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Rev. bras. cir. cardiovasc ; 37(4): 493-500, Jul.-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394720


Abstract Introduction: The goal of this study is to investigate the association between diagnosis and severity of coronary artery disease (CAD) and Asprosin level. Methods: Patients diagnosed with CAD who underwent conventional coronary angiography for the first time were included in the present study. The patients were divided into four groups, each consisting of 20 individuals, as medical group, single coronary lesion group, double coronary lesion group, and multiple coronary lesions group. Serum Asprosin values and Gensini scores of the groups were compared in terms of compliance. Results: In this study, Asprosin values were found to be significantly higher in the multiple coronary lesions group than in the medical, single coronary, and double coronary lesion groups (P<0.05). In the double coronary lesion group, Asprosin values were significantly higher (P<0.05) than the in the medical and single coronary lesion groups. It was also found that Asprosin values did not differ at significant levels in the medical and single coronary lesion groups (P>0.05). It was determined that the increases in Asprosin values and Gensini scores were compatible with each other. Conclusion: The present study showed that the increases in serum Asprosin levels, along with the increases in the number of coronary arteries with critical stenosis, might be a marker in diagnosing and determining the severity of CAD.

Rev. bras. cir. cardiovasc ; 37(3): 350-355, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376543


Abstract Objective: To investigate the expression level and significance of T cell immunoglobulin and mucin-domain containing molecules-3 (Tim-3) and interleukin-7 (IL-7) in CD4+ T lymphocytes in peripheral blood of patients with coronary heart disease (CHD). Methods: 75 patients with CHD treated at our hospital were selected and classified as mild group (25 cases), moderate group (25 cases) and severe group (25 cases), according to the severity of illness. Twenty-five healthy volunteers who underwent a physical examination at our hospital during the same period were selected as the control group. The expression level of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients in four groups was detected by flow cytometry and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The expression level of IL-7 in peripheral blood serum was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analyses of Tim-3 and IL-7, Tim-3 and disease severity and IL-7 and disease severity were performed, respectively. Results: Flow cytometry and qRT-PCR demonstrated that the expression of Tim-3 in CD4+ T lymphocytes in peripheral blood of patients with CHD increased with the aggravation of the disease. ELISA showed that the tendency of IL-7 expression in peripheral blood serum was consistent with the expression of Tim-3, and the expression of Tim-3 had a positive correlation with IL-7. The expression levels of both Tim-3 and IL-7 were positively correlated with the Gensini score. Conclusion: The expression of Tim-3 and IL-7 in peripheral blood of patients with CHD was upregulated and increased with the aggravation of CHD.

Rev. bras. cir. cardiovasc ; 37(2): 161-175, Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1376515


Abstract Introduction: The left ventricular ejection fraction (LVEF) is commonly used as a marker of aortic stenosis (AS) disease severity and to indicate surgical intervention. However, an LVEF <50% identifies mainly advanced disease. Hence, earlier detection of subclinical LV systolic dysfunction may improve clinical decision-making. The global longitudinal strain (GLS) can identify subclinical systolic dysfunction at earlier stages of AS progression even in the presence of preserved LVEF. To this end, we evaluated the preoperative prognostic significance of the LVGLS to identify patients who will undergo a more extensive postoperative LV reverse remodeling as a surrogate marker for clinical recovery. Methods: We performed a prospective observational study based on detailed pre- and postoperative 2D transthoracic echocardiographic examinations, including strain analysis with speckle tracking. We screened 60 consecutive patients with severe AS and a preoperative LVEF ≥50% indicated for surgery; 39 patients met the study entry criteria and consented to their participation. Results: The median age was 67 (range 30-79) years; 56.4% were female. At baseline, the GLS was 61.64±7.22%. Surgery led to an improvement in the GLS; the mean difference was 3.23% [95% CI=1.96 to 4.49%] during a median follow up time of 5 (interquartile range 4-6) months. The preoperative GLS correlated with the postoperative LV mass index (LVMI) r=0.526, P=0.001 and the intraventricular septal thickness in diastole (IVSd) r=0.462, P=0.003. Furthermore, patients with a normal GLS (≤-18.9%) at baseline experienced a better recovery of their LV morphology and systolic function during the postoperative course compared to those with an abnormal GLS (>-18.9%). The effect size, hedges g, was at least >0.75 for the LVMI, IVSd, intraventricular septal thickness in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and LVEF, suggesting a clinically significant difference between subgroups at follow-up. Conclusion: A normal preoperative left ventricular global longitudinal strain is associated with an improved left ventricular reverse remodeling and systolic function following surgery to resolve aortic stenosis.

Arq. neuropsiquiatr ; 80(2): 137-144, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364372


ABSTRACT Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases characterized by deterioration of balance and functionality that tends to follow disease progression. There is no established link between formal clinical markers for severity and functional/balance scores that could guide rehabilitation teams. Objective: To evaluate the relationship between functional scales and ataxia severity in order to identify cutoff landmarks for functional loss and estimate the mean SARA (Scale for Assessment and Rating of Ataxia) score for the risk ratings for falls on the BBS (Berg Balance Scale). Methods: Consecutive patients with a molecular diagnosis of SCA (total 89: 31 with SCA2 and 58 with SCA3) were assessed for functionality FIM-ADL (Functional Independence Measure-activities of daily living and Lawton-IADL (instrumental activities of daily living), balance (BBS) and disease severity (SARA). Results: The main disability cutoff landmarks were that the need for supervision for FIM-ADL starts with 12 points on SARA and the need for supervision for Lawton-IADL starts with 14 points on SARA. The first items to require assistance were "expression" and "shopping", respectively. At 20 points on SARA, patients were dependent on all FIM and Lawton items. The item with the greatest impact on distinguishing dependents from independents was "means of transport" in Lawton-IADL and the domain "locomotion" in FIM-ADL. The mean SARA score for patients classified as low risk in the BBS was 9.9 points, and it was 17.4 for medium risk and 25.2 for high risk. Conclusions: Analysis on the correlation between the severity of ataxia and functional scales can form an important guide for understanding the progression of functional dependence among individuals with SCAs.

