Predictores de mortalidad precoz en el mieloma múltiple de nuevo diagnóstico / Predictors of early mortality in the new diagnosis multiple myeloma

Introducción: El mieloma múltiple es una neoplasia maligna de células B caracterizada por una proliferación clonal incontrolada de células plasmáticas. Se define como mortalidad precoz en el mieloma múltiple de nuevo diagnóstico, al porcentaje de muerte que ocurre dentro de los primeros seis meses y afecta entre el 10 y 14 % de los casos. Los biomarcadores han evolucionado desde la caracterización del tumor hasta el reconocimiento de las aberraciones cromosómicas y moleculares que desempeñan un papel en la supervivencia. Objetivo: Describir los principales predictores identificados con relación a la mortalidad precoz y su función en la patogénesis de la enfermedad. Métodos: Se analizó la literatura científica publicada. Se utilizaron motores de búsqueda como Google Scholar, PubMed y ScienceDirect. Se consultaron un total de 80 artículos y se incluyeron 52, en su mayoría de los últimos cinco años. Análisis y síntesis de la información: Se evidenciaron mecanismos genéticos y epigenéticos que contribuyen de manera decisiva en la mortalidad precoz de pacientes con mieloma múltiple de nuevo diagnóstico. Conclusiones: El aumento del riesgo de mortalidad precoz en pacientes con mieloma múltiple de nuevo diagnóstico está asociado a factores clínicos y biológicos, por lo que existe la necesidad de estratificación de los pacientes para un manejo personalizado que impone el uso de datos clínicos y biológicos de una forma integrada.

Introduction: Multiple Myeloma is a malignant B-cell neoplasm characterized by uncontrolled clonal proliferation of plasma cells. Early mortality in newly diagnosed Multiple Mieloma is defined as the percentage of death that occurs six months or less after diagnosis and, it affects 10 to 14 % of the cases. Biomarkers have evolved from the characterization of tumor to the recognition of chromosomal and molecular aberrations that play a rol in survival. Objective: To describe the main predictors identified related to early mortality and their role in the pathogenesis of the disease. Methods: The scientific literature was analyzed using search engines such as Google Scholar, PubMed and ScienceDirect. Consulted articles were 80 and included articles were 52, mostly from the last five years. Analysis and information synthesis: Genetic and epigenetic mechanisms that contribute decisively in the early mortality in new diagnosis Multiple Myeloma patients were evidenced. Conclusions: The increased risk of early mortality in patients with newly diagnosed Multiple Myeloma is associated with clinical and biological factors and there is a need to stratify patients in terms of early mortality risk for personalized management, for which it is imposed the use of clinics and biological data in an integrative way.

Predictores de mortalidad precoz en pacientes con trauma complejo hemorrágico / Early mortality predictors in patients with complex hemorrhagic trauma

RESUMEN Fundamento: El trauma complejo es un problema de salud a nivel mundial y cuando es de tipo hemorrágico la mortalidad es superior a los otros tipos de traumas complejos. Objetivo: Determinar las variables predictoras de mortalidad precoz en pacientes hospitalizados con trauma complejo hemorrágico en una institución hospitalaria del segundo nivel de atención en Cuba. Metodología: Se realizó un estudio transversal en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, durante 6 años. Se incluyeron 207 pacientes. Las variables se agruparon en sociodemográficas, enfermedades crónicas asociadas, mecanismo lesional, tipo de trauma, localización topográfica, tiempo entre admisión hospitalaria, diagnóstico y tratamiento, complicaciones precoces, tratamiento médico y quirúrgico, y mortalidad precoz. Se elaboró un árbol de decisión mediante el método Chaid exhaustivo, la variable dependiente fue la mortalidad por trauma complejo hemorrágico. Resultados: Predominaron los pacientes del sexo masculino (85 %), con 60 años y menos (83 %), con trauma contuso (57.5 %) y politraumatizados (42.5 %). Predominaron también los que presentaron acidosis metabólica (66.7 %), coagulopatía aguda (44.4 %), hipotermia (41.5 %). El 30 % de los pacientes falleció precozmente. El árbol de decisión tuvo una sensibilidad de 82.3 %, una especificidad de 97.2 % y un porcentaje global de pronóstico correcto del 92.8 %. Se identificaron 4 variables predictores de mortalidad: hipotermia, acidosis metabólica, coagulopatía aguda y trauma penetrante. Conclusiones: La probabilidad más alta de fallecer precozmente durante un trauma complejo hemorrágico se da entre pacientes con hipotermia, acidosis metabólica, coagulopatía aguda y trauma penetrante.

