PREDICTORS OF ACUTE HEART FAILURE OUTCOMES AT UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA.

Background: Studies of acute heart failure (AHF) outcomes suggest that there are different predictors of mortality depending on region, ethnicity, and gender. Objective: The purpose of this study was to identify predictors of six months' post discharge outcome among AHF patients in a Nigerian tertiary hospital. Methods and Materials: This study was a prospective observational study conducted at the cardiology unit of the Department of Medicine at the University College Hospital Ibadan. One hundred and sixty AHF participants ≥ 18 years old were recruited. Results: The mean age of the cohort was 58.0±15.1 years and most were males (59.4%). The independent predictors for death outcome after six months of discharge for AHF and the adjusted hazard ratio) (95% CI) were male gender 2.77 (1.17 -6.56); p =0.020 ; systolic blood pressure (mmHg) 0.98 (0.96 - 0.99); p = 0.011 ; and the presence of hepatomegaly 2.58 (1.02 - 6.51); p = 0.045 . Independent predictors for readmission or rehospitalization within 6 months after discharge were presence of right abdominal pain adjusted HR (95% CI): 2.07(1.14 - 3.76), p=0.017; SBP 0.98(0.96 - 0.99), p=0.005. Independent predictors for composite endpoint were male gender: adjusted HR: 2.08 (1.16 - 3.72), p= 0.014 and pericardial effusion and tamponade: 5.31(1.79 - 15.74), p=0.003 . Conclusion: The study provided an insight into the factors contributing to outcomes six-month after admission in a tertiary centre in South-Western Nigeria, and it highlighted the predictive role of systolic blood pressure.

Rat liver and kidney post-mitochondrial dysfunction by addition of chronic mixed metal intoxication and hepatorenal wellness mediated by phenolic components from Croton zambiscus leaves.

Chronic exposure of mixed-metal intoxication has been associated with prolonged oxidative stress and severe hepatorenal damage. This present study demonstrates the hepatoprotective and renoprotective activity of Croton zambesicus (C-ZAMB) leaves, naturally occurring phenolic compounds against chronic mixed-metal (EOMABRSL) induced toxicity. 0.5 ml of EOMABRSL via oral route induced chronic hepatoxicity and nephrotoxicity on exposure for 98 days (non-withdrawal) and 70 days (withdrawal) by abnormal alteration in the levels of endogenous antioxidants. Moreover, EOMABRSL induced hepatorenal damage by increasing the markers of liver toxicity (ALT, AST, ALP, GGT and bilirubin) and kidney failure (creatinine, urea, uric acid, and renal electrolytes-Na+ and K+). Both non-withdrawal and withdrawal approaches of EOMABRSL-exposed animals exhibited hepatorenal dysfunctions by increasing the activity of eco-51-nucleotidase (51ENT) followed by the decreased in the activity of lactate dehydrogenase (LDH)-index of cellular ATP. These results were further supported by the histopathological examination of nephritic cells, hepatocytes and splenocytes, manifested by hepatocellular necrosis, swelling or degeneration of tubular kidney epithelial cells as well as coalescing splenic periarteriolar lymphoid sheaths (PALSs) and lymphoid haemosiderin. The chronic EOMABRSL intoxication was ameliorated by administration of phenolic antioxidants from C-ZAMB leaves. Therefore, our study supports the view that phenolic C-ZAMB leaves may mediate hepatorenal wellness on chronic exposure to mixed-metal intoxication.