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1.
BMC Infect Dis ; 21(1): 674, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34247585

RESUMO

BACKGROUND: Anemia, which is a condition with reduced healthy red blood cells, is reported to be closely related to the development of infectious diseases. We aimed to investigate the association between history of anemia and 12-year mortality rate due to infections, and compare it with that among non-anemic individuals. METHODS: Data from the National Health Insurance Service Health Screening Cohort were used in this population-based cohort study. Adults who underwent standardized medical examination between and 2002-2003 were included, and the mortality rate due to infection between 2004 and 2015 was analyzed. Individuals were considered to have a history of anemia if the serum hemoglobin level in 2002-2003 was < 12 g/dL for women and < 13 g/dL for men. The severity of anemia at that time was categorized as mild (12 g/dL > hemoglobin ≥11 g/dL in women and 13 g/dL > hemoglobin ≥11 g/dL in men), moderate (hemoglobin 8-10.9 g/dL), or severe (hemoglobin < 8 g/dL). Propensity score (PS) matching and Cox regression analysis were used as statistical methods. RESULTS: Overall, 512,905 individuals were included in this study. The mean age of the participants was 54.5 years old (range: 40-98), and 49,042 (9.6%) individuals were classified in the anemic group, which comprised of 36,383 (7.1%), 11,787 (2.3%), and 872 (0.2%) participants in the mild, moderate, and severe sub-groups, respectively. After PS matching, 49,039 individuals in each group were included in the analysis. The risk of mortality due to infection in the anemic group was 1.77-fold higher (hazard ratio [HR]: 1.77, 95% confidence interval [CI]: 1.52-2.60; P < 0.001) than that in the non-anemic group. In the subgroup analysis, the mild and moderate anemia groups had 1.38-fold (HR: 1.38, 95% CI: 1.23 to 1.55; P < 0.001) and 2.02-fold (HR: 2.02, 95% CI: 1.62 to 2.50; P < 0.001) risk of mortality due to infection compared to that of the non-anemic group, respectively. The severe anemia group did not have a significantly different risk of mortality due to infection (P = 0.448). CONCLUSIONS: History of anemia was associated with increased mortality rate due to infection at 12-year follow-up.


Assuntos
Anemia/complicações , Infecções/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Hemoglobinas/análise , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , República da Coreia , Fatores de Tempo
2.
Georgian Med News ; (314): 107-110, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34248037

RESUMO

Anemia and iron deficiency (ID) are important and common comorbidities that often coexist in patients with heart failure (HF). Both conditions, together or independently, are associated with poor clinical status and worse outcomes. The aim of our research was to study prevalence and clinical impact of ID and anemia in HF patients attending cardiology department of our hospital. We studied 133 patients with HF who have been admitted to hospital since September 2019: 78 (58.6%) patient had ID, 55 (42.4%) with HF and without ID were included in the control group. Patient baseline assessment included a standardized HF history regarding HF etiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class. Blood samples were drawn for the assessment of a full blood count and clinical chemistry, including iron and serum ferritin and kidney function (creatinine). Assessment of exercise capacity was performed by a 6-min walk test. ID was present in 78(58.6%) patients. 70(52.6%) patients from 133 presented with anemia. Most patients in both groups are men, patients with ID were elderly, in both groups, most patients had arterial hypertension, more patients with ID had diabetes mellitus, HF etiology was predominantly ischemic in both groups, most patients were with NYHA class III, patients with ID had significantly low LVEF. No differences were recorded for body weight, diastolic blood pressure, platelets, eGFR or serum creatinine, no such differences were found regarding hypertension and chronic obstructive pulmonary disease. There was a highly significant association between hemoglobin and serum ferritin in patients with ID, but in patients without ID, this association was only of borderline significance. The presence of anemia, ID, or both was associated with significantly higher NYHA class. We found that gender, NYHA class, LVEF, the presence of anemia, eGFR all predicted lower exercise capacity.