RESUMO Antecedentes: As ataxias espinocerebelares (SCA) são um grupo de doenças neurodegenerativas caracterizadas pela deterioração do equilíbrio e da funcionalidade, que tende a acompanhar a progressão da doença. Não existe uma ligação estabelecida entre os marcadores clínicos formais de gravidade e escores funcionais e de equilíbrio que possam orientar as equipes de reabilitação. Objetivo: Avaliar a relação entre escalas funcionais e de gravidade da ataxia, buscando identificar pontos de corte para a perda funcional relacionados aos escores de gravidade e aos patamares de Risco de Quedas. Métodos: Uma amostra consecutiva de 89 pacientes com diagnóstico molecular de SCA (31-SCA2 e 58-SCA3) foram avaliados para funcionalidade MIF-AVDs (Medida de independência funcional-Atividades da vida diária) e Lawton-AIVDs (Atividades instrumentais da vida diária), equilíbrio (EEB-escala de Equilíbrio de Berg), e gravidade da ataxia (SARA-escala para avaliação e graduação de ataxia). Resultados: Os principais pontos de corte de deficiência foram: com 12 pontos no SARA começa a necessidade de supervisão para MIF-AVDs e com 14 pontos no SARA começa a necessidade de supervisão para Lawton-AIVDs. Os primeiros itens a necessitar de assistência foram "expressão" e "compras", respectivamente. Com 20 pontos no SARA os pacientes eram dependentes em todos os itens MIF/LAWTON. O item com maior impacto na discriminação entre dependentes e independentes foi "meio de transporte" na Lawton e o domínio "locomoção" na MIF. O escore médio no SARA foi de 9,9 pontos para pacientes classificados com baixo risco na EEB, 17,4 para médio risco e 25,2 para alto risco. Conclusões: A análise da correlação entre a gravidade da ataxia e as escalas funcionais pode ser um importante guia no entendimento da progressão da dependência funcional em indivíduos com SCA.

Humans , Activities of Daily Living , Spinocerebellar Ataxias , Severity of Illness Index
Rev. bras. enferm ; 75(6): e20210207, 2022. tab
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1376598


ABSTRACT Objectives: to investigate the impact of age, motor dysfunction and neuropsychiatric symptoms on the quality of life of people with multiple sclerosis in comparison to healthy peers. Methods: a total of 141 participants were tested in a single session. The assessments were composed by general questionnaires applied in both groups and by specific instruments restricted to multiple sclerosis. Multiple regression models were applied to assess relationships between predictors and outcome. Results: age, motor dysfunction and neuropsychiatric symptoms explained 56.6% of quality of life of the multiple sclerosis group. Age and neuropsychiatric symptoms explained 36.6% of quality of life in the control group. Age impacted more the multiple sclerosis group than the control group. Neuropsychiatric symptoms affected both groups similarly. Motor dysfunction impacted 21.9% of the quality of life in multiple sclerosis. Conclusions: the predictors explained considerable variance of quality of life in multiple sclerosis, which should guide public health policies.

RESUMO Objetivos: investigar o impacto da idade, da disfunção motora e dos sintomas neuropsiquiátricos sobre a qualidade de vida de pessoas com esclerose múltipla na comparação com controles saudáveis. Métodos: 141 participantes foram testados em uma única sessão. As avaliações foram compostas por questionários gerais aplicados em ambos os grupos e por instrumentos específicos à esclerose múltipla. Modelos de regressão múltipla foram usados para avaliar relações entre preditores e desfecho. Resultados: idade, disfunção motora e sintomas neuropsiquiátricos explicaram 56,6% da qualidade de vida do grupo esclerose múltipla. Idade e sintomas neuropsiquiátricos corresponderam a 36,6% da qualidade de vida do grupo-controle. Idade impactou mais o grupo esclerose múltipla do que o grupo-controle. Sintomas neuropsiquiátricos afetaram os grupos semelhantemente. A disfunção motora impactou 21,9% da qualidade de vida na esclerose múltipla. Conclusões: os preditores explicaram considerável variação da qualidade de vida na esclerose múltipla, o que deve nortear políticas públicas de saúde.

RESUMEN Objetivos: investigar el impacto de edad, disfunción motora y síntomas neuropsiquiátricos en la calidad de vida de personas con esclerosis múltiple en comparación con controles saludables. Métodos: 141 participantes fueron evaluados en una sesión. Las evaluaciones fueron compuestas por cuestionarios generales aplicados en ambos grupos y por instrumentos específicos a la esclerosis múltiple. Modelos de regresión múltiple fueron utilizados para evaluar relaciones entre predictores y resultado. Resultados: edad, disfunción motora y síntomas neuropsiquiátricos explicaron 56,6% de la calidad de vida en la esclerosis múltiple. Edad y síntomas neuropsiquiátricos explicaron 36,6% de la calidad de vida del grupo control. Edad afectó más la esclerosis múltiple que al grupo de control. Síntomas neuropsiquiátricos afectaron los grupos similarmente. La disfunción motora impactó 21,9% de la calidad de vida en la esclerosis múltiple. Conclusiones: los predictores explicaron una considerable variación de la calidad de vida en la esclerosis múltiple, lo que debe guiar políticas de salud pública.

