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BACKGROUND: Traumatic brain injury (TBI) has substantial physical, psychological, social and economic impacts, with high rates of morbidity and mortality. Considering its high incidence, the aim of this study was to identify epidemiological and clinical characteristics that predict mortality in patients hospitalized for TBI in intensive care units (ICUs). METHODS: A retrospective cohort study was carried out with patients over 18 years old with TBI admitted to an ICU of a Brazilian trauma referral hospital between January 2012 and August 2019. TBI was compared with other traumas in terms of clinical characteristics of ICU admission and outcome. Univariate and multivariate analyses were used to estimate the odds ratio for mortality. RESULTS: Of the 4816 patients included, 1114 had TBI, with a predominance of males (85.1%). Compared with patients with other traumas, patients with TBI had a lower mean age (45.3 ± 19.1 versus 57.1 ± 24.1 years, p < 0.001), higher median APACHE II (19 versus 15, p < 0.001) and SOFA (6 versus 3, p < 0.001) scores, lower median Glasgow Coma Scale (GCS) score (10 versus 15, p < 0.001), higher median length of stay (7 days versus 4 days, p < 0.001) and higher mortality (27.6% versus 13.3%, p < 0.001). In the multivariate analysis, the predictors of mortality were older age (OR: 1.008 [1.002-1.015], p = 0.016), higher APACHE II score (OR: 1.180 [1.155-1.204], p < 0.001), lower GCS score for the first 24 h (OR: 0.730 [0.700-0.760], p < 0.001), greater number of brain injuries and presence of associated chest trauma (OR: 1.727 [1.192-2.501], p < 0.001). CONCLUSION: Patients admitted to the ICU for TBI were younger and had worse prognostic scores, longer hospital stays and higher mortality than those admitted to the ICU for other traumas. The independent predictors of mortality were older age, high APACHE II score, low GCS score, number of brain injuries and association with chest trauma.
Subject(s)
Brain Injuries, Traumatic , Brain Injuries , Male , Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Adolescent , Female , Cohort Studies , Retrospective Studies , Intensive Care Units , Glasgow Coma Scale , Hospitals , Hospital MortalityABSTRACT
INTRODUCTION: hemorrhagic shock is a significant cause of trauma-related deaths in Brazil and worldwide. This study aims to compare BE and lactate values at ICU admission and twenty-four hours after in identifying tissue hypoperfusion and mortality. METHODS: examines a historical cohort of trauma patients over eitheen years old submittet to damage control resuscitation approch upon hospital admission and were then admitted to the ICU. We collected and analyzed ISS, mechanism and type of trauma, need for renal replacement therapy, massive transfusion. BE, lactate, pH, bicarbonate at ICU admission and twenty-four hours later, and mortality data. The patients were grouped based on their BE values (≥-6 and <-6mmol/L), which were previously identified in the literature as predictors of severity. They were subsequently redivided using the most accurate values found in this sample. In addition to performing multivariate binary logistic regression. The data were compared using several statistical tests due to diversity and according to the indication for each variable. RESULTS: there were significant changes in perfusion upon admission to the Intensive Care Unit. BE is a statistically significant value for predicting mortality, as determined by using values from previous literature and from this study. CONCLUSION: the results demonstrate the importance of monitoring BE levels in the prediction of ICU mortality. BE proves to be a valuable bedside marker with quick results and wide availability.
Subject(s)
Biomarkers , Lactic Acid , Shock, Hemorrhagic , Humans , Shock, Hemorrhagic/mortality , Shock, Hemorrhagic/blood , Male , Female , Lactic Acid/blood , Adult , Biomarkers/blood , Middle Aged , Cohort Studies , Intensive Care UnitsABSTRACT
ABSTRACT Introduction: hemorrhagic shock is a significant cause of trauma-related deaths in Brazil and worldwide. This study aims to compare BE and lactate values at ICU admission and twenty-four hours after in identifying tissue hypoperfusion and mortality. Methods: examines a historical cohort of trauma patients over eitheen years old submittet to damage control resuscitation approch upon hospital admission and were then admitted to the ICU. We collected and analyzed ISS, mechanism and type of trauma, need for renal replacement therapy, massive transfusion. BE, lactate, pH, bicarbonate at ICU admission and twenty-four hours later, and mortality data. The patients were grouped based on their BE values (≥-6 and <-6mmol/L), which were previously identified in the literature as predictors of severity. They were subsequently redivided using the most accurate values found in this sample. In addition to performing multivariate binary logistic regression. The data were compared using several statistical tests due to diversity and according to the indication for each variable. Results: there were significant changes in perfusion upon admission to the Intensive Care Unit. BE is a statistically significant value for predicting mortality, as determined by using values from previous literature and from this study. Conclusion: the results demonstrate the importance of monitoring BE levels in the prediction of ICU mortality. BE proves to be a valuable bedside marker with quick results and wide availability.
