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2.
Medicine (Baltimore) ; 98(44): e17806, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689863

RESUMO

Hypoalbuminemia and anemia are frequent among in patients with traumatic brain injury (TBI). We assess whether serum albumin and hemoglobin at admission can predict outcome in children with moderate to severe TBI.This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale of ≤13.A total of 213 patients were included of whom 45 died in hospital. Multivariate logistic regression showed that hypoalbuminemia (serum albumin <30 g/L) was independently associated with mortality (adjusted odds ratio [OR] = 3.059; 95% confidence interval [CI]: 1.118-8.371; P = .030) in children with moderate to severe TBI, while anemia (hemoglobin <90 g/L) was not independently associated with mortality (adjusted OR = 1.742; 95% CI: 0.617-4.916; P = .295). Serum albumin was significantly superior to hemoglobin (area under the curve [AUC] 0.738 vs AUC 0.689, P < .05) under receiver operating characteristic curve analysis. Hypoalbuminemia was also associated with reduced 14-day ventilation-free days, 14-day intensive care unit (ICU)-free days, and 28-day hospital-free days.Serum albumin at admission was superior to hemoglobin in predicting the mortality in children with moderate to severe TBI and also associated with reduced ventilator-free, ICU-free, and hospital-free days.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Hemoglobina A Glicada/metabolismo , Mortalidade Hospitalar , Albumina Sérica/metabolismo , Anemia/complicações , Anemia/diagnóstico , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/diagnóstico , Masculino , Valor Preditivo dos Testes , Respiração Artificial , Estudos Retrospectivos
3.
Rev Cardiovasc Med ; 20(3): 161-169, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31601090

RESUMO

Transcatheter aortic valve replacement is becoming a more common therapeutic option for the treatment of aortic stenosis in patients at high risk for invasive surgery, but detecting which patients will benefit clinically can be challenging. Hypoalbuminemia is a useful prognostic marker for chronic inflammation in this population. We carried out a systematic review and meta-analysis of studies evaluating the prognostic value of serum albumin level in patients undergoing transcatheter aortic valve replacement. A literature search of PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Wanfang, and CNKI databases was conducted. Articles published between January 2000 and December 2017 reporting on the prognostic value of low levels of serum albumin in patients undergoing transcatheter aortic valve replacement were analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 11 studies including 6456 patients met inclusion criteria for meta-analysis. A lower serum albumin level was associated with a lower survival rate at follow-up in patients who underwent transcatheter aortic valve replacement. A sub-group analysis of eight studies reporting adjusted hazard ratios indicated that low serum albumin was independently correlated with increased post-operative mortality. The hazard ratio of mortality risk associated with each 1 g/dL increment in serum albumin level was 0.46, suggesting a potential dose-response relationship between increased serum albumin level and increased survival rate in patients undergoing transcatheter aortic valve replacement. This meta-analysis provides strong evidence for the utility of serum albumin as a prognostic marker in aortic stenosis patients undergoing transcatheter aortic valve replacement, with low serum albumin levels (2.5-3.5 g/dL) suggesting poor prognosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Hipoalbuminemia/sangue , Albumina Sérica Humana/metabolismo , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Biomarcadores/sangue , Feminino , Nível de Saúde , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/mortalidade , Masculino , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
4.
J Korean Med Sci ; 34(33): e223, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31436052

RESUMO

BACKGROUND: This study aimed to determine the prognostic role of the categorized hemodynamic stage (HS) based on the hepatic venous pressure gradient (HVPG) in patients with portal hypertension. METHODS: Of 1,025 cirrhotic patients who underwent HVPG measurement, data on 572 non-critically-ill patients were collected retrospectively between 2008 and 2013. The following two HS categorizations were used: HS-1 (6-9, 10-12, 13-16, 17-20, and > 20 mmHg; designated as groups 1-5, respectively) and HS-2 (6-12, 13-20, and > 20 mmHg). Clinical characteristics, mortality rates, and prognostic predictors were analyzed according to the categorized HS. RESULTS: During the mean follow-up period of 25 months, 86 (15.0%) patients died. The numbers of deaths in HS-1 groups were 7 (6.3%), 7 (6.9%), 30 (18.0%), 20 (15.6%), and 22 (34.4%), respectively (P < 0.001). However, the traditional HVPG cutoffs of 10 and 16 mmHg did not improve the discrimination of mortality. In contrast, the mortality rates did differ significantly between the three HS-2 groups (P < 0.05). In the multivariate analysis, all models revealed that HS-2 was a common prognostic factor in predicting mortality. The mortality rates increased significantly according to HS-2 in patients with hypoalbuminemia (HVPG, 13-20 mmHg; hazard ratio [HR], 2.54 and HVPG > 20 mmHg; HR, 5.45) and intermediate model for end-stage liver disease (MELD) score (HVPG, 13-20 mmHg; HR, 3.86 and HVPG > 20 mmHg; HR, 8.77; P < 0.05). CONCLUSION: Categorizing HVPG values according to HS-2 is a useful prognostic modality in patients with portal hypertension and can play an independent role in predicting the prognosis in patients with hypoalbuminemia and an intermediate MELD score.


