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2.
Ir J Med Sci ; 184(4): 893-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25354569

RESUMO

OBJECTIVE: The national early warning score (NEWS) was developed to detect the early signs of patient deterioration with a view to instituting higher levels of care. There is a concern about the sensitivity of the NEWS score in patients with chronic hypoxaemic conditions. METHODS: This cross-sectional audit sought to determine the clinical relevance of a NEWS score of 7 or higher in medical patients by determining whether there was any change in clinical management. Patients with chronic hypoxaemic conditions had a modified early warning score applied retrospectively, the chronic respiratory early warning score (CREWS) to determine if it made a difference to the trigger threshold. The study also aimed to determine the discharge outcome of such patients. RESULTS: A NEWS score ≥7 did not result in a change in clinical management in 64.6% of cases; 94.1% of patients with no change in clinical management were subsequently discharged home. Oxygen supplementation and oxygen saturation were the primary determinants of elevated NEWS scores with 89.9 and 31.6% of cases having high scores, respectively; 19.7% of patients were receiving home oxygen therapy. Retrospective application of the CREWS scoring system in these patients would have reduced the number of reviews by 70.3%. CONCLUSIONS: In medical patients admitted to a Model 2 hospital with chronic respiratory illness, the 'respiratory variables' of the NEWS score are poor discriminators of patients who are clinically deteriorating. Better tools (such as the CREWS score) are required to distinguish acutely ill from chronically ill patients with respiratory disease in Model 2 hospitals.


Assuntos
Hipóxia/fisiopatologia , Modelos Organizacionais , Doença Crônica , Estudos Transversais , Hospitalização , Humanos , Hipóxia/diagnóstico , Irlanda , Estudos Retrospectivos
3.
QJM ; 107(9): 701-13, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24633257

RESUMO

BACKGROUND: The contribution of novel risk factors to mortality in chronic kidney disease remains controversial. AIM: To explore the association of plasma fibrinogen with mortality among individuals with normal and reduced kidney function. METHODS: We identified 9184 subjects, age 40 and over from the Third National Health and Nutrition Examination Survey (1988-94) with vital status assessed through 2006. Plasma fibrinogen was modeled as continuous variable and in quartile groups (0 to <7.7, 7.7 to <9.0, 9.0 to <10.5 and ≥ 10.5 µmol/l) with total and cardiovascular mortality across categories of glomerular filtration rate (eGFR); <60, 60-90, >90 ml/min/1.73 m(2) using Cox regression. RESULTS: In multivariate analysis, the adjusted hazard ratio (HR) per 1 µmol/l (34 mg/dl) increase in fibrinogen was 1.07 [95% confidence interval (CI) 1.04-1.09] for total mortality and 1.06 (95% CI 1.03-1.09) for cardiovascular mortality. The adjusted HR for total mortality was 1.05 (1.01-1.09) for subjects with eGFR 60-90 ml/min/1.73 m(2) and 1.06 (1.02-1.10) for subjects with eGFR <60 ml/min/1.73 m(2). Subjects in the highest quartiles within each eGFR category; >90, 60-90 and <60 ml/min/1.73 m(2) experienced HRs of 1.45 (95% CI 1.03-2.03), 1.35 (95% CI 1.00-1.83) and 1.72 (95% CI 1.14-2.58), respectively, compared with subjects in the lowest quartile group. The patterns were similar for cardiovascular mortality. CONCLUSIONS: Plasma fibrinogen associates with mortality among subjects with mild to moderate kidney impairment as it does in subjects with normal kidney function and should be considered a therapeutic target for cardiovascular risk reduction.


Assuntos
Doenças Cardiovasculares , Fibrinogênio/análise , Insuficiência Renal Crônica , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Causas de Morte , Intervalos de Confiança , Feminino , Humanos , Irlanda/epidemiologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Mortalidade , Inquéritos Nutricionais , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença
4.
QJM ; 107(8): 623-33, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24599805

