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3.
Wilderness Environ Med ; 30(4): 450-453, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31685322

RESUMO

Loxoscelism is a systemic inflammatory reaction in response to a brown recluse spider bite (BRSB). In this case we describe a patient with a heightened inflammatory response to a presumed BRSB, with Coomb's positive hemolysis, cytoplasmic antineutrophil cytoplasmic antibody (cANCA) vasculitis, and features of hemophagocytic lymphohistiocytosis (HLH). A 24-y-old female presented with sudden pain and swelling to her lower back, nausea, fever, and tachycardia after a presumed BRSB. Hemolysis began on hospital day 3 (15.9 g·dL-1) with a nadir on hospital day 5 (6.3 g·dL-1). She had an lactate dehydrogenase of 1415 U·L-1, ferritin of 15534 ng·mL-1, persistent fever, and signs of bone marrow suppression despite hemolysis, with thrombocytopenia (100,000 µL-1) and an inadequate reticulocyte response (1.7%) suggestive of HLH. The patient's blood was Coomb's and cANCA/antiproteinase 3 positive. She had signs of toxin-induced vasculitis, with respiratory failure requiring bilevel positive airway pressure, radiographs with bilateral pulmonary infiltrates, and a desquamating rash. She received 6 U of packed red blood cells, furosemide for pleural and pericardial effusions, antibiotics, and symptomatic treatment during the acute phase of her illness. Hemolysis improved without glucocorticoids by hospital day 6. The patient demonstrated a dysregulated immunologic and complement-mediated response to the presumed BRSB. The triad of Coomb's positive hemolysis, cANCA vasculitis, and HLH-like reaction associated with a presumed BRSB is described for the first time in the literature and brings up questions for future research regarding the role of immune modulators and complement inhibitors in the treatment of severe loxoscelism as well as the genetic factors that predispose certain individuals to such reactions.


Assuntos
Aranha Marrom Reclusa , Picaduras de Aranhas/imunologia , Picaduras de Aranhas/patologia , Animais , Antibacterianos , Diuréticos/uso terapêutico , Transfusão de Eritrócitos , Furosemida/uso terapêutico , Humanos , Oxigênio/uso terapêutico , Picaduras de Aranhas/terapia , Venenos de Aranha , Adulto Jovem
4.
Am J Audiol ; 28(3): 548-552, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31430172

RESUMO

Objective Current recommendations for cochlear hydrops treatment include systemic glucocorticoids and diuretics. Cochlear cells express dopamine receptors, although their role is unknown in the pathophysiology of cochlear hydrops. Case Description We report the case of remission of recurrent right-sided cochlear hydrops in a young male patient treated with bromocriptine due to pituitary macroprolactinoma. Transient improvement was observed after oral steroid and diuretic treatment, but cochlear hydrops recurred until the dose of bromocriptine was increased to 10 mg daily. Conclusion Bromocriptine may stimulate dopamine receptors in cochlear cells with potential therapeutic role in patients with cochlear hydrops. There are no widely accepted and effective treatments for endolymphatic hydrops, and identifying potential new and efficacious therapeutics is of high relevance.


Assuntos
Bromocriptina/uso terapêutico , Doenças Cocleares/tratamento farmacológico , Perda Auditiva Neurossensorial/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Audiometria de Tons Puros , Doenças Cocleares/complicações , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Prolactinoma/patologia , Recidiva
5.
Intern Med ; 58(21): 3069-3075, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292400

