Predictive potential of serum and cerebrospinal fluid biomarkers for disease activity in treated multiple sclerosis patients.

BACKGROUND: Our objective was to explore various biomarkers for predicting suboptimal responses to disease-modifying treatments (DMTs) in patients with MS (pwMS). METHODS: We conducted a longitudinal, bicentric study with pwMS stratified based on their DMTs responses. Treatment failure (TF) was defined as the onset of a second relapse, presence of two or more T2 new lesions, or disability progression independent of relapse during the follow-up period. We evaluated intrathecal synthesis (ITS) of IgG and IgM using OCB, linear indices, and Reibergrams. Free kappa light chains ITS was assessed using the linear index (FKLCi). NfL and GFAP in serum and CSF, and CHI3L1 in CSF were quantified. Quantitative variables were dichotomized based on the third quartile. Predictive efficacy was assessed through bivariate and multivariate analyses, adjusting for age, sex, EDSS, acute inflammatory activity (AI) -defined as the onset of a relapse or gadolinium-enhancing lesions within a 90-day window of lumbar puncture-, treatment modality, study center, and time from disease onset to treatment initiation. In case of collinearity, multiple models were generated or confounding variables were excluded if collinearity existed between them and the biomarker. The same methodology was used to investigate the predictive potential of various combinations of two biomarkers, based on whether any of them tested positive or exceeded the third quartile. RESULTS: A total of 137 pwMS were included. FKLCi showed no differences based on AI, no correlation with EDSS and was significantly higher in pwMS with TF (p = 0.008). FKLCi>130 was associated with TF in bivariate analysis (Log-Rank p = 0.004). Due to collinearity between age and EDSS, two different models were generated with each of them and the rest of the confounding variables, in which FKLCi>130 showed a Hazard Ratio (HR) of 2.69 (CI: 1.35-5.4) and 2.67 (CI: 1.32-5.4), respectively. The combination of either FKLC or sNfL exceeding the third quartile was also significant in bivariate (Log-Rank p = 0.04) and multivariate (HR=3.1 (CI: 1.5-6.5)) analyses. However, when analyzed independently, sNfL did not show significance, and FKLCi mirrored the pattern obtained in the previous model (HR: 3.04; CI: 1.51-6.1). Treatment with highefficacy DMTs emerged as a protective factor in all models. DISCUSSION: Our analysis and the fact that FKLCi is independent of EDSS and AI suggest that it might be a valuable parameter for discriminating aggressive phenotypes. We propose implementing high-efficacy drugs in pwMS with elevated FKLCi.

Impact of deoxygenation/reoxygenation processes on the superconducting properties of commercial coated conductors.

We report the evolution of the superconducting properties of a commercial coated conductor during deoxygenation and reoxygenation processes. By analyzing the changes on the critical temperature, Tc, and critical current density, Jc, at 4 and 77 K, we have identified the conditions that cause a complete deoxygenation of the coated conductor and, also, the reoxygenation conditions that allow a recovery of the superconducting properties. A complete suppression of superconductivity happens at ~ 500-550 °C under a pure argon flow. After a complete deoxygenation, we observed that a reoxygenation process at ~ 400-450 °C in pure oxygen flow allows, not only a full recovery, but even an improvement in Jc, both at 4 and 77 K. Such an increase of Jc is kept or even enhanced, especially at 77 K, in the presence of magnetic fields up to ~ 6 T. A microstructural analysis by transmission electron microscopy did not give evidence of major differences in the densities of Y2O3 nanoparticles and stacking faults between the pristine and reoxygenated samples, suggesting that these defects should not be the cause of the observed enhancement of Jc. Therefore, the combined action of other types of defects, which could appear as a consequence of our reoxygenation process, and of a new level of oxygen doping should be responsible of the Jc enhancement. The higher Jc that can be achieved by using our simple reoxygenation process opens new parameter space for CCs optimization, which means choosing a proper pO2-temperature-time trajectory for optimizing Jc.

