Analysis of mortality and cause of death in inpatients with single-center cerebral infarction / 中国脑血管病杂志

Objective To investigate the mortality and cause of death in inpatients with cerebral infarction. Methods The clinical data of 515 patients with cerebral infarction as the underlying cause of death from January 2005 to December 2009 were analyzed retrospectively. The hospital mortality, direct cause of death,and constituent ratio of the cause of death were calculated. The clinical features,such as classification of the Trial of Org 10 172 in acute stroke treatment( TOAST),age and duration of hospital-ization were analyzed. Results ( 1 )The hospital mortalities in patients with cerebral infarction from 2005 to 2009 were 2. 0%(91/4 659),2. 1%(110/5 264),1. 9%(95/5 035),1. 2%(100/8 656),and 1. 0%(119/11 640),respectively. The overall mortality rate was 1. 5%(515/35 254),basically had a declining trend year by year(χ2 =42. 39;P74 years)groups were 1. 1%( 22/2 009 ),1. 0%( 112/11 158 ),1. 5%( 221/14 311 ),and 2. 1%(160/7 776),respectively. They increased with increasing age(P<0. 01).(3)The TOAST classification in 515 died patients were as follows:57. 3%(n=295)for large-artery atherosclerosis,19. 4%(n=100) for cardioembolism,14. 4%(n=74)for cryptogenic stroke,7. 0%(n=36)for small-artery occlusion and 1. 9%(n=10)for other reasons. The five leading direct cause of death were cerebral hernia 49. 3%(n=254),primary central respiratory and circulatory failure 25.0%(n=129),pneumonia 8. 9%(n =46), cerebral-cardiac syndrome 5. 8%( n =30 ),and multiple organ failure 5. 6%( n =29 ).( 4 ) The mean age of death was 67 ± 12 years old. The patients who died of cerebral hernia and primary central respiratory and circulatory failure were younger than those who died of pneumonia(65 ± 13,68 ± 11,and 75 ± 10,respectively;all P<0. 01). The median length of hospital stay was 3 days. The length of hospital stay in patients who died of hernia,primary central respiratory and circulatory failure,and cerebral-cardiac syndrome were significantly shorter than those who died of pneumonia and multiple organ failure( the median length of hospital stay was 3. 0,3. 0,3. 0,12. 5,and 9. 0 days,respectively;all P <0. 05). Conclusions The mortality of hospitalized patients with cerebral infarction have a declining trend year by year. Brain disease itself is the most important reason of early death for patients with cerebral infarction, indicating that it is the important point of prevention and treatment in clinical work.

La hipertensión arterial como causa de mortalidad / The high blood pressure as a cause of death

Introducción: la hipertensión arterial constituye el factor de riesgo mayor sobre la morbilidad y mortalidad de causa cardiovascular, estimado a través de los certificados de defunción. Objetivo: evaluar la repercusión de este factor de riesgo como causa de mortalidad. Métodos: se realizó un estudio descriptivo, retrospectivo de los pacientes fallecidos con hipertensión arterial entre el 2002 y 2007. Las variables estudiadas fueron: edad, sexo, color de la piel, causa directa de muerte, causa básica de muerte, causa contribuyente de muerte y correlación clínica/patológica. Resultados: se encontró que el 9,1 por ciento de los fallecidos eran hipertensos, el grupo de edad más afectado fue el de 65 a 74 años (23,4 por ciento) y la edad promedio fue de 65 años. En 248 fallecidos existió coincidencia diagnóstica total en la causa directa de muerte (74,6 por ciento) y en 236 en la causa básica de muerte (71,0 por ciento). La hipertensión arterial constituyó la causa básica de muerte en el 59,3 por ciento y la causa contribuyente de muerte en el 18,97 por ciento. En más de la mitad de los casos, la hipertensión arterial participó en los mecanismos de muerte a través de la causa básica de muerte y causa contribuyente de muerte. Conclusiones: la hipertensión arterial constituye un determinante causal en la mortalidad y progresión del daño vascular aterosclerótico

Introduction: high blood pressure is a major risk factor on the morbidity and mortality of cardiovascular origin according to the death certificate, Objective: to assess the repercussion of this risk factor as cause of death. Methods: a retrospective and descriptive study was conducted in patients deceased with high blood pressure between 2002 and 2007. Study variables were: age, sex, skin color, direct cause of death, basic cause of death, contributing cause of death and clinical/pathological correlation. Results: there found that the 9.1 percent of deceases were hypertensive, the more involved age group was that of 65-74 years (23.4 percent) and the mean age was of 65 years. In 248 deceased there was a total diagnostic coincidence in relation to the direct cause of death (74.6 percent) and in 236 deceased in the basic cause of death (71.0 percent). High blood pressure was the basic cause of death in the 59.3 percent and the contributing cause of death in the 18.97 percent. In more than a half of cases, high blood pressure was involved in the death mechanisms through the basic and the contributing cause of death. Conclusions: High blood pressure is a causal determinant factor in the mortality and the progression of atherosclerotic vascular damage

Neumonía por Pneumocystis jirovecii / Pneumocystic jirovecii pneumonia

OBJETIVO: presentar un caso atípico de una paciente VIH negativo, fallecida por Pneumocystis jirovecii, más frecuente en personas infectadas por el virus del SIDA y postrasplantados. DESCRIPCIÓN: se presenta una paciente con antecedentes de alcoholismo, asma, con síntomas respiratorios y fiebre, VIH negativo, con evolución tórpida que fallece a los 11 días del ingreso. Pulmones: enfisema periférico, zonas dispersas de aspecto rojo carnoso entre mezclado con zonas poco aireadas, empastadas. INTERVENCIÓN: se realizó autopsia clínica encontrándose como causa directa de la muerte, neumonía por Pneumocystis jirovecii, diagnosticado con coloración de hematoxilina y eosina donde se observó presencia del edema espumoso característico. Se corroboró con coloración de plata metenamina donde se pudo observar el microorganismo. CONCLUSIONES: el caso presentó como causa directa de la muerte una neumonía por Pneumocystis jirovecii, patógeno oportunista reportado con frecuencia como causa de muerte en pacientes infectados por el VIH-SIDA y en inmunocomprometidos por otras causas, como los trasplantados.

OBJECTIVE: to present the atypical case of a HIV-negative patient, deceased from Pneumocystis jirovecii more frequent in persons infected with the AIDS virus and in those underwent transplantation. DESCRIPTION: a patient with a history of alcoholism, asthma, respiratory symptoms and fever, HIV-negative, with a torpid course deceased at 11 days after admission. Lung: peripheral emphysema, scattered zones of a fleshy red appearance mixed with not much aired zones and impasted. INTERVENTION: a clinical necropsy was carried out where the direct cause of death was from Pneumocystis jirovecii, diagnosed using hematoxylin-esosin stain proving the presence of a characteristic foamy edema. In the silver methenamine stain it was possible to corroborate the presence of the microorganism. CONCLUSIONS: in this case the leading cause of death was Pneumocystis jirovecii pneumonia, an opportunistic pathogen frequently reported a cause of death in HIV-AIDS patients and also in those immunocompromised due to other causes, e.g. those with transplantation.