RESUMO

Objective Ascites becomes refractory to diuretics in cirrhotic patients, who then require repeated large-volume paracentesis or cell-free and concentrated ascites reinfusion therapy (CART). The objective of this study was to confirm the safety and efficacy of CART, evaluate the actual situations with respect to the prescription of diuretics and determine the role of diuretics after the introduction of CART. Patients and Methods We recruited 34 cirrhotic patients who received CART with concomitant diuretics using furosemide (76.2%), spironolactone (48.5%), thiazide (4.0%) and tolvaptan (53.5%) from a post-marketing surveillance of CART. Results CART improved the tested clinical indices, i.e., body weight, abdominal circumference, performance status, dietary intake, total protein and albumin. The intervals of CART sessions were significantly prolonged in patients who received tolvaptan (mean, 22.5 days) compared to those not receiving tolvaptan (mean, 10.8 days) (p<0.001). The drop-out rate was significantly decreased in patients receiving tolvaptan compared to those not receiving tolvaptan when drop-out was defined as paracentesis (p<0.05). Conclusion We confirmed that CART is an effective treatment for refractory ascites occurring in cirrhotic patients. The administration of tolvaptan in combination with CART leads to a significantly reduced rate of ascites accumulation.


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Ascite/terapia , Líquido Ascítico , Diuréticos/uso terapêutico , Hidratação/métodos , Cirrose Hepática/complicações , Tolvaptan/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ascite/sangue , Ascite/etiologia , Feminino , Furosemida/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados , Albumina Sérica , Espironolactona/uso terapêutico
8.
PLoS One ; 14(5): e0217911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150512

RESUMO

PURPOSE: To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and inclusion of an initial bolus with continuous furosemide infusions. MATERIALS AND METHODS: In this descriptive study, we retrospectively studied 46,037 adult ICU admissions from a publicly available database of patients in an urban, academic medical center. RESULTS: Diuretics were employed in nearly half (49%, 22,569/46,037) of ICU admissions. Mechanical ventilation, a history of heart failure, and admission to the post-cardiac surgery unit were associated with a higher frequency of diuretic use. Combination use of different diuretic classes was uncommon. Patients with severely impaired kidney function were less likely to receive diuretics. Furosemide was by far the most common diuretic given and the initial intravenous dose was only 20 mg in more than half of ICU admissions. Among patients treated with a continuous infusion, 30% did not receive a bolus on the day of infusion initiation. CONCLUSIONS: Patterns of diuretic use varied by patient-specific factors and by ICU type. Diuretic dosing strategies may be suboptimal.


Assuntos
Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Unidades de Terapia Intensiva , Idoso , Diuréticos/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Furosemida/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Administração Hospitalar , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade
9.
J Med Case Rep ; 13(1): 150, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31104633

RESUMO

BACKGROUND: Guillain-Barré syndrome is an autoimmune disorder in which autoantibodies mainly affect the peripheral nervous system. Autonomic dysfunction is a common and severe complication of Guillain-Barré syndrome. Cardiomyopathy, though, is a rare complication in Guillain-Barré syndrome, with only a few cases reported in the literature. CASE PRESENTATION: We present a case of a 65-year-old Greek woman with Guillain-Barré syndrome who developed cardiomyopathy shortly after admission to the intensive care unit due to respiratory deterioration. Her estimated left ventricular ejection fraction upon admission was 20%. The result of coronary angiography was negative for coronary artery disease, and cardiac magnetic resonance imaging excluded myocarditis. Her clinical condition improved with supportive therapy, and her estimated left ventricular ejection fraction at discharge was normal. CONCLUSIONS: Clinicians should be aware of this potentially lethal complication of Guillain-Barré syndrome and the therapeutic options, because early diagnosis can improve prognosis. Routine electrocardiographic and echocardiographic assessments should be performed in patients with Guillain-Barré syndrome presenting with hemodynamic instability.


