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Background and purpose: Parkinsonism is commonly seen in many clinical conditions, and the establishment of its etiology may take many years. The possible development of neuroprotective treatments for Parkinsons disease (PD) in the near future will require correct and early diagnosis. This study aims to analyze the accuracy of a low-cost MRI sequence to differentiate PD from patients with essential tremor (ET) and healthy control (HC) individuals. Material and methods: We recruited 70 individuals with clinical diagnoses of PD (38 patients), ET (11 patients) and healthy volunteers (21 individuals), all of whom underwent 3T MRI multiecho GRE sequence. Two blinded neuroradiologists independently evaluated the presence or absence of nigrosome-1(N1). We considered the unilateral or bilateral absence of nigrosome 1 signal as indicative of PD. Results: The absence of at least one N1 could differentiate with 98% accuracy patients with clinical established PD from healthy controls. The presence of both nigrosomes was 96% accurate as a sign to differentiate PD from ET patients. Conclusion: The 3T MRI with multiecho GRE is a simple and universally available technique and it can be used as a good auxiliary tool to differentiate PD from ET patients and controls.
Subject(s)
Essential Tremor , Parkinson Disease , Essential Tremor/diagnostic imaging , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Neuroimaging , Substantia NigraABSTRACT
OBJETIVO: Comparar características clínicas e evolução de pacientes com e sem injúria renal aguda adquirida em unidade de terapia intensiva geral de um hospital universitário terciário e identificar fatores de risco associados ao desenvolvimento de injúria renal aguda e à mortalidade. MÉTODOS: Estudo prospectivo observacional com 564 pacientes acompanhados diariamente durante a internação em unidade de terapia intensiva geral do Hospital das Clínicas da Faculdade de Medicina de Botucatu por 2 anos consecutivos (de maio de 2008 a maio de 2010), divididos em 2 grupos: com injúria renal aguda adquirida (G1) e sem injúria renal aguda adquirida (G2). RESULTADOS: A incidência de injúria renal aguda foi 25,5 por cento. Os grupos diferiram quanto à etiologia da admissão em unidade de terapia intensiva (sepse: G1:41,6 por cento x G2:24,1 por cento, p<0,0001 e pós operatório neurológico 13,8 por cento x 38,1 por cento, p<0,0001), idade (56,8±15,9 x 49,8± 17,8 anos, p< 0,0001), APACHE II (21,9±6,9 x 14,1±4,6, p<0,0001), ventilação mecânica (89,2 x 69,1 por cento, p<0,0001) e uso de drogas vasoativas (78,3 x 56,1 por cento, p<0,0001). Com relação aos fatores de risco e às comorbidades, os grupos foram diferentes quanto à presença de diabetes mellitus, insuficiência cardíaca congestiva, insuficiência renal crônica e uso de anti-inflamatórios não hormonais (28,2 x 19,7 por cento, p=0,03; 23,6 x 11,6 por cento, p=0,0002, 21,5 x 11,5 por cento, p< 0,0001 e 23,5 x 7,1 por cento, p<0,0001, respectivamente). O tempo de internação e a mortalidade foram superiores nos pacientes que adquiriram injúria renal aguda (6,6 ± 2,7 x 12,9± 5,6 dias p<0,0001 e 62,5 x 16,4 por cento, p<0,0001). À análise multivariada foram identificados como fatores de risco para injúria renal aguda, idade>55 anos, APACHE II>16, creatinina (cr) basal>1,2 e uso de anti-inflamatórios não hormonais (OR=1,36 IC:1,22-1,85, OR=1,2 IC:1,11-1,33, OR=5,2 IC:2,3-11,6 e OR=2,15 IC:1,1-4,2, respectivamente) e a injúria renal aguda esteve independentemente associada ao maior tempo de internação e à mortalidade (OR=1,18 IC:1,05-1,26 e OR=1,24 IC:1,09-1,99 respectivamente). À análise da curva de sobrevida, após 30 dias de internação, a mortalidade foi de 83,3 por cento no G1 e 45,2 por cento no G2 (p<0,0001). CONCLUSÃO: A incidência de injúria renal aguda é elevada em unidade de terapia intensiva, os fatores de riscos independentes para adquirir injúria renal aguda são idade >55 anos, APACHE II>16, Cr basal >1,2 e uso de anti-inflamatórios não hormonais e a injúria renal aguda é fator de risco independente para o maior tempo de permanência em unidade de terapia intensiva e mortalidade.
