Alterações hidroeletrolíticas em pessoas com cirrose / Hydroelectrolytic alterations in cirrhotic patients

O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)

The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)

Prevalence of hypoalbuminemia in outpatients with HIV/AIDS

Abstract INTRODUCTION: Hypoalbuminemia may predict progression of disease and mortality in patients with human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS). This study was conducted to investigate the risk factors associated with hypoalbuminemia in outpatients with HIV/AIDS. METHODS: A cross-sectional study was performed in 196 outpatients with HIV/AIDS. RESULTS: The prevalence of hypoalbuminemia was 11.7%. The only risk factor associated with hypoalbuminemia was current antiretroviral therapy (no exposure: odds ratio=3.46, 95% confidence interval=1.20-10.02). CONCLUSIONS: The monitoring of plasma albumin is key to determine when antiretroviral therapy should be initiated in individuals not exposed to antiretroviral medicines.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children / Sinais clínicos e laboratoriais para o dengue com evolução grave em crianças hospitalizadas

Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. Results: Of the total (n = 145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p < 0.01), but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p < 0.01). Despite statistical significance (p < 0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Resumo Objetivo Avaliar a validade dos sinais clínicos e laboratoriais para o dengue com evolução grave em crianças hospitalizadas. Métodos Coorte retrospectivo de crianças (<18 anos) internadas com dengue (2007-2008). Evolução grave foi definida como óbito ou pelo uso de terapia de suporte avançado de vida. Foram calculadas medidas de acurácia e área sob a curva ROC. Resultados Do total (n = 145), 53,1% casos eram do sexo feminino, 69% de 2 a 11 anos e 15,9% evoluíram para gravidade. Letargia obteve a melhor acurácia (razão de verossimilhança positiva RVP > 19 e RV negativa RVN < 0,6). Derrame pleural e distensão abdominal apresentaram maior sensibilidade (se = 82,6%). Relato de sangramentos (epistaxe, gengivorragia ou gastrointestinal) e hemorragia grave (pulmonar ou gastrointestinal) presente no exame físico foi mais frequente nos casos com evolução grave (p <0,01), porém com baixa acurácia (RVP = 1,89 e 3,89; RVN = 0,53 e 0,60, respectivamente). Os níveis de albumina sérica foram mais baixos nas formas graves (p <0,01). Ambos os grupos apresentaram trombocitopenia, apesar da diferença estatística (p <0,05). Contagem de plaquetas, hematócrito e hemoglobina apresentaram área sob a curva ROC < 0,5. Conclusões Letargia, distensão abdominal, derrame pleural e hipoalbuminemia foram os melhores marcadores clínicos e laboratoriais de dengue com evolução grave em crianças hospitalizadas, enquanto sangramento, hemorragia grave, hemoconcentração e trombocitopenia não tiveram boa acurácia diagnóstica. Em hospitais de referência pediátricos, a ausência de hemoconcentração não implica ausência de extravasamento plasmático, particularmente quando há reposição anterior de volume. Esses resultados podem contribuir para o manejo clínico do dengue em crianças em hospitais de referência.

Preemptive antiviral therapy with entecavir can reduce acute deterioration of hepatic function following transarterial chemoembolization

BACKGROUND/AIMS: Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. METHODS: This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. RESULTS: Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P=0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P=0.013), hypoalbuminemia (HR=3.990, P=0.015), and absence of antiviral therapy (HR=7.597, P=0.006) were significantly associated with treatment-related hepatic decompensation. CONCLUSIONS: Our findings suggest that preemptive antiviral therapy significantly reduces the risk of acute hepatic deterioration. Preventing hepatic deterioration during TACE by applying such a preemptive approach may facilitate the continuation of anticancer therapy and thus improve long-term outcomes.

Usefulness of hemoglobin and albumin as prognostic markers for highly active antiretroviral therapy for HIV-1 infection.