ABSTRACT Background: Complex trauma is a worldwide health problem and when hemorrhagic, mortality is higher than other types of complex trauma. Objective: To determine predictive variables of early mortality in hospitalized patients with complex hemorrhagic trauma in a second care level hospital in Cuba. Methodology: A cross-sectional study was conducted at Camilo Cienfuegos Provincial General Hospital in Sancti Spíritus, for 6 years. 207 patients were included. The variables were grouped into sociodemographic, associated chronic diseases, injury mechanism, type of trauma, topographic location, time between hospital admission, diagnosis and treatment, early complications, medical and surgical treatment, and early mortality. A decision tree was developed using the exhaustive Chaid method, the dependent variable was mortality due to complex hemorrhagic trauma. Results: Male patients (85 %), 60 years and younger (83 %), with blunt trauma (57.5 %) and polytraumatized patients (42.5 %) predominated. Those who presented metabolic acidosis (66.7 %), acute coagulopathy (44.4 %), and hypothermia (41.5 %) also predominated. 30 % of patients died early. The decision tree had a sensitivity of 82.3 %, a specificity of 97.2 % and an overall percentage of correct forecast of 92.8 %. Four variables that predicted mortality were identified: hypothermia, metabolic acidosis, acute coagulopathy, and penetrating trauma. Conclusions: The highest probability of early dying during a complex hemorrhagic trauma occurs among patients with hypothermia, metabolic acidosis, acute coagulopathy and penetrating trauma.

Predictores de mortalidad precoz en pacientes con trauma complejo hemorrágico / Early mortality predictors in patients with complex hemorrhagic trauma

Fundamento: El trauma complejo es un problema de salud a nivel mundial y cuando es de tipo hemorrágico la mortalidad es superior a los otros tipos de traumas complejos. Objetivo: Determinar las variables predictoras de mortalidad precoz en pacientes hospitalizados con trauma complejo hemorrágico en una institución hospitalaria del segundo nivel de atención en Cuba. Metodología: Se realizó un estudio transversal en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, durante 6 años. Se incluyeron 207 pacientes. Las variables se agruparon en sociodemográficas, enfermedades crónicas asociadas, mecanismo lesional, tipo de trauma, localización topográfica, tiempo entre admisión hospitalaria, diagnóstico y tratamiento, complicaciones precoces, tratamiento médico y quirúrgico, y mortalidad precoz. Se elaboró un árbol de decisión mediante el método Chaid exhaustivo, la variable dependiente fue la mortalidad por trauma complejo hemorrágico. Resultados: Predominaron los pacientes del sexo masculino, con 60 años y menos, con trauma contuso (57.5 porciento) y politraumatizados (42.5 porciento). Predominaron también los que presentaron acidosis metabólica , coagulopatía aguda, hipotermia. El 30 %porciento de los pacientes falleció precozmente. El árbol de decisión tuvo una sensibilidad de 82.3 porciento, una especificidad de 97.2 porciento y un porcentaje global de pronóstico correcto del 92.8 porciento. Se identificaron 4 variables predictores de mortalidad: hipotermia, acidosis metabólica, coagulopatía aguda y trauma penetrante. Conclusiones: La probabilidad más alta de fallecer precozmente durante un trauma complejo hemorrágico se da entre pacientes con hipotermia, acidosis metabólica, coagulopatía aguda y trauma penetrante [AU]

Insuficiencia Cardíaca: una Enfermedad Maligna Conclusiones del Estudio REFERENCE / Heart Failure a Malignant Disease- Insights from the REFERENCE Study

