Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada / Frailty in patients admitted to hospital with acute decompensated heart failure

Background: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. Aim: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Material and Methods: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. Results: Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03-1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). Conclusions: The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2) / Clinical characteristics, complications and mortality in 506 patients with infective endocarditis and determinants of survival rate at 10 years

Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Correlación entre factor de crecimiento insulínico tipo 1 (IGF-1), citoquinas proinflamatorias y activación neurohumoral en pacientes con isuficiencia cardíaca crónica avanzada / Correlation of insulin like growth factor (IGF-1), cytokines and neurohumoral activation in patiens with advanced congestive heart failure

Hemos demostrado previamente que la actividad del eje hormona de crecimiento (GH) y su mediador activo, el factor de crecimiento insulínico tipo 1 (IGF-1) se encuentra disminuido en pacientes (pts) con insuficiencia cardíaca crónica (ICC). Por otra parte, se ha reportado que otras moléculas biológicamente activas, las citoquinas, se encuentran aumentadas en pts con ICC avanzada. Es posible que estas alteraciones neurohumorales contribuyan al compromiso del estado general y a un mayor deterioro de la función ventricular izquierda en estos pts. El objetivo del presente estudio fue evaluar si existe correlación entre la actividad del eje GH-IGF- 1, niveles de citoquinas proinflamatorias como el factor de necrosis tumoral (TNF) e interleuquína 6 (IL-6), y noradrenalina en reposo y ejercicio (NAD rep-NAD ex) en pts con ICC avanzada. Se estudiaron en forma prospectiva 10 pts con ICC por cardiopatía dilatada o isquémica. Se determinó consumo de 02 máximo (V02 max), Fracción de eyección (FE) radiolisotópica y niveles sóricos de GH e IGF- 1 (técnica IRMA), catecolaminas plasmáticas en reposo y en ejercicio máximo (NAD replex) (técnica RIA) y TNF e IL-6 (técnica ELISA). El análisis estadístico se realizó mediante regresión lineal Los resultados se expresaron como promedio k desviación estándar. La FE promedio del grupo fue de 17 por ciento ñ 4 por ciento y el V02 máx promedio de 15,9 ñ 3,9 ml/kg/min. LA GH fue de 3,4 ñ 4,55 ng/ml; IGF- 1 de 177,1 ñ 69,4 ng/ml, NAD rep 612,9 ñ 407,3 pg/ml y NAD ex de 4250 ñ 2620 pg/ml. El TNF del grupo fue de 1,2 ñ 1,4 pg/ml y la IL-6 de 4,4 ñ 3,55 pg/ml. Hubo correlación estadísticamente significativa entre el Logaritmo (log) IGF- 1 y Log NADex (r=-0, 66 p=0, 03 ), Log IGF- 1 y Log TNF(r=-0, 65p=0, 04)e IL-6 y NADex (r=0, 781 p=0,0l). Nuestro estudio demuestra por primera vez una correlación entre el aumento de la actividad simpática (NAD ex) y la menor actividad del eje GH-IGF- 1 en pts con ICC avanzada. Al mismo tiempo, confirma que también existe una correlación entre la actividad simpática exagerada y el aumento de citoquinas proinflamatorias en pts con ICC avanzada