Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
J Gen Intern Med ; 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33575909

RESUMO

BACKGROUND: Identification of patients on admission to hospital with coronavirus infectious disease 2019 (COVID-19) pneumonia who can develop poor outcomes has not yet been comprehensively assessed. OBJECTIVE: To compare severity scores used for community-acquired pneumonia to identify high-risk patients with COVID-19 pneumonia. DESIGN: PSI, CURB-65, qSOFA, and MuLBSTA, a new score for viral pneumonia, were calculated on admission to hospital to identify high-risk patients for in-hospital mortality, admission to an intensive care unit (ICU), or use of mechanical ventilation. Area under receiver operating characteristics curve (AUROC), sensitivity, and specificity for each score were determined and AUROC was compared among them. PARTICIPANTS: Patients with COVID-19 pneumonia included in the SEMI-COVID-19 Network. KEY RESULTS: We examined 10,238 patients with COVID-19. Mean age of patients was 66.6 years and 57.9% were males. The most common comorbidities were as follows: hypertension (49.2%), diabetes (18.8%), and chronic obstructive pulmonary disease (12.8%). Acute respiratory distress syndrome (34.7%) and acute kidney injury (13.9%) were the most common complications. In-hospital mortality was 20.9%. PSI and CURB-65 showed the highest AUROC (0.835 and 0.825, respectively). qSOFA and MuLBSTA had a lower AUROC (0.728 and 0.715, respectively). qSOFA was the most specific score (specificity 95.7%) albeit its sensitivity was only 26.2%. PSI had the highest sensitivity (84.1%) and a specificity of 72.2%. CONCLUSIONS: PSI and CURB-65, specific severity scores for pneumonia, were better than qSOFA and MuLBSTA at predicting mortality in patients with COVID-19 pneumonia. Additionally, qSOFA, the simplest score to perform, was the most specific albeit the least sensitive.

2.
Ann Med ; 53(1): 103-116, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33063540

RESUMO

BACKGROUND: Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS: This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS: Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS: Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.


Assuntos
Infecções por Coronavirus/mortalidade , Hiperglicemia/complicações , Pneumonia Viral/mortalidade , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Glicemia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Hiperglicemia/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Respiração Artificial/estatística & dados numéricos , Espanha/epidemiologia
3.
J Clin Med ; 9(10)2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32998337

RESUMO

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32928792

RESUMO

INTRODUCTION: This study assessed the efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in insufficiently controlled people with type 2 diabetes. RESEARCH DESIGN AND METHODS: COBALTA (for its acronym in Spanish, COntrol Basal durante la hospitalizacion y al ALTA) was a multicenter, open-label, single-arm, phase IV trial including 112 evaluable inpatients with type 2 diabetes insufficiently controlled (glycosylated hemoglobin (HbA1c) 8%-10%) with basal insulin and/or non-insulin antidiabetic drugs. Patients were treated with a basal-bolus-correction insulin regimen with Gla-300 during the hospitalization and with Gla-300 and/or non-insulin antidiabetics for 6 months after discharge. The primary endpoint was the HbA1c change from baseline to month 6 postdischarge. RESULTS: HbA1c levels decreased from 8.8%±0.6% at baseline to 7.2%±1.1% at month 6 postdischarge (p<0.001, mean change 1.6%±1.1%). All 7-point blood glucose levels decreased from baseline to 24 hours predischarge (p≤0.001, mean changes from 25.1±66.6 to 63.0±85.4 mg/dL). Fasting plasma glucose also decreased from baseline to 24 hours predischarge (p<0.001), month 3 (p<0.001) and month 6 (p<0.001) postdischarge (mean changes 51.5±90.9, 68.2±96.0 and 77.6±86.4 mg/dL, respectively). Satisfaction was high and hyperglycemia/hypoglycemia perception was low according to the Diabetes Treatment Satisfaction Questionnaire at month 6 postdischarge. The incidence of confirmed (glucose<70 mg/dL)/severe hypoglycemia was 25.0% during hospitalization and 59.1% 6 months after discharge. No safety concerns were reported. CONCLUSIONS: Inpatient and intensification therapy at discharge with Gla-300 improved significantly glycemic control of patients with type 2 diabetes insufficiently controlled with other basal insulin and/or non-insulin antidiabetic medication, with high treatment satisfaction. Gla-300 could therefore be a treatment choice for hospital and postdischarge diabetes management.