Ten-Year Survival of Heart Failure Patients with Left Ventricular Ejection Fraction of 40-59%: A Potential Phenotypic Classification? / Sobrevida em 10 Anos de Pacientes com Insuficiência Cardíaca com FEVE 40-59%: Uma Classificação Fenotípica Viável?

Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups.

Os limites da fração de ejeção do ventrículo esquerdo (FEVE) para a insuficiência cardíaca (IC) com FEVE levemente reduzida (ICFElr) têm sido questionados, já que evidências demonstram que alguns medicamentos utilizados para IC com FEVE <40% (ICFEr) demonstram eficácia também em populações com FEVE < 60%. Objetivo do estudo foi comparar a sobrevida total e cardiovascular de pacientes com IC com FEVE 40-59% com paciente com ICFEr e IC com FEVE ≥ 60%. Foram incluídos pacientes com IC descompensada que preencheram os critérios diagnósticos de Framingham na admissão hospitalar entre 2009 e 2011. Os pacientes foram divididos em ICFEr, IC com FEVE 40-59% e IC com FEVE ≥ 60%. O método de Kaplan-Meier foi usado para detectar a sobrevida geral e cardiovascular em 10 anos. A significância estatística foi estabelecida em p <0,05. Foram incluídos 400 pacientes, com idade média de 69 ± 14 anos. A sobrevida cardiovascular nos pacientes com IC e FEVE 40-59% não foi diferente em comparação aos pacientes com ICFEr [Hazard Ratio (HR) ajustado 0,86 ­ Intervalo de Confiança (IC) 95% 0,61-1,22; Ptrend = NS], mas foi estatisticamente diferente em comparação aos com FEVE ≥ 60% (HR ajustado = 0,64 - IC95% 0,44-0,94; Ptrend = 0,023). Não houve diferença na taxa de sobrevida de 10 anos entre diferentes grupos de FEVE. O grupo de pacientes com IC e FEVE ≥ 60% teve maior sobrevida cardiovascular que os outros grupos.

Sobrevida em 10 Anos de Pacientes com Insuficiência Cardíaca com FEVE 40-59%: Uma Classificação Fenotípica Viável? / Ten-Year Survival of Heart Failure Patients with Left Ventricular Ejection Fraction of 40-59%: A Potential Phenotypic Classification?

Resumo Os limites da fração de ejeção do ventrículo esquerdo (FEVE) para a insuficiência cardíaca (IC) com FEVE levemente reduzida (ICFElr) têm sido questionados, já que evidências demonstram que alguns medicamentos utilizados para IC com FEVE <40% (ICFEr) demonstram eficácia também em populações com FEVE < 60%. Objetivo do estudo foi comparar a sobrevida total e cardiovascular de pacientes com IC com FEVE 40-59% com paciente com ICFEr e IC com FEVE ≥ 60%. Foram incluídos pacientes com IC descompensada que preencheram os critérios diagnósticos de Framingham na admissão hospitalar entre 2009 e 2011. Os pacientes foram divididos em ICFEr, IC com FEVE 40-59% e IC com FEVE ≥ 60%. O método de Kaplan-Meier foi usado para detectar a sobrevida geral e cardiovascular em 10 anos. A significância estatística foi estabelecida em p <0,05. Foram incluídos 400 pacientes, com idade média de 69 ± 14 anos. A sobrevida cardiovascular nos pacientes com IC e FEVE 40-59% não foi diferente em comparação aos pacientes com ICFEr [Hazard Ratio (HR) ajustado 0,86 - Intervalo de Confiança (IC) 95% 0,61-1,22; Ptrend = NS], mas foi estatisticamente diferente em comparação aos com FEVE ≥ 60% (HR ajustado = 0,64 - IC95% 0,44-0,94; Ptrend = 0,023). Não houve diferença na taxa de sobrevida de 10 anos entre diferentes grupos de FEVE. O grupo de pacientes com IC e FEVE ≥ 60% teve maior sobrevida cardiovascular que os outros grupos.

Abstract Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups.

Mineral Content (Essential and Toxic Elements) of Squid Flesh Is Affected by Maceration with Sodium Salts and Vacuum-Cooking.