RESUMO Introdução: o choque hemorrágico é a principal causa reversível de morte no trauma no Brasil e no mundo. Objetivo: comparar o valor de BE ao do lactato na admissão da UTI e vinte e quatro horas após o internamento na identificação de hipoperfusão tecidual e predição de mortalidade Método: coorte histórica de pacientes traumatizados, maiores de dezoito anos, submetidos à estratégia de controle de danos na admissão hospitalar, seguido de internamento em UTI. Foram coletados e analisados ISS, mecanismo e tipo de trauma, necessidade de terapia de substituição renal e transfusão maciça; BE, lactato, pH e bicarbonato coletados na admissão da UTI e vinte e quatro horas após, e a mortalidade. Os pacientes foram divididos em grupos conforme valores de BE (≥-6 e <-6mmol/L) já descritos na literatura como preditores de gravidade, e após redivididos de acordo com os valores de melhor acurácia encontrados nesta amostra, além de realização de regressão logística binária multivariada. Os dados foram comparados através de diversos testes estatísticos devido a diversidade e conforme a indicação para cada variável. Resultados: houve alterações perfusionais impactantes já na admissão da UTI. BE manteve-se com valor estatisticamente significativo para predição de mortalidade tanto quando utilizado os valores já conhecidos da literatura como quando aplicados os valores neste estudo identificados. Conclusão: valores de BE e de lactato foram capazes de predizer hipoperfusão tecidual e mortalidade nos dois momentos estudados, quando comparados, o BE tem boa performance como preditor de mortalidade, com rápido resultado e ampla disponibilidade.
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A Síndrome de Turner (ST) é uma doença genéticacaracterizada pela monossomia completa ou parcial docromossomo X e possui uma grande variabilidade fenotípica,podendo se manifestar na forma clássica oucom poucos sinais dismórficos que possam chamaratenção ao diagnóstico. Mulheres com Síndrome deTurner têm um risco cardiovascular duas vezes maiorque a população geral e apresentam maior prevalênciade hipertensão arterial sistêmica, dislipidemia, aumentoda resistência insulínica e deficiência estrogênica,além de doenças cardíacas congênitas, principalmenteacometendo grandes vasos, podendo estar presenteem até 50% das mulheres com ST. Devido a essas complicaçõescardiovasculares, o reconhecimento de possíveismanifestações cardíacas agudas em pacientescom anomalias genéticas torna-se imprescindível parao sucesso terapêutico. O objetivo do presente artigo édescrever um caso de infarto agudo do miocárdio emuma paciente jovem com Síndrome de Turner.
Turner?s syndrome is a genetic disease related eitherto a homogeneous complete or a partial XO monosomyand has a fenotipic variability, presenting suchin a classic syndrome or with few dysmorfic signs thatcan draw attention to diagnosis. Womem with Turner?ssyndrome have a cardiovascular risk twice higher thangeneral population and presents more prevalence inhypertension, dyslipidemia, insulin resistence and estrogendeficiency, besides cardiac congenital cardiacdiseases, mainly affecting big vassels, in approximately50% of these patients. Due to these cardiovascularcomplications, recognition of possible acute cardiacmanifestations in patients with genetic abnormalities isnecessary to therapeutic success. The goal of this articleis to present a case report of a young woman with AMIand Turner syndrome.