Assuntos
Anemia Ferropriva , Anemia , Insuficiência Cardíaca , Idoso , Anemia/complicações , Anemia/epidemiologia , Anemia Ferropriva/complicações , Anemia Ferropriva/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitais , Humanos , Masculino , Prevalência
3.
Behav Neurol ; 2021: 8360627, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34306250

RESUMO

Methods: We systematically searched articles on electronic databases such as PubMed, Embase, Scopus, and Google Scholar between January 1, 2000 and July 30, 2020. Articles were independently evaluated by two authors. We included observational studies (case-control and cohort) and calculated the risk ratios (RRs) for associated with anemia and PD. Heterogeneity among the studies was assessed using the Q and I 2 statistic. We utilized the random-effect model to calculate the overall RR with 95% CI. Results: A total of 342 articles were identified in the initial searches, and 7 full-text articles were evaluated for eligibility. Three articles were further excluded for prespecified reasons including insufficient data and duplications, and 4 articles were included in our systematic review and meta-analysis. A random effect model meta-analysis of all 4 studies showed no increased risk of PD in patients with anemia (N = 4, RRadjusted = 1.17 (95% CI: 0.94-1.45, p = 0.15). However, heterogeneity among the studies was significant (I 2 = 92.60, p = <0.0001). The pooled relative risk of PD in female patients with anemia was higher (N = 3, RRadjusted = 1.14 (95% CI: 0.83-1.57, p = 0.40) as compared to male patients with anemia (N = 3, RRadjusted = 1.09 (95% CI: 0.83-1.42, p = 0.51). Conclusion: This is the first meta-analysis that shows that anemia is associated with higher risk of PD when compared with patients without anemia. However, more studies are warranted to evaluate the risk of PD among patients with anemia.


Assuntos
Anemia , Doença de Parkinson , Anemia/complicações , Anemia/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Risco
4.
Nutrients ; 13(5)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066873

RESUMO

To evaluate whether women with anaemia or high haemoglobin (Hb) in early pregnancy would be at higher risk of miscarriage, this population-based cohort study involved 9453 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories were used to collect: Hb measurements (up to 14 weeks of gestation), miscarriage before or by 24 weeks of gestation, and other maternal characteristics. The relation between anaemia (Hb < 110 g/L), normal Hb (110-140 g/L, reference), and high Hb concentrations (≥140 g/L) with miscarriage were expressed as adjusted OR with 95%CI. Restricted cubic spline models were applied to evaluate the dose-response relationships. A total of 520 (5.5%) women were recorded as having a miscarriage. The rate of miscarriage in anaemia, normal Hb, and high Hb concentrations was 8.4%, 5.1%, and 10.2%, respectively. Compared with women with normal Hb at the first trimester, the multivariable-adjusted OR for miscarriage was 2.11 (95%CI, 1.38-3.21) for women with anaemia and 1.83 (95%CI, 1.29-2.58) for women with high Hb. Hb concentrations showed a U-shaped association with miscarriage, with the lowest incidence among women with Hb of 120-130 g/L. These data highlight the importance of considering anaemia and high Hb levels in early pregnancy as harmful indicators for miscarriage.


Assuntos
Aborto Espontâneo/epidemiologia , Anemia/epidemiologia , Hemoglobinas/análise , Complicações Hematológicas na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez/sangue , Aborto Espontâneo/etiologia , Adulto , Anemia/complicações , Estudos de Coortes , Feminino , Humanos , Incidência , Razão de Chances , Gravidez , Complicações Hematológicas na Gravidez/etiologia , Fatores de Risco
5.
Thromb Res ; 203: 155-162, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34023735

RESUMO

INTRODUCTION: Clinical characteristics and outcomes of venous thromboembolism (VTE) patients with concomitant anemia are unclear. This study compares baseline characteristics, treatment patterns, and 24-month outcomes in patients with and without anemia within GARFIELD-VTE. MATERIALS AND METHODS: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a global, prospective, non-interventional registry of real-world treatment practices. Of the 10,679 patients enrolled in GARFIELD-VTE, 7698 were eligible for analysis. Primary outcomes were all-cause mortality, recurrent VTE, and major bleeding in VTE patients with or without concomitant anemia over 24-months after diagnosis. Event rates and 95% confidence intervals were estimated using Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models. RESULTS: Distribution of VTE events in 2771 patients with anemia and 4927 without anemia was similar (deep-vein thrombosis alone: 61·1% vs. 55·9%, pulmonary embolism ± deep vein thrombosis: 38·9% vs. 44·0%, respectively). Patients with anemia were older (62.6 year vs. 58.9 years) than those without. At baseline, VTE risk factors that were more common in patients with anemia included hospitalization (22·0% vs. 6·8%), surgery (19·2% vs. 8·2%), cancer (20·1% vs. 5·6%) and acute medical illness (8·3% vs. 4·2%). Patients with anemia were more likely to receive parenteral anticoagulation therapy alone than those without anemia (26·6% vs. 11·7%) and less likely to receive a direct oral anticoagulant (38·5% vs. 53·5%). During 24-months of follow-up, patients with anemia had a higher risk (adjusted hazard ratio [95% confidence interval]) of all-cause mortality (1·84 [1·56-2·18]), major bleeding (2·83 [2·14-3·75]). Among anemia patients, the risk of all-cause mortality and major bleeding remained higher in patients with severe anemia than in those with mild/moderate anemia, all-cause mortality: HR 1·43 [95% CI: 1·21-1·77]; major bleeding: HR 2·08 [95% CI: 1·52-2·86]). CONCLUSIONS: VTE patients with concomitant anemia have a higher risk of adverse clinical outcomes compared with those without anemia. Further optimization of anticoagulation therapy for VTE patients with anemia is warranted.