Maceration with sodium salts is applied to irmprove water holding capacity in squid-based products. The aim of this work was to determine how the mineral content of squid flesh is affected by maceration and further vacuum-cooking. Atlantic squids (Loligo vulgaris) from two fisheries (FAO areas No. 47 and 34) were sampled. Macrominerals (g/100 g) present in raw flesh were Na, Mg, P, S, K and Ca, while microminerals accounting for >1 mg/kg were Zn, Si, Sr, Fe, Cu, Al and Mn. As a result of maceration (3 + 1.5% w: w NaCl+ Na citrate) and vacuum-cooking (at 65 °C for 20 min), some squid minerals was removed. The levels of Cd and As were reduced by half, while Na content increased from 0.28 to 0.49 g/100 g. Maceration with sodium salts generally led to minerals leaching (except for Na) with the medium. Further cooking produced additional losses of most of the minerals present in macerated squid (except Pb and Cd). Squid microminerals were hardly removed with the cooking juice. The consumption of macerated-cooked squid covered > 10% of the recommended dietary intake for Na, P, Zn, Mg and Mn, while health risks were almost negligible and mainly concerned Cd (up to 14% of the probable tolerable weekly intake). The combination of both treatments involves certain loss of most of the essential minerals but also contributes to reducing toxicological risks related to mineral intake through squid products.

Survival of Patients with Acute Heart Failure and Mid-range Ejection Fraction in a Developing Country - A Cohort Study in South Brazil. / Sobrevida de Pacientes com Insuficiência Cardíaca Aguda e Fração de Ejeção Intermediária em um País em Desenvolvimento ­ Estudo de Coorte no Sul do Brasil.

BACKGROUND: Heart Failure with mid-range Ejection Fraction (HFmEF) was recently described by European and Brazilian guidelines on Heart Failure (HF). The ejection fraction (EF) is an important parameter to guide therapy and prognosis. Studies have shown conflicting results without representative data from developing countries. OBJECTIVE: To analyze and compare survival rate in patients with HFmEF, HF patients with reduced EF (HFrEF), and HF patients with preserved EF (HFpEF), and to evaluate the clinical characteristics of these patients. METHODS: A cohort study that included adult patients with acute HF admitted through the emergency department to a tertiary hospital, reference in cardiology, in south Brazil from 2009 to 2011. The sample was divided into three groups according to EF: reduced, mid-range and preserved. A Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was done. Statistical significance was established as p < 0.05. RESULTS: A total of 380 patients were analyzed. Most patients had HFpEF (51%), followed by patients with HFrEF (32%) and HFmEF (17%). Patients with HFmEF showed intermediate characteristics related to age, blood pressure and ventricular diameters, and most patients were of ischemic etiology. Median follow-up time was 4.0 years. There was no statistical difference in overall survival or cardiovascular mortality (p=.0031) between the EF groups (reduced EF: 40.5% mortality; mid-range EF 39.7% and preserved EF 26%). Hospital mortality was 7.6%. CONCLUSION: There was no difference in overall survival rate between the EF groups. Patients with HFmEF showed higher mortality from cardiovascular diseases in comparison with HFpEF patients. (Arq Bras Cardiol. 2021; 116(1):14-23).

