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1.
Liver Int ; 29(7): 1071-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19302181

RESUMO

BACKGROUND: Hyponatraemia increases risk of adverse outcomes following orthotopic liver transplantation (OLT), but it is unclear whether improvement of pretransplant hyponatraemia ameliorates post-transplant complications. AIMS: To assess impact of pretransplant hyponatraemia on post-transplant outcomes. METHODS: We performed a retrospective analysis of 213 patients with cirrhosis who underwent liver transplantation. Patients with serum sodium 130 mEq/L at transplantation ('resolved hyponatraemia'; n=56) and to those without history of hyponatraemia before transplantation ('never hyponatraemic'; n=123). Primary endpoint was survival at 180 days post-OLT. Secondary outcomes included time until discharge alive, complications during hospitalization, length of time ventilated and length of post-transplant intensive care unit stay. RESULTS: There was no survival difference at 180 days post-OLT between groups. After transplantation, patients with either hyponatraemia at OLT or resolved hyponatraemia had longer time until discharge alive and had higher rates of delirium, acute renal failure, acute cellular rejection and infection than those who were never hyponatraemic. As compared with patients with hyponatraemia at OLT, those with resolved hyponatraemia were more likely to be discharged alive within 3 weeks, but other outcomes, including survival, did not differ significantly. CONCLUSIONS: We conclude that hyponatraemia at any time before liver transplantation is associated with adverse post-transplant outcome, even when hyponatraemia has resolved.


Assuntos
Hiponatremia/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Adolescente , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/mortalidade , Estimativa de Kaplan-Meier , Tempo de Internação , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Modelos de Riscos Proporcionais , Respiração Artificial , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sódio/sangue , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Clin Gastroenterol Hepatol ; 5(9): 1085-91; quiz 1007, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17588823

RESUMO

BACKGROUND & AIMS: The natural history of specific morphologic stages of chronic pancreatitis (CP) is not well defined. The aim of this study was to determine if worsening morphologic stages of CP are associated with poorer clinical outcomes. METHODS: A retrospective analysis of 159 subjects with CP was performed. The baseline stage of CP was categorized according to the Cambridge classification. Pain was categorized as type A (intermittent acute), B (continuous), or combined. Exocrine failure was defined by steatorrhea; endocrine failure was characterized as diabetes mellitus. Complications were defined clinically. RESULTS: Pancreatic duct (PD) morphology was equivocal in 37.1%, minimal in 12.6%, moderate in 7.5%, and severe in 42.8% of the patients. Over a median follow-up period of 3.7 years, the risk of developing exocrine insufficiency and diabetes was 28% and 19%, respectively. Recurrent acute flares of pancreatitis predicted the development of exocrine insufficiency (P = .004). Severe PD morphology predicted the likelihood of having persistent pain (P = .008). Patients with concurrent type A and B pain and older age at diagnosis had a greater likelihood of having persistent pain (P = .021). The risk of developing bile duct stricture was higher in the advanced morphologic stages of CP (P = .005). CONCLUSIONS: Recurrent flares of pancreatitis predispose to the development of exocrine insufficiency in CP. Patients with complex-type pain, older age at diagnosis, and advanced morphologic stage are more likely to have persistent pain. PD morphology does not correlate with the risk of developing exocrine failure and/or diabetes. Pain does not necessarily decrease or disappear with the onset of exocrine insufficiency and diabetes.


Assuntos
Insuficiência Pancreática Exócrina/etiologia , Pancreatite Crônica/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Endoscopia , Insuficiência Pancreática Exócrina/diagnóstico , Insuficiência Pancreática Exócrina/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/mortalidade , Prognóstico , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Ultrassonografia , Virginia/epidemiologia
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