Aims: Heart failure (HF) short-term prognosis persists poor. We studied the rate of short-term readmission due to HF, short-term all-cause mortality and end of follow-up all-cause mortality. Material and Methods: We assessed patients admitted with acuteHF in class III or IV of NYHA. Univariate Cox proportional hazard model was performed. Survival curves were plotted using the Kaplan-Meier method and compared with the log-rank test for readmission days post-discharge. Results: We followed 65 patients for a median of 13.7 (Q1-Q3 6.7-18.9) months. The 30-day post-discharge readmission rate was 13.8%, the 90-day post-discharge readmission percentage was 33.8% and year readmission rate 61.5%. The 30-day mortality rate was 10.8% and 90- day mortality was 18.5%. Year mortality rate was 36.9% and 40% of the patients were deceased by the end of the follow-up. Length of stay (LOS) correlated with short-term readmission in the general population (HR: 1.022, 95% CI: 1.009-1.036, P value<0.001) and in Heart Failure with Reduced Ejection Fraction patients (HFrEF) (HR: 1.029, 95% CI: 1.008-1.050, Pvalue=0.006). The number of hospitalizations correlated with short-term readmission in the general population (HR: 1.543, 95% CI: 1.224-1.945, P- value<0.001) and in the Heart Failure with Mid-Range Ejection Fraction subgroup (HFmrEF) (HR: 2.814, 95% CI: 1.075-7.365, P- value=0.035). In the Heart Failure with Preserved Ejection Fraction (HFpEF) subgroup both the LOS per specific admission (HR: 1.063, 95% CI: 1.006-1.123, P value=0.030) and the accumulated LOS for all admissions (HR: 1.051, 95% CI: 1.008-1.095, P value=0.019) were associated with end of followup mortality... (AU)

Introducción: La insuficiencia cardíaca (IC) tiene un mal pronóstico a corto plazo. Estudiamos las tasas de reingreso precoz por IC, mortalidad global precoz y mortalidad global al final del seguimiento. Material y métodos: Evaluamos a enfermos ingresados por IC descompensada en clase III o IV de la NYHA. Se utilizó el modelo de riesgo proporcional de Univariante Cox. Se aplicó el método de Kaplan-Meier para obtener curvas de supervivencia para dias de reingreso pós-alta e se comparó al log-rank test. Resultados: La mediana de seguimiento de los 65 enfermos fue de 13.7 (Q1-Q3 6.7-18.9) meses. La tasa de reingreso a los 30 días del alta fue del 13.8%, a los 90 días del alta fue del 33.8% y la tasa anual fue del 61.5%. La mortalidad a los 30 días del alta fue del 10.8% y del 18.5% a los 90 días. La mortalidad anual fue del 36.9% y al final del seguimiento del 40%. La duración del ingreso se correlacionó con el reingreso precoz en la población general (HR: 1.022, 95% CI: 1.009-1.036, P-value<0.001) y en el subgrupo con fracción de eyección reducida (HR: 1.029, 95% CI: 1.008-1050, P-value=0.006). El número de ingresos fue un marcador de mal pronóstico para el reingreso precoz en la población general (HR: 1.543, 95% CI: 1.224-1.945, P-value<0.001) y en el subgrupo con fracción de eyección intermedia (HR: 2.814, 95% CI: 1,075-7,365, P-value=0.035). En el subgrupo con fracción de eyección preservadala duración de ingreso por hospitalización... (AU)

Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control.

OBJECTIVE: To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN: A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING: ICU at a University Hospital in Spain. PATIENTS: All consecutive patients admitted to the ICU with CASS. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS: During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS: The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

Clinical risk factors for early mortality in patients with community-acquired septic shock. The importance of adequate source control.

OBJECTIVE: To evaluate the incidence and risk factors for early mortality (EM) in the ICU in patients with community-acquired septic shock (CASS). DESIGN: A retrospective cohort study of patients with CASS admitted to the ICU (2003-2016). SETTING: ICU at a University Hospital in Spain. PATIENTS: All consecutive patients admitted to the ICU with CASS. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: CASS was defined according to the Sepsis-3 definitions. EM were defined as occurring within of 72h following ICU admission. A multinomial logistic regression analysis was performed to identify the risk factors associated with early deaths. RESULTS: During the study period, 625 patients met the Sepsis-3 criteria and admitted with CASS. 14.4% of all patients died within the first 72h. Of 161 patients who died in the ICU, 90 (55.9%) died within the first 72h. The percentage of early and late mortality did not vary significantly during the study period. The need and adequacy of source control were significantly lower in patients with EM. In the multivariate analysis, ARDS, non-respiratory infections, bacteremia and severity at admission were variables independently associated with EM. The only factor that decreased EM was adequate source control in patients with infections amenable to source control. CONCLUSIONS: The incidence of EM has remained stable over time, which means that more than half of the patients who die from CASS do so within the first 72h. Infections where adequate source control can be performed have lower EM.