RESUMO

BACKGROUND: The transferrin saturation (TSAT) ratio is a commonly used indicator of iron deficiency and iron overload in clinical practice but precise relationships with total and cardiovascular mortality are unclear. PURPOSE: To better understand this relationship, we explored the association of TSAT ratio (serum iron/total iron binding capacity) with mortality in the general population. METHODS: The relationships of TSAT ratio with total and cardiovascular mortality were explored in 15 823 subjects age 20 and older from the Third National Health and Nutrition Examination Survey (1988-94). All subjects had vital status assessed through to 2006. RESULTS: During follow-up, 9.7% died of which 4.4% were from cardiovascular disease. In unadjusted analysis, increasing TSAT ratio was inversely associated with mortality. With adjustment for baseline demographic and clinical characteristics, the TSAT-mortality relationship followed a j-shaped pattern. Compared with the referent group [ratio 23.7-31.3%: hazard ratio (HR) =1.00], subjects in the lowest two quartiles, <17.5 % and 17.5-23.7 %, experienced significantly higher mortality risks of 1.45 (1.19-1.77) and 1.27 (1.06-1.53), respectively, whereas subjects in the highest quartile, >31.3 %, experienced significantly higher mortality risks of 1.23 (1.01-1.49). The pattern of association was more pronounced for cardiovascular mortality with significantly higher mortality risks for the lowest two quartiles [HR = 2.09 (1.43-3.05) and 1.90 (1.33-2.72), respectively] and highest quartile HR = 1.59 (1.05-2.40). CONCLUSIONS: Both low and high TSAT ratios are significantly and independently associated with increased total and cardiovascular mortality. The optimal TSAT ratio associated with the greatest survival is between 24% and 40%.


Assuntos
Doenças Cardiovasculares/mortalidade , Transferrina/metabolismo , Adulto , Distribuição por Idade , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Feminino , Inquéritos Epidemiológicos , Hemoglobinas/metabolismo , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Sensibilidade e Especificidade , Distribuição por Sexo , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
5.
QJM ; 106(7): 647-58, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23564632

RESUMO

BACKGROUND: Gout and serum uric acid are associated with mortality but their simultaneous contributions have not been fully evaluated in the general population. PURPOSE: To explore the independent and conjoint relationships of gout and uric acid with mortality in the US population. METHODS: Mortality risks of gout and serum uric acid were determined for 15 773 participants, aged 20 years or older, in the Third National Health and Nutrition Examination Survey by linking baseline information collected during 1988-1994 with mortality data up to 2006. Multivariable Cox proportional hazards regression determined adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for each exposure and all analyses were conducted in 2011 and 2012. RESULTS: Compared with subjects without a history of gout, the multivariable HR for subjects with gout were 1.42 (CI 1.12-1.82) for total and 1.58 (CI 1.13-2.19) for cardiovascular mortality. Adjusted HRs per 59.5 µmol/l (1 mg/dl) increase in uric acid were 1.16 (CI 1.10-1.22) for total and cardiovascular mortality and this pattern was consistent across disease categories. In the conjoint analysis, the adjusted HRs for mortality in the highest two uric acid quartiles were 1.64 (CI 1.08-2.51) and 1.77 (CI 1.23-2.55), respectively, for subjects with gout, and were 1.09 (CI 0.87-1.37) and 1.37 (CI (1.11-1.70), respectively, for subjects without gout, compared with those without gout in the lowest quartile. A similar pattern emerged for cardiovascular mortality. CONCLUSION: Gout and serum uric acid independently associate with total and cardiovascular mortality. These risks increase with rising uric acid concentrations.


Assuntos
Doenças Cardiovasculares/mortalidade , Gota/sangue , Hiperuricemia/mortalidade , Ácido Úrico/sangue , Adulto , Fatores Etários , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hiperuricemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
6.
Clin Nephrol ; 73(3): 250-2, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20178728

RESUMO

A 14-year-old boy presented with ongoing constipation as a manifestation of newly diagnosed Crohn's disease (CD) and a concomitant decline in renal function with biopsy-proven interstitial nephritis. Initiation of steroid therapy and mesalazine was associated with an improvement in symptoms and renal function. We describe a rare case of a 5-aminosalicylic acid (5-ASA)-naïve patient who developed interstitial nephritis in association with CD with no evidence of other primary glomerulopathy. A unique feature of the case being a profound systemic inflammatory response at the time of diagnosis and a relapse in nephritis 2 months after cessation of mesalazine in the absence of any macroscopic colitis.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Mesalamina/uso terapêutico , Nefrite Intersticial/etiologia , Adolescente , Anti-Inflamatórios não Esteroides/efeitos adversos , Biópsia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Seguimentos , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Túbulos Renais/patologia , Masculino , Mesalamina/efeitos adversos , Nefrite Intersticial/diagnóstico , Recidiva
7.
Kidney Int ; 60(4): 1484-9, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11576363

