ABSTRACT
El objetivo de este estudio fue evaluar las causas de ingreso y la mortalidad de pacientes con LES admitidos en Unidad de Terapia Intensiva (UTI), e identificar factores de riesgo asociados con mortalidad así comola utilidad de la escala de APACHE II como factor de pronóstico. Se estudiaron retrospectivamente pacientes con diagnóstico de LES acorde al ACR 1997, ingresados en UTI del Hospital Córdoba des de junio de 2008 a marzo del 2011. Se analizaron datos demográficos, características de la enfermedad, causas de admisión, escala de APACHEII en las primeras 24 hs de internación, tratamiento realizado, días de internación y mortalidad. Valores de p <0,05 fueron considerados estadísticamente significativos. Se incluyeron 23 pacientes con edad promedio de 31 años, 87,5% de sexo femenino. Las principales causas de ingreso fueron la actividad lúpica e infección en 52,1%. El promedio de días de internación fue de 12. Los tratamientos recibidos más frecuentes fueron: antibióticos 93,8%, pulsos de esteroides 62,5%, ARM e inmunosupresores 56,3%, respectivamente. Ninguno se correlacionó conmortalidad. La mortalidad fue de un 21,7% principalmente causada por la combinación de actividad lúpica con infección. El scoreAPACHE II no tuvo asociación estadísticamente significativa con lamortalidad. Conclusión: La tasa de mortalidad en los pacientes lúpicos admitidosen UTI fue elevada. Sería importante desarrollar instrumentos más certeros de pronóstico en pacientes lúpicos que ingresen a UTI.
Objective: To study the causes of admission and mortality in lupus patients admitted to Intensive Care Unit (ICU) and to identify risk factors associated with mortality.We retrospectivel y studied patients with SLE diagnosis with ACRCriteria who were admitted to ICU of Córdoba hospital from June2008 to March 2011. We analyzed demographic data (age, gender, socioeconomic status by Graffar scale), duration of disease, treatment, disease activity by ECLAM score, organic damage by SLICC, causes of ICU admission, APACHE II score in the first 24 hours of hospitalization, days in ICU and mortality. P value <0.05 was considered statistically significant.23 patients were included with a mean age of 31 years, 87.5% female and 81.3% with good socioeconomic status. The duration of SLE beforeICU admission was 53 months, 37.5% had no treatment at admission.The main reasons for admission were lupus activity and infection in 52.1% of the patients. The average days of ICU hospitalization was12. The most frequent treatments used were steroid pulses (62.5%), ARM, immunosuppressive treatment (56.3%), and antibiotics 93.8%. Treatments received were not correlated with mortality. Mortality was21.7% and the most frequent cause was the combination of lupus activity with infection. The APACHE II score was not statistically significant association with mortality. Conclusion: The mortality rate in lupus patients admitted to ICU remains high despite of treatment.
Subject(s)
Humans , Critical Care , Lupus Erythematosus, SystemicABSTRACT
Introducción: El objetivo del presente trabajo es evaluar los cambios en flujo y composición orgánica en saliva, así como la presencia de anticuerpos anti Ro/SSA y La/SSB séricos y salivales y su implicancia en el diagnóstico no invasivo del SS. Diseño del estudio: Estudio de corte transversal, de 73 pacientes distribuidos en los siguientes grupos experimentales: Síndrome de Sjõgren primario (SSp) (n = 15), SS secundario (SSs) (n = 17), boca seca y ojo seco sin Síndrome de Sjõgren (BO) (n = 20), y controles sanos (C) (n = 21). Se realizó una determinación del flujosalivalbasal y una toma de muestras de saliva para la medición de proteínas totales, IgA, urea y anticuerpos. Se determinaron anticuerpos anti Ro/SSA y La/SSB en muestras de suero y saliva. Resultados: El flujo salival en SSp, SSs, BO fue significativamente menor (p < 0,001) comparado con C. La composición salival de SS mostró modificaciones de componentes estudiados. Los anticuerpos anti Ro/SSA y anti La/SSB aparecieron con mayor frecuencia en suero y saliva en pacientes con SS en comparación con BO y C, siendo la frecuencia de positividad superior en suero en comparación con saliva. Conclusión: La determinación de anticuerpos Ro/SSA en saliva podrían ayudar a diagnosticar a pacientes con xerostomía como el Síndrome de Sjõgren.
Introduction: The aim of this study was to evaluate changes in flow andorganic composition in saliva, the presence of anti Ro/SSA and La/SSBantibodies in serum and saliva and its implication in the noninvasivediagnosis of SS.Study Design: Cross sectional study, 73 patients divided into four experimentalgroups: Primary Sjögren's syndrome (pSS) (n = 15), secondarySS (sSS) (n = 17), dry eye and dry mouth syndrome without Sjögren's(DEMS) (n = 20) and healthy controls (C) (n = 21). We performed a determinationof basal salivary flow and saliva sampling for measurement oftotal protein, IgA, urea and antibodies. We determined anti Ro/SSA andLa/SSB in serum and saliva.Results: The salivary flow in pSS, sSS, DEMS patients was significantlylower (p <0.001) compared with C. The composition of SS salivary componentsstudied showed changes. The anti Ro/SSA and anti La/SSB occurredmore frequently in serum and saliva in SS patients comparedwith DEMS and C, the frecuency of positivity was higher in serum thanin saliva.Conclusion: The determination in saliva of antibodies Ro/SSA may helpdiagnose patients with xerostomy as Sjögren's Syndrome.
Subject(s)
Antibodies , Sjogren's Syndrome , XerostomiaABSTRACT
Introduction: Antiphospholipid Antibodies (APA) are detected in 30 and 40% of patients with Systemic lupus erythematosus (SLE). Antiphospholipid Syndrome nephropathy (APSN) is one of renal manifestations of APS. Histological lesions of APSN have been described in SLE. Objective: To evaluate the prevalence of APA in patients with lupus nephritis (LN), its clinical and laboratory association and the presence of APSN in renal biopsies from LN patients. Patients and Methods: We retrospectively studied 28 patients with SLE diagnosis according to ACR criteria, who underwent renal biopsies with diagnosis of LN. These patients attended to our rheumatology unit for the last 2 years. Demographic, clinical and serological data were collected at the time of the first biopsy. APA (Anticardiolipin Ig G, Ig M and lupus anticoagulant) were considered positivewhen they were positive in two opportunities during the follow up. Renal biopsies were classified according to NL classification 2004. Histological features of APSN were analyzed by 2 different pathologists who were blind to clinical data. P value <0.05 was considered statistically significant. Results: Mean age was 31 years old (17-53), 86% were female and mean SLE duration was 47 months (1-180). 54% of patients were positive for APA. There was not association between APA and first creatinine level, hypertension, amount of proteinuria and active sediment. Class II LN was most frequently associated with APA. Glomerular collapse and focal cortical atrophy (FCA) were associatedwith APA (p<0.008, p<0.005). Conclusions: APA were present in 54% of patients with LN. There was not association between APA and clinical features or histological type of LN. The main histological features of APSN were glomerular collapse and FCA