Risk for early death in acutely ill older adults attended by prehospital emergency medical services. / Modelo de riesgo de mortalidad precoz en pacientes ancianos con enfermedad aguda atendidos por servicios de emergencias prehospitalarias.

OBJECTIVES: To develop and validate a prehospital risk model to predict early in-hospital mortality (#48 hours) in patients aged 65 years or older. MATERIAL AND METHODS: Prospective multicenter observational study in a cohort of patients aged 65 years or older attended by advanced life support emergency services and transferred to 5 Spanish hospitals between April 2018 and July 2019. We collected demographic, clinical and laboratory variables. A risk score was constructed and validated based on the analysis of prehospital variables associated with death within 48 hours. Predictors were selected by logistic regression. RESULTS: A total of 1759 patients were recruited. The median age was 79 years (interquartile range, 72-85 years), and 766 (43.5%) were women. One hundred eight patients (6.1%) died within 48 hours. Predictors in the Prehospital Older Adults Warning Scale (POAWS) were age, systolic blood pressure, temperature, the ratio of oxygen saturation to the fraction of inspired oxygen, score on the Glasgow coma scale, and lactic acid concentration in venous blood. The area under the receiver operating characteristic curve of the model to predict early mortality was 0.853 (95% CI, 0.80-0.91; P<.001). Mortality in patients at high risk (POAWS score, >7) was 69%. CONCLUSION: The prehospital POAWS score can be used to stratify risk for death within 48 hours in patients aged 65 years or older.

OBJETIVO: Diseñar y validar un modelo predictivo de mortalidad hospitalaria precoz (# 48 horas) en pacientes $ 65 años y basado en variables determinadas a nivel prehospitalario. METODO: Estudio multicéntrico de cohorte prospectivo y observacional. Se incluyeron pacientes $ 65 años atendidos por unidades de soporte vital avanzado y trasladados a un servicio de urgencias hospitalario. Se recogieron variables demográficas, clínicas y analíticas. Se construyó y validó una escala de puntuación mediante la categorización de las variables seleccionadas mediante regresión logística en función de la mortalidad en # 48 horas. RESULTADOS: Se reclutaron 1.759 pacientes, la edad mediana fue de 79 años (RIC 72-85), 766 eran mujeres (43,5%), y fallecieron 108 pacientes (6,1%) en # 48 horas. El modelo predictivo ­escala POAWS (Prehospital Older Adults Warning Score)­ incluyó la edad, presión arterial sistólica, temperatura, saturación de oxígeno en relación con la fracción inspirada de oxígeno, escala de coma de Glasgow y ácido láctico en sangre venosa. El área bajo la curva de la característica operativa del receptor para la mortalidad en # 48 horas fue de 0,853 (IC 95%: 0,80-0,91; p < 0,001). La mortalidad en los pacientes de alto riesgo (> 7 puntos en la escala) fue del 69%. CONCLUSIONES: La escala POAWS desarrollada en el presente estudio puede ser de utilidad para estratificar el riesgo de muerte de los patientes de 65 o más años durante las 48 horas siguientes a la atención en el ámbito prehospitalario.

Predictive value of the prehospital NEWS2-L ­National Early Warning Score 2 Lactate­ for detecting early death after an emergency. / Valor predictivo del preNEWS2-L (Pre-hospital National Early Warning Score 2 Lactate) para la detección de la mortalidad precoz en el ámbito prehospitalario.