Chinese Journal of Dermatology ; (12): 523-527, 2022.
Article in Chinese | WPRIM | ID: wpr-933579


Objective:To detect the serum level of chitinase-3-like protein 1 (YKL-40) in patients with pemphigus vulgaris, and to analyze its correlation with the severity of pemphigus vulgaris.Methods:From January 2017 to May 2018, serum samples were collected from 38 patients with pemphigus vulgaris in Department of Dermatology, the Affiliated Hospital of Southwest Medical University, and those collected from 14 age-, gender- and body mass index-matched healthy volunteers served as controls. Serum levels of YKL-40 and Th1/Th2/Th17-related cytokines were detected by using Luminex ? 200 TM system. Mann-Whitney U test was used to compare serum levels of cytokines between the patient group and control group; binary logistic regression was used to investigate factors independently related to the severity of pemphigus vulgaris; a receiver operating characteristic (ROC) curve was drawn, and the area under the curve, sensitivity and specificity were calculated to evaluate the ability of YKL-40 to predict the severity of pemphigus vulgaris. Results:Compared with the control group, the patient group showed significantly increased serum levels of YKL-40 (expressed as median[ Q1, Q3]: 15.22 [14.19, 15.93] vs. 13.64 [13.21, 14.63]μg/L, z=-3.88, P < 0.05) , interleukin (IL) -6 (2.05 [1.49, 4.21] vs. 1.57[1.38, 1.75]ng/L, z=-2.44, P < 0.05) , IL-7 (7.45[5.63, 11.63] vs. 3.77[2.21, 5.97]ng/L, z=-3.26, P < 0.05], IL-8 (6.59[3.60, 14.73] vs. 4.36[2.96, 6.53]ng/L, z=-1.96, P < 0.05) , IL-2R-α (509.08 [386.36, 757.67] vs. 336.44[309.86, 458.71]ng/L, z=-2.35, P < 0.05) , and C5a (100.35 [78.31, 140.84] vs. 72.08 [37.23, 82.08] ng/L, z = -3.04, P < 0.05) . The concentration of serum YKL-40 gradually decreased along with the reduction of lesion areas ( r = 0.63, P < 0.001) , and YKL-40 was independently correlated with the severity of pemphigus vulgaris ( P = 0.025, OR = 46.54, 95% CI: 1.61, 1 347.19) . The area under the curve of YKL-40 was 0.783 (95% CI: 0.613, 0.953) for distinguishing between patients with severe to extremely severe pemphigus vulgaris and those with mild to moderate pemphigus vulgaris. Conclusion:The serum level of YKL-40 is strongly correlated with the severity of pemphigus vulgaris, and has a potential value in predicting the severity of this disease.

Chinese Journal of Dermatology ; (12): 442-445, 2022.
Article in Chinese | WPRIM | ID: wpr-933574


Research progress in the establishment of long-term control goals and treat-to-target in the treatment of atopic dermatitis (AD) was searched and summarized in this review. The TREatment of ATopic eczema (TREAT) Registry Taskforce defined a minimum follow-up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment; the international Harmonising Outcome Measures for Eczema (HOME) group recommended that the long-term control of AD should be measured by either the Recap of Atopic Eczema (RECAP) instrument or the Atopic Dermatitis Control Tool (ADCT) . In order to achieve the treat-to-target in AD, a panel comprising 87 participants from 28 countries developed and published "Treat-to-target in atopic dermatitis: an international consensus on a set of core decision points for systemic therapies" in early 2021, which recommended 3 months and 6 months as two evaluation time points, and various disease outcome domains spanning symptoms, signs, quality of life plus patient global assessment as the target. By setting the time-specific outcome thresholds, the consensus provided a framework for shared decision-making on systemic treatment adjustment for AD patients. This review summarizes concepts and indicators related to the assessment of long-term control of and treat-to-target in AD, in the hope of providing some ideas for clinical management, especially the long-term control, of AD in China.

Chinese Journal of Dermatology ; (12): 268-271, 2022.
Article in Chinese | WPRIM | ID: wpr-933532


With in-depth research and development of dermoscopy, the dermoscopic features including perifollicular pigments, perilesional pigments, pigment network structure, satellite phenomenon and "tapioca sago" appearance, micro-Koebner phenomenon and comet tail-like phenomenon have provided a basis for the evaluation of vitiligo activity. This review summarizes progress in the evaluation of vitiligo activity with dermoscopy in recent years, aiming to promote the application of dermoscopy in the assessment of vitiligo activity.

Article in Chinese | WPRIM | ID: wpr-932441


Objective:To investigate the value of proteinuria in evaluating the severity of pre-eclampsia (PE) and assessing the maternal and neonatal outcomes of PE.Methods:The clinical records of 265 pregnant women who were diagnosed with PE at Peking Union Medical College Hospital from January 2011 to June 2021 were retrospectively analyzed. According to 24-hour urine protein (24-hUPro) results, pregnant women were divided into two groups: the non-proteinuric group (24-hUPro<0.3 g, n=10) and proteinuric group (24-hUPro≥0.3 g, n=255). The proteinuric group was further divided into 3 subgroups based on proteinuria levels: mild group (0.3 g≤24-hUPro<2.0 g, n=119), moderate group (2.0 g≤24-hUPro<5.0 g, n=59), and severe group (24-hUPro≥5.0 g, n=77). The demographic and clinical data, laboratory indicators, pregnancy complications, maternal and neonatal outcomes were compared between different groups. Results:In proteinuric subgroups, increased proteinuria was associated with earlier onset gestations, higher incidence of headache, peripheral tissue edema, serosal effusion, intrauterine growth restriction, and abnormal umbilical cord blood flow (all P<0.05). There were no significant differences in the incidence of placental abruption, eclampsia and maternal mortality among the three subgroups, but there were significant differences in the incidence of neonatal birth weight and multiple neonatal complications (all P<0.05). Compared with the proteinuric group, the non-proteinuric group showed later onset gestation (median:34.7 vs 37.6 weeks) and gestational age of delivery (median:36.0 vs 38.4 weeks), lower proportion of ocular vascular lesions [56.7% (135/238) vs 2/9], higher birth weight (median: 2 325 vs 2 750 g), and lower rate of neonatal intensive care unit occupancy [54.3%(127/234) vs 1/10;all P<0.05]. Conclusions:The proteinuria plays an important role in assessing the severity of PE and maternal and neonatal outcomes, but it is not the only indicator. The non-proteinuric PE pregnant women might still lead to severe maternal and neonatal outcomes.