Assuntos
Síndrome de Guillain-Barré/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Anti-Hipertensivos/uso terapêutico , Cardiotônicos/uso terapêutico , Dobutamina/uso terapêutico , Ecocardiografia , Feminino , Furosemida/uso terapêutico , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Ramipril/uso terapêutico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/etiologia , Resultado do Tratamento
11.
J Cardiovasc Med (Hagerstown) ; 20(6): 379-388, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30950982

RESUMO

AIMS: Loop diuretics have become a mainstay of chronic heart failure management. Furosemide and torsemide are the two most common loop diuretics; nevertheless, there is inconsistent evidence regarding the optimal choice of loop diuretic with respect to clinical outcomes. METHODS: Medline and Cochrane Databases were systemically reviewed for randomized and observational studies comparing patients with chronic heart failure on oral torsemide versus oral furosemide and their association with intermediate-term outcomes (5-12 months) through May 2018. Odds ratios with corresponding 95% confidence intervals (CIs) were used for outcomes. A random effect model was used to account for heterogeneity among studies. Heterogeneity was assessed with the Higgins I-square statistic. RESULTS: A total of 8127 patients were included in the analysis from a total of 14 studies (10 randomized, four observational); 5729 patients were prescribed furosemide and 2398 were given torsemide. There was no significant difference in intermediate-term mortality among heart failure patients on furosemide compared with torsemide [odds ratio (OR) 1.01, CI 0.64-1.59, I = 65.8%]; however, furosemide was associated with an increased risk of heart failure readmissions (OR 2.16, CI 1.28-2.64, I = 0.0%). Heart failure patients taking torsemide were more likely to have an improvement in New York Heart Association class compared with those on furosemide (OR 0.73, CI 0.58-0.93, I = 19.6%). CONCLUSION: Torsemide is associated with a reduction in intermediate-term heart failure readmissions and improvement in New York Heart Association class compared with furosemide but is not associated with a reduced mortality risk. Additional randomized trials are needed to examine the impact of loop diuretics on clinical outcomes in patients with heart failure.


Assuntos
Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Torasemida/uso terapêutico , Furosemida/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Estudos Observacionais como Assunto , Readmissão do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Fatores de Tempo , Torasemida/efeitos adversos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(16): e15300, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008980

RESUMO

BACKGROUND: Previous clinical studies have reported that furosemide can be used to treat liver cirrhosis (LC) effectively. However, no study systematically explored this issue. This systematic review aims to investigate the efficacy and safety of furosemide for treatment of LC. METHODS: This study will be conducted through searching the following literature sources from their inception to February 28, 2019 without any language limitations: PUBMED, EMBASE, PsycINFO, Web of Science, Scopus, OpenGrey, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. In addition, reference lists of relevant reviews and websites of clinical trial registry will also be searched. Only randomized controlled trials of furosemide for treatment of LC will be included in this study. Two reviewers will independently select studies, collect data, and determine risk of bias. RevMan 5.3 software will be used to pool the data and to conduct meta-analysis if sufficient studies will be included with acceptable heterogeneity. RESULTS: This study will investigate the efficacy and safety of furosemide for LC by the assessment of primary and secondary outcomes. The primary outcome includes mortality rate. The secondary outcomes consist of response rate, overall survival, body weight, urinary volume, quality of life, as measured by any relevant scales, and adverse events. CONCLUSION: The results of this study may provide summarized evidence of furosemide for the treatment of LC. ETHICS AND DISSEMINATION: No individual patient data will be used in this study, thus no ethics approval is needed. The findings of this study will be published in peer-reviewed journals.


Assuntos
Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Cirrose Hepática/tratamento farmacológico , Diuréticos/efeitos adversos , Furosemida/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Indian Pediatr ; 56(2): 119-122, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30819990

RESUMO

OBJECTIVE: To determine the incidence, risk factors and outcome of acute kidney injury (AKI) in hospitalized children with nephrotic syndrome. METHODS: All consecutive hospitalized children (aged 1-14 years) with diagnosis of nephrotic syndrome between February 2016 and February 2017 were enrolled for the study. Children (aged 1-14 years) with features of nephritis, underlying secondary causes of nephrotic syndrome as well as children admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. RESULTS: A total of 73 children (81 admissions) were enrolled; incidence of AKI was 16% (95% CI, 9-23). On multivariate logistic regression analysis, furosemide infusion was observed as an independent risk factor for acute kidney injury (OR 23; 95% CI, 3-141; P<0.001). Out of 13 children with AKI, three died. CONCLUSIONS: Acute kidney injury in hospitalized children with nephrotic syndrome has high risk of mortality. Children receiving furosemide infusion should be closely monitored for occurrence of acute kidney injury.