Assuntos
Veias Hepáticas/fisiopatologia , Hipertensão Portal/diagnóstico , Cirrose Hepática/mortalidade , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/patologia , Hipoalbuminemia/diagnóstico , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Taxa de Sobrevida
5.
Pan Afr Med J ; 32: 161, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303930

RESUMO

Serum protein electrophoresis (SPE) is a routine analysis in the daily practice of a medical biology laboratory. This study aimed to analyze the different electrophoretic profiles seen in our current practice. We conducted a cross-sectional study of 410 serum samples collected during the routine analyses in the Laboratory of Biochemistry at the University Hospital Mohammed VI in Oujda. Serum protein electrophoresis was performed using automated instrument CAPILLARYS 2 FLEX-PIERCING, SEBIA. 241 sera from women and 169 sera from men were collected. Patients were aged between 1-91 years, with an average age of 49 years; 19.5% of SPEs were normal, hypoalbuminemia was found in 34% of cases, chronic inflammatory syndrome in 19.5% of cases, nephrotic syndrome in 2% of cases, 5.8% of our patients had betagamma block, hypogammaglobulinemia was found in 8.5% of cases and 29 monoclonal peaks were noted, bisalbuminemia was found in 2 patients. Out of 410 collections: 92 immunofixations were performed, of whom 23 were positive (showing monoclonal gammopathy). This study highlights the variability in prescribing serum protein electrophoresis as well as the importance of clinical data for a better interpretation.


Assuntos
Eletroforese das Proteínas Sanguíneas/métodos , Hipoalbuminemia/diagnóstico , Inflamação/diagnóstico , Paraproteinemias/diagnóstico , Adolescente , Adulto , Agamaglobulinemia/diagnóstico , Agamaglobulinemia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Hipoalbuminemia/epidemiologia , Lactente , Inflamação/epidemiologia , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/epidemiologia , Paraproteinemias/epidemiologia , Adulto Jovem
6.
Yonsei Med J ; 60(7): 700-703, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31250585

RESUMO

Congenital analbuminemia (CAA) is an autosomal recessive disease characterized by extremely low serum levels of albumin. CAA is caused by various homozygous or heterozygous mutations of the ALB gene. Patients often exhibit no clinical symptoms, aside from rare accompanying conditions, such as fatigue, ankle edema, and hypotension. This case report describes the case of a 28-year-old asymptomatic Korean male referred to our center with hypocalcemia, vitamin D deficiency, and hypoalbuminemia who was diagnosed with CAA. To determine the cause of hypoalbuminemia in the patient, laboratory tests, radiological examination, and DNA sequencing were performed. The patient was confirmed to not exhibit any other clinical conditions that can induce hypoalbuminemia and was diagnosed with CAA using DNA sequencing. The present case of CAA is the first to be reported in Korea.


Assuntos
Hipoalbuminemia/congênito , Hipoalbuminemia/genética , Polimorfismo de Nucleotídeo Único , Albumina Sérica Humana/genética , Adulto , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/metabolismo , Masculino , República da Coreia , Análise de Sequência de DNA
7.
Medicine (Baltimore) ; 98(18): e15513, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045842