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Introdução: Apesar da evolução em relação às opções terapêuticas no infarto agudo do miocárdio (IAM) e do advento de unidades coronarianas, percebe-se que os índices de mortalidade desse evento permanecem substancialmente elevados e com isso, questiona-se o fato de muitos pacientes com IAM não estarem recebendo de maneira integral o tratamento preconizado. Este trabalho teve como objetivo avaliar, em um centro de referência em cardiologia, se medidas recomendadas no atendimento inicial do IAM estão sendo realizadas. Métodos: Foi realizado um estudo observacional, no período de fevereiro de 2009 a novembro de 2009, no Hospital Regional Hans Dieter Schmidt / Joinville - SC, onde foram incluídos os pacientes com diagnóstico de IAM e indicação de angioplastia primária, observando-se quais medicações foram empregadas na fase aguda, além de exames complementares e o tempo necessário para realizar o diagnóstico de IAM com necessidade de reperfusão coronariana. Resultados: Uma amostra de 83 pacientes foi reunida, sendo que 80,72% fizeram uso de AAS e 54,22% de betabloqueadores. Não houve diferença estatisticamente significativa entre as prescrições nas diferentes faixas etárias. Radiografia do tórax foi solicitada em 43,37% e nenhum paciente realizou ecocardiograma. Do total, 23 pacientes (27,71%) tiveram tempo porta-diagnóstico abaixo de 10 minutos, sem diferença significativa quando comparado por sexos. Conclusões: Quando comparado com dados da literatura, nosso estudo mostrou que medicações que comprovadamente aumentam a sobrevida de pacientes com IAM estão sendo subutilizadas. Além disso, houve demora em realizar a indicação de angioplastia primária como recomendado pelas principais diretrizes.
Introduction: Despite the evolution in therapeutic options in acute myocardial infarction and the advent of Coronary Units, one can notice that the mortality rates of this event remains substantially high, and by that, it is questioned the fact of many patients with AMI are not receiving the full praised treatment. This paper had as goal to asses, in a Cardiology Reference Center, if the recommended treatments in the initial attendance of AMI are being fulfilled. Methods: An observational study was carried through, in the period of February/2009 to November/2009 in Hans Dieter Schmidt regional Hospital/ Joinville-SC, where patients diagnosed with AMI and primary angioplasty indication were included, observing which medications were prescribed, which ancillary tests were requested and time necessary to diagnose a AMI with coronary reperfusion treatment indication Results: A sample of 83 patients was selected, of whom 80,72% received Aspirin and 54,22% received betablockers. There was no meaningful statistic difference in prescriptions between different age groups. Chest radiographs was requested in 43,37% and in none patients a Echocardiogram was performed. In 23 patients (27,71%), less than 10 minutes were necessary between arrival in the Emergency Department to diagnosis, without statistic differences between sex groups. Conclusions : Compared to available data, this study showed that increasing survival proven drugs in AMI are misused. Besides, there were a delay in time of performing primary angioplasty indication as recommended by the main guidelines.
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JUSTIFICATIVA E OBJETIVOS: As doenças cardiovasculares são as principais causas de mortalidade no Brasil. É um distúrbio difuso, sendo as suas principais formas: doença arterial coronariana, acidente vascular encefálico e doença arterial periférica. A apresentação dessas doenças está relacionada diretamente ao número e intensidade de fatores de risco, sendo o conhecimento desses fatores a principal forma de prevenção. O objetivo deste estudo foi analisar os seus principais fatores de risco. MÉTODO: Realizou-se um estudo caso-controle pareado por sexo e idade (± 5 anos), na proporção de 1:1, com 46 pacientes diagnosticados com acidente vascular encefálico isquêmico e 50 pacientes com doença vascular periférica, internados no Hospital Nossa Senhora da Conceição, na cidade de Tubarão, SC, no período de novembro de 2006 a abril de 2007. RESULTADOS: Os fatores de riscos identificados em ordem decrescente de força de associação foram: hipertensão arterial (OR = 4,00; p < 0,0001), antecedente familiar precoce para doença aterosclerótica (OR = 3,73; p = 0,0001), depressão (OR = 3,23; p = 0,0001), relato de diabetes mellitus (OR = 3,09; p < 0,001). Outros fatores que apresentaram associação inversa com o desenvolvimento de doença aterosclerótica não coronariana foram: consumo regular de frutas (OR = 0,43; p = 0,03), verdura (OR = 0,34; p = 0,01), atividade física regular (OR = 0,33; p = 0,01) e atividade de lazer regular (OR = 0,28; p < 0,001). CONCLUSÃO: Hipertensão arterial foi o fator de risco mais importante, seguido de história familiar precoce de doença cardiovascular, diabetes e depressão. Consumo de frutas e verduras, atividade física e lazer regular foram associados à redução do risco de doença aterosclerótica não coronariana.