Assuntos
Anemia , Embolia Pulmonar , Tromboembolia Venosa , Anemia/complicações , Anticoagulantes/uso terapêutico , Humanos , Estudos Prospectivos , Tromboembolia Venosa/complicações
6.
J Bone Miner Res ; 36(7): 1211-1219, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33949002

RESUMO

Erythropoietin (EPO) is the primary regulator of bone marrow erythropoiesis. Mouse models have provided evidence that EPO also promotes bone remodeling and that EPO-stimulated erythropoiesis is accompanied by bone loss independent of increased red blood cell production. EPO has been used clinically for three decades to treat anemia in end-stage renal disease, and notably, although the incidence of hip fractures decreased in the United States generally after 1990, it rose among hemodialysis patients coincident with the introduction and subsequent dose escalation of EPO treatment. Given this clinical paradox and findings from studies in mice that elevated EPO affects bone health, we examined EPO treatment as a risk factor for fractures in hemodialysis patients. Relationships between EPO treatment and hip fractures were analyzed using United States Renal Data System (USRDS) datasets from 1997 to 2013 and Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) datasets for 2013. Fracture risks for patients treated with <50 units of EPO/kg/week were compared to those receiving higher doses by multivariable Cox regression. Hip fracture rates for 747,832 patients in USRDS datasets (1997-2013) increased from 12.0 per 1000 patient years in 1997 to 18.9 in 2004, then decreased to 13.1 by 2013. Concomitantly, average EPO doses increased from 11,900 units/week in 1997 to 18,300 in 2004, then decreased to 8,800 by 2013. During this time, adjusted hazard ratios for hip fractures with EPO doses of 50-149, 150-299, and ≥ 300 units/kg/week compared to <50 units/kg/week were 1.08 (95% confidence interval [CI], 1.01-1.15), 1.22 (95% CI, 1.14-1.31), and 1.41 (95% CI, 1.31-1.52), respectively. Multivariable analyses of 128,941 patients in CROWNWeb datasets (2013) replicated these findings. This study implicates EPO treatment as an independent risk factor for hip fractures in hemodialysis patients and supports the conclusion that EPO treatment may have contributed to changing trends in fracture incidence for these patients during recent decades. Published 2021. This article is a U.S. Government work and is in the public domain in the USA. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).


Assuntos
Anemia , Eritropoetina , Fraturas do Quadril , Falência Renal Crônica , Anemia/complicações , Anemia/tratamento farmacológico , Anemia/epidemiologia , Animais , Fraturas do Quadril/epidemiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Camundongos , Diálise Renal , Estados Unidos/epidemiologia
7.
World J Surg ; 45(8): 2326-2336, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34002269