RESUMO

INTRODUCTION: Over the last few decades, the concepts of minimally invasive surgery and enhanced recovery after surgery (ERAS) protocols have been introduced into the field of total joint arthroplasty (TJA), and tranexamic acid (TXA) has been widely used in TJA. Modern-day surgical techniques and perioperative care pathways of TJA have experienced unexpected improvements. Recently, the necessity of the practice of ordering routine postoperative laboratory tests for patients undergoing primary TJA has been challenged, especially in the context of implementation of ERAS protocols in TJA. These studies have consistently suggested that routine postoperative laboratory tests are not necessary in modern-day primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), and laboratory tests after surgery should only be obtained for patients with risk factors. However, it remains unclear whether routine postoperative laboratory tests after THA and TKA remains justified in the Chinese patient population. Therefore, we developed this study to address this issue. METHODS AND ANALYSIS: This retrospective cohort study will include adult patients who underwent primary unilateral THA or TKA and received multimodal perioperative care pathways according to ERAS protocols. The following patient data will be collected from the electronic medical record system: patients' demographics, preoperative and postoperative laboratory values, operation time, intraoperative blood loss, TXA use, tourniquet use, postoperative length of stay, and any medical intervention directly related to abnormal laboratory values. The main study outcomes are the incidence of acute anemia requiring transfusion and incidence of hypoalbuminemia requiring albumin supplementation. The secondary outcomes are the rates of acute kidney injury, incidence of abnormal serum sodium level, incidence of abnormal serum potassium level, and incidence of abnormal serum calcium level. These clinical data will be analyzed to determine the incidence of abnormal postoperative laboratory values following primary unilateral THA and TKA; to clarify the frequency of any medical intervention directly related to abnormal postoperative laboratory values; and to identify risk factors that predispose patients to have abnormal postoperative laboratory results. STUDY REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900020690.


Assuntos
Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Técnicas de Laboratório Clínico/normas , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/diagnóstico , Adulto , Anemia/diagnóstico , Anemia/epidemiologia , Anemia/etiologia , Antifibrinolíticos/uso terapêutico , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Técnicas de Laboratório Clínico/métodos , Protocolos Clínicos/normas , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Projetos de Pesquisa , Estudos Retrospectivos , Fatores de Risco , Ácido Tranexâmico/uso terapêutico
8.
J Pak Med Assoc ; 69(5): 761-763, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105313

RESUMO

Strongyloidiasis is a human parasitic disease caused by infection of Strongyloidesstercoralis. It can manifest from asymptomatic eosinophilia in an immunocompetent host and disseminate the disease in the immunocompromised ones. The inconsistency of eosinophilia and low sensitivity of a standard microscopic stool examination makes it difficult to diagnose the disease. We report a case of chronic strongyloidiasis who, despite being immunocompetent, developed dissemination. The patient was a 30-years-old male who presented with diarrhoea, vomiting, high-grade fever and dyspnoea. On examination, he was pale, oedematous and had ascites with systolic murmurs in tricuspid area. After a fullworkup for differentials, biopsy confirmed the diagnosis of strongyloidiasis. Echocardiogram revealed vegetations on mitral and tricuspid valves and regurgitation through the valves, which confirmed dissemination to endocardium. A course of Ivermectin 9 mg daily for two weeks eradicated the infection in time. In conclusion, awareness for physicians and the use of various diagnostic methods like serology, endoscopy and biopsy should be considered for high risk patients.


Assuntos
Endocardite/diagnóstico , Imunocompetência , Estrongiloidíase/diagnóstico , Adulto , Anemia/diagnóstico , Anemia/terapia , Antiparasitários/uso terapêutico , Ascite/diagnóstico por imagem , Transfusão de Sangue , Dieta Rica em Proteínas , Duodeno/patologia , Endocardite/terapia , Hidratação , Hematínicos/uso terapêutico , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/terapia , Imunoglobulina E/imunologia , Ivermectina/uso terapêutico , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Estrongiloidíase/imunologia , Estrongiloidíase/patologia , Estrongiloidíase/terapia , Tomografia Computadorizada por Raios X , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ultrassonografia
9.
Scott Med J ; 64(3): 116-118, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31142210

RESUMO

BACKGROUND: Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. CASE PRESENTATION: A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months' follow-up. CONCLUSION: Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.