5.
Eur J Intern Med ; 47: 43-48, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28882417

RESUMO

BACKGROUND: An objective and simple prognostic model for hospitalized patients with hypoglycemia could be helpful in guiding initial intensity of treatment. METHODS: We carried out a derivation rule for hypoglycemia using data from a nationwide retrospective cohort study of patients with diabetes or hyperglycemia carried out in 2014 (n=839 patients). The rule for hypoglycemia was validated using a second data set from a nationwide retrospective cohort study carried out in 2016 (n=561 patients). We derived our prediction rule using logistic regression with hypoglycemia (glucose less than 70mg/dL) as the primary outcome. RESULTS: The incidence of hypoglycemia in the derivation cohort was 10.3%. Patient's characteristics independently associated with hypoglycemia included episodes of hypoglycemia during the previous three months (odds ratio [OR]: 6.29, 95% confidence interval [95%CI]: 3.37-11.79, p<0.001) estimated glomerular filtration rate lower than 30mL/min/1.73m2 (OR: 2.32, 95%CI: 1.23-4.35, p=0.009), daily insulin dose greater than 0.3units per Kg (OR: 1.74, 95%CI: 1.06-2.85, p=0.028), and days of hospitalization (OR: 1.03, 95%CI: 1.01-1.04, p=0.001). The model showed an area under the curve (AUC): 0.72 (95%CI: 0.66-0.78, p<0.001). The AUC in the validation cohort was: 0.71 (95%CI: 0.63-0.79, p<0.001). CONCLUSIONS: The rule showed fair accuracy to predict hypoglycemia. Implementation of the rule into computer systems could be used in guiding initial insulin therapy.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Hipoglicemia/epidemiologia , Pacientes Internados , Insulina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Hospitais , Humanos , Hipoglicemia/etiologia , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
6.
Mol Diagn Ther ; 18(6): 599-604, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24989720

RESUMO

Galectin-3 is a soluble ß-galactoside-binding lectin released by activated cardiac macrophages. Elevated levels of galectin-3 have been found to be associated with adverse outcomes in patients with heart failure. A number of recent studies suggest that galectin-3 may provide relevant information regarding the pathophysiologic process of heart failure. We analyzed the most recent and comprehensive studies which are focused on the association between galectin-3 and heart failure. Galectin-3 has also been associated with acute and chronic heart failure. Although most of the studies involved patients with heart failure and systolic dysfunction, galectin-3 seems to have more accurate role in heart failure with preserved left ventricular ejection fraction. However, the mechanism of this relationship and its clinical implications remain uncertain. Some studies have not been able to prove the association between galectin-3 and heart failure, so there are many questions to answer. Galectin-3 has also been involved to renal dysfunction, so it could be a mediator of worsening renal function. Serial measurement of galectin-3 could provide further prognostic information in heart failure patients.


Assuntos
Biomarcadores/metabolismo , Galectina 3/metabolismo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/terapia , Humanos , Prognóstico , Índice de Gravidade de Doença
7.
Med Clin (Barc) ; 142 Suppl 1: 59-65, 2014 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-24930086

RESUMO

Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF.


Assuntos
Insuficiência Cardíaca/terapia , Doença Aguda , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Síndrome Cardiorrenal/etiologia , Síndrome Cardiorrenal/prevenção & controle , Síndrome Cardiorrenal/terapia , Fármacos Cardiovasculares/uso terapêutico , Comorbidade , Complicações do Diabetes , Diuréticos/uso terapêutico , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Hiperglicemia/tratamento farmacológico , Hiperglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Ferro/uso terapêutico , Ventilação não Invasiva , Oxigenoterapia , Prognóstico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia
8.
Diabetes Res Clin Pract ; 104(3): 410-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24768593

RESUMO

AIMS: Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF. METHODS: We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-"Registro Nacional de Insuficiencia Cardiaca" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model. RESULTS: A total of 1082 patients (mean age 77.6±8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF. CONCLUSION: T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.


Assuntos
Anemia/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Função Ventricular Esquerda/fisiologia , Idoso , Anemia/mortalidade , Comorbidade , Feminino , Seguimentos , Insuficiência Cardíaca/patologia , Humanos , Incidência , Masculino , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Espanha/epidemiologia , Volume Sistólico/fisiologia , Taxa de Sobrevida
9.
Med. clín (Ed. impr.) ; 142(supl.1): 59-65, mar. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-141025

