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1.
Sleep Breath ; 28(4): 1617-1624, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38717714

RESUMO

PURPOSE: Interstitial lung disease (ILD) often coexists with obstructive sleep apnea (OSA), contributing to increased morbidity and mortality. However, the effectiveness of continuous positive airway pressure (CPAP) therapy in this population remains unclear. We conducted a systematic review to evaluate CPAP therapy's impact on clinical outcomes in patients with ILD and comorbid OSA. METHODS: Following PRISMA guidelines, we systematically searched multiple databases for studies assessing CPAP therapy's effects on ILD exacerbation, hospitalization, quality of life, and mortality in ILD-OSA patients. Studies were selected based on predefined inclusion criteria, and their quality was assessed using the Newcastle-Ottawa quality scale. RESULTS: Among 485 articles screened, 82 underwent full review, with four observational studies meeting inclusion criteria. CPAP therapy demonstrated potential benefits in improving quality of life and reducing ILD exacerbations in ILD-OSA patients. However, its impact on mortality was inconclusive due to variability in study definitions and methodology. CONCLUSION: CPAP therapy may improve outcomes in ILD-OSA patients, particularly in terms of quality of life and ILD exacerbations. Nonetheless, further research with standardized definitions and rigorous methodology is needed to confirm its efficacy, particularly regarding mortality outcome.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Doenças Pulmonares Intersticiais , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Doenças Pulmonares Intersticiais/terapia , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/mortalidade , Qualidade de Vida , Comorbidade , Resultado do Tratamento
2.
Postgrad Med J ; 98(1155): 43-47, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33087530

RESUMO

BACKGROUND: We aimed to report the incidence of hospital-acquired hypophosphataemia and hyperphosphataemia along with their associated in-hospital mortality. METHODS: We included 15 869 adult patients hospitalised at a tertiary medical referral centre from January 2009 to December 2013, who had normal serum phosphate levels at admission and at least two serum phosphate measurements during their hospitalisation. The normal range of serum phosphate was defined as 2.5-4.2 mg/dL. In-hospital serum phosphate levels were categorised based on the occurrence of hospital-acquired hypophosphataemia and hyperphosphataemia. We analysed the association of hospital-acquired hypophosphataemia and hyperphosphataemia with in-hospital mortality using multivariable logistic regression. RESULTS: Fifty-three per cent (n=8464) of the patients developed new serum phosphate derangements during their hospitalisation. The incidence of hospital-acquired hypophosphataemia and hyperphosphataemia was 35% and 27%, respectively. Hospital-acquired hypophosphataemia and hyperphosphataemia were associated with odds ratio (OR) of 1.56 and 2.60 for in-hospital mortality, respectively (p value<0.001 for both). Compared with patients with persistently normal in-hospital phosphate levels, patients with hospital-acquired hypophosphataemia only (OR 1.64), hospital-acquired hyperphosphataemia only (OR 2.74) and both hospital-acquired hypophosphataemia and hyperphosphataemia (ie, phosphate fluctuations; OR 4.00) were significantly associated with increased in-hospital mortality (all p values <0.001). CONCLUSION: Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate.


Assuntos
Hiperfosfatemia/mortalidade , Hipofosfatemia/mortalidade , Fosfatos/sangue , Complexo Repressor Polycomb 1/metabolismo , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Proteína Proto-Oncogênica c-fli-1/metabolismo , Estudos Retrospectivos
3.
Medicina (Kaunas) ; 56(3)2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32121573