Arq. bras. cardiol ; 118(2): 478-485, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364331


Resumo Fundamento A relação direta entre a doença arterial coronariana (DAC) e o câncer de pulmão não é bem conhecida. Objetivo Investigar a associação entre a gravidade anatômica da DAC e do câncer de pulmão. Métodos Trezentos pacientes, incluindo 75 recém-diagnosticados com câncer de pulmão e 225 pacientes correspondentes sem câncer, foram submetidos à angiografia coronária durante a internação, sem intervenção coronária percutânea (ICP) prévia nem enxerto de bypass da artéria coronária (CABG). O escore SYNTAX foi utilizado para avaliar a gravidade da DAC. Uma pontuação alta no escore foi definida como > 15 (o maior quartil do escore SYNTAX). O teste de tendência de Cochran-Armitage foi utilizado para verificar a distribuição dos escores dos pacientes. Uma análise de regressão logística foi utilizada para avaliar a associação entre a gravidade da DAC e o câncer de pulmão. Os valores de p foram estabelecidos quando o nível de significância era 5%. Resultados A tendência de distribuição dos escores SYNTAX dos pacientes por quartis foi diferente entre aqueles com câncer de pulmão e controles (do quartil mais baixo ao mais alto: 20,0%; 20,0%; 24,0%; 36,0% vs. 26,7%; 26,2%; 25,8%; 21,3%; p=0,022). A pontuação no escore SYNTAX foi mais alta em pacientes com câncer do que nos pacientes controle (36,0% vs. 21,3%, p=0,011).O maior quartil do escore demonstrou mais riscos de desenvolver câncer de pulmão em comparação ao quartil mais baixo (OR: 2.250, IC95%: 1.077 a 4.699 ; P -trend= 0,016). Após ajustes, os pacientes no maior quartil do escore SYNTAX tinham mais risco de desenvolver câncer de pulmão (OR: 2.1o49, IC95%: 1.008 a 4.584; P -trend= 0,028). Pacientes com escores SYNTAX alto (> 15) tinham 1.985 mais chances de ter câncer de pulmão (IC95%: 1.105-3.563, P= 0,022). Conclusão A gravidade anatômica da DAC está associada ao risco de câncer de pulmão, o que indica que um rastreamento completo deste tipo de câncer possa ser mais significativo entre pacientes com DAC.

Abstract Background The direct relationship between coronary artery disease (CAD) and lung cancer is not well known. Objective To investigate the association between the anatomical severity of CAD and lung cancer. Methods Three-hundred study patients, including 75 recently diagnosed lung cancer patients and 225 matched non-cancer patients, underwent coronary angiography during hospitalization without previous percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The SYNTAX score (SXscore) was used to assess the severity of CAD. A high SXscore (SXhigh) grade was defined as SXscore > 15 (the highest quartile of the SXscore). The Cochran-Armitage test for trend was used to assess the distribution of patients' SXscores. Logistic regression analysis was used to assess the association between the severity of CAD and lung cancer. P-values were set when significance level was 5%. Results The distribution trend of patients' SXscore by quartiles was different between lung cancer patients and control patients (from the lowest to the highest quartile: 20.0%, 20.0%, 24.0%, 36.0% vs. 26.7%, 26.2%, 25.8%, 21.3%, p=0.022). The SX high rate was higher in lung cancer patients than in control patients (36.0% vs. 21.3%, p=0.011).The highest quartile of the SXscore showed higher risk of lung cancer in comparison to the lowest quartile (OR: 2,250, 95%CI: 1,077 to 4,699 ; P-trend= 0.016). After adjustment, patients in the highest quartile of the SXscore had higher risk of lung cancer (OR: 2,149, 95%CI: 1,008 to 4,584; P-trend= 0.028). Patients with high SXscore (> 15) had 1,985 times more chances of having lung cancer (95%CI: 1,105-3,563, P= 0.022). Conclusions The anatomical severity of CAD is associated with the risk of lung cancer, which indicates that a thorough lung cancer screening may be significant among severe CAD patients.

Humans , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Percutaneous Coronary Intervention , Severity of Illness Index , Cross-Sectional Studies , Coronary Angiography , Early Detection of Cancer , Lung Neoplasms/diagnostic imaging
Acta méd. peru ; 38(4): 273-278, oct.-dic 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1374114


RESUMEN Objetivo : comparar el índice SatO2/FiO2 versus PaO2/FiO2 para predecir mortalidad en pacientes con COVID-19 en un hospital de altura. Materiales y métodos : estudio observacional, retrospectivo y transversal, donde se compararon la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de ambos índices. Resultados : La edad promedio de los pacientes con COVID-19 fue 62.2 ±12.8 años, el 73.7 % fueron varones, las comorbilidades de mayor frecuencia fueron la diabetes mellitus 21.6 % y la hipertensión arterial 27.2 % . Por otro lado, el índice promedio SatO2/FiO2 fue 234.9 ±121.9 y el PaO2/ FiO2 fue 169.7 ± 84 y el 30.5 % de pacientes falleció. Se evidenció relación significativa entre los índices en mención y la mortalidad. Se obtuvo como puntos de corte 114.4 para SatO2/ FiO2, con sensibilidad de 43.1 %, especificidad de 91.2 %, valor predictivo positivo de 68.3 % y valor predictivo negativo de 78.5 %, mientras que el punto de corte para PaO2/FiO2 fue 134.2, con sensibilidad de 63.1 %, especificidad de 67.6 %, valor predictivo positivo de 46.1 % y valor predictivo negativo de 80.7 %. Conclusión : Ambos índices son predictores de mortalidad, sin embargo, el SatO2/FiO2 presentó mejores valores, con respecto a algunos de los criterios de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo.