RESUMO

BACKGROUND: Anemia is common before major abdominal surgery (35%). It is an independent factor for postoperative complications and longer length of stay (LOS). The aim of this study was to evaluate the extent to which preoperative anemia impacts on enhanced recovery programs (ERP) outcomes. MATERIALS AND METHODS: The data for patients scheduled for colorectal surgery between 2015 and 2019, were analyzed (n = 494). All patients were managed with the same ERP. Demographic data, preoperative risk factors, postoperative complications, LOS and adherence to ERP were compared between anemic and non-anemic patients. Anemia was defined by a hemoglobin concentration < 13 g dL-1 in men and < 12 g dL-1 in women. RESULTS AND DISCUSSION: In total, 173 patients had preoperative anemia. They were older (p < 0.001) and more often male (p = 0.02). The following risk factors were significantly more frequent in the anemic group: renal failure (p = 0.04), malnutrition (p < 0.001), cardiac arrhythmia (p < 0.001), coronaropathy (p = 0.02) and anticoagulant treatment (p < 0.001). Despite more risk factors, anemic patients did not experience more postoperative complications (38.2% vs. 31.2%, p = 0.12). Overall adherence to ERP was similar (18 [16-19] vs. 18 [17-19], p = 0.06). LOS was 4 [3-7] and 3 [2-6.25] days in the anemic and the non-anemic groups, respectively (p < 0.002). Multivariate analysis showed that anemia did not affect LOS (p = 0.27). CONCLUSION: Our study suggests that preoperative anemia does not detract from the benefits of ERP after elective colorectal surgery.


Assuntos
Anemia , Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Anemia/complicações , Anemia/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
9.
J Cardiothorac Surg ; 16(1): 109, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33892775

RESUMO

BACKGROUND: Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery. METHODS: This study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day. RESULTS: Preoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day. CONCLUSIONS: Preoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.


Assuntos
Anemia/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Cardiopatias/cirurgia , Idoso , Transfusão de Sangue , Ponte Cardiopulmonar , Feminino , Taxa de Filtração Glomerular , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pré-Operatórios , Período Pré-Operatório , Prevalência , Estudos Retrospectivos
10.
ANZ J Surg ; 91(5): E280-E285, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33851493

RESUMO

BACKGROUND: Anaemia is a common manifestation of colorectal cancer (CRC). However, appropriate workup prior to surgery and the effect of anaemia on outcomes have not been well defined. This study aimed to describe preoperative anaemia incidence, investigations performed, treatment and associated complications in a CRC surgical population at a single large tertiary institution in Australia. METHODS: Patients who received surgery with curative intent for CRC between 2012 and 2017 were identified from a prospectively maintained database. Demographic and clinical outcome data were analysed. RESULTS: In total, 754 patients with CRC were included. Anaemia was found in 350 (46.4%) patients, of which 124 (35.4%) were microcytic, 20 (5.7%) were macrocytic and 206 (58.9%) were normocytic. Older patients were more likely to have anaemia (mean age 70.28 years, standard deviation (SD) 12.98 versus 64.74 years, SD 11.74). Only 89 patients (25.4%) were tested for iron deficiency, and of these, 76 (85.4%) were found to be iron deficient and 42 (47.7%) had low ferritin. Preoperative anaemia was associated with a higher incidence of postoperative complications (adjusted odds ratio (OR) 1.46, 95%, CI 1.04-2.05; P = 0.03) and a longer length of stay (LOS; average 1.8 days; 95% CI 0.3-3.3 days). CONCLUSION: A significant proportion of CRC patients had anaemia and the majority were normocytic. Only a small number of anaemic patients were tested for iron deficiency. Preoperative anaemia had an adverse effect on LOS and postoperative complications. The evaluation of anaemic patients is essential in CRC patients undergoing surgery.


Assuntos
Anemia , Neoplasias Colorretais , Idoso , Anemia/complicações , Anemia/epidemiologia , Austrália/epidemiologia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Humanos , Ferro , Resultado do Tratamento
12.
Clin Transl Oncol ; 23(5): 931-939, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33768441

RESUMO

Anaemia is defined by the presence of haemoglobin (Hb) levels < 13 g/dL in men and 12 g/dL in women. Up to 39% of cancer patients present it at the time of diagnosis and up to 40% have iron deficiency. Anaemia causes fatigue, functional deterioration and a reduction in the quality of life; it has also been associated with a poorer response to anti-tumour treatment and lower survival. Basic diagnostic tests for anaemia are simple and should be a routine part of clinical practice. These guidelines review the available evidence on the use of different therapies for treating anaemia: erythropoiesis-stimulating agents, iron supplements, and transfusion of blood products.