RESUMO

Background and objectives: Goodpasture's syndrome (GS) is a rare, life-threatening autoimmune disease. Although the coexistence of anti-neutrophil cytoplasmic antibody (ANCA) with Goodpasture's syndrome has been recognized, the impacts of ANCA vasculitis on mortality and resource utilization among patients with GS are unclear. Materials and Methods: We used the National Inpatient Sample to identify hospitalized patients with a principal diagnosis of GS from 2003 to 2014 in the database. The predictor of interest was the presence of ANCA-associated vasculitis. We tested the differences concerning in-hospital treatment and outcomes between GS patients with and without ANCA-associated vasculitis using logistic regression analysis with adjustment for other clinical characteristics. Results: A total of 964 patients were primarily admitted to hospital for GS. Of these, 84 (8.7%) had a concurrent diagnosis of ANCA-associated vasculitis. Hemoptysis was more prevalent in GS patients with ANCA-associated vasculitis. During hospitalization, GS patients with ANCA-associated required non-significantly more mechanical ventilation and non-invasive ventilation support, but non-significantly less renal replacement therapy and plasmapheresis than those with GS alone. There was no significant difference in in-hospital outcomes, including organ failure and mortality, between GS patients with and without ANCA-associated vasculitis. Conclusions: Our study demonstrated no significant differences between resource utilization and in-hospital mortality among hospitalized patients with coexistence of ANCA vasculitis and GS, compared to those with GS alone.


Assuntos
Doença Antimembrana Basal Glomerular/mortalidade , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/mortalidade , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Doença Antimembrana Basal Glomerular/imunologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
4.
Nephrol Dial Transplant ; 32(6): 991-996, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27190375

RESUMO

BACKGROUND: The risks of proteinuria and chronic kidney disease (CKD) in adults who regularly have short sleep duration (short sleepers) are controversial. The aim of this meta-analysis was to assess the effects of short sleep duration on proteinuria and CKD. METHODS: A literature search was conducted using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the inception of the databases through November 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risks of proteinuria and CKD in short sleepers were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were computed utilizing a random-effect, generic inverse variance method. RESULTS: Six observational studies with 252 075 individuals and three observational studies with 37 197 individuals were included in the analyses to assess the risks of CKD and proteinuria in short sleepers, respectively. The pooled RR of CKD in short sleepers was 1.51 (95% CI, 0.99-2.55). When meta-analysis was restricted only to studies with adjusted analysis for confounders assessing the risk of CKD in short sleepers, the pooled RR of CKD was 1.54 (95% CI, 0.80-2.95). The pooled RR of proteinuria in short sleepers was 1.47 (95% CI, 1.26-1.72). CONCLUSIONS: Despite the lack of significant association between short sleep duration and CKD, our meta-analysis suggests a potential association between short sleep duration and proteinuria, a surrogate marker for kidney disease progression. Future study is required to investigate if reversal of short sleep helps reduce proteinuria.


Assuntos
Proteinúria/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Privação do Sono/epidemiologia , Progressão da Doença , Humanos , Razão de Chances , Proteinúria/etiologia , Insuficiência Renal Crônica/etiologia , Risco , Privação do Sono/complicações
5.
J Am Soc Nephrol ; 27(6): 1854-60, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26487562

RESUMO

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P=0.21), major adverse kidney events (2.1% versus 1.5%; P=0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P=0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.


Assuntos
Injúria Renal Aguda/etiologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos
6.
J Card Surg ; 32(9): 550-555, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28833503

RESUMO

BACKGROUND: Acute kidney injury (AKI) and its severity after transcatheter aortic valve replacement (TAVR) have been associated with worse outcomes. Studies have shown that AKI duration (transient or persistent) affects outcomes independently of AKI severity. This study was undertaken to determine the association, risk factors, and outcomes associated with persistent AKI (pAKI) after TAVR. METHODS: Adult patients undergoing TAVR at Mayo Clinic between January 1, 2008 and June 30, 2014 were enrolled. pAKI was defined as an increased serum creatinine at hospital discharge (≥0.3 mg/dL or ≥50% from baseline). Risk factors associated with pAKI were identified with multivariate logistic regression. RESULTS: A total of 386 patients met the inclusion criteria. Fifty patients (13%) had pAKI. Independent risk factors for pAKI on multivariate analysis included diabetes mellitus (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.29-4.66), prior percutaneous coronary intervention (PCI) (OR, 2.39; 95%CI, 1.24-4.80), intra-aortic balloon pump (IABP) use (OR, 8.14; 95%CI, 1.60-45.78), and blood transfusion (OR, 2.22; 95%CI, 1.15-4.27). Protective factors for pAKI included a higher baseline estimated glomerular filtration rate (eGFR) (OR, 0.83 per 10-mL/min/1.73 m2 increase in eGFR; 95%CI, 0.71-0.99). After adjusting for the Society of Thoracic Surgeons cardiac surgery risk score, pAKI occurrence remained significantly associated with increased 2-year mortality among hospital survivors (hazard ratio, 2.65; 95%CI, 1.51-4.41). CONCLUSION: pAKI was significantly associated with higher mortality risk following TAVR. Baseline eGFR, diabetes mellitus, previous PCI, IABP, and blood transfusion were risk factors for post-procedural pAKI.