RESUMO

La diabetes, la enfermedad pulmonar obstructiva crónica (EPOC) y la anemia son comorbilidades con elevada prevalencia e impacto en la insuficiencia cardíaca (IC). El pronóstico de la IC aguda empeora considerablemente ante la presencia de estas comorbilidades. Los pacientes diabéticos tienen mayor probabilidad de desarrollar clínica de IC, y tanto el tratamiento de la diabetes como el de la IC aguda se ven alterados ante la coexistencia de ambas entidades. Los objetivos glucémicos en pacientes con IC aguda no están bien definidos, pero podrían comportarse con una curva en U. La hiperglucemia de estrés en pacientes con IC aguda no diabéticos también tiene un efecto muy deletéreo en el pronóstico a medio plazo. La interrelación entre EPOC e IC aguda dificulta la fase diagnóstica al compartir síntomas, signos y estudios complementarios. El tratamiento de la IC aguda también se ve modulado por la presencia de la EPOC. La anemia es muy prevalente y, a menudo, es la causa directa de la descompensación de la IC, siendo la ferropenia la etiología más frecuente. Las terapias de reposición de hierro, concretamente la disposición de preparados de administración intravenosa, han contribuido a mejorar el pronóstico de la IC aguda (AU)


Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF (AU)


Assuntos
Humanos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Síndrome Cardiorrenal/etiologia , Síndrome Cardiorrenal/prevenção & controle , Síndrome Cardiorrenal/terapia , Doença Aguda , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Comorbidade , Complicações do Diabetes , Diuréticos/uso terapêutico , Hiperglicemia/tratamento farmacológico , Hiperglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Ferro/uso terapêutico , Ventilação não Invasiva , Oxigenoterapia , Prognóstico
10.
Int J Cardiol ; 169(3): 177-82, 2013 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-24207066

RESUMO

AIMS: This study was conducted to determine whether galectin-3 (Gal3), a ß-galactoside-binding lectin, has usefulness to predict outcomes in patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF). METHODS AND RESULTS: We measured Gal3, urea, creatinine and natriuretic peptides on admission in 419 selected patients with HF and LVEF over 45%. The primary endpoint was all-cause mortality and/or readmission at one-year follow-up. Multivariable Cox proportional hazards models were generated for Gal3 and classical risk factors. We also evaluated the reclassification of patients on the basis of the different score category after adding Gal3 levels. A total of 219 patients had combined adverse events, and 129 patients died during the follow-up. Kaplan-Meir survival curve showed significantly increased primary endpoint and all-cause mortality according to quartiles of Gal3 (log rank, P<0.001). Serum Gal3 levels above median (13.8 ng/ml) was a significant predictor of primary endpoint risk after adjustment for age, estimated glomerular filtration rate, anemia, diabetes, serum sodium, brain natriuretic peptide levels, NYHA class and urea, respectively (hazard ratio 1.43, 95% CI 1.07-1.91 P=0.015). The reclassification index increased significantly after addition of Gal3 (9.5%, P<0.001) and the integrated discrimination index was 0.022, (P=0.001). The clinical prediction model with Gal3 increased the c-statistic from 0.711 to 0.731 (difference of 0.020, P=0.001). CONCLUSIONS: Serum Gal3 is a strong and independent predictor of unfavorable outcomes in patients with HF and preserved LVEF. We also demonstrated the improvement of adding the new biomarker to the model.


Assuntos
Galectina 3/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Volume Sistólico/fisiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos Prospectivos
11.
Med. clín (Ed. impr.) ; 141(10): 423-429, nov. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-126206

RESUMO

Fundamento y objetivos: La prevalencia de la insuficiencia cardiaca (IC) aumenta con la edad. Aunque la mortalidad de los enfermos ≥ 80 años con IC y fracción de eyección del ventrículo izquierdo (FEVI) preservada es muy elevada, no son bien conocidas las variables predictoras. El objetivo principal fue evaluar los factores predictores de mortalidad en este subgrupo de población anciana. Pacientes y métodos: Estudio observacional y prospectivo de pacientes hospitalizados por IC con FEVI preservada. Se evaluaron factores demográficos, clínicos, funcionales y analíticos en el momento del ingreso, con especial atención a las comorbilidades. El suceso evaluado fue la mortalidad total en el subgrupo de pacientes ≥ 80 años al año de seguimiento. Se estudiaron las variables predictoras mediante una regresión multivariante de Cox. Resultados: De un total de 218 pacientes, con una edad media (DE) de 75,6 (8,7) años, 75 pacientes (34,4%) tenían ≥ 80 años. La mortalidad en los pacientes de ≥ 80 años alcanzó el 42,7%, respecto al 26,6% para el grupo de menor edad (p < 0,001). Tras un análisis multivariante mediante regresión de Cox en los pacientes ≥ 80 años, la urea por encima de la mediana (hazard ratio [HR] 3,93; intervalo de confianza del 95% [IC 95%] 1,58-9,75; p = 0,003), la edad (HR 1,17; IC 95% 1,07-1,28; p < 0,001), la hiponatremia (HR 3,19; IC 95% 1,51-6,74; p = 0,002) y una menor puntuación en el índice de Barthel (IB) (HR 1.016; IC 95% 1.002-1.031; p = 0,034) fueron predictores independientes de mortalidad al año. Conclusiones: La urea, la edad, la hiponatremia y una menor puntuación en el IB podrían proponerse como predictores independientes de mortalidad en pacientes ≥ 80 años hospitalizados por IC con FEVI preservada (AU)


