ABSTRACT
Resumen Introducción: la estimación temprana del riesgo en falla cardiaca aguda puede ayudar en la toma de decisiones clínicas. Objetivo: identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con falla cardiaca aguda. Métodos: análisis de una cohorte retrospectiva de pacientes mayores de 18 años ingresados a hospitalización por falla cardiaca aguda en un hospital de tercer nivel, entre los años 2012 y 2016. Resultados: se incluyeron 247 pacientes, con edad promedio de 62,8 años; predominó el sexo masculino con un 60%. El 84% de los pacientes tenía falla cardiaca con fracción de expulsión disminuida (mediana de 25%). La mortalidad intrahospitalaria fue de 9,3% y la acumulada a 30 días y 6 meses posterior al egreso hospitalario fue de 10,9 y 14,1%, respectivamente. Los dos predictores asociados a muerte intrahospitalaria fueron el nitrógeno ureico en sangre (BUN)> 37 mg/dl (OR: 10,8; 95% IC: 4,10-28,8) y la presión arterial sistólica (PAS) ≤ 125 mm Hg (OR: 3,42; 95% IC:1,15-10,0). El modelo de árbol de regresión y clasificación (CART) identificó como el mejor predictor de mortalidad los niveles elevados de BUN (≥ 32,5 mg/dl), seguido por la presión sistólica disminuida (< 97 mm Hg) y finalmente por los niveles elevados de creatinina (≥ 1,75 mg/dl). Conclusión: el análisis mediante el CART permite clasificar en forma temprana la probabilidad de muerte por un árbol de riesgo que incluye el BUN ≥ 32,5 mg/dl, la presión sistólica < 97 mm Hg y los niveles de creatinina ≥ 1,75 mg/dl.
Abstract Introduction: The early estimation of risk in acute heart failure may help in the taking of clinical decisions. Objective: To identify the risk factors associated with in-hospital mortality in patients with acute heart failure. Methods: An analysis was performed on a retrospective cohort of patients greater than 18 years admitted to a tertiary hospital due acute heart failure between the years 2010 and 2016. Results: A total of 247 patients were included, with a mean age of 62.8 years, and of which 60% were male. The large majority (84%) of the patients had heart failure with a reduced ejection fraction (median 25%). The in-hospital mortality was 9.3%, and the accumulated rate at 30 days and 6 months after hospital discharge was 10.9% and 14.1%, respectively. The two predictors associated with in-hospital death was a blood urea nitrogen (BUN) > 37 mg/dL (OR: 10.8; 95% CI: 4.10-28.8) and a systolic blood pressure (SBP) ≤ 125 mmHg (OR: 3.42; 95% CI: 1.15-10.0). The classification and regression tree (CART) model identified elevated levels of as the best predictor of mortality, followed by a decreased systolic pressure (< 97 mmHg), and finally due to elevated creatinine levels (≥ 1,75 mg/dL). Conclusion: The analysis using the classification and regression tree (CART) model can provide an early classification of the probability of death by a risk tree that includes BUN ≥ 32.5 mg/dL, systolic pressure <97 mm Hg, and creatinine levels ≥ 1.75 mg/dL.
Subject(s)
Humans , Male , Female , Middle Aged , Risk Factors , Hospital Mortality , Heart Failure , Trees , Blood Urea Nitrogen , Clinical Decision-MakingABSTRACT
Triatoma dimidiata (Latreille) is considered to be one of the primary vectors of Chagas disease in Southern Mexico and Central America. The objective of the present study was to obtain ecological information on T. dimidiata in two rural communities of Campeche, Mexico, where the vector is poorly studied. Our work consisted of monthly samplings carried out during one-year time at three levels: sylvatic, peridomestic and intradomestic, in order to estimate the population abundance of this species and its rate of infection with Trypanosoma cruzi. Triatoma dimidiata was the unique vector of this disease collected in San Juan Bautista Sakcabchen (SJBS) and Crucero San Luis (CSL). The total of 145 individuals were captured in SJBS; from these, 26.9 percent, 20 percent and 53.1 percent were collected in the sylvatic, peridomestic and intradomestic area, respectively. In CSL captures yielded 108 individuals: 40.7 percent in the sylvatic area, 20.4 percent peridomestic and 38.9 percent intradomestic. We found no correlation between climatic variables and population abundance of T. dimidiata. Dataset obtained suggests that individuals from the sylvatic area exhibit a high rate of natural infection by T. cruzi, with monthly percentages up to 61.5 percent for SJBS and 50 percent for CSL. At the peri and intradomestic level, the reservoirs apparently play an important role in the transmission, as the seroprevalence in dogs was 61.5 percent y 65.4 percent, for SJBS y CSL, respectively. Based on these findings, it was concluded that inhabitants of both communities are at a high risk of Chagas disease infection.