RESUMO

INTRODUCTION AND OBJECTIVES: Ischemic cardiopathy constitutes the leading cause of death worldwide. Our aim was to evaluate the prognostic capacity of the leukoglycemic index as well as to create a predictive model of in-hospital complications in patients with ST elevation myocardial infarction. MATERIALS AND METHODS: This was a multicentral and cohort study, which included patients inserted in the Cuban Registry of acute myocardial infarction. The study investigated 900 patients with a validation population represented by 233 external subjects. In order to define the performance of the leukoglycemic index were evaluated the discrimination with the statistical C and the calibration by Hosmer - Lemeshow test. A model of logistic binary regression was employed in order to define the predictive factors.  RESULTS: Optimal cut point of the leukoglycemic index to predict in-hospital complications was 1188 (sensibility 60%; specificity 61.6%; area under the curve 0.623; p < 0.001). In-hospital complications were significantly higher in the group with the leukoglycemic index ≥ 1188; a higher value was significantly associated with a higher risk to develop an in-hospital complication [RR (IC 95%) = 2.4 (1.804-3.080); p<0.001]. The predictive model proposed is composed by the following factors: age ≥ 66 years, leukoglycemic index ≥ 1188, Killip-Kimball classification ≥ II and medical history of hypertension. This scale had a good discrimination in both, the training and the validation population. CONCLUSION: The leukoglycemic index possesses a low performance when used to assess the risks for in hospital complications in patients with ST elevation myocardial infarction. The new predictive model has a good performance, which can be applied to estimate risk of in-hospital complications. This model would be able to contribute to the health systems of developing countries without additional cost; it enables prediction of the patients having a higher risk of complications and a negative outcome during the hospitable admission.

RESUMO

Introducción: A pesar de las nuevas técnicas para la reperfusión del vaso en el infarto agudo de miocardio, las complicaciones y la mortalidad en estos pacientes es elevada. La hiperglucemia y la leucocitosis se han descrito como factores de riesgo y de peor pronóstico. Objetivo: Evaluar la capacidad predictiva de la hiperglucemia y la leucocitosis de complicaciones intrahospitalarias en pacientes con infarto de miocardio agudo con elevación del segmento ST. Material y Métodos: Estudio prospectivo de cohorte desde 2013 hasta 2020 que incluyó a 507 pacientes consecutivos que ingresaron en la Unidad de Cuidados Coronarios del Hospital Militar Central Dr. Carlos J. Finlay y el Hospital General Docente Enrique Cabrera con el diagnóstico de infarto del miocardio agudo con elevación del segmento ST. Se dividieron los pacientes de acuerdo con la ocurrencia de complicaciones intrahospitalarias. Resultados: Los valores de glucemia y leucograma presentaron diferencias significativas entre los grupos de pacientes (p = 0,002 y p = 0,005; respectivamente). La capacidad discriminativa de ambos exámenes se clasificó como mala. El análisis univariado de regresión logística reveló que la glucemia y el leucograma eran factores de riesgo para la aparición de complicaciones, pero solo el leucograma se consideró un predictor independiente del evento final del estudio. Al asociar los valores de leucograma al modelo multivariado, se elevó su capacidad predictiva (área bajo la curva: 0,735; p < 0,001). Conclusiones: La leucocitosis es un predictor independiente de complicaciones intrahospitalarias en pacientes con Infarto del miocardio agudo con elevación del segmento ST(AU)

ABSTRACT Introduction: Despite the use of novel techniques for reperfusion of the vessel in acute myocardial infarction, complications and mortality in these patients are high. Hyperglycemia and leukocytosis have been described as risk factors and worse prognosis. Objective: To evaluate the predictive capacity of hyperglycemia and leukocytosis for in-hospital complications of myocardial infarction with ST-segment elevation patients. Material and Methods: Prospective cohort study conducted from 2013 to 2020 that included 507 consecutive patients admitted to the Intensive Coronary Care Unit of the Dr. Carlos J. Finlay Central Military Hospital and the Enrique Cabrera General Teaching Hospital with the diagnosis of acute myocardial infarction with ST- segment elevation. The patients were divided into groups according to the occurrence of in-hospital complications. Results: The values of glycemia and leukocyteswere significantly different among the groups of patients (p = 0.002 and p = 0.005; respectively). The discriminative capability of both tests was classified as bad. The univariate analysis of logistic regression revealed that glycemia and leukocytes were risk factors for the appearance of complications, but only the leukocyte test was considered as an independent predictor of the final event of the study. When the values of the leukocyte test were associated with the multivariate model, its predictive capacity increased (area under curve: 0.735; p < 0.001). Conclusions: Leukocytosis is an independent predictor of in-hospital complications of acute myocardial infarction with ST-segment elevation(AU)

Assuntos

RESUMO

Objectives: To describe the association of frailty level on admittance to the Emergency Department (ED) with various hospital complications including delirium, low phase angle, and low handgrip strength. Design: Prospective cohort. Setting: ED rooms of two public general hospitals in Mexico City. Participants: A total of 548 persons 60 years or older who were admitted to the ED and who were alive during follow-up testing at home were included. Measurements: A 32-item frailty index (FI) was measured on admission to the ED. Outcome measures included delirium, phase angle, and hand grip strength measured during different stages of the hospitalization (i.e., from admission to the ED through to follow-up at home). Results: From this final sample, mean age was 76 years (± SD 7.2) and 58.4% (n = 320) were women. Mean waiting time in the ED was 5.1 h (± SD 6.2), the average stay in the ED was 99.9 (±68.2) h, and 274 subjects (50%) were admitted to a general ward after ED admission. FI was not associated with phase angle and was negatively associated with handgrip strength at admission to ED (ß = -3.97, confidence interval [CI] 95% -5.56 -2.38, p < 0.001), discharge from ED (ß = -3.94, CI 95% -5.97 -1.90, p < 0.001), and discharge from hospital (ß = -4.93, CI 95% -7.68 -2.18, p = 0.01). FI was positively associated with delirium (ß = 3.68, CI 95% 1.53-5.83, p < 0.01). Conclusion: Higher frailty at ED admission was associated with lower hand grip strength and delirium during hospitalization in Mexican older adults.