Background and objectives: The prevalence of heart failure (HF) increases with age. Even though the mortality of patients 80 years of age with HF and preserved left ventricle ejection fraction (LVEF) is very high, the predictor variables are not well-known. The main goal of this study was to evaluate the mortality predictor factors in this subgroup of the elderly population. Patients and methods: An observational and prospective study of patients hospitalized due to HF with preserved LVEF has been conducted. The demographic, clinical, functional and analytic factors were evaluated when the patients were admitted with special attention to the co-morbidities. The primary endpoint was the total mortality in the subgroup of patients 80 years of age after a year of follow-up. The predictor variables were studied by means of a multivariate Cox regression model. Results: From a total of 218 patients with an average age of 75.6 ( 8.7) years of age, 75 patients (34.4%) were 80 years. The mortality rate of patients 80 years of age totaled 42.7%, in relation to 26.6% for the lower age group (log-rank < .001). After a multivariate analysis using the Cox regression model in patients 80, the serum urea levels above the average (hazard ratio [HR] 3.93; 95% confidence interval [95% CI] 1.58-9.75; P = .003), the age (HR 1.17; 95% CI 1.07-1.28; P < .001), the hyponatremia (HR 3.19; 95% CI 1.51-6.74; P = .002) and a lower score on the Barthel index (BI) (HR 1.016; 95% CI 1.002-1.031; P = .034) were independent mortality predictors after an one-year follow-up. Conclusions: Serum urea levels, age, hyponatremia and a low BI score could be proposed as independent mortality predictors in patients 80 of age hospitalized for HF with preserved LVEF (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Risco Ajustado/métodos , Fatores de Risco , Idoso/estatística & dados numéricos , Volume Sistólico , Insuficiência Cardíaca Sistólica/complicações , Ureia/análise , Nitrogênio da Ureia Sanguínea , Biomarcadores/análise , Hiponatremia/epidemiologia
13.
Med Clin (Barc) ; 141(10): 423-9, 2013 Nov 16.
Artigo em Espanhol | MEDLINE | ID: mdl-23790575

RESUMO

BACKGROUND AND OBJECTIVES: The prevalence of heart failure (HF) increases with age. Even though the mortality of patients ≥ 80 years of age with HF and preserved left ventricle ejection fraction (LVEF) is very high, the predictor variables are not well-known. The main goal of this study was to evaluate the mortality predictor factors in this subgroup of the elderly population. PATIENTS AND METHODS: An observational and prospective study of patients hospitalized due to HF with preserved LVEF has been conducted. The demographic, clinical, functional and analytic factors were evaluated when the patients were admitted with special attention to the co-morbidities. The primary endpoint was the total mortality in the subgroup of patients ≥ 80 years of age after a year of follow-up. The predictor variables were studied by means of a multivariate Cox regression model. RESULTS: From a total of 218 patients with an average age of 75.6 (±8.7) years of age, 75 patients (34.4%) were ≥ 80 years. The mortality rate of patients ≥ 80 years of age totaled 42.7%, in relation to 26.6% for the lower age group (log-rank<.001). After a multivariate analysis using the Cox regression model in patients ≥ 80, the serum urea levels above the average (hazard ratio [HR] 3.93; 95% confidence interval [95% CI] 1.58-9.75; P = .003), the age (HR 1.17; 95% CI 1.07-1.28; P<.001), the hyponatremia (HR 3.19; 95% CI 1.51-6.74; P = .002) and a lower score on the Barthel index (BI) (HR 1.016; 95% CI 1.002-1.031; P = .034) were independent mortality predictors after an one-year follow-up. CONCLUSIONS: Serum urea levels, age, hyponatremia and a low BI score could be proposed as independent mortality predictors in patients ≥ 80 of age hospitalized for HF with preserved LVEF.