RESUMO

BACKGROUND: Previous studies have reported an association between obstructive sleep apnea (OSA) and proteinuria, but are limited in their ability to assess proteinuria accurately, to adjust for confounders such as obesity, or to exclude confidently underlying renal disease in patients with OSA and nephrotic-range proteinuria. METHODS: The spot urine protein/creatinine ratio was measured in a prospective consecutive series of 148 patients referred for polysomnography who were not diabetic and had not been treated previously for OSA. The urine protein/creatinine ratio was compared across four levels of OSA severity, based on the frequency of apneas and hypopneas per hour: <5 (absent), 5 to 14.9 (mild), 15 to 29.9 (moderate), and > or =30 (severe). RESULTS: The median level of urine protein/creatinine ratio in all categories of OSA was <0.2 (range 0.03 to 0.69; median 0.06 in patients with normal apnea hypopnea index, 0.06, 0.07, 0.07 in patients with mild, moderate, and severe OSA, respectively). Eight subjects had a urine protein/creatinine ratio greater than 0.2. Univariate analysis showed a significant association between urine protein/creatinine ratio and older age (P < 0.0001), hypertension (P < 0.0001), coronary artery disease (P = 0.003), and arousal index (P = 0.003). Body mass index (P = 0.16), estimated creatinine clearance (P = 0.17), and apnea hypopnea index (P = 0.13) were not associated with the urine protein/creatinine ratio. In multiple regression analysis, only age and hypertension were independent positive predictors of the urine protein/creatinine ratio (P < 0.0001, R2 = 0.17). CONCLUSION: Clinically significant proteinuria is uncommon in sleep apnea. Nephrotic range proteinuria should not be ascribed to sleep apnea and deserves a thorough renal evaluation.


Assuntos
Proteinúria/complicações , Síndromes da Apneia do Sono/urina , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston , Creatinina/sangue , Creatinina/urina , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Síndrome Nefrótica/urina , Prevalência , Estudos Prospectivos , Proteinúria/sangue , Proteinúria/epidemiologia , Proteinúria/urina , Síndromes da Apneia do Sono/sangue
8.
Am J Kidney Dis ; 36(2): 405-11, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10922321

RESUMO

Venous thromboembolic disease is considered an uncommon event in the end-stage renal disease (ESRD) population. We report five cases of venous thromboembolism (VTE) occurring in dialysis patients within a 1-year period at a single center. Analysis of these cases and review of the literature suggest that risk factors for VTE in the ESRD population are similar to those of the general population. Chronically ill, debilitated patients appear to be those most likely to develop VTE.


Assuntos
Falência Renal Crônica/complicações , Embolia Pulmonar/complicações , Trombose Venosa/complicações , Idoso , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Fatores de Risco
9.
Am J Kidney Dis ; 34(3): e11, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10471757

RESUMO

The manifestations of polyarteritis nodosa (PAN) are varied, but urological abnormalities other than ureteric stenosis and orchitis have not been described. We report a case of hepatitis B-associated PAN with bilateral hydronephrosis without obstruction. Retrograde urography conclusively demonstrated the absence of obstruction. Vasculitis-related myopathy, or neuropathy of the ureter, is the most likely cause of this finding. The patient was treated with high-dose steroids, cyclophosphamide, and plasmapheresis with resolution of hydronephrosis. Although the patient required dialysis at initiation of therapy, she went on to recover sufficient renal function to discontinue dialysis. We review the literature on the treatment of hepatitis B-associated PAN and discuss the pitfalls in diagnosis of this condition.


Assuntos
Hepatite B/complicações , Hidronefrose/etiologia , Poliarterite Nodosa/complicações , Adulto , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Hidronefrose/terapia , Imunossupressores/uso terapêutico , Rim/patologia , Plasmaferese , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/terapia , Diálise Renal , Ureter/diagnóstico por imagem , Urografia
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