RESUMO

Objetivo: Investigar as possíveis complicações no processo de alimentação dos pacientes submetidos à cirurgia bariátrica com a técnica de RYGBP, numa abordagem biopsíquica. Método: estudo retrospectivo de natureza clínico quantitativa, realizado no Ambulatório de Cirurgia bariátrica de um hospital público do interior de São Paulo. Casuística: 47 pacientes que apresentaram complicações no processo de alimentação pós-cirurgia bariátrica, com sintomas orgânicos, psíquicos ou ambos, na faixa etária de 27 a 63 anos, 05 do sexo masculino e 42 do sexo feminino. Procedimento: Levantamento e categorização dos sintomas orgânicos e psíquicos, a partir da análise de prontuários no período de fevereiro de 2004 a dezembro de 2010, seguido de análise estatística descritiva do material coletado. Resultados: 31 pacientes (65,95%) apresentaram sintomas psíquicos: dependência afetiva, ansiedade e angústia, imagem corporal distorcida, transtornos compulsivos obsessivos e depressão, segundo avaliação psicológica e psiquiátrica; 12 pacientes (25,53%) apresentaram sintomas orgânicos: deslocamento e retirada de anel de contenção, hérnia hiatal, refluxo gastro esofágico, colecistite e fistulas gástricas segundo avaliação médica; e 04 pacientes (8,51%) apresentaram sintomas de ambas naturezas. Conclusão: Os resultados sugerem a pertinência de abordagens biopsíquicas a estes pacientes, o que implica em ajustes nas anamneses nutricionais tradicionais (diários e recordatórios) de maneira a abranger investigações psíquicas relacionadas aos desequilíbrios nutricionais pós-cirúrgicos.(AU)(AU)

Objective: To investigate the possible complications in the process of feeding of patients undergoing bariatric surgery with the technique of RYGBP, in a biopsychic approach. Method: Retrospective study of clinical quantitative nature, performed at the Ambulatory of Bariatric Surgery of a public hospital in the countryside of São Paulo, according to established ethical standards for research involving human beings. Casuistry: 47 patients selected from a group of 183 medical records of patients operated on CB, who had complications in the process of feeding after CB with organics, psychics and both symptoms. Of the 47 patients, the age group was of 27 to 63 years old, five male and 42 female. Procedure: A survey and categorization of organics and psychics symptoms, from the analysis of medical records in period of February 2004 to December 2010, followed by statistical analysis of the collected material. Results and Discussion: 31 patients (65.95%) had psychics symptoms: emotional dependence, anxiety and anguish, distorted body image, obsessive compulsive disorders and depression according to psychological and psychiatric evaluation, 12 patients (25.53%) had organics symptoms: displacement and removal of containment ring, incision hernia, gastro esophageal reflux, cholecystitis and gastric fistulas according to medical evaluation, and four patients (8.51%) had both symptoms. Conclusion: The results suggest the need to invest in biopsychic approach of these patients with adjustments in traditional nutritional case histories (daily and recall) covering psychics investigations related to nutritional imbalances after surgery.(AU)(AU)

Objetivo: Investigar las posibles complicaciones en el proceso de alimentación de pacientes sometidos a cirugía bariátrica con la técnica DGYR, en un enfoque biopsíquico. Métodos: Estudio retrospectivo de carácter cuantitativo clínico, realizado en Consultas de Cirugía Bariátrica en un hospital público del interior de São Paulo. Pacientes: 47 pacientes que presentaron complicaciones en el proceso de alimentación después de la cirugía bariátrica, con síntomas orgánicos, psicológicos o ambos, en el grupo de edad de 27-63 años, 05 hombres y 42 mujeres. Procedimiento: Levantamiento y categorización de los síntomas organicos y psiquicos, basadas en el análisis de archivos en el período de febrero de 2004 a diciembre 2010, seguido de un análisis estadístico descriptivo de los materiales recogidos. Resultados: 31 pacientes (65,95%) presentaron síntomas psiquiátricos: dependencia afectiva, ansiedad y angustia, imagen corporal distorsionada, trastornos compulsivo obsesivos y depresión, segundo evaluación psiquiátrica y psicológica; 12 pacientes (25,53%) presentaron síntomas orgánicos: desplazamiento y eliminación de anillo de contención, hernia hiatal, reflujo gastro esofágico, fístulas gástricas y colecistitis segundo evaluación médica segundo; y 04 pacientes (8,51%) presentaron síntomas de ambas naturalezas. Conclusión: Los resultados sugieren la importancia del enfoque biopsíquico con estos pacientes, lo que implica ajustes en la anamnesis nutricional tradicional (diario y recuerdas) para abarcar investigaciones psíquicas relacionadas con los desequilibrios nutricionales postcirurgicos.(AU)(AU)

Assuntos