OBJECTIVE:To compare the clinical features and outcomes of patients with and without acute kidney injury in an intensive care unit of a tertiary university hospital and to identify acute kidney injury and mortality risk factors. METHODS: This was a prospective observational study of a cohort including 564 patients followed during their stay in the intensive care unit of Hospital das Clinicas da Faculdade de Medicina de Botucatu (Botucatu, São Paulo, Brazil) between May 2008 and May 2010. Patients were allocated to two different groups: with (G1) and without (G2) acute kidney injury. RESULTS: The incidence of acute kidney injury was 25.5 percent. The groups were different with respect to the reason for admission to the intensive care unit (sepsis, G1: 41.6 percent versus G2: 24.1 percent; P < 0.0001; neurosurgery, postoperative G1: 13.8 percent versus G2: 38.1 percent; P < 0.0001); age (G1: 56.8 ± 15.9 vs. G2: 49.8 ± 17.8 years; P < 0.0001); Acute Physiological Chronic Health Evaluation (APACHE) II score (G1: 21.9 ± 6.9 versus G2: 14.1 ± 4.6; P < 0.0001); use of mechanical ventilation (G1: 89.2 percent vs. G2: 69.1 percent; P < 0.0001) and use of vasoactive drugs (G1: 78.3 percent vs. G2: 56.1 percent; P < 0.0001). Higher rates of diabetes mellitus, congestive heart failure, chronic renal disease and use of non-steroidal anti-inflammatory drugs were more frequent in acute kidney injury patients (28.2 percent vs. 19.7 percent, P = 0.03; 23.6 vs. 11.6 percent, P = 0.0002; 21.5 percent vs. 11.5 percent, P < 0.0001 and 23.5 percent vs. 71. percent, P < 0.0001, for G1 versus G2, respectively). Length of hospital stay and mortality were also higher for acute kidney injury patients (G1: 6.6 ± 2.7 days versus G2: 12.9 ±5.6 days, P < 0.0001 and G1: 62.5 percent versus G2: 16.4 percent, P < 0.0001). Multivariate analysis identified the following as risk factors for acute kidney injury: age above 55 years, APACHE II score above 16, baseline creatinine above 1.2 and use of non-steroidal anti-inflammatory drugs (odds ratio (OR) = 1.36, 95 percent confidence interval (95 percentCI): 1.22 - 1.85; OR = 1.2, 95 percentCI: 1.11 - 1.33; OR = 5.2, 95 percentCI: 2.3 - 11.6 and OR = 2.15, 95 percentCI: 1.1 - 4.2, respectively). Acute kidney injury was independently associated with longer hospital stay and increased mortality (OR = 1.18, 95 percentCI: 1.05 - 1.26 and OR = 1.24, 95 percentCI: 1.09 - 1.99, respectively). Analysis of the survival curve 30 days after admission showed 83.3 percent mortality for acute kidney injury patients and 45.2 percent for non-acute kidney injury patients (P < 0.0001). CONCLUSION: The incidence of acute kidney injury was high in this intensive care unit; the independent risk factors associated with acute kidney injury were age > 55 years, APACHE II > 16, baseline serum creatinine > 1.2 and use of non-steroidal anti-inflammatory drugs. Acute kidney injury is an independent risk factor for longer intensive care unit stay and mortality.