BACKGROUND AND OBJECTIVES: Coronary artery disease, cerebrovascular disease, and peripheral vascular disease. The presentations of these diseases are linked directly to the number and intensity of the risk factors, therefore the knowledge of these is the main form of prevention. This study analyzed the maile risk factors. METHODS: A case-control study pared by sex and age (± 5 years), in a 1:1 proportion with 46 patients diagnosed with ischemic cerebrovascular stroke, and 50 with peripheral vascular disease, admitted in the Nossa Senhora da Conceição Hospital, in the city of Tubarão, SC, between the period of November of 2006 to April of 2007. RESULTS: The risk factors analyzed in decreasing order of strength were: arterial hypertension (OR = 4.00; p < 0.0001), early family history of risk for coronary atherosclerotic disease (OR = 3.73; p = 0.0001), depression (OR = 3.23; p = 0.0001), and diabetes mellitus (OR = 3.09; p < 0,001). Other factors such as: regular fruit ingest (OR = 0.43; p = 0.03), regular vegetable ingest (OR = 0.34; p = 0.01), regular physical activity (OR = 0.33; p = 0.01), and regular leisure activity (OR = 0.28; p < 0.001), showed an inverse association with the development of the noncoronary atherosclerotic disease. CONCLUSION: Arterial hypertension was the most important risk factor, followed by early family history of coronary atherosclerotic disease, diabetes mellitus, and depression. Ingest of fruits and vegetables, regular physical activity and, regular leisure activity were associated with a reduction in the risk of noncoronary atherosclerotic disease.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Cardiovascular Diseases , Risk Factors , Case-Control StudiesABSTRACT
Fundamento: O hábito de fumar se associa fortemente com a ocorrência de infarto agudo do miocárdio (IAM) eé um importante fator de risco prevenível para esse evento.Entretanto, os tabagistas com IAM tendem a apresentar melhor evolução intra-hospitalar quando comparados aosnão-tabagistas. Objetivos: Avaliar o impacto do tabagismo sobre a morbidade intra-hospitalar dos pacientes vítimas de IAM e verificar a associação do hábito de fumar com outros fatores de risco cardiovascular e dados clínicos. Métodos: Foi realizado um estudo do tipo observacional nos pacientes com diagnóstico de IAMatendidos no Hospital Nossa Senhora da Conceição, em Tubarão - SC, no período de novembro de 2005 a novembro de 2006. Resultados: Observou-se que os tabagistas eram mais jovens e apresentaram menor prevalência de hipertensão arterial sistêmica (RR = 0,68; IC 95% 0,54-0,85; p=0,0009), diabetes mellitus (RR = 0,49; IC 95% 0,32- 0,76; p=0,001) e circunferência abdominal acima dos valores desejáveis (RR = 0,64; IC 95% 0,51-0,80;p=0,0002). Além disso, chegaram ao hospital em até 6 horas do início dos sintomas (RR = 1,70; IC 95% 1,29-2,25; p=0,00006). Houve uma tendência entre ostabagistas de uma melhor evolução intra-hospitalar (RR = 1,32; IC 95% 1,07-1,65; p=0,01), avaliada através daClassificação de Killip-Kimball.Conclusões: Os tabagistas têm uma menor prevalência de outros fatores de risco cardiovascular e uma tendênciaem apresentarem melhor evolução intra-hospitalar.