Assuntos
Injúria Renal Aguda/etiologia , Complicações Pós-Operatórias/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Injúria Renal Aguda/mortalidade , Idoso , Transfusão de Sangue , Diabetes Mellitus , Feminino , Taxa de Filtração Glomerular , Humanos , Balão Intra-Aórtico , Modelos Logísticos , Masculino , Análise Multivariada , Intervenção Coronária Percutânea , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
7.
Ren Fail ; 39(1): 13-18, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27767371

RESUMO

BACKGROUND: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR). METHODS: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI. RESULTS: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68-4.36) and propensity score adjustment: OR 2.83 (CI 1.66-4.80) for stratification and 3.82 (CI 2.04-7.44) for matching. Nonetheless, there was no statistically significant difference among the TA and TF groups with respect to major adverse kidney events (MAKE) or estimated glomerular filtration rate (eGFR) at six months post-procedure. CONCLUSION: In a cohort of patients undergoing TAVR for aortic stenosis, a TA approach significantly increases the AKI risk compared with a TF approach. However, the TAVR approach did not affect severe renal outcomes or long-term renal function.


Assuntos
Injúria Renal Aguda/epidemiologia , Estenose da Valva Aórtica/cirurgia , Artéria Femoral/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Resultado do Tratamento
8.
Nephrology (Carlton) ; 21(12): 1041-1046, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26714182

RESUMO

AIM: This study aimed to determine the incidence and risk factors of acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR). METHODS: We included all adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital. AKI was defined based on Kidney Disease: Improving Global Outcomes criteria. We performed a multivariate logistic regression to identify factors associated with post-procedural AKI occurrence. RESULTS: Three hundred eighty-six patients met the inclusion criteria, of which 106 (28%) developed AKI. In multivariate analysis, AKI development was independently associated with a transapical approach (odds ratio (OR), 2.81; 95% confidence interval (CI), 1.72-4.65 compared with transfemoral approach) and the need for an intra-aortic balloon pump (OR, 9.11; 95% CI, 1.77-68.29). Higher baseline renal function (OR, 0.78 per 10 mL/min per 1.73 m2 increment in glomerular filtration rate; 95% CI, 0.68-0.87) was significantly associated with a decreased risk of AKI. After adjustment for the Society of Thoracic Surgeons' risk score, post-procedural AKI development remained significantly associated with an increased in-hospital (OR, 4.74; 95% CI, 1.39-18.48) and 6-month mortality (OR, 4.66; 95% CI, 2.32-9.63). CONCLUSION: In a cohort of patients undergoing TAVR for aortic stenosis, AKI commonly occurred and was significantly associated with increased mortality. Baseline renal function, procedure approach and the need for circulatory support were important predictive factors for post-procedural AKI occurrence.


