ABSTRACT
Abstract Background: Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective: To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods: Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results: A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion: Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital.
Resumo Fundamento: Apesar da insuficiência cardíaca (IC) apresentar elevada morbimortalidade, são escassos os estudos na América Latina sobre causas e preditores de mortalidade intra-hospitalar. Desconhece-se, também, a evolução de pacientes com IC compensada hospitalizados por outros motivos. Objetivo: Identificar causas e preditores de mortalidade intra-hospitalar em pacientes que internam por IC aguda descompensada (ICAD), comparativamente aqueles que possuem IC e internam por outras condições (ICND). Métodos: Coorte histórica de pacientes internados em um hospital público terciário no Brasil com diagnóstico de IC identificados pelo escore de comorbidade de Charlson (ECCharlson). Resultados: Foram avaliados 2056 pacientes que internaram entre janeiro de 2009 e dezembro de 2010 (51% homens; idade mediana de 71 anos; tempo de permanência de 15 dias). Ocorreram 17,6% de óbitos durante a internação, dos quais 58,4% por causa não cardiovascular (63,6% ICND versus 47,4% ICAD, p = 0,004). As causas infecciosas foram responsáveis pela maior parte dos óbitos e apenas 21.6% das mortes foram atribuídas à IC. Os preditores independentes de mortalidade intra-hospitalar foram semelhantes entre os grupos e incluíram: idade, tempo de permanência, potássio elevado, comorbidades clínicas e ECCharlson. A insuficiência renal foi o preditor de maior relevância em ambos grupos. Conclusão: Pacientes internados com IC apresentam elevada mortalidade intra-hospitalar, independentemente do motivo primário de internação. Poucos óbitos são diretamente atribuídos à IC; Idade, alteração na função renal e níveis séricos de potássio, tempo de permanência, comorbidades e ECCharlson foram preditores independentes de morte intra-hospitalar em hospital terciário brasileiro. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Hospital Mortality , Tertiary Care Centers/statistics & numerical data , Heart Failure/mortality , Brazil/epidemiology , Multivariate Analysis , Predictive Value of Tests , Prospective Studies , Risk Factors , Cause of Death , Age Factors , Statistics, Nonparametric , Risk Assessment , Hospitalization/statistics & numerical dataABSTRACT
Description of two cases of pyogenic liver abscess. The first case: a 3-years-old immunocompetent girl with fever, abdominal pain, vomiting, and diarrhea. Abdominal ultrasound: multiloculated heterogeneous collection in the right hepatic lobe (figure 1A). The second case, a 1-year-old girl with congenital neutropenia, showed fever,malaise, anorexia, sweating and pallor. Abdominal computed tomography showed hypodense lesion with heterogeneous impregnation by contrast in the left hepatic lobe (figure 1B). Different clinical presentations, images and treatment are of special interest in pediatrics and are reviewed in this text.