Abstract Objective : To compare the SatO2/FiO2 rate against PaO2/FiO2 rate for predicting mortality in COVID-19 patients in a high altitude hospital. Materials and Methods : This is an observational, retrospective, and cross-sectional study, where sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for both rates were compared. Results : The average age of COVID-19 patients was 62.2 ± 12.8 years. Three quarters (73.7 %) of all patients were male, most frequent comorbidities were diabetes mellitus (21.6 %), and high blood pressure (27.2 %). On the other hand, average SatO2/FiO2 rate was 234.9 ± 121.9, and PaO2/FiO2 was 169.7 ± 84, and 30.5 % of all patients died. A significant relationship between the aforementioned rates and mortality was evidenced. The cutoff point for SatO2/FiO2 was 114.4, with 43.1 % sensitivity, 91.2 % specificity, 68.3 % positive predictive value, and 78.5 % negative predictive value. The cutoff point for PaO2/FiO2 was 134.2, with 63.1 % sensitivity, 67.6 % specificity, 46.1 % positive predictive value, and 80.7 % negative predictive value. Conclusion : Both rates are predictors for mortality; however, SatO2/FiO2 showed better results with respect to the following parameters: sensitivity, specificity, positive predictive value, and negative predictive value.

Rev. bras. ter. intensiva ; 33(3): 394-400, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347294


RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Critical Illness , Simplified Acute Physiology Score , Retrospective Studies , APACHE , Intensive Care Units
Radiol. bras ; 54(4): 219-224, July-Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1287748


Abstract Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.

Resumo Objetivo: Descrever a segurança e eficácia da embolização das artérias prostáticas (EAP) em pacientes com próstatas muito aumentadas (≥ 200 cm3). Materiais e Métodos: Este estudo retrospectivo incluiu 18 pacientes consecutivos com hiperplasia prostática benigna portadores de próstatas ≥ 200 cm3 (idade média de 74 anos), que foram submetidos a EAP para tratar sintomas de trato urinário inferior moderados a graves. Resultados: A EAP foi tecnicamente bem-sucedida em 17 pacientes (94,4%). Falha clínica (IPSS ≥ 8) foi detectada em dois pacientes durante o seguimento (11,1%). Observamos melhora significativa em todos os parâmetros relevantes aos três meses de acompanhamento: IPSS: 15,7 vs. 2,9; qualidade de vida: 5,2 vs. 1,0); PSA: 11,4 vs. 1,82 ng/mL; pico de fluxo urinário: 7,45 vs. 18,6 mL/s); volume prostático: 252,4 vs. 151,6 cm3; e volume urinário residual: 143,7 vs. 28,3 mL - p < 0,05 para todos). Um paciente (5,6%) apresentou eliminação de tecido prostático e hematúria autolimitada durante o seguimento, que não necessitou de tratamento específico. Conclusão: A EAP em pacientes com próstata muito aumentada foi segura e eficaz, com significativas melhoras clínica, urodinâmica e imaginológica.

Arq. Asma, Alerg. Imunol ; 5(2): 195-198, abr.jun.2021. ilus
Article in Portuguese | LILACS | ID: biblio-1398931


A urticária é uma lesão cutânea eritematosa, edematosa e pruriginosa, mais prevalente em mulheres entre 30 a 50 anos de idade, sendo classificada em aguda ou crônica. O quadro clínico da urticária crônica espontânea é desencadeado independentemente de estímulos exógenos, podendo ser acompanhado de angioedema em 40% dos casos. O diagnóstico é clínico e a doença pode ser monitorada com escores. O tratamento da urticária crônica espontânea é baseado em anti-histamínicos H1 de segunda geração como primeira linha. A segunda linha se baseia no aumento da dose de anti-histamínicos H1 em até quatro vezes a dose habitual, a terceira linha consiste na associação de imunobiológicos como o omalizumabe, e a quarta linha no uso de ciclosporina. Este relato de caso teve como objetivo analisar a eficácia e segurança do tratamento com dupilumabe na urticária crônica espontânea refratária ao omalizumabe, utilizando os escores de atividade da urticária e o questionário de qualidade de vida em dermatologia. A partir dos resultados obtidos, verificou-se sucesso terapêutico com dupilumabe, que se manteve mesmo após suspensão do medicamento. O uso off label do dupilumabe justificou-se pelo seu mecanismo de ação na fisiopatologia da doença. Este é o primeiro relato de caso brasileiro do uso de dupilumabe para urticária crônica espontânea refratária ao omalizumabe.

Urticaria is an erythematous, edematous, and pruritic skin lesion, most prevalent in women between 30 and 50 years of age, and classified as acute or chronic. The clinical features of spontaneous chronic urticaria are triggered regardless of exogenous stimuli and may be accompanied by angioedema in 40% of cases. The diagnosis is clinical and the disease can be monitored with scores. The first-line treatment of spontaneous chronic urticaria is based on second-generation H1 antihistamines. The second-line treatment is based on increasing the dose of H1 antihistamines by up to four times the standard dose, the third line consists of the association with biologics such as omalizumab, and the fourth line consists of the use of cyclosporine. The present case report aimed to analyze the efficacy and safety of dupilumab treatment for chronic spontaneous urticaria refractory to omalizumab, quantifying clinical improvement and quality of life using urticaria activity scores and a dermatology quality of life questionnaire, respectively. The results obtained showed therapeutic success with dupilumab, which was maintained even after drug suspension. Offlabel use of dupilumab was justified by its mechanism of action in the pathophysiology of the disease. This is the first Brazilian case report of the use of dupilumab for chronic spontaneous urticaria refractory to omalizumab.