Assuntos
Injúria Renal Aguda/epidemiologia , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/mortalidade , Distribuição de Qui-Quadrado , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Incidência , Balão Intra-Aórtico/efeitos adversos , Rim/fisiopatologia , Modelos Logísticos , Masculino , Minnesota/epidemiologia , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
9.
BMC Nephrol ; 17: 6, 2016 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-26748909

RESUMO

BACKGROUND: Baseline serum creatinine (SCr) level is frequently not measured in clinical practice. The aim of this study was to investigate the effect of various methods of baseline SCr determination measurement on accuracy of acute kidney injury (AKI) diagnosis in critically ill patients. METHODS: This was a retrospective cohort study. All adult intensive care unit (ICU) patients admitted at a tertiary referral hospital from January 1, 2011 through December 31, 2011, with at least one measured SCr value during ICU stay, were included in this study. The baseline SCr was considered either an admission SCr (SCrADM) or an estimated SCr, using MDRD formula, based on an assumed glomerular filtration rate (GFR) of 75 ml/min/1.73 m(2) (SCrGFR-75). Determination of AKI was based on the KDIGO SCr criterion. Propensity score to predict the likelihood of missing SCr was used to generate a simulated cohort of 3566 patients with baseline outpatient SCr, who had similar characteristics with patients whose outpatient SCr was not available. RESULTS: Of 7772 patients, 3504 (45.1 %) did not have baseline outpatient SCr. Among patients without baseline outpatient SCr, AKI was detected in 571 (16.3 %) using the SCrADM and 997 (28.4 %) using SCrGFR-75 (p < .001). Compared with non-AKI patients, patients who met AKI only by SCrADM, but not SCrGFR-75, were significantly associated with 60-day mortality (OR 2.90; 95 % CI 1.66-4.87), whereas patients who met AKI only by SCrGFR-75, but not SCrADM, had a non-significant increase in 60-day mortality risk (OR 1.33; 95 % CI 0.94-1.88). In a simulated cohort of patients with baseline outpatient SCr, SCrGFR-75 yielded a higher sensitivity (77.2 vs. 50.5 %) and lower specificity (87.8 vs. 94.8 %) for the AKI diagnosis in comparison with SCrADM. CONCLUSIONS: When baseline outpatient SCr was not available, using SCrGFR-75 as surrogate for baseline SCr was found to be more sensitive but less specific for AKI diagnosis compared with using SCrADM. This resulted in higher incidence of AKI with larger likelihood of false-positive cases.


Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Creatinina/sangue , Taxa de Filtração Glomerular , Injúria Renal Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Biomarcadores/sangue , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Conceitos Matemáticos , Pessoa de Meia-Idade , Admissão do Paciente , Pontuação de Propensão , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença
10.
Neurol India ; 64(5): 906-11, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27625227

RESUMO

BACKGROUND: Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to an increased risk of cerebrovascular accident (CVA), but the data on polymyalgia rheumatica (PMR) remains unclear. MATERIALS AND METHODS: We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing the risk of CVA in patients with PMR versus non-PMR controls. Pooled risk ratio and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Three retrospective cohort studies and one cross-sectional study were identified and included in the data analysis. We found a significantly elevated CVA risk in patients with PMR, with the pooled risk ratio of 1.87 (95% CI, 1.43-2.43). The statistical heterogeneity was high, with an I2 of 91%. CONCLUSIONS: Our study demonstrated a statistically significantly increased CVA risk among patients with PMR.


Assuntos
Polimialgia Reumática/complicações , Acidente Vascular Cerebral/complicações , Humanos , Estudos Observacionais como Assunto , Fatores de Risco
11.
Rheumatology (Oxford) ; 54(4): 736-42, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25252703

RESUMO

OBJECTIVE: The aim of this study was to integrate and examine the association between NSAID use and venous thromboembolism (VTE). METHODS: We conducted a systematic review and meta-analysis of studies that reported odds ratios, relative risks, hazard ratios or standardized incidence ratios for VTE among NSAID users compared with non-users. Pooled risk ratios and 95% CIs were calculated using a random effects generic inverse variance model. RESULTS: Six studies with 21 401 VTE events were identified and included in the data analysis. The pooled risk ratio of VTE in NSAID users was 1.80 (95% CI 1.28, 2.52). CONCLUSION: Our study demonstrated a statistically significant increased risk of VTE among NSAID users. This finding has important public health implications given the prevalence of NSAID use in the general population.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Embolia Pulmonar/epidemiologia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Humanos , Incidência , Razão de Chances , Modelos de Riscos Proporcionais , Embolia Pulmonar/induzido quimicamente , Tromboembolia Venosa/induzido quimicamente , Trombose Venosa/induzido quimicamente
12.
Am J Nephrol ; 41(4-5): 372-82, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26113391