Assuntos
Anemia/diagnóstico , Anemia/terapia , Hematínicos/uso terapêutico , Ferro/administração & dosagem , Neoplasias/complicações , Algoritmos , Anemia/sangue , Anemia/complicações , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Diagnóstico Diferencial , Suplementos Nutricionais/efeitos adversos , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/métodos , Feminino , Hematínicos/efeitos adversos , Humanos , Ferro/efeitos adversos , Masculino , Oncologia , Neoplasias/mortalidade , Qualidade de Vida , Sociedades Médicas , Espanha
13.
J Pediatr Hematol Oncol ; 43(4): e486-e493, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625076

RESUMO

Diastolic dysfunction is a known cause of mortality in adults with sickle cell disease (SCD). Left atrial function (LAf) and strain (LAS) are novel echocardiographic parameters to assess early diastolic dysfunction, which have not been assessed in pediatric SCD. Through a retrospective single-center study, we describe echocardiographic parameters of diastology in children with SCD and evaluate their relationship with clinical variables including anemia and blood pressure. Baseline clinical data, 24-hour ambulatory blood pressure monitoring data and echocardiography results were collected. LAf and LAS were measured using volumetric data and speckle-tracking echocardiography, respectively. Sixty-seven children with SCD (13.5±7 y, 47% male, 7% hypertensive) with a mean hemoglobin of 8.8±1.3 g/dL, LAf of 61±8% (n=53) and LAS of 46.3±7.4% (n=28) were included. LAS was significantly associated with hemoglobin (ρ=0.43, P=0.022) but not with maximal left atrial (LA) volume (ρ=-0.05, P=0.79) or any blood pressure parameters. On multivariate analysis, LAS decreased by 3.2% (1.3, 5.1) and LA volume increased by 1.6 mL/m2 (3.1, 0.08) for every 1 g/dL decrease in hemoglobin. Thus, severity of baseline anemia in pediatric SCD correlates with diastolic function as measured by LAS, independent of LA dilation.


Assuntos
Anemia Falciforme/fisiopatologia , Anemia/fisiopatologia , Pressão Sanguínea , Diástole , Adolescente , Anemia/complicações , Anemia Falciforme/complicações , Criança , Pré-Escolar , Feminino , Coração/fisiopatologia , Humanos , Masculino
14.
JAMA ; 325(6): 552-560, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33560322

RESUMO

Importance: The optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear. Objective: To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy. Design, Setting, and Participants: Open-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL. Enrollment could be considered at any time during the index admission for myocardial infarction. The first participant was enrolled in March 2016 and the last was enrolled in September 2019. The final 30-day follow-up was accrued in November 2019. Interventions: Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin ≤8; n = 342) or a liberal (transfusion triggered by hemoglobin ≤10 g/dL; n = 324) transfusion strategy. Main Outcomes and Measures: The primary clinical outcome was major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days. Noninferiority required that the upper bound of the 1-sided 97.5% CI for the relative risk of the primary outcome be less than 1.25. The secondary outcomes included the individual components of the primary outcome. Results: Among 668 patients who were randomized, 666 patients (median [interquartile range] age, 77 [69-84] years; 281 [42.2%] women) completed the 30-day follow-up, including 342 in the restrictive transfusion group (122 [35.7%] received transfusion; 342 total units of packed red blood cells transfused) and 324 in the liberal transfusion group (323 [99.7%] received transfusion; 758 total units transfused). At 30 days, MACE occurred in 36 patients (11.0% [95% CI, 7.5%-14.6%]) in the restrictive group and in 45 patients (14.0% [95% CI, 10.0%-17.9%]) in the liberal group (difference, -3.0% [95% CI, -8.4% to 2.4%]). The relative risk of the primary outcome was 0.79 (1-sided 97.5% CI, 0.00-1.19), meeting the prespecified noninferiority criterion. In the restrictive vs liberal group, all-cause death occurred in 5.6% vs 7.7% of patients, recurrent myocardial infarction occurred in 2.1% vs 3.1%, emergency revascularization prompted by ischemia occurred in 1.5% vs 1.9%, and nonfatal ischemic stroke occurred in 0.6% of patients in both groups. Conclusions and Relevance: Among patients with acute myocardial infarction and anemia, a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of MACE after 30 days. However, the CI included what may be a clinically important harm. Trial Registration: ClinicalTrials.gov Identifier: NCT02648113.