Humans , Female , Young Adult , Antibodies, Monoclonal, Humanized , Omalizumab , Chronic Urticaria , Histamine Antagonists , Histamine H1 Antagonists , Therapeutics , Efficacy , Cyclosporine , Dosage , Angioedema
Medicina (B.Aires) ; 81(3): 401-407, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346476


Resumen La pandemia por COVID-19 significó una crisis mundial sin precedentes, que implicó la reorganización de los sistemas de salud y la racionalización de los recursos diagnósticos y terapéuticos disponibles. El objetivo de este estudio observacional y retrospectivo fue analizar características clínicas y evo lución de los pacientes internados en guardia, sala general y terapia intensiva en un hospital privado de alta complejidad de la Ciudad de Buenos Aires, durante los primeros siete meses de circulación viral. Se incluyeron 1005 pacientes con COVID-19 confirmado por laboratorio. La mediana de edad fue de 45 años; 73.7% eran varones. La mitad de los pacientes presentaba al menos una comorbilidad. La mediana de leucocitos totales fue 6300 células/mm3 y de linfocitos 818 células/mm3. El 82.3% presentó alteraciones en la tomografía de tórax; y el patrón radiológico observado con mayor frecuencia fue opacidad tipo vidrio esmerilado (33%). El 82.4% recibió antibioticoterapia empírica dirigida a foco respiratorio y, además, el 18.7% fu e tratado con dexametasona. Respecto de la gravedad, el 14.7% presentó enfermedad no complicada, el 55.2% neumonía leve, el 20.8% neumonía moderada y el 9.2% neumonía grave. Asimismo, el 8.7% fue transferido a terapia intensiva. Se registró una mortalidad hospitalaria del 2.3% y del 20.5% en terapia intensiva. Se encontró asociación estadísticamente significativa entre mortalidad y edad, con una diferencia de edad de 9.6 años, siendo mayor entre los fallecidos (p = 0.0004; IC 95% 4-14). Sin embargo, no hubo asociación entre presencia de comorbilidades y sexo vs. mortalidad y gravedad de la enfermedad.

Abstract Coronavirus disease 2019 (COVID-19) meant an unprecedented global crisis, which involved the reorganization of health systems and the rationalization of available diagnostic and therapeutic resources. The objective of this observational and retrospective study was to analyze the clinical characteristics and evolution of patients admitted to general ward, intensive care unit and emergency department of a high complexity hospital in Buenos Aires city, during the first seven months of viral circulation. A total of 1005 patients with laboratory-confirmed COVID-19 were included. The median age was 45 years, and 73.7% were men. Half of the patients had at least one comorbidity. Among the laboratory findings, the median of total leukocytes was 6300 cells/mm3 and that of lymphocytes 818 cells/mm3; 82.3% of the patients presented alterations in the chest tomography, and the most frequently observed radiological pattern was ground-glass opacity (33%); 82.4% of them received empirical antibiotic therapy directed to the respiratory focus and, in addition, 18.7% were treated with dexamethasone. Regarding severity, 14.7% of the patients presented uncomplicated disease, 55.2% mild pneumonia, 20.8% moderate pneumonia, and 9.2% severe pneumonia. Likewise, 8.7% of them were transferred to intensive care. In-hospital mortality was 2.3%, and 20.5% among critically ill patients. A statistically significant association was found between mortality and age, with an age difference of 9.6 years, being greater among the deceased (p = 0.0004; 95% CI 4-14). However, there was no association between the presence of comorbidities and sex vs. mortality and severity of the disease.

Humans , Male , Female , Child , Middle Aged , SARS-CoV-2 , COVID-19 , Comorbidity , Retrospective Studies , Critical Illness , Intensive Care Units
Rev. colomb. cir ; 36(3): 471-480, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1254297


Introducción. En el paciente con pancreatitis aguda severa, la presencia de necrosis infectada y falla multiorgánica se asocian con una mortalidad del 20-40 %. La tomografía computarizada con contraste intravenoso y la clasificación del Consenso de Atlanta 2012 son importantes herramientas de diagnóstico para el tratamiento oportuno. En esta investigación, se analizó la relación del índice de severidad tomográfico y los cambios morfológicos locales según dicha clasificación, con la estancia hospitalaria, intervención, infección y mortalidad de los pacientes. Métodos. Estudio de cohorte retrospectiva realizado entre los años 2015 y 2019, donde se incluyeron pacientes mayores de 15 años con pancreatitis aguda severa diagnosticado por tomografía computarizada con contraste, y se evaluó el índice de severidad tomográfico y los cambios morfológicos según la clasificación de Atlanta 2012, en relación con los desenlaces clínicos de los pacientes. Resultados. Se incluyeron 56 pacientes, en el 82,1 % (n=46) de los casos la causa fue litiásica. La falla orgánica fue principalmente pulmonar 53,6 % (n=30) y cardiovascular 55,4 % (n=31). Según la tomografía, se clasificó como severa (7-10 puntos) en el 91,1 % (n=51) de los pacientes. En pacientes con necrosis amurallada infectada la estancia hospitalaria media fue mayor (78,5 días); en todos los pacientes con pancreatitis severa se encontró infección y fueron sometidos a algún tipo de intervención. La mortalidad fue menor del 10 % (n=5).Discusión. El índice de severidad tomográfica para la categorización de severo se correlacionó en un 90 % con pancreatitis aguda severa. Una tomografía de control a la cuarta semana podría identificar complicaciones tardías para un manejo precoz

Introduction. In patients with severe acute pancreatitis, the presence of infected necrosis and multiple organ failure are associated with a mortality of 20-40%. Computed tomography with intravenous contrast and the 2012 Atlanta Consensus classification are important diagnostic tools for timely treatment. In this research, the relationship between the tomographic severity index and the local morphological changes according to that classification, with the hospital stay, intervention, infection and mortality of the patients was analyzed.Methods. Retrospective cohort study carried out between the years 2015 and 2019, which included patients older than 15 years with severe acute pancreatitis diagnosed by contrast computed tomography, the tomographic severity index and morphological changes according to the Atlanta 2012 classification were evaluated, in relationship with the clinical outcomes of the patients. Results. Fifty-six patients were included, in 82.1% (n=46) of the cases the cause was lithiasis. Organ failure was mainly pulmonary 53.6% (n=30) and cardiovascular 55.4% (n=31). According to the tomography, it was classified as severe (7-10) in 91.1% (n=51) of the patients. In patients with infected walled necrosis, the mean hospital stay was longer (78.5 days); infection was found in all patients with severe pancreatitis and they underwent some type of intervention. Mortality was less than 10% (n=5).Discussion. The tomographic severity index for the categorization of severity is 90% correlated with severe acute pancreatitis. A control tomography at the fourth week could identify late complications for early management

