Acute effects of dipyrone on renal function in patients with cirrhosis: a randomized controlled trial.

Use of non-steroidal anti-inflammatory drugs in cirrhosis has been associated with impairment of renal function based on its ability to inhibit the renal production of prostaglandins. Renal effects of dipyrone in patients with cirrhosis have not been evaluated. We aimed to assess the renal effect of therapeutic doses of dipyrone used for short periods of time in patients with cirrhosis. Twenty-nine patients with cirrhosis were included in an observer-blind clinical trial. Patients were randomized to receive three times a day oral acetaminophen (500 mg; N = 15) or dipyrone (575 mg; N = 14) for 72 hr. Serum and urine samples were obtained at baseline, 48 and 72 hr, and cystatin C, creatinine, aldosterone, 6-keto-Prostaglandin-F1 alpha and prostaglandin E2 were measured. Cystatin C and creatinine levels remained comparable in patients treated with acetaminophen and dipyrone. Urine and serum prostaglandins concentrations were significantly decreased at 72 hr in patients treated with dipyrone regardless of the status of ascites. One patient with ascites treated with dipyrone required a paracentesis and developed renal insufficiency. We conclude that dipyrone and acetaminophen did not reduce renal function when used for short periods of time (up to 72 hr) in patients with cirrhosis. However, considering that dipyrone lowered renal vasodilator prostaglandins synthesis, acetaminophen appears as the safest choice with respect to kidney function in cirrhosis.

[Is troponin I useful for predicting in-hospital risk for unstable angina patients in a community hospital? Results of a prospective study]. / Es la troponina I útil para predecir el riesgo hospitalario en pacientes con angina inestable ingresados en un hospital comarcal? Resultados de un estudio prospectivo.

INTRODUCTION AND OBJECTIVES: Before including troponin I detection in the daily practice of our hospital we performed a prospective study to determine its real usefulness and to establish the best cut-off point. METHODS: We studied 82 consecutive patients admitted with unstable angina to a community hospital. Troponin I was determined (> 10 h after chest pain). Patients were referred to a tertiary hospital for catheterization/revascularization if clinical events developed. RESULTS: Twenty-five patients (31%) suffered events during admission: recurrent angina in 23 cases (28%); heart failure in 5 (6%); exitus in 3 (4%); myocardial infarction in 1 (1%). The cut-off point for troponin I that best predicted events was 0.1 ng/ml. Patients with troponin I > 0.1 (34 patients, 42%) experienced more events [47 vs. 19%; OR = 3.8 (1.4-10.4); p = 0.01] and had higher rates of recurrent angina (42 vs. 19%), heart failure (12 vs. 2%) and exitus (9 vs 0%). Patients with ECG changes and troponin I > 0.1 showed a significantly higher percentage of events (63%) than those with ECG changes alone (23%) or troponin I > 0.1 alone (15%) or those without ECG changes and troponin I < 0.1 (17%) (p < 0.0001). CONCLUSIONS: Troponin I elevation is useful for predicting in-hospital risk for unstable angina patients admitted to a community hospital. A low cut-off value (0.1 ng/ml) predicts events. The association of ECG changes and high troponin I identifies a population at very high risk; however, the absence of both variables in patients with a diagnosis of unstable angina does not preclude the development of events.

¿Es la troponina i útil para predecir el riesgo hospitalario en pacientes con angina inestable ingresados en un hospital comarcal? Resultados de un estudio prospectivo / Is Troponin I Useful for Predicting In-Hospital Risk for Unstable Angina Patients in a Community Hospital? Results of a Prospective Study

Introducción y objetivos. Antes de incluir la troponina I en la práctica diaria de nuestro hospital, realizamos un estudio prospectivo para determinar su utilidad real y el mejor punto de corte. Métodos. Estudiamos a 82 pacientes consecutivos ingresados por angina inestable en un hospital comarcal. Se determinó la troponina I (> 10 h del episodio de dolor torácico). Los pacientes fueron remitidos a un hospital terciario para cateterismo/revascularización en caso de algún acontecimiento clínico. Resultados. Durante el ingreso se detectaron acontecimientos en 25 casos (31 por ciento): angina recurrente en 23 (28 por ciento), insuficiencia cardíaca en 5 (6 por ciento), infarto en 1 (1 por ciento) y muerte en 3 (4 por ciento). El mejor punto de corte de la troponina I para predecir acontecimientos fue 0,1 ng/ml. Los 34 pacientes (42 por ciento) con troponina I > 0,1 presentaron más acontecimientos (47 frente a 19 por ciento; OR = 3,8 [1,4-10,4]; p = 0,01), angina recurrente (42 frente a 19 por ciento), insuficiencia cardíaca (12 frente a 2 por ciento) y fallecimiento (9 frente a 0 por ciento). Los pacientes con cambios ECG y troponina I > 0,1 sufrieron más acontecimientos (63 por ciento; p 0,1 (15 por ciento), o aquellos sin cambios ECG y troponina I < 0,1 (17 por ciento).Conclusiones. La troponina I es de utilidad para predecir el riesgo hospitalario en pacientes con angina inestable en un hospital comarcal. Un punto de corte bajo (0,1 ng/ml) predice la aparición de acontecimientos. La asociación de cambios ECG y troponina I positiva identifica a un grupo de alto riesgo; sin embargo, la ausencia de ambas variables en pacientes con un diagnóstico de angina inestable no asegura una buena evolución (AU)