Assuntos
Anemia/terapia , Transfusão de Sangue , Infarto do Miocárdio/terapia , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Hemoglobinas/análise , Humanos , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações
15.
BMC Urol ; 21(1): 31, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639914

RESUMO

BACKGROUND : This study aimed to determine the prognostic value of preoperative blood parameters in renal cell carcinoma (RCC) and tumour thrombus (TT) patients that were surgically treated. METHOD: We retrospectively analysed clinicopathological data and blood parameters of 146 RCC and TT patients that were surgically treated. Univariate or multivariate Cox regression analyses were performed to determine the risk factors associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier analysis and logistic regression were performed to study the risk factors. Receiver operating characteristic curves were applied to test improvements in the predictive accuracy of the established prognosis score. RESULTS: On univariate and multivariate analysis, anaemia (HR 2.873, P = 0.008) and lymph node metastasis (HR 4.811, P = 0.015) were independent prognostic factors linked to OS. Besides, thrombocytosis (HR 2.324, P = 0.011), histologic subtype (HR 2.835, P = 0.004), nuclear grade (HR 2.069, P = 0.033), and lymph node metastasis (HR 5.739, P = 0.001) were independent prognostic factors associated with PFS. Kaplan-Meier curves revealed that patients with anaemia exhibited worse OS than those without it (P = 0.0033). Likewise, patients with thrombocytosis showed worse PFS than those without it (P < 0.0001). Adding the anaemia and thrombocytosis to the SSIGN score improved its predictive accuracy related to OS and PFS. Preoperative anaemia was linked to more symptom at presentation (OR 3.348, P = 0.006), longer surgical time (OR 1.005, P = 0.001), more blood loss (OR 1.000, P = 0.018), more transfusion (OR 2.734, P = 0.004), higher thrombus level (OR 4.750, P = 0.004) and higher nuclear grade (OR 3.449, P = 0.001) while thrombocytosis was associated with more symptom at presentation (OR 7.784, P = 0.007). CONCLUSIONS: Preoperative anaemia and thrombocytosis were adverse prognostic factors in non-metastatic RCC patients with TT. Also, both preoperative anaemia and thrombocytosis can be clinically used for risk stratification of non-metastatic RCC and TT patients.


Assuntos
Anemia/complicações , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/cirurgia , Células Neoplásicas Circulantes , Trombocitose/complicações , Idoso , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
16.
Neurosciences (Riyadh) ; 26(1): 15-20, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530038

RESUMO

OBJECTIVES: To assess cerebral venous thrombosis risk factors, and associated clinical outcomes in Jazan region, Kingdom of Saudi Arabia. METHODS: This study is a retrospective review of the medical records of patients diagnosed with cerebral venous thrombosis and admitted to King Fahad Central Hospital in Jazan between 2010 and 2019. Data concerning socio-demographics, clinical features, risk factors, laboratory, and imaging investigations were retrieved. Furthermore, data about cases management, and outcomes, including death, were collected and analysed. RESULTS: A total of 51 medical records were identified. The majority of the patients were females (68.6%), and the mean age of the patients was 33.3 years, of which three patients were under 18 years old. The most frequently recorded symptom was headache (76.5%), followed by seizure (45.1%). The most commonly recorded risk factor was protein S deficiency (57%), followed by anaemia (51%). Venous infarction and haemorrhage were the most common acute complications (13.7%). The majority of the patients had a favourable prognosis where only 27.5% recovered with disability and only one patient died due to the disease. CONCLUSION: Clinical presentation of cerebral venous thrombosis in Jazan region is similar to other local and international studies. However, anaemia was recorded as a main risk factor for the disease, which might require further investigation to assess the possible association between prevalence of anaemia in Jazan region and the incidence of cerebral venous thrombosis.


Assuntos
Anemia/complicações , Trombose Intracraniana/etiologia , Deficiência de Proteína S/complicações , Trombose Venosa/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Trombose Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Fatores Sexuais , Trombose Venosa/epidemiologia , Adulto Jovem
17.
Nutrients ; 13(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33535496

RESUMO

Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.