FUNDAMENTO: A insuficiência cardíaca (IC) com fração de ejeção na faixa média ou intermediária (ICFEI) (em inglês, "mid-range ejection fraction) foi recentemente descrita em diretrizes europeia e brasileira recentes sobre o manejo da insuficiência cardíaca (IC). A fração de ejeção (FE) é um parâmetro importante para direcionar terapia e prognóstico. Estudos têm mostrado resultados conflitantes sem dados representativos de países em desenvolvimento. OBJETIVO: Analisar e comparar a taxa de sobrevida em pacientes com ICFEI com pacientes com IC e FE reduzida (ICFEr), e pacientes com IC e FE preservada, e avaliar as características clínicas desses pacientes. MÉTODOS: Estudo coorte que incluiu pacientes com IC aguda admitidos no departamento de emergência de um hospital terciário, referência em cardiologia, localizado no sul do Brasil, entre 2009 e 2011. A amostra foi dividida em três grupos de acordo com a FE: reduzida, intermediária e preservada. Curva de Kaplan-Meier foi analisada de acordo com a FE, e uma análise de regressão logística foi realizada. A significância estatística foi estabelecida em p<0,05. RESULTADOS: Um total de 380 pacientes foram analisados. A maioria dos pacientes apresentaram ICFEp (515), seguido de ICFEr (32%) e ICFEI (17%). Os pacientes com ICFEI apresentaram características intermediárias em relação à idade, pressão arterial, e diâmetros ventriculares, e a maioria era de etiologia isquêmica. O período mediano de acompanhamento foi de 4 anos. Não se observou diferença na sobrevida geral ou na mortalidade cardiovascular (p=0,03) entre os grupos de FE (FE reduzida: mortalidade de 40,5%; FE intermediária: 39,7%, e FE preservada 26%). A mortalidade hospitalar foi 7,6%. CONCLUSÃO: Não houve diferença na taxa de sobrevida entre os grupos de FE diferentes. Os pacientes com ICFEI apresentaram maior mortalidade por doenças cardiovasculares em comparação a pacientes com ICFEp. (Arq Bras Cardiol. 2021; 116(1):14-23).

Sobrevida de Pacientes com Insuficiência Cardíaca Aguda e Fração de Ejeção Intermediária em um País em Desenvolvimento - Estudo de Coorte no Sul do Brasil / Survival of Patients with Acute Heart Failure and Mid-range Ejection Fraction in a Developing Country - A Cohort Study in South Brazil

Resumo Fundamento A insuficiência cardíaca (IC) com fração de ejeção na faixa média ou intermediária (ICFEI) (em inglês, "mid-range ejection fraction) foi recentemente descrita em diretrizes europeia e brasileira recentes sobre o manejo da insuficiência cardíaca (IC). A fração de ejeção (FE) é um parâmetro importante para direcionar terapia e prognóstico. Estudos têm mostrado resultados conflitantes sem dados representativos de países em desenvolvimento. Objetivo Analisar e comparar a taxa de sobrevida em pacientes com ICFEI com pacientes com IC e FE reduzida (ICFEr), e pacientes com IC e FE preservada, e avaliar as características clínicas desses pacientes. Métodos Estudo coorte que incluiu pacientes com IC aguda admitidos no departamento de emergência de um hospital terciário, referência em cardiologia, localizado no sul do Brasil, entre 2009 e 2011. A amostra foi dividida em três grupos de acordo com a FE: reduzida, intermediária e preservada. Curva de Kaplan-Meier foi analisada de acordo com a FE, e uma análise de regressão logística foi realizada. A significância estatística foi estabelecida em p<0,05. Resultados Um total de 380 pacientes foram analisados. A maioria dos pacientes apresentaram ICFEp (515), seguido de ICFEr (32%) e ICFEI (17%). Os pacientes com ICFEI apresentaram características intermediárias em relação à idade, pressão arterial, e diâmetros ventriculares, e a maioria era de etiologia isquêmica. O período mediano de acompanhamento foi de 4 anos. Não se observou diferença na sobrevida geral ou na mortalidade cardiovascular (p=0,03) entre os grupos de FE (FE reduzida: mortalidade de 40,5%; FE intermediária: 39,7%, e FE preservada 26%). A mortalidade hospitalar foi 7,6%. Conclusão Não houve diferença na taxa de sobrevida entre os grupos de FE diferentes. Os pacientes com ICFEI apresentaram maior mortalidade por doenças cardiovasculares em comparação a pacientes com ICFEp. (Arq Bras Cardiol. 2021; 116(1):14-23)