Humans , Pancreatitis , Severity of Illness Index , Infections , Tomography , Mortality , Intraoperative Complications , Necrosis
An. Fac. Med. (Perú) ; 82(2): 113-117, abr.-jun 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339082


RESUMEN Objetivo. Determinar la extensión de la afectación pulmonar en pacientes con neumonía por SARS-CoV-2 mediante tomografía. Método. Evaluación retrospectiva en pacientes con evidencia de COVID-19 del Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú, al inicio de la pandemia COVID-19, entre el 15 de marzo y el 14 de mayo de 2020. La extensión de la neumonía se determinó mediante tomografía con base en la Clasificación de la Sociedad Francesa de Imagen Torácica. Resultados. Se incluyeron en el estudio 485 pacientes. La extensión de la neumonía fue: ausente 1,2%, mínima 4,9%, moderada 20,6%, extensa 27,4%, grave 30,7% y crítica 15,1%. La afectación pulmonar se asoció con edad mayor de 60 años (p=0,014) y saturación de oxígeno ambiental por debajo de 90% (n=372, p=0,000). Conclusiones. Por su extensión, las neumonías por SARS-CoV-2 en los primeros dos meses de la epidemia de COVID-19 en el Hospital Almenara fueron graves, extensas y moderadas en su gran mayoría. La extensión de la neumonía se asoció con edad y saturación de oxígeno ambiental al ingreso.

ABSTRACT Objective. To determine the extent of pulmonary involvement in patients with SARS-CoV-2 pneumonia using tomography. Method. Retrospective evaluation in patients with evidence of COVID-19 at the Guillermo Almenara Irigoyen National Hospital, Lima - Peru, at the beginning of the COVID-19 pandemic, between March 15 and May 14, 2020. The extent of pneumonia was determined by means of tomography based on the Classification of the French Society of Thoracic Imaging. Results. 485 patients were included in the study. The extent of pneumonia was: 1.2% absent, 4.9% minimal, 20.6% moderate, 27.4% extensive, 30.7% severe, and 15.1% critical. Lung involvement was associated with age older than 60 years (p = 0.014) and ambient oxygen saturation below 90% (n = 372, p = 0.000). Conclusions. Due to its extension, the SARS- CoV-2 pneumonia in the first two months of the COVID-19 epidemic at Hospital Almenara were severe, extensive and mostly moderate. The extent of pneumonia was associated with age and ambient oxygen saturation at admission.

Arq. gastroenterol ; 58(1): 17-25, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248993


ABSTRACT BACKGROUND: New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012. OBJECTIVE: The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices. METHODS: A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study. RESULTS: Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification. CONCLUSION: Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.

RESUMO CONTEXTO: Após a revisão da Classificação de Atlanta, em 2012, foram estabelecidas novas recomendações no manejo dos pacientes com pancreatite aguda. OBJETIVO: Objetiva-se avaliar o grau de aceitação e implementação dessas recomendações na prática clínica. MÉTODOS: Foi realizada revisão sistemática da literatura com auxílio das bases: PubMed/Medline, Cochrane e SciELO, por meio de busca de estudos em humanos, publicados em inglês e português, no período de 25/10/2012 até 30/11/2018, utilizando os descritores e operador booleano: "Acute pancreatitis" E "Atlanta". Foram incluídos apenas estudos do tipo Ensaios Clínicos Randomizados que avaliaram alguma recomendação relacionada a revisão da Classificação de Atlanta após 2012. RESULTADOS: Foram selecionados 89 estudos após aplicação dos critérios de inclusão, exclusão e avaliação qualitativa. Esses foram estratificados quanto à aplicação ou não das recomendações propostas após a revisão da Classificação de Atlanta. Verificou-se que 68,5% dos estudos aplicaram essas recomendações, principalmente, na classificação da gravidade dos pacientes (leve, moderadamente grave, grave). Desses 16,4% eram estudos de origem norte-americana e 14,7% chineses. Os outros 31,5% limitaram-se a comparar ou apenas validar essa classificação de gravidade. CONCLUSÃO: Poucos estudos divulgaram alguma forma de implementação das novas recomendações, apesar dos esforços norte-americanos e chineses. A falta da aparente incorporação dessas recomendações na prática clínica, não permitiu o aproveitamento de suas vantagens (principalmente a melhora da comunicação entre os profissionais e estabelecimento da classificação e identificação precoce dos pacientes mais graves), sendo necessário toda a comunidade médica internacional se mobilizar de alguma forma para mudar esse cenário.

Humans , Pancreatitis/therapy , Prognosis , Severity of Illness Index , Acute Disease
Arq. gastroenterol ; 58(1): 39-47, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248990


