Worsening of heart failure by coronavirus disease 2019 is associated with high mortality.

AIMS: Patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) and concurrent coronavirus disease 2019 (COVID-19) might have a higher risk of severe events. METHODS AND RESULTS: We retrospectively studied 16 patients with advanced HFrEF who developed COVID-19 between 1 March and 29 May 2020. Follow-up lasted until 30 September. Ten patients previously hospitalized with decompensated HFrEF were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization. Six patients undergoing ambulatory care at initiation of COVID-19 symptoms were hospitalized because of advanced HFrEF. All patients who experienced worsening of HFrEF due to COVID-19 required higher doses or introduction of additional inotropic drugs or intra-aortic balloon pump in the intensive care unit. The mean intravenous dobutamine dose before SARS-CoV-2 infection in previously hospitalized patients (n = 10) and the median (inter-quartile range) peak intravenous dobutamine dose during SARS-CoV-2 infection in all patients (n = 16) were 2 (0-7) µg/kg/min and 20 (14-20) (P < 0.001), respectively. During follow-up, 56% underwent heart transplantation (n = 2) or died (n = 7). Four patients died during hospitalization from mixed shock consequent to severe acute respiratory syndrome with inflammatory storm syndrome associated with septic and cardiogenic shock during COVID-19. After COVID-19 recovery, two patients died from mixed septic and cardiogenic shock and one from sustained ventricular tachycardia and cardiogenic shock. Five patients were discharged from hospital to ambulatory care. Four were awaiting heart transplantation. CONCLUSION: Worsening of advanced HF by COVID-19 is associated with high mortality. This report highlights the importance of preventing COVID-19 in patients with advanced HF.

Factors associated with mortality in hepatitis c patients / Fatores associados com mortalidade em pacientes com Hepatite C

Introduction: Hepatitis C still is the major responsible for progressive liver disease, which evolves to its chronic form in 80% of acutely infected patients, and can cause cirrhosis, digestive hemorrhage, liver failure, liver cancer, and death. Objective: Determine the factors associated with death in hepatitis C patients. Methods: A detailed review was carried out in 10.304 medical records from the Liver Study Nucleus of the Onofre Lopes University Hospital, at the Federal University of Rio Grande do Norte (Northeast Brazil), between May 1995 and December 2013. Cases considered as suspect when the anti-HCV tested positive and confirmed when the qualitative RNA HCV tested positive (512 cases). Death was the dependent variable. The independent variables considered were: socio-demographic variables, variables associated with HCV infection, and those related to the progression of the disease. The association between independent variables and death was assessed, and the statistical significance (p) was calculated, along with OddsRatio (OR), and confidence intervals (95%). Results: The following associations were established with hepatitis C mortality: patients over the age of 35, treatment dropouts, diabetes mellitus, use of insulin, total bilirubin over 1.3 mg/dL, International Normalized Ratio at final consultation and low albumin at initial consultation (<3.5 g/dL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), long prothrombin reaction time (PT), cirrhosis and liver carcinoma. Conclusion: The factor that most influences hepatitis C is the early diagnosis of the disease, before it progresses to cirrhosis and liver carcinoma. These patients must have easy access to health services, which should be guaranteed by public policies that are specifically defined for this purpose (AU).

Introdução: A hepatite C continua sendo a maior causa de doença hepática progressiva que evolui para forma crônica em 80% dos pacientes agudamente infectados, podendo desencadear cirrose, hemorragia digestiva, falência hepática, câncer de fígado e morte. Objetivos: Conhecer fatores associados ao óbito em pacientes com hepatite C. Métodos: Revisou-se 10.304 prontuários, do Núcleo de Estudos do Fígado do Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte, Brasil, entre maio-1995 e maio-2013. Considerou-se casos suspeitos pacientes com anti-HCV positivo e casos confirmados, aqueles com HCV RNA qualitativo positivo, que resultou em 512 casos. O óbito foi a variável dependente. Foram consideradas variáveis independentes: as sócio-demográficas, as associadas à infecção pelo HCV e as relacionadas à progressão da doença. Avaliou-se associação das variáveis independentes e o óbito, e calculou-se significância estatística (p), Odds Ratio (OR) e intervalos de confiança de 95% (IC 95%). Resultados: Encontrou-se as seguintes associações com mortalidade por hepatite C: pacientes com idade acima de 35 anos, com abandono do tratamento, diabete melito, uso de insulina, bilirrubina total acima de 1,3 mg/dL, INR na consulta final e albumina baixa (<3,5g/dL) na consulta inicial, AST, ALT, TAP alargado, cirrose e hepatocarcinoma. Conclusão: Conclui-se que em função de sua magnitude e severidade, o fator de maior impacto na hepatite C é a descoberta precoce da doença, antes de evoluir para cirrose e carcinoma hepático, o que presume que esses pacientes precisam ter acesso facilitado ao serviço de saúde, que deverá ser garantido por políticas públicas específicas definidas (AU)