Factors of mortality in patients with cardiac implantable electronic device: 5-year experience.

OBJECTIVE: The use of cardiac implantable electronic devices has increased in recent years. It has also brought some issues. Among these, the complications of cardiac implantable electronic devices infection and pocket hematoma are difficult to manage. It can be fatal with the contribution of patient-related risk factors. In this study, we aimed to find mortality rates in patients who developed cardiac implantable electronic devices infection and pocket hematoma over 5 years. We also investigated the risk factors affecting mortality in patients with cardiac implantable electronic devices. METHODS: A total of 288 cardiac implantable electronic devices patients were evaluated. Demographic details, history, and clinical data of all patients were recorded. Cardiac implantable electronic devices infection was defined according to the modified Duke criteria. The national registry was used to ascertain the mortality status of the patients. The patients were divided into two groups (exitus and survival groups). In addition, the pocket hematoma was defined as significant bleeding at the pocket site after cardiac implantable electronic devices placement. RESULTS: The cardiac implantable electronic devices infection was similar in both groups (p=0.919), and the pocket hematoma was higher in the exitus group (p=0.019). The exitus group had higher usage of P2Y12 inhibitors (p≤0.001) and novel oral anticoagulants (p=0.031). The Cox regression analysis, including mortality-related factors, revealed that renal failure is the most significant risk factor for mortality. Renal failure was linked to a 2.78-fold higher risk of death. CONCLUSION: No correlation was observed between cardiac implantable electronic devices infection and mortality, whereas pocket hematoma was associated with mortality. Furthermore, renal failure was the cause of the highest mortality rate in patients with cardiac implantable electronic devices.

Association between arteriovenous fistulae and hematomas in a dialysis center in the state of Rio Grande do Sul, Southern Brazil

Introduction: Chronic kidney disease (CKD) is characterized by slow, progressive, and irreversible loss of kidney function. CKD has become a serious public health issue because of its increasing morbidity and mortality rates. The present study aimed to investigate factors associated with hematomas caused by arteriovenous fistula (AVF) at a Renal Replacement Therapy Unit in the state of Rio Grande do Sul, southern Brazil. Methods: In this cross-sectional study, 72 patients with CKD aged 18 years or over, presenting with AVF, and undergoing three hemodialysis sessions per week were evaluated from June 2014 to March 2015. Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated for identification of risk factors associated with AVF. P-values < 0.05 were considered significant. Results: Sex, age, self-reported skin color, educational level, hypertension, diabetes, nephrotic syndrome, congestive heart failure, and hepatitis C were not associated with hematoma formation (i.e., all estimated PRs had p-values > 0.05). The single factor associated with hematomas was AVF time shorter than 60 days (PR = 2.04; 95% CI: 1.28-3.27; p < 0.01). Conclusion: AVF maturation time was associated with higher prevalence of hematomas at the cannulation site. Therefore, AVF time should be given special attention in patients undergoing renal therapy at dialysis centers. (AU)

[Is the international normalised ratio a prognostic factor of mortality in intracerebral haemorrhage?]. / ¿Es el cociente normalizado internacional un factor pronóstico de mortalidad en hemorragias intracerebrales?

BACKGROUND: Oral anticoagulant therapy (ACO) is considered an independent predictor of mortality in patients with intracerebral haemorrhage (ICH), with the role of the international normalised ratio (INR) being unclear. The aim of this work is to evaluate the relationship between ACO and the INR value and the ICH volume, and to determine the relationship between both variables and mortality. PATIENTS AND METHODS: Patients were retrospectively analysed using the Private Community Cerebrovascular Hospital Register (Registro Cerebrovascular del Hospital Privado de Comunidad), between December 2003 and May 2009. Volumes of the haematomas (dependent variable) were calculated from the first image performed, using the abc/2 method. Independent variables were age, gender, vascular risk factors, site of bleeding, intraventricular dump, clinical severity (Glasgow scale), time to image, antiplatelet drugs, and INR value on admission. An analysis of the relationship between all these variables and mortality was also performed. RESULTS: A total of 327 patients with HIC were identified (35 with ACO). Median volume was higher in the anticoagulated patients (55ml vs 24ml P<.05), with no statistically significant relationship between volume and the other variables. In the multivariate analysis, a statistically significant higher mortality associated to volume was observed, but not with anticoagulation. CONCLUSIONS: Oral anticoagulation was associated with a higher initial volume of the haematoma, with no correlation between the INR value and volume. The HIC volume was directly related to mortality, however, like the volume, the INR was not associated with increased mortality.