RESUMO

BACKGROUND: The objective of this meta-analysis was to evaluate the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR). METHODS: A literature search was performed using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception through October, 2014. Studies that reported relative risks, ORs, or hazard ratios comparing the AKI risk in patients who underwent TAVR versus those who underwent surgical aortic valve replacement were included. We performed the pre-specified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Three randomized controlled trials (RCTs) with 1,852 patients and 14 cohort studies with 3,113 patients were analyzed to assess the AKI risk in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing TAVR were 0.65 (95% CI 0.36-1.15, I(2) = 75%) in the analysis of RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34, I(2) = 79%) in the analysis of observational studies. Sensitivity analysis in RCTs and propensity score-based studies using a standard AKI definition demonstrated a significant association between TAVR and lower AKI risk (RR 0.35, 95% CI 0.25-0.50, I(2) = 0%). Our meta-analyses of RCTs and propensity score-based studies did not find associations between TAVR and reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79, I(2) = 63%). CONCLUSIONS: Our meta-analysis demonstrates an association between TAVR and lower AKI risk.


Assuntos
Injúria Renal Aguda/epidemiologia , Estenose da Valva Aórtica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Razão de Chances
13.
Nephrol Dial Transplant ; 30(6): 978-88, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25800881

RESUMO

BACKGROUND: Previous trials of interventions to prevent acute kidney injury (AKI) have been unsuccessful and additional interventions are needed. Existing reviews of preoperative renin-angiotensin system (RAS) inhibitors have suggested harm. We included more recent studies and conducted this meta-analysis to evaluate the risk of postoperative AKI in patients who received preoperative RAS inhibitors. METHODS: A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through October, 2014. Studies that reported relative risks, odds ratios or hazard ratios comparing the AKI risk in patients who received preoperative RAS inhibitors versus those who did not were included. We performed the prespecified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Twenty-four studies (1 randomized controlled trial and 23 cohort studies) with 102 675 patients were included in the analysis to assess the risk of postoperative AKI and preoperative RAS inhibitors use. The pooled RR of AKI in patients receiving RAS inhibitors was 1.05 (95% CI: 0.92-1.20). The meta-analysis of the RCT and 11 studies with propensity score analysis demonstrated the pooled RR of AKI in patients receiving RAS inhibitors of 0.92 (95% CI: 0.85-0.99). Within the selected studies, preoperative RAS inhibitor therapy was not associated with a significant increase or decrease in mortality (RR: 0.93; 95% CI: 0.80-1.09). CONCLUSIONS: Our meta-analysis demonstrates an association between preoperative RAS inhibitor treatment and lower incidence of AKI.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Sistema Renina-Angiotensina/efeitos dos fármacos , Humanos
14.
Clin Exp Rheumatol ; 33(5): 746-50, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26087815

RESUMO

OBJECTIVES: Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to an increased risk of venous thromboembolism (VTE). However, the data on Sjögren's syndrome (SS) remain unclear. This study aimed to investigate this association. METHODS: We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio or standardised incidence ratio comparing risk of VTE in patients with SS versus non-SS subjects. Pooled risk ratio and 95% confidence intervals were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Out of 306 potentially relevant articles, four eligible studies were identified and included in the data analysis. The pooled risk ratio of VTE in patients with SS was 2.05 (95% CI, 1.86-2.27). The statistical heterogeneity of this study was insignificant with an I2 of 0%. CONCLUSIONS: Our study demonstrated a statistically significant increased VTE risk among patients with SS.