Assuntos
Insuficiência Cardíaca/mortalidade , Volume Sistólico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Nitrogênio da Ureia Sanguínea , Peso Corporal , Doenças Cardiovasculares/epidemiologia , Comorbidade , Cistatina C/sangue , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Humanos , Hiponatremia/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
14.
Eur J Intern Med ; 24(4): 346-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23433980

RESUMO

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFPEF) represent an important group of patients presenting in clinical practice. However, whether it is an earlier stage of heart failure with reduced ejection fraction (HFREF) remains uncertain. We evaluated the potential progression of HFPEF to HFREF. METHODS AND RESULTS: We evaluated retrospectively 178 patients (mean age 80.5±5.8 years; 75.3% females) with heart failure with preserved ejection fraction from a specialized Internal Medicine unit, offering an integrated usual care. Diagnosis of heart failure with preserved ejection fraction was made according to European guidelines. The main objective was to evaluate the progression to systolic dysfunction, defined by left ventricular ejection fraction less than 45%. Mean baseline left ventricular ejection fraction was 64.6±7.2. After a mean follow-up of 24-months, mean baseline ejection fraction was 67.1±9.3%. Only five patients (2.8%) progressed to HFREF. Brain natriuretic peptide values were significantly higher in those patients who progressed. CONCLUSIONS: These results strongly suggest that heart failure with preserved and reduced ejection fraction could be distinct pathophysiological entities, at least in elderly patients.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Peptídeos Natriuréticos/sangue , Volume Sistólico/fisiologia , Disfunção Ventricular/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Fenótipo , Disfunção Ventricular/fisiopatologia
15.
Eur J Intern Med ; 23(7): 599-603, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22939803

RESUMO

BACKGROUND: Cystatin C (CysC) is a good prognostic marker in heart failure. However, there is not much information of CysC combined with other biomarkers in acute heart failure (AHF). AIM: To assess prognostic value of CysC and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients hospitalized for AHF with no apparent deterioration of renal function. DESIGN: Prospective, multicenter, observational study. METHODS: CysC and NTpro-BNP were measured in patients consecutively admitted with a diagnosis of AHF. Patients with, NTpro-BNP concentration above 900 pg/mL and serum creatinine below 1.3mg/dL, were included for statistical analysis. End-point of the study was all-cause mortality during a 12-month follow-up. RESULTS: 526 patients with AHF and NTpro-BNP concentration above 900 pg/mL were included in the study. From this group, 367 patients (69.8%) had serum creatinine below 1.3mg/dL. Receiver operating characteristic (ROC) curves were used to determine the best cut-off value for CysC. Patients with a concentration of CsyC above 1.25mg/dL had a 37.8% mortality rate, vs. 13.6% for those below cut-off (p<0.001). After Cox proportional hazard model, age, CysC, low total cholesterol and HF with preserved ejection fraction remained significantly associated with all-cause mortality during one-year follow-up. CONCLUSIONS: In AHF and normal or slightly impaired renal function, performance of CysC may be superior to NT-proBNP. Hence, CysC may be the preferred biomarker in the assessment of patients with AHF and slightly impaired renal function.


Assuntos
Cistatina C/sangue , Insuficiência Cardíaca/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Creatinina/sangue , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC
17.
J Card Fail ; 17(1): 31-8, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21187262

RESUMO

BACKGROUND: Cystatin C has emerged as a new biomarker of renal function that has been found to predict adverse cardiovascular outcomes, especially heart failure (HF). Evidence of the usefulness of cystatin C in patients with heart failure with preserved ejection fraction (HFPEF) remains sparse. It is hypothesized that serum cystatin C levels in HFPEF has prognostic value. METHODS AND RESULTS: Cystatin C, urea nitrogen, creatinine, and N-terminal proBNP-type natriuretic peptide levels were measured on admission in 218 consecutive patients with HF and left ventricular ejection fraction >45%, as measured by Doppler echocardiography. The primary end point was all-cause mortality and/or readmission at 1 year. We determined the adjusted hazard ratio (HR) by Cox regression model. During the 1-year follow-up period, 70 patients (32.2%) died, and 126 patients (57.8%) died and/or required rehospitalization. Serum cystatin C levels by quartiles were associated with increased risk for adverse events. Kaplan-Meier survival curves showed significantly increased primary end point with each quartile of cystatin C (log rank <0.001). Patients in the highest quartile of cystatin C level were at increased adjusted risk for the primary end point (HR 3.40; 95% confidence interval [CI] 1.86-6.21; P < .0001) and all-cause mortality (HR 8.14; 95% CI 1.21-23.26; P < .01). Furthermore, high serum cystatin C levels were also associated with poor prognosis despite normal or mildly reduced renal function. CONCLUSIONS: Serum cystatin C level on admission in patients with HFPEF is a strong and independent predictor of an unfavorable outcome. This relationship remains in patients without advanced renal dysfunction.


Assuntos
Cistatina C/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Admissão do Paciente , Volume Sistólico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/tendências , Readmissão do Paciente/tendências , Prognóstico , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...