Different clinical features of aortic intramural hematoma versus dissection involving the descending thoracic aorta.

OBJECTIVE: The objective of this study is to test the hypothesis that the absence of flow communication in aortic intramural hematoma (IMH) involving the descending aorta may have a different clinical course compared with aortic dissection (AD). METHODS: We prospectively evaluated clinical and echocardiographic data in AD (76 patients) and IMH (27 patients) of the descending thoracic aorta. RESULTS: Patients did not differ with regard to age, gender, or clinical presentation. IMH and AD had the same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Surgical treatment was more frequently selected in AD (39% vs. 22%, P < 0.01) and AD patients who underwent surgical treatment had higher mortality than those with IMH (36% vs. 17%, P < 0.01). There was no difference in mortality with medical treatment (14% in AD vs. 19% in IMH, P = 0.7). During follow-up, of 23 patients with IMH, 11 (47%) showed complete resolution or regression, 6 (26%) increased the diameter of the descending aorta, and typical AD developed in 3 patients (13%). No changes occurred in 14% of the group. Three-year survival rate did not show significant differences between both groups (82 +/- 6% in IMH vs. 75 +/- 7% in AD, P = 0.37). CONCLUSION: IMH of the descending thoracic aorta has a relatively frequent rate of complications at follow-up, including dissection and aneurysm formation. Medical treatment with very frequent imaging and timed elective surgery in cases with complications allows a better patient management.

[Clinical and tomographic aspects of hemorrhagic cerebrovascular disease associated with hypertensive crisis in adults under 50 years of age]. / Aspectos clínicos y tomográficos de la enfermedad cerebrovascular hemorrágica asociada con crisis hipertensiva en adultos menores de 50 años.

The purpose of this study was to analyze both the clinical and tomographic aspects of the hemorrhagic cerebrovascular disease (HCd), associated with hypertensive crisis in adults under 50 years of age. Forty six patients, who were not under anticoagulant therapy, were not using illegal drugs, who had not a cerebral tumor disease, and who had neither arteriovenous malformations nor past traumatic episodes, were studied. Seventy eight percent of the patients had preexisted arterial hypertension, 30% of them had at least a previous emergency for a hypertensive crisis. Mortality for intracerebral hematoma (ICH) and for subarachnoid hemorrhage (SAH) was 21% and 23% respectively. In 68% of the cases, ICH was located in the deep structures of the brain. Asymmetric ventricular system, compression or the absence of mesencephalic cisterna were significantly associated (p > 0.01; p > 0.001 respectively) with higher mortality. There was not a significant difference between the deceased and the survivors in relation with their systolic and diastolic arterial pressure on admission to the emergency unit. A significant positive relation was found between the severity of the injury (percentage of patients with an Scale Coma Glasgow < or = 8 points) and the mortality percentage for the type of HCd (r = 0.81 for ICH; p < 0.001, r = 0.98 for SAH; p < 0.001). Age and a low Scale Coma Glasgow score on the admission, represent unfavorable prognostic factors. Due to the different criteria used to evaluate the tomographic characteristics of intracerebral hematomas, comparisons of the present results with other findings can be difficult.

[Spontaneous intraparenchymatous hematomas. Experience with 134 cases]. / Hematomas intraparenquimatosos espontâneos. Experiência com 134 casos.

One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols--conservative, conservative with I.C.P. monitoring, and surgical--were different in each group. Results have shown an increased mortality (p < 0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.