Assuntos
Doença Celíaca/diagnóstico , Síndrome Nefrótica/diagnóstico , Doença Aguda , Adulto , Doença Celíaca/complicações , Edema/diagnóstico , Edema/etiologia , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/etiologia , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Período Pós-Parto , Gravidez
12.
Int J Clin Pract ; 73(6): e13314, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30664804

RESUMO

AIMS: To determine the relationship between trends in admission serum albumin and long-term mortality in medical patients with hospital readmission. MATERIALS AND METHODS: We used a cohort of patients admitted to five departments of internal medicine during 3 years. Survival analysis was performed based on mean admission serum albumin levels and trends in albumin values from recurrent admissions. RESULTS: A total of 5396 patients had 16 640 admissions (readmission cohort), another 9422 patients were admitted only once (single admission cohort). Readmitted patients with low mean albumin were older, predominantly females and had higher comorbidity index than patients with normal mean albumin. The 6-month all-cause mortality rate of the normal and low mean albumin groups was 5.2% and 24.2%, respectively (P < 0.001). Survival analysis showed that patients with persistently normal albumin levels had the highest survival rates at 6 months (97.7%), compared with patients who had hypoalbuminemia at index admission but normalised their albumin levels in subsequent admissions (92%), patients with declining albumin trends (85.6%) and patients with persistently low albumin levels (68.9%) (P < 0.0001). CONCLUSIONS: Serum albumin is strongly associated with long-term mortality in readmitted medical patients. Persistent hypoalbuminemia during recurrent admissions is associated with increased risk of long-term mortality.


Assuntos
Hipoalbuminemia/mortalidade , Readmissão do Paciente , Albumina Sérica/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Hipoalbuminemia/sangue , Hipoalbuminemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Adulto Jovem
14.
Medicine (Baltimore) ; 97(30): e11357, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045258

RESUMO

RATIONALE: Although systemic lupus erythematosus (SLE) can be complicated by various gastrointestinal tract diseases, it is rarely associated with lupus enteritis and protein-losing enteropathy (PLE). We report here the successful surgical treatment of lupus enteritis and therapy-resistant and refractory PLE in a patient with SLE. We also provide a review of relevant literature. PATIENT CONCERNS: A 16-year-old girl presenting with polyarthritis, malar rash, and palmar erythema was indicated for steroid therapy on the basis of positive results for antinuclear, anti-Smith, and antiphospholipid antibodies, which confirmed the diagnosis of SLE. During the course of steroid therapy, the patient developed acute abdomen and hypoalbuminemia. DIAGNOSES: Computed tomography and Tc-labeled human serum albumin scintigraphy revealed abnormal findings, and a diagnosis of lupus enteritis and PLE was made. Steroid treatment was continued but no significant improvement was observed, and the patient was referred and admitted to our hospital. Double-balloon enteroscopy revealed multiple ischemic stenoses and mucosal necroses in the small intestine, suggesting that PLE was associated with ischemic enteritis due to antiphospholipid syndrome. The patient received steroids, immunosuppressive drugs, and antithrombotic therapy, with no improvement in symptoms. Thus, the disease was judged to be refractory and resistant to medical therapy, and the patient was indicated for surgical treatment. INTERVENTIONS: Partial small intestinal resection was performed by removing the segment of the small intestine presenting PLE lesions, and a double-end ileostomy was created. OUTCOMES: Multiple stenotic lesions were confirmed in the resected segment. Histopathology evaluation revealed marked inflammatory cell infiltration in the intestinal tract wall and recanalization of the vessels, suggesting a circulatory disorder caused by vasculitis and antiphospholipid syndrome. Postoperatively, the clinical course was good. Serum albumin levels and body weight increased as nutritional status improved significantly. Secondary enteroenterostomy with ileostomy closure could be performed at 2 months after the initial surgery. LESSONS: Timely surgical treatment can be successful in managing therapy-resistant and refractory PLE in patients with SLE.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hipoalbuminemia , Intestino Delgado/cirurgia , Lúpus Eritematoso Sistêmico , Enteropatias Perdedoras de Proteínas/cirurgia , Adolescente , Dissecação/métodos , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/etiologia , Testes Imunológicos/métodos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Enteropatias Perdedoras de Proteínas/sangue , Enteropatias Perdedoras de Proteínas/diagnóstico , Enteropatias Perdedoras de Proteínas/etiologia , Cintilografia/métodos , Albumina Sérica/análise , Resultado do Tratamento
15.
J Dermatol ; 45(10): 1211-1215, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30035313