OBJECTIVES: To evaluate the ability of the prehospital National Early Warning Score 2 Lactate (preNEWS2-L) to predict early mortality, defined as death within 48 hours of the index event. We also explored the predictive capacity of the score for 7- and 30-day all-cause mortality. MATERIAL AND METHODS: Prospective, observational longitudinal study in patients attended by ambulance responders and transferred to the emergency departments of reference hospitals. We collected demographic, physiologic, clinical, and analytical data and the main diagnosis. The main outcome measure was all-cause mortality. RESULTS: s. A total of 707 patients were included. Thirty-seven patients (5.2%) died within 48 hours of the index event. The area under the receiver operating characteristic curve (AUC) for the preNEWS2-L score's prediction of early death was 0.91 (95% CI, 0.83-0.96). The AUCs for death within 7 and 30 days were 0.86 (95% CI, 0.79-0.92) and 0.82 (95% CI, 0.76-0.87), respectively, showing that the score's ability to predict death decreases by almost 10% between 48 hours and 30 days. CONCLUSION: The preNEWS2-L is a useful prognostic tool that can be assessed quickly and easily in prehospital settings.

OBJETIVO: Evaluar la capacidad de la escala Pre-hospital National Early Warning Score 2 lactate (preNEWS2-L) para predecir la mortalidad precoz (antes de 48 h) desde el suceso índice. Además, como objetivo secundario, analizar el rendimiento de la nueva escala para la mortalidad a 7 y 30 días por cualquier causa. METODO: Estudio observacional, prospectivo y longitudinal de pacientes que son atendidos por unidades móviles de emergencias y trasladados a los servicios de urgencias de su hospital de referencia. Se recogieron variables demográficas, fisiológicas, clínicas, analíticas y de diagnóstico principal. La variable de resultado principal fue la mortalidad por cualquier causa. RESULTADOS: Se incluyeron 707 pacientes. La mortalidad precoz tras el suceso índice antes de las primeras 48 h fue de 37 pacientes (5,2%). La escala preNEWS2-L obtuvo un área bajo la curva (ABC) de la característica operativa del receptor (COR) de 0,91 (IC 95%: 0,83-0,96; p < 0,001), 0,86 (IC 95%: 0,79-0,92; p < 0,001) y 0,82 (IC 95%: 0,76- 0,87; p < 0,0017) para la mortalidad a 2, 7 y 30 días, respectivamente. Su capacidad de valorar la mortalidad desciende prácticamente un 10% entre el ABC-ROC a los 2 días y el ABC a los 30 días. CONCLUSIONES: La escala generada, denominada preNEWS2-L, puede ser considerada una herramienta pronóstico muy útil para ser usada en el medio prehospitalario, por facilidad de manejo, rápida obtención y capacidad de predicción.

Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era. / Predictores pretrasplante de mortalidad precoz en receptores adultos de trasplante hepático en la era MELD-Na.

AIMS: To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTR). DESIGN: An observational, retrospective, nested cases-controls study from a consecutive cohort of LTRs was carried out. SETTING: University hospital. PATIENTS: All consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. MAIN VARIABLES OF INTEREST: Pretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). RESULTS: The MELD-Na score (OR = 1.069, 95% CI = 1.014-1.127), age > 60 years (OR = 2.479, 95% CI = 1.226-5.015), and LTR height < 163cm (OR = 4.092, 95% CI = 2.115-7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. CONCLUSIONS: In LTR due to decompensated cirrhosis, the MELD-Na score, age > 60 years, and height < 163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality.

Intervención genética en la cardiopatía isquémica temprana / Genetic intervention in the early ischemic heart disease

Introducción: La aparición prematura de la enfermedad coronaria en una misma familia ha sido reconocida y se ha establecido como un factor de riesgo independiente de la enfermedad coronaria, se han demostrado cambios a corto plazo en la expresión genética en respuesta a la dieta, el ejercicio y el manejo del stress, produciendo cambios positivos a nivel molecular.Materiales y métodos: Al haber encontrado evidencia de estudios que apoyan la hipótesis de que la aparición de la enfermedad coronaria prematura es un fuerte factor de riesgo se realizó una revisión utilizando las bases de datos: PubMed, Embase, MEDLINE y Scielo, donde se revisaron los artículos en Ingles y Castellano hasta comienzos del 2014. Desarrollo. Los pacientes con historia parenteral de cardiopatía isquémica, presentaron una mortalidad más elevada a los 35 años, la implicación más importante es el riesgo sostenido de la enfermedad coronaria prematura, la cual comienza mucho antes de que los otros procesos patológicos se conviertan en factores de riesgo tradicionales, se identifiquen y traten, han sido demostrados cambios genéticos y moleculares asociados a mejoría del estado vascular, además existen enzimas capaces de modificar la actuación y eliminación de los medicamentos.Conclusiones: La identificación de un evento coronario en una persona menor de 60 años debe indicar la necesidad urgente de una intervención activa en sus niños, buscando cambios dietéticos, de ejercicios físicos, e intervenciones sobre la tensión arterial, que debe ser continuada y sostenida para reducir factores de riesgo y obtener una mejor adhesión a los medicamentos(AU)