Hematomas intraparenquimatosos espontâneos: experiência com 134 casos / Spontaneous intraparenchymatous hematomas: experience with 134 cases

Säo estudados 134 casos de hematomas intraparenquimatosos espontâneos. Os pacientes säo divididos em 6 grupos, obedecendo a critérios de topografia, nível de consciência e volume do hematoma. O tratamento variou segundo o grupo, sendo conservador, com ou sem monitorizaçäo da pressäo intracraniana, ou cirúrgico. Os resultados mostraram maior mortalidade (p < 0,50) nos pacientes que foram internados com maior comprometimento de consciência, nos acima de 50 anos e nos com hematoma quadrilateral, intraventricular ou de tronco. A mortalidade global do grupo estudado foi 26,1%

[Spontaneous intracerebral hematomas: study of 121 cases]. / Hematomas intracerebrais espontâneos: estudo de 121 casos.

Results are reported on the study of 121 patients committed by spontaneous intracerebral haematomas (HIE): mean age 53.4 years, 62.8% males, mean admission time of 36 hours (3 hours to 12 days) from onset; 63.5% were graded over 7 in the Glasgow scale and 81.9% were graded 3 or over in the Boterell scale. The HIE location was 45.5% in the basal ganglia, multilobar in 14.7%, lobar in 22.8%, brain stem in 4%, and cerebellum in 2%. The mean diameter was 46.6 mm (16-93) and mean area was 1422.9 mm2 (60-4818). CSF in 67 cases showed mean opening pressure of 234 mmH20 and mean protein content of 416.9 mg/dl. Treatment was conservative in 107 cases and surgical in 14; 55.8% cases survived. The majority of patients who died were graded 3 in the Boterell scale and below 9 in the Glasgow scale. It was found a statistical correlation between death and: low Glasgow and high Boterell scales grading, motor ocular nerve palsy, motor deficit, decerebration signs, bronchopneumonia, large diameter and area of hematomas. No statistical correlation was found regarding survival and treatment with dexamethasone, antifibrinolytics, anticonvulsants, antihypertensive drugs and diuretics. Use of mannitol, fall in the systolic blood pressure and surgical therapy increased the mortality rate. From 14 patients who underwent surgical drainage, 11 died. The main complication who lead to death was bronchopneumonia. A discussion is made on HIE pathogenesis, localization, present day incidence, clinical findings, death causes, size of hematomas and type of treatment used.

Hematomas intracerebrais espontâneos: estudo de 121 casos / Spontaneous intracerebral hematomas: study of 121 cases

Foram analisados retrospectivamente 121 pacientes com hematomas intracerebrais espontâneos (HIE): com média de idade de 53,4 ñ 14,8 anos, 62,8% do sexo masculino, tempo médio de sangramento na admissäo de 36 horas (3 horas a 12 dias); 63,5% estavam acima de 7 na escala de Galsgow e 81,9% com grau igual ou maior que 3 na escala de Botterel. Os HIE eram: em gânglios da base em 45.5%, multilobares em 14,7%, lobares em 22,8%, no tronco cerebral em 4% e cerebelares em 2%. Seus diâmetros médios eram de 46,6 mm (16 a 93) e a área média de 1422,9 mm2 (60 a 4818). O LCR em 67 casos revelou pressäo inicial média de 234 mmH20 (30 a 700) e concentraçäo protéica média de 416,9 mg/dl (30 a 1960). O tratamento foi conservador em 107 casos e cirúrgico em 14. Sobreviveram 55,8% dos pacientes; a maioria dos que faleceram estava em grau acima de 3 na escala de Boterell e abaixo de 9 na de Glasgow. Houve correlaçäo estatística entre a sobrevida e óbito com a escala de Glasgow e com a de Boterell, paralisia de músculos oculares, déficit motor, sinais de descerebraçäo, broncopneumonia, diâmetro e área do hematoma; näo houve relaçäo estatística com uso de dexametasona, antifibrinolítico, anticonvulsivantes e diuréticos. O uso de manitol e a queda da pressäo arterial nos primeiros dias tiveram relaçäo com maior mortalidade. Dos 14 casos submetidos a cirurgia, 11 faleceram. A principal complicaçäo que levou a óbito foi broncopneumonia. Säo feitos comentários sobre a patogenia dos HIE, incidência atual, sinais clínicos, localizaçäo, tamanho, causas de óbito e tratamento empregado em relaçäo ao prognóstico