RESUMO

Heavy-chain deposition disease (HCDD) is characterized by tissue deposits of a truncated monoclonal immunoglobulin heavy-chain (HC) on basement membranes. Diagnosis is usually made on kidney biopsy, showing nodular glomerulosclerosis with HC deposits which can be missed, resulting in delay in diagnosis. We report four γ1-HCDD patients presenting with cutis laxa, hypocomplementemia and hypoalbuminemia. In two patients, unsuspected HCDD was revealed by cutis laxa and diagnosis was made on skin biopsy. In all patients, serum albumin and complement represented surrogate markers for disease monitoring. In γ-HCDD, extrarenal manifestations such as cutis laxa may precede renal injury and are precious tools for an early diagnosis, which is crucial to avoid progression of irreversible renal and elastic tissue damage.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cútis Laxa/etiologia , Doença das Cadeias Pesadas/diagnóstico , Hipoalbuminemia/diagnóstico , Insuficiência Renal/etiologia , Adulto , Idoso , Biópsia , Proteínas do Sistema Complemento/análise , Feminino , Doença das Cadeias Pesadas/sangue , Doença das Cadeias Pesadas/complicações , Doença das Cadeias Pesadas/tratamento farmacológico , Humanos , Hipoalbuminemia/sangue , Cadeias gama de Imunoglobulina , Rim/patologia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/terapia , Pele/patologia , Resultado do Tratamento
16.
J Card Surg ; 33(8): 469-478, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29968261

RESUMO

BACKGROUND: We performed a single-center retrospective analysis to determine whether preoperative serum albumin levels were associated with postoperative adverse events and short- and long-term survival in patients who underwent continuous-flow left ventricular assist device (CF-LVAD) implantation. METHODS: From November 2003 through March 2016, 526 patients underwent CF-LVAD implantation. Patients whose preoperative serum albumin level was normal (≥3.5 g/dL) were compared to patients with preoperative hypoalbuminemia (<3.5 g/dL), which was further categorized as moderate (2.5-3.5 g/dL) or severe (<2.5 g/dL). These groups were compared regarding preoperative demographics, incidence of postoperative complications, and long-term survival. RESULTS: Patients with hypoalbuminemia had higher serum levels of liver enzymes (P < 0.05) and total bilirubin (P < 0.001) and significantly lower platelet counts (P = 0.02) and prealbumin levels (P < 0.001) than patients with normal preoperative albumin levels. Survival in patients with moderate and severe preoperative hypoalbuminemia was significantly decreased compared with patients with normal preoperative serum albumin levels (P < 0.001). Preoperative hypoalbuminemia was also associated with higher incidences of postoperative infection, gastrointestinal bleeding, neurological dysfunction, and acute kidney injury (P ≤ 0.01 for all) but did not affect the success of bridge to transplantation or survival after transplantation. CONCLUSIONS: Our data demonstrated that there is a significant association of preoperative low serum albumin levels with postoperative adverse outcomes and lower survival rates. This highlights the importance of a patient's preoperative nutritional status on postoperative outcomes after CF-LVAD implantation.


Assuntos
Coração Auxiliar , Hipoalbuminemia/diagnóstico , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/mortalidade , Albumina Sérica , Lesão Renal Aguda/etiologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hemorragia Gastrointestinal/etiologia , Ventrículos do Coração , Humanos , Hipoalbuminemia/complicações , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
17.
Ann Hepatol ; 17(4): 547-560, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29893696

RESUMO

Decompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important tool in the management of patients with cirrhosis, since it decreases for less than half the risk for post-paracentesis cardiocirculatory dysfunction and mortality associated with spontaneous bacterial infection, as well as, it triplicates the response to terlipressin in patients with hepatorenal syndrome. Recently, research on albumin has been a hot topic, with important new insights such as the characterization of the pleiotropic effects of albumin (which surpass its oncotic properties) and the concept of effective albumin concentration. In fact, patients with liver cirrhosis present posttranslational modifications on albumin that compromises its function. Those modified albumin forms were proved to have prognostic value and its knowledge may change the paradigm of albumin treatment. In this review, we critically summarize the latest evidence on the potential benefits of albumin in patients with end-stage liver disease.


Assuntos
Doença Hepática Terminal/tratamento farmacológico , Hipoalbuminemia/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Fígado/efeitos dos fármacos , Albumina Sérica Humana/uso terapêutico , Animais , Biomarcadores/sangue , Doença Hepática Terminal/sangue , Doença Hepática Terminal/diagnóstico , Humanos , Hipoalbuminemia/sangue , Hipoalbuminemia/diagnóstico , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Processamento de Proteína Pós-Traducional , Albumina Sérica Humana/metabolismo , Resultado do Tratamento
19.
Clin Cardiol ; 41(6): 782-787, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29604093