Assuntos
Lesão Renal Aguda , Síndrome Nefrótica , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adolescente , Criança , Pré-Escolar , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Feminino , Furosemida/efeitos adversos , Furosemida/uso terapêutico , Hospitalização , Humanos , Lactente , Masculino , Síndrome Nefrótica/complicações , Síndrome Nefrótica/epidemiologia , Síndrome Nefrótica/terapia , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
14.
Stud Health Technol Inform ; 257: 86-91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741178

RESUMO

Death, as a biological phenomenon, is well understood and a commonly employed endpoint for clinical trials. However, death identification and adjudication may be difficult for pragmatic clinical trials (PCT) that rely upon electronic health record and patient reported data. We propose a novel death identification and verification approach that is being used in the ToRsemide compArisoN with furoSemide FOR Management of Heart Failure (TRANSFORM-HF) PCT. We describe our hybrid approach that includes gathering information from clinical trial sites, a centralized call center, and National Death Index searches. Our methods detail how a possible death is triggered from each of these components and the types of information we require to verify a triggered death. Our different trigger/verification elements collectively define the TRANSFORM-HF PCT's definition of a death event.


Assuntos
Determinação de Ponto Final , Insuficiência Cardíaca , Mortalidade , Ensaios Clínicos como Assunto , Coleta de Dados , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Torasemida/uso terapêutico
15.
BMJ Case Rep ; 12(2)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30787024

RESUMO

We present a case that illustrates the fluctuations in calcium levels to be expected while managing an infant with maternal gestational diabetes mellitus who also develops subcutaneous fat necrosis (SCFN). There is initial hypocalcaemia due to functional hypoparathyroidism, requiring judicious calcium replacement. But with increased extrarenal production of 1,25-dihydroxyvitamin D due to granulomatous inflammation of subcutaneous adipose tissue, hypercalcaemia ensues. With a self-limiting course, SCFN of the newborn has an excellent prognosis and resolves spontaneously. However, aberrations in serum calcium levels can manifest in life-threatening complications and must hence be closely monitored.


Assuntos
Gluconato de Cálcio/uso terapêutico , Necrose Gordurosa/patologia , Hipocalcemia/diagnóstico , Gordura Subcutânea/patologia , Administração Intravenosa , Administração Oral , Gluconato de Cálcio/administração & dosagem , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/complicações , Furosemida/administração & dosagem , Furosemida/uso terapêutico , Humanos , Hipercalcemia/induzido quimicamente , Hipercalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Recém-Nascido , Masculino , Gravidez , Resultado do Tratamento
16.
Congenit Heart Dis ; 14(1): 65-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30811794

RESUMO

The ductus arteriosus is a lifeline for the developing fetus prior to delivery, allowing the circulation of oxygen-rich blood from the placenta to bypass the lungs and perfuse the body. However, when the ductus fails to close after birth, the pressures can cause blood to shunt from the aorta back into the lungs, causing pulmonary edema. This is called a left-to-right shunt. The patent ductus arteriosus (PDA) can also shunt blood from the pulmonary arteries to the aorta, bypassing the lungs and causing oxygen-poor blood to mix with the oxygen-rich blood circulating to the body. This is called a right-to-left shunt. Too much shunting in either direction can cause significant long-term problems for the neonate. These three case studies compare the outcomes of patients with PDAs closed using different treatment techniques. The first patient's ductus arteriosus closed >2 months after birth following pharmacologic treatment. The second was closed by surgical ligation. The third was closed by transcatheter device closure.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Furosemida/uso terapêutico , Glucocorticoides/uso terapêutico , Indometacina/uso terapêutico , Dispositivo para Oclusão Septal , Inibidores de Ciclo-Oxigenase , Diuréticos/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/tratamento farmacológico , Ecocardiografia , Feminino , Seguimentos , Humanos , Recém-Nascido , Ligadura/métodos , Masculino
17.
Intern Med ; 58(11): 1587-1591, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30713322

