Neurological events after liver transplantation: a single-center experience.

The aim of this study was to identify potential risk factors linked to neurologic events (NE) occurring after liver transplantation (LT) and use them to construct a model to predict such events. From odds ratios (OR) of risk factors, a scoring system was assessed using multivariate regression analysis. Forty-one of 307 LT patients presented NE (13.3%), with prolonged hospital stay and decreased post-LT survival. On multivariate analysis, factors associated with NE included: severe pre-LT ascites OR 3.9 (1.80-8.41; P = 0.001), delta sodium ≥12 mEq/l OR 3.5 (1.36-8.67; P = 0.01), and post-LT hypomagnesemia OR 2.9 (1.37-5.98; P = 0.005). Points were assigned depending on ORs as follows: ascites 4 points, and hypomagnesemia and delta sodium ≥12 mEq/l, 3 points each (score range = 0-10 points). ROC curve analysis suggested good discriminative power for the model, with a c-statistic of 0.72 (CI 0.62-0.81; P < 0.0001), best performance for a cutoff value >3 points (71% sensitivity, 60% specificity). NE risk increased progressively from 6.4%, to 10.3%, 12.8%, 31.5% and 71.0% as scores rose from 0 to 3, 4, 6-7 and 10 cumulative points, respectively. The score described helps to identify patients potentially at risk for neurologic events, and its prevention would decrease morbidity and mortality after LT.

El médico inteniivista ante la autonomía del paiente: una aproximación a partiir de algunos casos cínnicos / The itensive-carre physician in the face of patient atonomy: an apprroach based on several clinical cases / O médico intnsivvista ante a autonomia do paciente: uma aproimação a partirr de alguns casos clínicos

En este artículo se presentan y analizan tres casos clínicos con el objetivo de clarificar los alcances y límites del principio de autonomía del paciente y la responsabilidad del médico a la hora de tomar decisiones terapéuticas en los pacientes internados en terapia intensiva. Se concluye que el consentimiento informado no le ahorra al médico la obligación de discernir qué es lo mejor en cada caso para cada paciente. El equipo médico debe respetar la autonomía del paciente siempre que la decisión de este no sea contraria a la ética.

Three clinical cases are introduced and analyzed in this article to clarifying the scope and limits of the principle of patient autonomy and the physician's responsibility when it comes to making therapeutic decisions regarding patients who are involved in intensive therapy. The conclusion is that informed consent does not relieve the physician of the obligation to discern what is best in each case for each patient. The medical team must respect the patient's autonomy, provided the patient's decision is not unethical.

Neste artigo, apresentam-se e se analisam três casos clínicos com o objetivo de esclarecer os alcances e limites do princípio de autonomia do paciente e da responsabilidade do médico na hora de tomar decisões terapêuticas nos pacientes internados em terapia intensiva. Conclui-se que o consentimento informado não exime o médico da obrigação de discernir o que é o melhor em cada caso para cada paciente. A equipe médica deve respeitar a autonomia do paciente sempre que a decisão deste não for contrária à ética.