Assuntos
Síndrome de Sjogren/complicações , Tromboembolia Venosa/etiologia , Distribuição de Qui-Quadrado , Humanos , Razão de Chances , Prognóstico , Medição de Risco , Fatores de Risco , Síndrome de Sjogren/sangue , Síndrome de Sjogren/diagnóstico , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico
15.
Nephrology (Carlton) ; 20(12): 881-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26032233

RESUMO

AIM: This study aimed to investigate how varied methods of determining baseline serum creatinine (SCr) would affect acute kidney injury (AKI) diagnosis and prediction of 60 day mortality in critically ill patients following an episode of AKI. METHODS: This is a single-centre retrospective study conducted at a tertiary referral hospital. All adult intensive care unit (ICU) patients between January and December 2011, who had at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed. The baseline SCr was calculated using either the most recent (SCrmost recent ) or the minimum (SCrmin ) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on KDIGO SCr definition. The primary outcome was 60 day mortality after ICU admission. RESULTS: A total of 4020 patients were included in the analysis. AKI was detected in 1204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrmost recent (P < 0.001). Compared with patients without AKI regardless of baseline SCr methodology, the 60 day mortality risk of patients who developed AKI using the SCrmin and SCrmost recent was significantly increased (odds ratio (OR) = 3.74; 95% confidence interval (CI) 2.98-4.70). Similarly, the risk of 60 day mortality in patients who met AKI criteria using the SCrmin but not the SCrmost recent was significant higher than in patients without AKI (OR = 2.04; 95% CI 1.36-3.00). CONCLUSION: Using the minimum value of preadmission SCr as a baseline kidney function not only can detect more AKI cases, but also provides the better predictive ability for 60 day mortality.


Assuntos
Injúria Renal Aguda/diagnóstico , Creatinina/sangue , Rim/fisiopatologia , Modelos Biológicos , APACHE , Injúria Renal Aguda/sangue , Injúria Renal Aguda/classificação , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Minnesota , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo
16.
Nephrology (Carlton) ; 20(10): 727-735, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25968971

RESUMO

AIM: The objective of this meta-analysis was to compare the effects of off-pump and on-pump coronary artery bypass grafting (CABG) on acute kidney injury (AKI) and the need of dialysis after surgery. METHODS: Comprehensive literature searches for randomized controlled trials (RCTs) of CABG with on-pump and off-pump was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception through September 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Thirty-three RCTs with 17 322 patients were enrolled in our study. Patients in the off-pump CABG group had overall lower incidence of AKI (19.1%) compared with the on-pump CABG group (22.2%). There was a protective effect of off-pump CABG on the incidence of AKI compared with the on-pump CABG group (RR: 0.87; 95% CI: 0.77-0.98). However, there was no significant difference in the need for dialysis in the off-pump group compared with the on-pump group (RR: 0.84; 95% CI 0.63-1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI, 0.77-1.23) in off-pump versus on-pump CABGs. CONCLUSIONS: Our study demonstrates a beneficial effect of off-pump CABG on the incidence of AKI. However, our meta-analysis does not show benefits of the need of dialysis or survival among patients undergoing off-pump CABG.

17.
Clin Exp Hypertens ; 37(7): 587-93, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26114357

RESUMO

BACKGROUND/OBJECTIVES: The risk of hypertension (HTN) in patients who regularly drink soda is controversial. The objective of this meta-analysis was to assess the associations between consumption of sugar and artificially sweetened soda and HTN. METHODS: A literature search was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through January 2015. Studies that reported relative risks, odd ratios or hazard ratios comparing the risk of HTN in patients consuming a significant amount of either sugar or artificially sweetened soda versus those who did not consume soda were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Eight studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and HTN. The pooled RR of HTN in patients consuming sugar-sweetened soda was 1.12 (95% CI, 1.03-1.23). Four studies were selected to assess the association between consumption of artificially sweetened soda and HTN. The pooled RR of HTN in patients consuming artificially sweetened soda was 1.15 (95% CI, 1.11-1.19). CONCLUSIONS: Our study demonstrates statistically significant associations between both sugar and artificially sweetened soda consumption and HTN. This finding may impact clinical management and primary prevention of HTN.