Assuntos
Anemia/complicações , Ferro/sangue , Estilo de Vida , Neoplasias/complicações , Anemia/sangue , Anemia Ferropriva/sangue , Animais , COVID-19 , Dieta , Alimentos Fortificados , Microbioma Gastrointestinal , Hepcidinas/sangue , Homeostase , Humanos , Inflamação/sangue , Fígado/metabolismo , Músculo Esquelético
18.
Anesth Analg ; 132(4): 1101-1111, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33543869

RESUMO

BACKGROUND: Preoperative anemia is common in cardiac surgery, yet there were limited data describing the role of sex in the associations between anemia and clinical outcomes. Understanding these relationships may guide preoperative optimization efforts. METHODS: This is an observational cohort study of adults undergoing isolated coronary artery bypass grafting or single- or double-valve surgery from 2008 to 2018 at a large tertiary medical center. Multivariable regression assessed the associations between preoperative hemoglobin concentrations and a primary outcome of postoperative acute kidney injury (AKI) and secondary outcomes of perioperative red blood cell (RBC) transfusion, reoperation, vascular complications (ie, stroke, pulmonary embolism, and myocardial infarction), and hospital length of stay (LOS). Each outcome was a single regression model, using interaction terms to assess sex-specific associations between hemoglobin and outcome. RESULTS: A total of 4117 patients were included (57% men). Linear splines with sex-specific knots (13 g/dL in women and 14 g/dL in men) provided the best overall fit for preoperative hemoglobin and outcome relationships. In women, each 1 g/dL decrease in hemoglobin <13 g/dL was associated with increased odds of AKI (odds ratio = 1.49; 95% confidence interval [CI], [1.23-1.81]; P < .001), and there was no significant association between hemoglobin per 1 g/dL >13 g/dL and AKI (0.90 [0.56-1.45]; P = .67). The association between hemoglobin and AKI in men did not meet statistical significance (1.10 [0.99-1.22]; P = .076, per 1 g/dL decrease <14 g/dL; 1.00 [0.79-1.26]; P = .98 for hemoglobin per 1 g/dL >14 g/dL). In women, lower preoperative hemoglobin (per 1 g/dL decrease <13 g/dL) was associated with increased odds of RBC transfusion (2.90 [2.33-3.60]; P < .001), reoperation (1.27 [1.11-1.45]; P < .001) and a longer hospital LOS (multiplicative increase in geometric mean 1.05 [1.03-1.07]; P < .001). In men, preoperative hemoglobin (per 1 g/dL decrease <14 g/dL) was associated with increased odds of perioperative RBCs (2.56 [2.27-2.88]; P < .001) and longer hospital LOS (multiplicative increase in geometric mean 1.02 [1.01-1.04] days; P < .001) but not reoperation (0.94 [0.85-1.04]; P = .256). Preoperative hemoglobin per 1 g/dL >13 g/dL in women and 14 g/dL in men were associated with lower odds of RBCs transfusion (0.57 [0.47-0.69]; P < .001 and 0.74 [0.60-0.91]; P = .005, respectively). CONCLUSIONS: Preoperative anemia was associated with inferior clinical outcomes after cardiac surgery. The associations between hemoglobin and outcomes were distinct for women and men, with different spline knot points identified (13 and 14 g/dL, respectively). Clinicians should consider data-driven approaches to determine preoperative hemoglobin values associated with increasing risk for adverse perioperative outcomes across sexes.


Assuntos
Anemia/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemoglobinas/análise , Complicações Pós-Operatórias/etiologia , Idoso , Anemia/sangue , Anemia/diagnóstico , Biomarcadores/sangue , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
19.
Eur J Obstet Gynecol Reprod Biol ; 258: 382-390, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33529973