RESUMO

A 73-year-old man with liver cirrhosis and advanced chronic kidney disease was admitted to our hospital due to bilateral lower leg edema and appetite loss. Furosemide to treat fluid retention markedly decreased extracellular water compared with intracellular water, but the addition of tolvaptan equally decreased both with a greater diuretic response than furosemide alone. Furthermore, tolvaptan administration increased the plasma colloid osmotic pressure, which might facilitate the shift of fluid from the extravascular space to the intravascular space. This is the first case showing different effects on the fluid distribution between furosemide and additional tolvaptan in the same patient.


Assuntos
Deslocamentos de Líquidos Corporais/efeitos dos fármacos , Furosemida/farmacologia , Cirrose Hepática/complicações , Insuficiência Renal Crônica/complicações , Tolvaptan/farmacologia , Idoso , Antagonistas dos Receptores de Hormônios Antidiuréticos/farmacologia , Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Benzazepinas/farmacologia , Benzazepinas/uso terapêutico , Diuréticos/farmacologia , Quimioterapia Combinada , Edema/tratamento farmacológico , Edema/etiologia , Edema/fisiopatologia , Furosemida/uso terapêutico , Humanos , Perna (Membro) , Masculino , Tolvaptan/uso terapêutico
18.
J Vet Intern Med ; 33(2): 462-470, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30703246

RESUMO

BACKGROUND: The effects of synthetic brain natriuretic peptide (BNP1-32) on cardiorenal and renin angiotensin aldosterone system in dogs with naturally occurring congestive heart failure (CHF) are unknown. OBJECTIVES: To evaluate the cardiorenal and endocrine effects of SC administered synthetic canine BNP1-32, with or without furosemide, in dogs with CHF caused by myxomatous mitral valve disease (MMVD). ANIMALS: Seven client-owned male dogs with compensated American College of Veterinary Internal Medicine stage C CHF caused by MMVD on chronic treatment with furosemide, benazepril, and pimobendan. METHODS: A single-dose, crossover, pilot study. Each dog received a dose of BNP1-32 (5 µg/kg), furosemide (2 mg/kg), and both BNP1-32/furosemide (5 µg/kg and 2 mg/kg, respectively) SC with a 2-week washout period among each treatment. Between- and within-treatment effects were evaluated using linear mixed modeling with restricted maximum likelihood estimation and evaluation of least square differences. RESULTS: Rapid absorption of BNP1-32 and a corresponding rise in urinary cyclic guanosine monophosphate excretion was observed at 1-2 hours after any treatment containing BNP1-32 (P < .05). However, BNP1-32 did not influence measured cardiorenal variables. Plasma aldosterone concentrations were below quantifiable levels in majority of the samples. CONCLUSIONS AND CLINICAL IMPORTANCE: No beneficial cardiorenal effects were detected. It is possible that dogs with chronic CHF have a reduction in natriuretic peptide responsiveness.


Assuntos
Insuficiência Cardíaca/veterinária , Insuficiência da Valva Mitral/veterinária , Peptídeo Natriurético Encefálico/uso terapêutico , Aldosterona/sangue , Animais , Estudos Cross-Over , Doenças do Cão/tratamento farmacológico , Cães , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Doenças das Valvas Cardíacas/veterinária , Masculino , Natriuréticos , Projetos Piloto
19.
Dig Dis ; 37(3): 239-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625470

RESUMO

AIMS: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. METHODS: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. RESULTS: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. CONCLUSION: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.


Assuntos
Ascite/complicações , Ascite/tratamento farmacológico , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Tolvaptan/uso terapêutico , Idoso , Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Feminino , Furosemida/uso terapêutico , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática/patologia , Masculino , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Resultado do Tratamento
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