Background: Smoking cigarette is strongly associated to the occuring of acute myocardial infarction (AMI) andis an important avertable risk factor to that event. However, smokers with AMI tend to present better evolution intra-hospital when compared to non-smokers.Objectives: Evaluate the impact of smoking on the intra-hospital morbidity of the patients victims of AMI and verity the association of smoking with othercardiovascular risk factors and clinical data. Methods: An observational study was made on the patients with AMI diagnosis attended in Hospital NossaSenhora da Conceição, Tubarão - SC, from november 2005 to november 2006.Results: It was observed that smokers were younger and had less prevalence of systemic arterial hypertension(RR = 0,68; IC 95% 0,54-0,85; p=0,0009), diabetes mellitus (RR = 0,49; IC 95% 0,32-0,76; p=0,001) andabdominal obesity (RR = 0,64; IC 95% 0,51-0,80; p=0,0002). In addition to that, they arrived at the hospitalwithin six hours after the symptoms appeared (RR = 1,70; IC 95% 1,29-2,25; p=0,00006). There was a tendency among the smokers of having a better intra-hospital evolution (RR = 1,32; IC 95% 1,07-1,65; p=0,01),evaluated through the Killip-Kimball rating. Conclusions: The smokers have less prevalence of other cardiovascular risk factors and a tendency to presenta better intra-hospital evolution.
Subject(s)
Humans , Male , Female , Aged , Clinical Evolution , Myocardial Infarction , Tobacco Use DisorderABSTRACT
Objetivo: Estimar o efeito dos principais fatores de risco cardiovascular em pacientes portadores de síndromecoronariana aguda e indivíduos sem doença cardíaca aparente. Métodos: Realizou-se um estudo caso-controlepareado por sexo e idade (±5 anos), na proporção de 1:2, com 51 pacientes diagnosticados com síndromecoronariana aguda e 102 pacientes sem doença cardiovascular, internados no Hospital Nossa Senhora da Conceição, na cidade de Tubarão, SC, no período demaio a agosto de 2005. Resultados: Os fatores de risco identificados emordem decrescente de força de associação foram: hipertensão arterial (odds ratio [OR] 10,3 e p<0,0001),relação cintura-quadril maior que 0,95 em homens e maior que 0,90 em mulheres (OR 5,6; p=0,0001), históriafamiliar de doença cardiovascular precoce (OR 4,6; p=0,0001), relato de diabetes melito (OR 2,7; p=0,02),sobrepeso ou obesidade (OR 2,5; p=0,0095) e estresse (OR 2,3; p=0,0428). Consumo de frutas mostrouassociação inversa com o desenvolvimento de síndromecoronariana aguda (OR 0,38; p=0,0241). Outros fatores de risco pesquisados não estiveram statisticamente associados. Conclusão: Hipertensão arterial foi o fator de risco mais importante, seguido da relação cintura-quadril, história familiar precoce de doença cardiovascular, diabetes, IMC igual ou superior a 25 e estresse. Consumode frutas esteve associado à redução do risco de síndrome coronariana aguda.
Objective: To estimate the effect of maincardiovascular risk factors in patients with acute coronary syndrome and patients without manifest heart disease.Methods: A case-control study matched by sex and age (±5 years), in the ratio of 1:2, was carried out with 51 patients with acute coronary syndrome and 102patients without any cardiovascular disease, admitted into Hospital Nossa Senhora da Conceição, in Tubarão, SC,from May to August of 2005. Results: The risk factors identified in associationstrength descending order were the following: reported arterial hypertension (odds ratio [OR] 10,3 andp<0,0001), waist-hip ratio higher than 0,95 in males and 0,90 in females (OR 5,6 p=0,0001), early family historycoronary disease (OR 4,6 p=0,0001), reported diabetes (OR 2,7 p=0,02), overweight or obesity (OR 2,5 p=0,0095) and stress (OR 2,3 p=0,0428). Regular fruit consumption showed inverse association with the acute coronary syndrome development (OR 0,38 p=0,0241). Other risk factors researched did not reached statisticalsignificance. Conclusion: Arterial hypertension was the most important risk factor, followed by the waist-hip ratio, early family history of cardiovascular disease, diabetes,BMI equal or over than 25 and stress. Fruit consumption was associated risk reduction of acute coronary syndrome.