Abstract Background Heart Failure with mid-range Ejection Fraction (HFmEF) was recently described by European and Brazilian guidelines on Heart Failure (HF). The ejection fraction (EF) is an important parameter to guide therapy and prognosis. Studies have shown conflicting results without representative data from developing countries. Objective To analyze and compare survival rate in patients with HFmEF, HF patients with reduced EF (HFrEF), and HF patients with preserved EF (HFpEF), and to evaluate the clinical characteristics of these patients. Methods A cohort study that included adult patients with acute HF admitted through the emergency department to a tertiary hospital, reference in cardiology, in south Brazil from 2009 to 2011. The sample was divided into three groups according to EF: reduced, mid-range and preserved. A Kaplan-Meier curve was analyzed according to the EF, and a logistic regression analysis was done. Statistical significance was established as p < 0.05. Results A total of 380 patients were analyzed. Most patients had HFpEF (51%), followed by patients with HFrEF (32%) and HFmEF (17%). Patients with HFmEF showed intermediate characteristics related to age, blood pressure and ventricular diameters, and most patients were of ischemic etiology. Median follow-up time was 4.0 years. There was no statistical difference in overall survival or cardiovascular mortality (p=.0031) between the EF groups (reduced EF: 40.5% mortality; mid-range EF 39.7% and preserved EF 26%). Hospital mortality was 7.6%. Conclusion There was no difference in overall survival rate between the EF groups. Patients with HFmEF showed higher mortality from cardiovascular diseases in comparison with HFpEF patients. (Arq Bras Cardiol. 2021; 116(1):14-23)

Management of severe thermal burns in the acute phase in adults and children.

OBJECTIVES: To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. DESIGN: A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. RESULTS: The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. CONCLUSION: Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.

[Adult thermal burn dressings in three acts]. / Les pansements de brûlés thermiques adultes en trois actes.

Dressings are a real challenge in the care of patients with thermal burns. They help to heal and prevent or treat possible skin infections. Paramedical teams must have a perfect strategy for organizing, managing pain and optimizing hygiene and asepsis rules. The purpose is to facilitate the understanding and implementation of this treatment by suggesting protocols that can be applied by all. It remains essential to mobilize specialized services to promote the evolution of burns.

Fatores de risco cardiovasculares e comorbidades em ambulatórios de cardiologia da região metropolitana de Porto Alegre, RS / Cardiovascular risk factors and comorbidities in cardiology outpatientin the metropolitan region of Porto Alegre, RS

As doenças cardiovasculares desempenham um importante papel na saúde pública atual, visto que representam a principal causa de morbimortalidade mundial e os mais altos custos em assistência médica. O objetivo do presente estudo foi descrever os fatores de riscos cardiovasculares e as comorbidades dos pacientes atendidos em ambulatórios de cardiologia na região metropolitana de Porto Alegre, RS. Métodos: Estudo transversal de pacientes adultos do ambulatório de cardiologia geral de atenção secundária à saúde, mantido pela Faculdade de Medicina da Universidade Luterana do Brasil (ULBRA). Entre setembro de 2009 e outubro de 2010, o estudo foi primeiramente realizado no posto de saúde da vila do IAPI, em Porto Alegre, e, posteriormente, no Hospital Universitário (HU), em Canoas. Foi utilizado um formulário padrão para a coleta de dados do prontuário médico. A análise estatística possibilitou descrever uma amostra única. Resultados: Foram analisados 204 pacientes no total. A maioria da população em estudo era composta de idosos (66%), mulheres (70,1%), brancos (83,3%), hipertensos (83,8%), sedentários (67%), com excesso de peso (85,6%) e obesidade visceral (92,1%). Quanto ao tabagismo, 12% eram ativos e 42% ex-tabagistas. A combinação de fatores de risco foi importante e identificada através da síndrome metabólica (85,0%). O cálculo do escore de risco de Framingham para um evento coronariano em 10 anos foi > 10% em 36,5% dos indivíduos. Conclusões: Foi identificada uma alta prevalência de fatores de risco cardiovasculares, suas combinações e comorbidades na população em estudo.