ABSTRACT BACKGROUND: H. pylori chronic atrophic gastritis is a premalignant lesion, and its staging, according to OLGA and OLGIM systems aims to identify patients at increased risk of developing gastric cancer and optimize their follow-up. GastroPanel®, serum biomarkers panel including pepsinogen I (PGI), pepsinogen II (PGII), Gastrin 17 (G17) and anti- H. pylori antibodies is a noninvasive test for adenocarcinoma risk assessment in chronic H. pylori gastritis patients. OBJECTIVE: Prospective study to evaluate the concordance between OLGA and OLGIM grading systems, as well as to evaluate GastroPanel´s performance in patients with premalignant lesions secondary to H. pylori chronic gastritis in Brazil. METHODS: Patients with H. pylori chronic gastritis with premalignant lesions confirmed by histology were recruited from the gastrointestinal clinic of a University Hospital. All participants underwent endoscopic examination with biopsies which were reported according to updated Sydney system and premalignant lesions grading systems (OLGA and OLGIM). Blood samples were collected for biomarkers serological analysis (GastroPanel®, Biohit, Helsinki, Finland). The cut off values used to define high risk patients were those recommended by the manufacturer: PGI ≤30 µm/L and PGI/PGII ≤3. RESULTS: 41 patients were recruited: 28 women, 13 men, mean age 67.3 (47-89, SD: 9.6) years. By OLGA system, were obtained: OLGA 0 (n=1), OLGA I (n=7), OLGA II (n=17), OLGA III (n=9), and OLGA IV (n=7). By OLGIM system, were obtained: OLGIM 0 (n=14), OLGIM I (n=5), OLGIM II (n=10), OLGIM III (n=10), and OLGIM IV (n=2). Regarding histological staging among patients staged as low risk (OLGA/OLGIM 0, I and II) and high risk (OLGA/OLGIM III and IV) for gastric cancer development, the concordance rate found between both classifications was 85.4%. Considering high risk patients, those patients thus included in at least one of the systems the final distribution of our sample considered 24 low-risk and 17 high-risk patients for the development of gastric cancer. To determine by GastroPanel® whether the patient would be at low or high risk of developing gastric cancer, PGI showed a sensitivity, specificity and accuracy of 0.47 (95%CI: 0.26-0.69), 0.67 (95%CI: 0.47-0.82), and 0.58 (95%CI: 0.43-0.72), respectively, while PGI/PGII showed sensitivity, specificity and accuracy of 0.06 (95%CI: 0.01-0.27), 0.83 (95%CI: 0.64-0.93) and 0.51 (95%CI: 0.36-0.66), respectively. CONCLUSION: The histological classifications OLGA and OLGIM presented a substantial concordance rate among themselves. Simultaneous use of both histological classification systems increased the identification's rate of high-risk patients. Biomarker analysis was not effective to distinguish low to high risk patients in the studied population. Further studies are needed to validate its use in clinical practice in Brazil.

RESUMO CONTEXTO: Gastrite atrófica crônica por H. pylori constitui lesão pré-maligna e seu estadiamento de acordo com os sistemas OLGA e OLGIM, visa identificar pacientes com maior risco de desenvolver câncer gástrico e otimizar seu acompanhamento. GastroPanel® é um teste não invasivo composto por painel de biomarcadores séricos incluindo pepsinogênio I (PGI), pepsinogênio II (PGII), gastrina 17 (G17) e anticorpos anti- H. pylori para avaliação de risco de adenocarcinoma gástrico em pacientes com gastrite crônica por H. pylori. OBJETIVO: Estudo prospectivo para avaliar a concordância entre os sistemas de classificação OLGA e OLGIM, bem como avaliar o desempenho do GastroPanel® em pacientes com lesões pré-malignas secundárias à gastrite crônica por H. pylori no Brasil. MÉTODOS: Pacientes com gastrite crônica por H. pylori portadores de lesões pré-malignas confirmadas por histologia (gastrite atrófica e metaplasia intestinal) foram recrutados no ambulatório de gastroenterologia de um hospital universitário. Todos os participantes foram submetidos a exame endoscópico com biópsias de antro e corpo gástricos analisadas de acordo com o Sistema Sydney atualizado e estadiadas pelos Sistemas OLGA e OLGIM de classificação das gastrites. Amostras de sangue foram coletadas para análise sorológica de biomarcadores (GastroPanel®, Biohit, Helsinki, Finlândia). Os valores de corte utilizados para definir pacientes de alto risco para desenvolvimento de câncer gástrico foram os recomendados pelo fabricante: PGI ≤30 µm e PGI/PGII ≤3. RESULTADOS: Foram recrutados 41 pacientes: 28 mulheres, 13 homens, idade média 67,3 (47-89, DP: 9,6) anos. Pelo sistema OLGA, foram obtidos: OLGA 0 (n=1), OLGA I (n=7), OLGA II (n=17), OLGA III (n=9) e OLGA IV (n=7). Pelo sistema OLGIM, foram obtidos: OLGIM 0 (n=14), OLGIM I (n=5), OLGIM II (n=10), OLGIM III (n=10) e OLGIM IV (n=2). Em relação ao estadiamento histológico entre os pacientes de baixo risco (OLGA/OLGIM 0, I e II) e alto risco (OLGA/OLGIM III e IV) para o desenvolvimento de câncer gástrico, a taxa de concordância encontrada entre as duas classificações foi de 85,4%, com valor kappa=0,678 (IC95%: 0,440-0,916). Considerando como pacientes de alto risco, aqueles assim estadiados em pelo menos um dos sistemas, a distribuição final de nossa amostra encontrou 24 pacientes de baixo risco e 17 de alto risco para o desenvolvimento de câncer gástrico. Na determinação pelo GastroPanel® para classificação do paciente como de baixo ou alto risco para desenvolvimento de câncer gástrico, PGI mostrou sensibilidade, especificidade e acurácia de 0,47 (IC95%: 0,26-0,69), 0,67 (IC95%: 0,47-0,82) e 0,58 (IC95%: 0,43-0,72), respectivamente, enquanto a razão PGI/PGII mostrou sensibilidade, especificidade e acurácia de 0,06 (IC95%: 0,01-0,27), 0,83 (IC95%: 0,64-0,93) e 0,51 (IC95%: 0,36-0,66), respectivamente. CONCLUSÃO: As classificações histológicas OLGA e OLGIM apresentaram taxa de concordância substancial entre si. O uso simultâneo de ambos os sistemas de classificação histológica aumentou a taxa de identificação de pacientes de alto risco para desenvolvimento de câncer gástrico. Os resultados do GastroPanel® não foram eficazes para distinguir pacientes de baixo e alto risco para desenvolvimento de câncer gástrico na população estudada. Mais estudos são necessários para validar seu uso na prática clínica no Brasil.

Humans , Male , Female , Aged , Stomach Neoplasms , Helicobacter pylori , Helicobacter Infections , Gastritis , Brazil , Biomarkers , Prospective Studies , Risk Factors , Metaplasia