Background: Usefulness of hemoglobin and albumin as prognostic markers for highly active anti-retroviral therapy for HIV-1 infection. Introduction: Anemia and hypoalbuminemia are common complications in human immunodeficiency virus (HIV) infection. We aimed to investigate the changes in hemoglobin and albumin levels in response to highly active antiretroviral therapy (HAART). Further, we evaluated the appropriateness of using hemoglobin and albumin as HIV disease progression markers. Materials and Methods: A prospective longitudinal study of 122 subjects was carried out. Pre-treatment, one year, and two year post-treatment hemoglobin, and albumin levels were correlated with respective CD4+ T cell counts. The sensitivity, specificity, and positive predictive value of each marker against CD4+ T cell counts were calculated in order to establish the appropriateness of use of these parameters as surrogate disease progression and prognostic markers. Results: Mean hemoglobin and albumin levels pre-, one, and two year post HAART were 9.7 g/dL, 12.1 g/dL, and 13.1 g/dL, respectively, P = 0.001; albumin: 3.7 gm%, 4.4 gm%, and 4.7 gm%, respectively, P = 0.001. There was a positive correlation between hemoglobin, albumin, and CD4+ T cell count at pre-treatment, one year, and two year post-treatment visit. Both albumin and hemoglobin had high sensitivity when compared to CD4+ T cell counts. Conclusions: Hemoglobin and albumin levels were found to increase after initiation of HAART. Hemoglobin and albumin were seen to be a strong prognostic marker of HIV disease progression at pre-, one, and two year post-treatment. Therefore, hemoglobin and albumin may be used together along with CD4 + T cell counts in HIV management, particularly in resource-poor settings.

Anemia and hypoalbuminemia at initiation of hemodialysis as risk factor for survival of dialysis patients

To determine the survival of patients undergoing chronic maintenance hemodialysis by determining the relative risk [RR] of anemia and hypoalbuminemia at initiation of dialysis on survival. Cohort study. Hemodialysis Unit of Shalamar Hospital, Lahore, from June 2003 to October 2006. This study was conducted on all patients of end stage renal disease who presented in Accident/Emergency Department of the hospital for the first time or received calls from other departments in getting dialysis. Patients with acute renal failure and those lost to follow-up were excluded from the study. At presentation, a history and examination was done and recorded. At the same time a blood sample was sent for routine hematological parameters [hemoglobin, total leucocyte count [TLC], biochemical [urea, creatinine, serum potassium and albumin] and viral markers [anti-HCV and HbsAg]. Patients were followed up for outcomes. The outcomes of the study were continued dialysis, death and renal transplant. Kaplan-Meier and log Rank tests were used for determining survival. Relative risk was assessed on medical 9.2. One hundred and eighty five patients were studied including 99 [52.8%] males and 86 [47.2%] females. Major causes of renal failure were Diabetes mellitus in 125 [67.6%], chronic glomerulonephrotis in 31 [16.8%] and hypertension in 18 [9.7%]. Most of the patients - 105 [60%] were euvolemic. Sixty percent of patients had very high urea [> 200 mg/dl] and creatinine [> 8.0 mg/dl]. The mortality of haemodialysis patients was seventy four percent per 100 patients per year, 62.24% being in the initial 6 months. One hundred and sixty four patients [91.1%] were anemic [hemoglobin < 11 gm/dl] and 124 [67%] were hypoalbuminemic [serum albumin < 4 gm/dl] on first presentation. Patients with group 1 have hemoglobin less than 11gm/dl [7.83 +/- 1.51], group 2 had hemoglobin of equal to more than 11 gm/dl [11.56 +/- 0.64] which was statistically significant [t = - 9.54, p= 0.000]. The survival freedom in group 2 [Hb > 11 gm/dl] was higher than group 1 [Hb < 11 gm/dl] which is statistical significant [p = 0.023]. On the basis of serum albumin [S.Alb], patients were divided into two groups i.e S.Alb less than 4 [3.15 +/- 0.38 gm/dl] was group 1, and more than or equal to 4 [4.23 + 0.28 gm/dl] was group 2, which were statistically significant [t = - 11.58, p < 0.001]. The overall survival time was significantly shorter in group 1 patients than group 2 [p = 0.037]. RR for low albumin was 1.27 and for low hemoglobin, it was 1.30. Mortality of haemodialysis patients was seventy four percent per 100 patients per year. Amongst these 62.24% were in the initial 6 months. The mean survival time was 296 days. Patients with very low hemoglobin and albumin are at more risk for early deaths than patients with normal hemoglobin and albumin on first presentation for dialysis