RESUMO
La endocarditis infecciosa (EI) es una infección con alta morbimortalidad. Identificar a los pacientes con mayor riesgo de presentar complicaciones proporciona la oportunidad de establecer una terapéutica agresiva. El péptido natriurético tipo B es un estudio rápido y disponible, y se ha relacionado a los niveles elevados con una mala evolución en la EI. Objetivos: Determinar la asociación entre los niveles de péptido natriurético tipo B y la morbimortalidad en pacientes con EI. Material y métodos: Se incluyeron pacientes ≥15 años, durante el periodo de julio de 2010 a julio de 2012. Se dividieron en distintos grupos con base en los niveles de péptido natriurético tipo B: grupo 1, péptido natriurético tipo B < 400 pg/mL; grupo 2, ≥ 400 < 1,000 pg/mL, y grupo 3, ≥ 1,000 pg/mL. Se evaluó como punto primario el conjunto de muerte y los eventos embólicos, y dichos componentes de forma individual fueron tomados como puntos secundarios. Se empleó estadística descriptiva con medidas de tendencia central y de dispersión. La significancia estadística fue evaluada mediante p de Pearson y prueba de χ² . Resultados: Se incluyeron 57 pacientes: 23 (40.4%) correspondientes al grupo 1; 21 (36.8%) al grupo 2, y 13 (22.8%) al grupo 3. El punto primario (conjunto de muerte y eventos embólicos) fue mayor en el grupo 3 (57.1%) comparado con el grupo 1 (0%) y 2 (42.9%), p = 0.024. En cuanto a los puntos secundarios evaluados en forma individual, la mortalidad intrahospitalaria fue mayor en el grupo 3 (75%), p < 0.0001. La mortalidad tardía se presentó en un paciente del grupo 2, p = 0.41. Los eventos embólicos se presentaron con más frecuencia en el grupo 2 (57.9%), p = 0.020. Conclusiones: Este estudio demuestra la asociación entre los niveles elevados de péptido natriurético tipo B y la mayor morbimortalidad en pacientes con endocarditis infecciosa.
Infective endocarditis (IE) is an infection with high morbidity and mortality. Identify patients with increased risk for complications, provides the opportunity to establish an aggressive therapeutic. B-type natriuretic peptide is a quick, available and high levels has been linked with poor outcome in IE. Objectives: To determine the association between B-type natriuretic peptide levels and morbidity and mortality in patients with infective endocarditis. Material and methods: We included patients ≥ 15 years, during the period July 2010 to July 2012. They were divided into groups based on the levels of B-type natriuretic peptide, group 1 B-type natriuretic peptide < 400 pg/mL, group 2 B-type natriuretic peptide ≥ 400 < 1,000 pg/mL and group 3 ≥ 1,000 pg/mL. The association between elevated B-type natriuretic peptide and a composite outcome of death and embolic was evaluated as a primary endpoint and these components individually as a secondary points. Descriptive statistics were employed measures of central tendency and dispersion. Statistical significance was evaluated using p Pearson and χ² test. Results: We included 57 patients, 23 (40.4%) in the group 1; 21 (36.8%) to group 2, and 13 (22.8%) in the group 3. The primary point (composite of death and embolic events) was higher in group 3 (57.1%) compared with group 1 (0%) and 2 (42.9%), p = 0.024. The secondary endpoints evaluated individually, in-hospital mortality was higher in group 3 (75%), p < 0.0001. Late mortality was present in one patient in group 2, p = 0.41. Embolic events were more frequent in group 2 (57.9%) p = 0.020. Conclusions: This study demonstrates the association between elevated B-type natriuretic peptide and increased morbidity and mortality in patients with infective endocarditis.
RESUMO
Patent ductus arteriosus (PDA) is the most common congenital heart disease in Mexico. The clinical manifestations of the PCA are from asymptomatic patients to the presence of heart failure. Its management should be individualized based on clinical, hemodynamic data and presence of pulmonary hypertension. Our objective was to provide current medical recommendations based on the best, available scientific evidence for the diagnosis, study and therapeutic decisions of the PCA. Established a standardized sequence to search for Practice Guidelines, based on the clinical questions about PCA diagnosis and treatment. Most of the recommendations were taken from selected guidelines and supplemented with the remaining material. The information is expressed in levels of evidence (E) and grade of recommendation (R) according to the characteristics of the study design and type of publications. Currently produces large amounts of medical information in a relatively short period of time which is necessary to have evidence-based CPG to facilitate and standardize the diagnostic decision-treatment to provide better care for children and adults with PCA.
