,3% (2/3) foram CAI na histologia. Considerando as diretrizes brasileiras, 17,5% das mulheres abaixo dos 25 anos, 39,9% entre 25 e 64 anos e 34,4% acima dos 65 repetiram o exame no intervalo recomendado. Conclusão: A maioria dos resultados posteriores foi negativa, porém, uma parte considerável das mulheres apresentou alteração no exame de repetição. Dos exames histopatológicos realizados, a maioria apresentou resultado de cervicite, porém, foram detectadas lesões mais graves subjacentes em 16,6% destas mulheres, evidenciando a importância do acompanhamento e investigação apropriada.
Assuntos
Programas de Rastreamento , Detecção Precoce de Câncer , Teste de Papanicolaou , Papillomaviridae , Células Escamosas Atípicas do Colo do ÚteroRESUMO
Atypical squamous cells of undetermined significance (ASC-US) is a very subjective category, defined as changes suggestive of lesion, but which are qualitatively or quantitatively insufficient for a definitive interpretation as such. Studies report that approximately 75% of cases returning to normal in cytology analysis repeat, but some of them in histology are lesions with high neoplastic potential. Objectives: To evaluate the follow-up of women diagnosed with ASC-US and adhesion to Brazilian guidelines. Methods: It was made a research for the subsequent exams of diagnoses of ASC-US in 2015, whose exams were analyzed at the Pathologic Anatomy department from Adolfo Lutz Institute. The mean time of repetition, age and subsequent diagnosis were evaluated. Results: Of all evaluated women, 71.7% repeated the cytology in the studied period, with a mean interval of 9 months and an average age of 37 years. In the cytology of repetition, 77.7% were negative. Of the altered repetitions, 1.7% were HSIL in cytology. In the histology,13.3% (4/30) were NIC 2 or NIC 3 and 3.3% (1/30) were cancer. According Brazilian guidelines, 17.5% of women under 25 years of age, 39.9% between 25 and 64 years old, and 34.4% of those over 65, repeated the Pap smear at the recommended interval. Conclusion: Most of the subsequent results were negative; however, a considerable proportion of the women had altered repetition tests. Of the histopathological examinations performed, the majority presented a result of cervicitis; however, more lesions that are serious were detected in 16.6% of these women, evidencing the importance of appropriate follow-up and investigation