Cardiovascular diseases play an important role in public health today as the major cause of morbidity and mortality worldwide and the highest costs in medical care. The aim of this study was to describe the cardiovascular risk factors and comorbidities of patients seen in cardiology clinics in the metropolitan region of Porto Alegre RS. Methods: Cross-sectional study of adult patients from the general cardiology outpatient clinic of secondary care, run by the Medical School of Lutheran University of Brazil (ULBRA). Between Sep 2009 and Oct 2010, the study was first conducted at the Health Center of IAPI, a district in Porto Alegre, and afterwards at the School Hospital in Canoas. We used a standard form to collect data from medical records. The statistical analysis allowed to describe a unique sample. Results: We analyzed 204 patients in total. Most of the study population consisted of elderly (66%), females (70.1%), whites (83.3%), hypertensive (83.8%), sedentary (67%), overweight (85, 6%) and with visceral obesity (92.1%). As for smoking, 12% were active and 42% former smokers. The combination of risk factors was important and identified through the metabolic syndrome (85.0%). The calculation of Framingham risk score for a coronary event in 10 years was > 10% in 36.5% of individuals. Conclusions: We identified a high prevalence of cardiovascular risk factors, their combinations and comorbidities in the studied population.

Risk index proposal to predict atrial fibrillation after cardiac surgery.

OBJECTIVE: Atrial fibrillation (AF) is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. METHODS: A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable logistic model were selected for the risk index. RESULTS: The average incidence of AF was 22.1%. The most associated factors with AF were: patients older than 75 years of age, mitral valve disease, no use of a beta blocker, withdrawal of a beta-blocker and a positive fluid balance. The absence risk factor determined 4.6% chance to postoperative AF, and for one, two and three or more risk factors, the chance was 16.6%, 25.9% and 46.3%, respectively. CONCLUSION: In a multivariable logistic model was possible to develop a risk index proposal to predict postoperative AF with a major risk of 46.3% in the presence of three or more risk factors.

Proposta de escore de risco para predição de fibrilação atrial após cirurgia cardíaca / Risk index proposal to predict atrial fibrillation after cardiac surgery

OBJETIVO: A fibrilação atrial (FA) é uma complicação frequente após cirurgia cardíaca e está associada ao aumento na morbidade e mortalidade dos pacientes. O objetivo deste estudo foi desenvolver uma proposta de escore de risco para FA após cirurgia cardíaca. MÉTODOS: Estudo prospectivo observacional, no qual 452 pacientes foram selecionados para avaliação da incidência e fatores de risco associados com FA pós-operatória. Foram selecionados somente pacientes submetidos à cirurgia cardíaca. A avaliação utilizou monitoramento cardíaco contínuo e eletrocardiograma diário. Os fatores com maior associação em modelo de regressão logística multivariável foram selecionados para o escore de risco. RESULTADOS: A incidência média de FA foi de 22,1 por cento. Os fatores mais associados com FA foram: pacientes com mais de 75 anos de idade, doença valvar mitral, não utilização de betabloqueador, interrupção do uso de betabloqueador e balanço hídrico positivo. A ausência fator de risco determinou 4,6 por cento de chance de FA pós-operatória e para um, dois e três ou mais fatores de risco a chance foi, respectivamente, de 16,6 por cento, 25,9 por cento e 46,3 por cento. CONCLUSÃO: Em modelo de regressão logística multivariada foi possível estabelecer uma proposta para escore de risco para predição de FA pós-operatória, com um risco máximo de 46,3 por cento na presença de três ou mais fatores de risco.

OBJECTIVE: Atrial fibrillation (AF) is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. METHODS: A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable logistic model were selected for the risk index. RESULTS: The average incidence of AF was 22.1 percent. The most associated factors with AF were: patients older than 75 years of age, mitral valve disease, no use of a beta blocker, withdrawal of a beta-blocker and a positive fluid balance. The absence risk factor determined 4.6 percent chance to postoperative AF, and for one, two and three or more risk factors, the chance was 16.6 percent, 25.9 percent and 46.3 percent, respectively. CONCLUSION: In a multivariable logistic model was possible to develop a risk index proposal to predict postoperative AF with a major risk of 46.3 percent in the presence of three or more risk factors.