RESUMO

BACKGROUND: Serum albumin is a strong prognostic indicator for many disease processes, yet limited data exist regarding its prognostic relationship in pulmonary arterial hypertension (PAH). Our study aims to assess the relationship of hypoalbuminemia with disease severity and mortality in this population. HYPOTHESIS: Serum albumin concentrations are a predictor of outcomes in PAH. METHODS: A retrospective review of all patients with World Health Organization group 1 PAH evaluated between March 2001 and August 2008 was performed. Patients were stratified into groups based on serum albumin concentration ≤3.3 g/dL (hypoalbuminemia) vs >3.3 g/dL. Clinical, hemodynamic, and survival comparisons were compared between groups using Student t test and χ2 test, followed by univariate analysis and multivariate logistic regression. RESULTS: A total of 163/273 (59.7%) patients had a documented serum albumin concentration. Hypoalbuminemia was present in 41 (25.2%) patients and serum albumin ≤3.3 g/dL represented the lowest quartile of serum albumin. Patients with hypoalbuminemia had higher rates of renal dysfunction (26.8% vs 9.8%, P =0.0069) and hepatic dysfunction (29.3% vs 6.6%, P <0.001), and lower hemoglobin levels (11.6 vs 13.4 g/dL, P < 0.001). Hemodynamic and functional capacity assessments were comparable between groups. Independent predictors of mortality included low albumin levels (hazard ratio [HR]: 0.485, P = 0.008), high right atrial systolic area (HR: 1.062, P = 0.003), low Fick-derived cardiac index (HR: 1.465, P = 0.016), and high New York Heart Association functional class (HR: 1.767, P = 0.042). Patients with hypoalbuminemia demonstrated a significantly lower survival rate at latest follow-up (P = 0.01). CONCLUSIONS: Lower serum albumin concentrations in patients with PAH are associated with higher mortality and can serve as a marker of disease severity in this patient population.


Assuntos
Hipertensão Pulmonar/sangue , Hipoalbuminemia/sangue , Albumina Sérica Humana/análise , Adulto , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/fisiopatologia , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/mortalidade , Hipoalbuminemia/fisiopatologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
20.
Arch. argent. pediatr ; 116(2): 331-335, abr. 2018. ilus, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-887481

RESUMO

El síndrome de Goldbloom es una rara entidad clínica de etiología desconocida que ocurre casi exclusivamente en pediatría. Consiste en un síndrome febril prolongado con hiperostosis perióstica y disproteinemia, que, con frecuencia, simula una patología hematooncológica o linfoproliferativa. El diagnóstico se hace por exclusión de las diferentes causas de dolor de los huesos y se asocia a hipergammaglobulinemia, hipoalbuminemia, eritrosedimentación acelerada e imágenes radiológicas de periostitis. La sintomatología, la radiología y los parámetros de laboratorio remiten en un tiempo variable, que va, habitualmente, de los 3 a los 12 meses. Se presenta a un paciente de 6 años con dolores óseos difusos, hiperostosis perióstica, síndrome febril prolongado de 8 meses de evolución, pérdida de peso y reactantes de fase aguda elevados con disproteinemia (hipergammaglobulinemia e hipoalbuminemia). Debe considerarse el síndrome de Goldbloom en un paciente con las manifestaciones descritas luego de la exclusión de la patología infecciosa, hematooncológica e inflamatoria de otra causa.


Goldbloom syndrome is a rare clinical entity, of unknown etiology that happens almost exclusively in pediatric population. It is a prolonged febrile syndrome with periosteal hyperostosis and dysproteinemia, and often simulates an hematooncology or lymphoproliferative disease. The diagnosis is to rule out the different causes of bone pain associated with hypergammaglobulinemia, hypoalbuminemia, high erythrocyte sedimentation rate and periostitis at the radiographies. Symptomatology, radiology and laboratory parameters refer in a variable time, usually from 3 to 12 months. We report the case of a six-year-old boy with diffuse bone pain, prolonged febrile syndrome (of 8 months of evolution), weight loss and elevated acute phase reactants with dysproteinemia (hypergammaglobulinemia and hypoalbuminemia). Goldbloom syndrome should be considered in patients with prolonged febrile syndrome and cortical hyperostosis after the exclusion of infectious, lymphoproliferative or inflammatory disease.


Assuntos
Humanos , Masculino , Criança , Hiperostose/diagnóstico , Febre/diagnóstico , Hipergamaglobulinemia/diagnóstico , Síndrome , Hipoalbuminemia/diagnóstico , Diagnóstico Diferencial
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