Assuntos
Bebidas/efeitos adversos , Carboidratos da Dieta/efeitos adversos , Hipertensão , Edulcorantes/efeitos adversos , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Razão de Chances , Fatores de Risco
18.
Ren Fail ; 37(4): 664-71, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25703707

RESUMO

BACKGROUND: The reports on the efficacy of statins for the prevention of contrast-induced acute kidney injury (CIAKI) remain controversial. The objective of this meta-analysis was to assess the effect of statins for the prevention of CIAKI. METHODS: Comprehensive literature searches for randomized controlled trials (RCTs) of periprocedural statin treatment for prevention of CIAKI were performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until May 2014. The primary outcome was the incidence of CIAKI. RESULTS: Thirteen prospective RCTs were included in our analysis. Of 5803 patients with contrast exposures, 304 patients (5.2%) had CIAKI. Patients in the statin group had an overall lower incidence of CIAKI (3.6%) compared to the control group (6.9%). Intravenous (IV) fluid hydration was used in both groups of all included studies for prevention of CIAKI. There was a significant protective effect of periprocedural statins on the incidence of CIAKI when compared to the control group [risk ratios (RRs): 0.49; 95% CI: 0.37-0.66, I(2) of 25%]. CONCLUSIONS: Our study demonstrates a statistically significant protective effect of statin treatment during procedures with contrast exposures. This finding suggests the use of statins in addition to standard IV crystalloid hydration may be beneficial in the prevention of CIAKI.


Assuntos
Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Injúria Renal Aguda/induzido quimicamente , Humanos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Ren Fail ; 37(7): 1237-41, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26108134

RESUMO

BACKGROUND: The reported risk of hypomagnesemia in patients with proton pump inhibitor (PPI) use is conflicting. The objective of this meta-analysis was to assess the association between the use of PPIs and the risk of hypomagnesemia. METHODS: A literature search of observational studies was performed using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews from inception through September 2014. Studies that reported odd ratios or hazard ratios comparing the risk of hypomagnesemia in patients with PPI use were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Nine observational studies (three cohort studies, five cross-sectional studies and a case-control study) with a total of 109,798 patients were identified and included in the data analysis. The pooled RR of hypomagnesemia in patients with PPI use was 1.43 (95% CI, 1.08-1.88). The association between the use of PPIs and hypomagnesemia remained significant after the sensitivity analysis including only studies with high quality score (Newcastle-Ottawa scale score ≥ 8) with a pooled RR of 1.63 (95% CI, 1.14-2.23). CONCLUSIONS: Our study demonstrates a statistically significant increased risk of hypomagnesemia in patients with PPI use. The finding of this meta-analysis of observational studies suggests that PPI use is associated with hypomagnesemia and may impact clinical management of patients who are taking PPIs and at risk for hypomagnesemia related cardiovascular events.


Assuntos
Magnésio/sangue , Inibidores da Bomba de Prótons/efeitos adversos , Humanos , Estudos Observacionais como Assunto , Razão de Chances , Inibidores da Bomba de Prótons/uso terapêutico , Viés de Publicação
20.
Mod Rheumatol ; 25(6): 893-897, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25849852

RESUMO

BACKGROUND: Several chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory myositis, and systemic vasculitides, have been linked to an increased risk of venous thromboembolism (VTE). However, the data on systemic sclerosis (SSc) remains unclear. METHODS: We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of VTE in patients with SSc versus non-SSc participants. Pooled risk ratio and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Out of 776 potentially relevant articles, five eligible studies were identified and included in the data analysis. The pooled risk ratio of VTE in patients with SSc was 2.51 (95% CI, 1.79-3.54). The statistical heterogeneity of this study was high with an I2 of 90%. CONCLUSIONS: Our study demonstrated a statistically significant increased VTE risk among patients with SSc.

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