ABSTRACT
ABSTRACT Introduction: Ventricular septal rupture is an important high-mortality complication in the scope of myocardial infarctions. The effectiveness of different treatment modalities is still controversial. This meta-analysis compares the efficacy of percutaneous closure vs. surgical repair for the treatment of postinfarction ventricular septal rupture (PI-VSR). Methods: A meta-analysis was performed on relevant studies found through PubMed®, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (or CNKI), Wanfang Data, and VIP databases searching. The primary outcome was a comparison of in-hospital mortality between the two treatments, and the secondary outcome was documentation of one-year mortality, postoperative residual shunts, and postoperative cardiac function. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. Results: Qualified studies (742 patients from 12 trials) were found and investigated for this meta-analysis (459 patients in the surgical repair group, 283 patients in the percutaneous closure group). When comparing surgical repair to percutaneous closure, it was found that the former significantly reduced in-hospital mortality (OR: 0.67, 95% CI 0.48-0.96, P=0.03) and postoperative residual shunts (OR: 0.03, 95% CI 0.01-0.10, P<0.00001). Surgical repair also improved postoperative cardiac function overall (OR: 3.89, 95% CI 1.10-13.74, P=0.04). However, there was no statistically significant difference in one-year mortality between the two surgical strategies (OR: 0.58, 95% CI 0.24-1.39, P=0.23). Conclusion: We found that surgical repair appears to be a more effective therapeutic option than percutaneous closure for PI-VSR.
ABSTRACT
BACKGROUND AND OBJETIVE: Acute kidney injury is related to high in-hospital mortality. The use of furosemide has been a controversial point in the prevention and treatment of acute kidney injury. The objective of this study was to identify predictors of mortality in critically ill patients with acute kidney injury with emphasis on use of furosemide. METHODS: A prospective cohort of 108 patients with acute kidney injury admitted consecutively in a intensive care unit and evaluated until death or hospital discharge. The dependent variable was death from any cause. The independent variables were age, sex, race, serum creatinine, potassium, admission diagnosis, urine output, volume infused, the twelve variables of Acute Physiology and Chronic Health disease Classification System II and furosemide use. We performed logistic regression analysis to identify predictors of death. RESULTS: The mean age of patients was 65.74 years with a predominance of women of African descent. The overall mortality rate was 44.4%. In logistic regression analysis, predictors of mortality were: using furosemide, age in years and Glasgow come scale. CONCLUSION: Use of furosemide was a predictor of mortality in a cohort of patients with acute kidney injury. The role of furosemide in the treatment and prevention of acute kidney injury certainly needs to be better evaluated...
JUSTIFICATIVA E OBJETIVO: A lesão renal aguda está relacionada a alta mortalidade intra-hospitalar. O uso de furosemida tem sido um ponto controverso em seu tratamento e sua prevenção. O objetivo deste estudo foi identificar preditores de mortalidade em pacientes gravemente enfermos com lesão renal aguda com ênfase para uso de furosemida. MÉTODOS: Coorte prospectiva de 108 portadores de lesão renal aguda admitidos consecutivamente em uma unidade de terapia intensiva e avaliados até o óbito ou a alta hospitalar. A variável dependente foi óbito por qualquer causa. As variáveis independentes foram: idade, gênero, raça, creatinina sérica, potássio, as 12 variáveis do Acute Physiology and Chronic Health Disease Classification System II (APACHE II), diagnóstico na admissão, débito urinário, volume infundido e uso de furosemida. Realizou-se análise de regressão logística para identificar os preditores de óbito. RESULTADOS: A média de idade dos pacientes foi de 65,74 anos com predomínio de mulheres afrodescendentes. A taxa de mortalidade global foi de 44,4%. Na análise de regressão logística, os preditores de mortalidade foram: uso de furosemida, idade em anos e escala de coma de Glasgow. CONCLUSÃO: Uso de furosemida foi preditor de mortalidade em uma coorte de portadores de lesão renal aguda. Seu papel no tratamento e na prevenção de lesão renal aguda certamente necessita ser mais bem avaliado...