RESUMO

AIM: To systematically and meta-analytically pool the existing evidence regarding the prognostic impact of preoperative anemia (hemoglobin level <12 mg/dl) in patients with endometrial cancer. METHODS: Four (PubMed, Embase, Scopus and Web of Science) databases were searched from inception to 20-August-2020. We assessed the risk of bias using the Newcastle-Ottawa Scale. We estimated the pooled prevalence of preoperative anemia in the included studies. We pooled odds ratios (ORs) and hazard ratios (HRs) with their 95 % confidence intervals (95 % CIs) to evaluate the correlation between preoperative anemia and its impact on clinicopathologic parameters and survival outcomes. Analyses were performed under random- or fixed-effects meta-analysis models depending on data heterogeneity. RESULTS: Seven studies met the inclusion criteria comprising 1495 patients with endometrial cancer. Nearly all studies had low risk of bias. The pooled prevalence of preoperative anemia was 26.5 % (95 % CI: 18.6%-36.2%). Preoperative anemia significantly correlated with advanced FIGO stage III-IV (OR = 5.14, 95 % CI [3.36, 7.86], p < 0.00001), ≥50 % myometrial invasion (OR = 1.95, 95 % CI [1.36, 2.78], p = 0.0003), lymph node metastasis (OR = 4.46, 95 % CI [2.39, 8.30], p < 0.00001), non-endometrioid histology (OR = 3.25, 95 % CI [1.89, 5.60], p < 0.0001), adnexal involvement (OR = 5.88, 95 % CI [3.05, 10.23], p < 0.001), cervical involvement (OR = 2.91, 95 % CI [1.65, 5.11], p = 0.0002), positive peritoneal cytology (OR = 3.24, 95 % CI [1.41, 7.44], p = 0.006), preoperative thrombocytosis (OR = 6.66, 95 % CI [3.05, 14.52], p < 0.00001) and lymphovascular space invasion (OR = 3.50, 95 % CI [1.82, 6.74], p = 0.0002). High tumor grade II-III was increased in patients with preoperative anemia, yet this effect was not statistically significant (OR = 2.12, 95 % CI [0.97, 4.66], p = 0.06). Consistently, the five-year overall survival (OS) and disease-free survival (DFS) rates were significantly lower in patients with preoperative anemia when compared to those without preoperative anemia. Pooled HR showed that preoperative anemia was significantly associated with reduced DFS at univariate (HR = 3.22, 95 % CI [1.28, 8.11], p = 0.01) and multivariate (HR = 1.02, 95 % CI [1.00, 1.05], p = 0.03) analyses. CONCLUSION: Preoperative anemia predicts poor clinicopathologic and survival outcomes in patients with endometrial cancer.


Assuntos
Anemia , Neoplasias do Endométrio , Anemia/complicações , Anemia/epidemiologia , Intervalo Livre de Doença , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Metástase Linfática , Prognóstico
20.
Transfusion ; 61(4): 1071-1079, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33533027

RESUMO

BACKGROUND: Consensus for transfusion in intensive care unit (ICU) patients recommends a restrictive strategy, based on a hemoglobin (Hb) concentration of 7 g/dL. Red blood cell (RBC) transfusion is used to prevent tissue hypoxia by improving oxygen transport (DO2 ) and therefore oxygen consumption (VO2 ). We studied the effects of RBC transfusion on systemic oxygenation parameters reflecting systemic oxygen extraction (EO2 = DO2 /VO2 ): S(c)vO2 , lactate level, venous-to-arterial carbon dioxide difference (Pv-aCO2 ), and cardiac index/EO2 (CI/EO2 ) and evaluated their usefulness in guiding transfusion decisions in ICU patients. STUDY DESIGN AND METHODS: Prospectively, all adult patients transfused were included except those with active bleeding or without a jugular or subclavian catheter. We measured O2 parameters before and after transfusion. Patients were a priori grouped according to their initial S(c)vO2 (< or ≥70%), treatment with vasopressors, cardiac function, and septic status. RESULTS: A total of 62 patients received 105 RBC transfusions. For all, mean arterial pressure (77 [69-88] to 81 [73-91] mm Hg), Hb concentration (7.4 [7.0-7.8] to 8.4 [7.7-8.9] g/dL) and S(c)vO2 (65% [59%-73%] to 69% [62%-75%]) increased after transfusion (all P < .001). S(c)vO2 improved after transfusion only when initial S(c)vO2 was less than 70% (62% [56%-65%] to 66% [61%-71%]; P < .001). In this group, Pv-aCO2 , lactate concentrations, and CI/EO2 did not change after transfusion. Cardiac function, sepsis, or vasopressor therapy did not affect these results. CONCLUSIONS: Among systemic O2 parameters, only a S(c)vO2 < 70% in anemic ICU patients improves after transfusion. As S(c)vO2 can reflect a DO2 /VO2 imbalance, it could be helpful when combined with the Hb concentration to decide whether to transfuse. However, the benefit on outcome should be further studied.


Assuntos
Anemia/sangue , Estado Terminal/terapia , Transfusão de Eritrócitos/efeitos adversos , Ácido Láctico/sangue , Oxigênio/sangue , Idoso , Anemia/complicações , Pressão Arterial/fisiologia , Bélgica/epidemiologia , Dióxido de Carbono/sangue , Consenso , Transfusão de Eritrócitos/métodos , Feminino , Hemoglobinas/análise , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Consumo de Oxigênio/fisiologia , Estudos Prospectivos , Sepse/complicações , Sepse/diagnóstico
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