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BACKGROUND: Patients who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The objectives of this study were to compare clinical and laboratory characteristics of AKI patients evaluated and not evaluated by nephrologists in ICU and generate the hypothesis of the relationship between timing of nephrology consultation and outcome. METHODS: We explored associations among presence and timing of nephrology consultation with ICU stay and in-ICU mortality in 148 ICU patients with AKI at a Brazilian teaching hospital from July 2008 to May 2010. Multivariable logistic regression was used to adjust confounding and selection bias. RESULTS: AKI incidence was 30% and 52% of these AKI patients were evaluated by nephrologists. At multivariable analysis, AKI patients evaluated by nephrologists showed higher Acute Tubular Necrosis-Index Specific Score and creatinine level, more dialysis indications, lower urine output and longer ICU stay. The mortality rate was similar to AKI patients who were not evaluated. Nephrology consultation was delayed (≥ 48 h) in 62.3% (median time to consultation, 4.7 days). Lower serum creatinine levels (P = 0.009) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased ICU mortality (65.4 versus 88.2%, P < 0.001). CONCLUSIONS: In AKI, patients evaluated by nephrologists seem to be more seriously ill than those not evaluated and present similar mortality rate. The delayed nephrology consultation can be associated with increased ICU mortality.
Subject(s)
Acute Kidney Injury/mortality , Hospital Mortality , Intensive Care Units , Nephrology , Acute Kidney Injury/epidemiology , Brazil/epidemiology , Creatinine/urine , Female , Humans , Incidence , Length of Stay , Male , Middle Aged , Prognosis , Referral and Consultation , Renal Dialysis , Risk Factors , Survival RateABSTRACT
OBJECTIVE: To compare the clinical features and outcomes of patients with and without acute kidney injury in an intensive care unit of a tertiary university hospital and to identify acute kidney injury and mortality risk factors. METHODS: This was a prospective observational study of a cohort including 564 patients followed during their stay in the intensive care unit of Hospital das Clinicas da Faculdade de Medicina de Botucatu (Botucatu, São Paulo, Brazil) between May 2008 and May 2010. Patients were allocated to two different groups: with (G1) and without (G2) acute kidney injury. RESULTS: The incidence of acute kidney injury was 25.5%. The groups were different with respect to the reason for admission to the intensive care unit (sepsis, G1: 41.6% versus G2: 24.1%; P < 0.0001; neurosurgery, postoperative G1: 13.8% versus G2: 38.1%; P < 0.0001); age (G1: 56.8 ± 15.9 vs. G2: 49.8 ± 17.8 years; P < 0.0001); Acute Physiological Chronic Health Evaluation (APACHE) II score (G1: 21.9 ± 6.9 versus G2: 14.1 ± 4.6; P < 0.0001); use of mechanical ventilation (G1: 89.2% vs. G2: 69.1%; P < 0.0001) and use of vasoactive drugs (G1: 78.3% vs. G2: 56.1%; P < 0.0001). Higher rates of diabetes mellitus, congestive heart failure, chronic renal disease and use of non-steroidal anti-inflammatory drugs were more frequent in acute kidney injury patients (28.2% vs. 19.7%, P = 0.03; 23.6 vs. 11.6%, P = 0.0002; 21.5% vs. 11.5%, P < 0.0001 and 23.5% vs. 71.%, P < 0.0001, for G1 versus G2, respectively). Length of hospital stay and mortality were also higher for acute kidney injury patients (G1: 6.6 ± 2.7 days versus G2: 12.9 ±5.6 days, P < 0.0001 and G1: 62.5% versus G2: 16.4%, P < 0.0001). Multivariate analysis identified the following as risk factors for acute kidney injury: age above 55 years, APACHE II score above 16, baseline creatinine above 1.2 and use of non-steroidal anti-inflammatory drugs (odds ratio (OR) = 1.36, 95% confidence interval (95%CI): 1.22 - 1.85; OR = 1.2, 95%CI: 1.11 - 1.33; OR = 5.2, 95%CI: 2.3 - 11.6 and OR = 2.15, 95%CI: 1.1 - 4.2, respectively). Acute kidney injury was independently associated with longer hospital stay and increased mortality (OR = 1.18, 95%CI: 1.05 - 1.26 and OR = 1.24, 95%CI: 1.09 - 1.99, respectively). Analysis of the survival curve 30 days after admission showed 83.3% mortality for acute kidney injury patients and 45.2% for non-acute kidney injury patients (P < 0.0001). CONCLUSION: The incidence of acute kidney injury was high in this intensive care unit; the independent risk factors associated with acute kidney injury were age > 55 years, APACHE II > 16, baseline serum creatinine > 1.2 and use of non-steroidal anti-inflammatory drugs. Acute kidney injury is an independent risk factor for longer intensive care unit stay and mortality.
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Objetivo: Analisar comparativamente características clínicas e evolução de pacientes com e sem IRA adquirida em UTI geral de um hospital universitário terciário. Método: Estudo prospectivo observacional com 263 pacientes acompanhados diariamente durante a internação em UTI Geral do Hospital das Clínicas da Faculdade de Medicina de Botucatu no período de julho de 2007 a abril de 2008. Resultados: A incidência de IRA foi de 31,2%. Os grupos foram semelhantes quanto ao sexo e diferiram quanto à etiologia da admissão em UTI (sepse: 31,7% x 13,1%, p<0,0001, pós operatório: 11% x 43%, p<0,0001), idade (59,6 +- 18,1 x 50,2 +- 18,6 anos, p< 0,0001), APACHE II: (21+- 11,1 x 11 +- 4,8, p= 0,002) oligúria (67,7% x 4,5%, p < 0,0001), presença de ventilação mecânica (81,7 x 57,7%, p= 0,0014), uso de drogas vasoativas (62,2 x 32,6%, p < 0,0001) e enfermaria de procedência (PS: 22x 14,5%, p= 0,02 e centro cirúrgico: 42,7 x 62,6%, p= 0,03). Quanto às comorbidades, os grupos foram diferentes quanto à presença de HAS e IRC (42,6 x 35,9%, p= 0,005 e 15,8 x 2,1%, p= 0,04, respectivamente) e semelhantes quanto à presença de diabetes e ICC (19,5x 11%, ns e 6x 1,1%, ns, respectivamente). A mortalidade foi superior nos pacientes que contraíram IRA (62,1 x 16,5%, p< 0,0001). Conclusão: A incidência de IRA é elevada em UTI e presente em pacientes com parâmetros clínicos e índices prognósticos de maior gravidade, o que justifica a maior mortalidade observada neles.
Objective: Compare the clinical features and outcome of patients with and without ARF acquired in a general ICU of a tertiary university hospital. Methods: Prospective observational study with 263 patients followed up daily during the ICU stay of General Hospital of the Medical School of Botucatu in the period from July 2007 to April 2008. Results: The incidence of ARF was 31.2%. The groups were similar regarding sex and differ in the etiology of ICU admission (sepsis: 31.7% vs. 13.1%, p <0.0001, postoperative: 11% x 43%, p <0.0001) , age (59.6 + - 18.1 x 50.2 + - 18.6 years, p <0.0001), APACHE II: (21 + - 11.1 x 11 + - 4.8, p = 0.002 ) oliguria (67.7% vs 4.5%, p <0.0001), presence of mechanical ventilation (81.7 x 57.7%, p = 0.0014), inotropic support (62.2 x 32.6%, p <0.0001) and ward of origin (PS: 22x 14.5%, p = 0.02 and the operating room: 42.7 x 62.6%, p = 0.03). Regarding comorbidity, the groups were different regarding the presence of hypertension and CRF (42.6 x 35.9%, p = 0.005 and 15.8 x 2.1%, p = 0.04, respectively) and similar in presence of diabetes and CHF (19.5 x 11%, ns and 6x 1.1%, ns, respectively). Mortality was higher in ARF patients (62.1 x 16.5%, p <0.0001). Conclusion: The incidence of ARF is high in the ICU and in patients with clinical and prognostic indices of severity, which explains the higher mortality observed in them.