Introduction: The premature appearance of the coronary heart disease in oneself family has been recognized and has settled down as a factor of independent risk of the coronary illness, short term changes have been demonstrated in the genetic expression in response to the diet, the exercise and the handling of the stress, producing positive changes at molecular level. Materials and Methods: When having found evidence of studies that support the hypothesis that the appearance of the premature coronary illness is a strong factor of risk, was carried out a revision using the following databases: PubMed, Embase, MEDLINE and Scielo, where the articles were revised in English and Castellano until beginnings of the 2014. Development: The patients with family history of ischemic heart disease, presented a higher mortality to the 35 years, the most important implication is the sustained risk of the premature coronary illness, which begins a lot before the other pathological processes become traditional factors of risk, are identified and try, genetic and molecular changes associated to improvement of the vascular state have been demonstrated, enzymes also exist able to modify the performance and elimination of the different drugs. Conclusions: The identification of a coronary event in a person smaller than 60 years should indicate the urgent necessity of an active intervention in its children, looking for dietary changes, of physical exercises, and interventions to the blood pressure that should be continued and sustained to reduce factors of risk and to obtain better adhesion to the drugs(AU)

Intervención genética en la cardiopatía isquémica temprana / Genetic intervention in the early ischemic heart disease

Introducción: La aparición prematura de la enfermedad coronaria en una misma familia ha sido reconocida y se ha establecido como un factor de riesgo independiente de la enfermedad coronaria, se han demostrado cambios a corto plazo en la expresión genética en respuesta a la dieta, el ejercicio y el manejo del stress, produciendo cambios positivos a nivel molecular. Materiales y métodos: Al haber encontrado evidencia de estudios que apoyan la hipótesis de que la aparición de la enfermedad coronaria prematura es un fuerte factor de riesgo se realizó una revisión utilizando las bases de datos: PubMed, Embase, MEDLINE y Scielo, donde se revisaron los artículos en Ingles y Castellano hasta comienzos del 2014. Desarrollo. Los pacientes con historia parenteral de cardiopatía isquémica, presentaron una mortalidad más elevada a los 35 años, la implicación más importante es el riesgo sostenido de la enfermedad coronaria prematura, la cual comienza mucho antes de que los otros procesos patológicos se conviertan en factores de riesgo tradicionales, se identifiquen y traten, han sido demostrados cambios genéticos y moleculares asociados a mejoría del estado vascular, además existen enzimas capaces de modificar la actuación y eliminación de los medicamentos. Conclusiones: La identificación de un evento coronario en una persona menor de 60 años debe indicar la necesidad urgente de una intervención activa en sus niños, buscando cambios dietéticos, de ejercicios físicos, e intervenciones sobre la tensión arterial, que debe ser continuada y sostenida para reducir factores de riesgo y obtener una mejor adhesión a los medicamentos.

Introduction: The premature appearance of the coronary heart disease in oneself family has been recognized and has settled down as a factor of independent risk of the coronary illness, short term changes have been demonstrated in the genetic expression in response to the diet, the exercise and the handling of the stress, producing positive changes at molecular level. Materials and Methods: When having found evidence of studies that support the hypothesis that the appearance of the premature coronary illness is a strong factor of risk, was carried out a revision using the following databases: PubMed, Embase, MEDLINE and Scielo, where the articles were revised in English and Castellano until beginnings of the 2014. Development: The patients with family history of ischemic heart disease, presented a higher mortality to the 35 years, the most important implication is the sustained risk of the premature coronary illness, which begins a lot before the other pathological processes become traditional factors of risk, are identified and try, genetic and molecular changes associated to improvement of the vascular state have been demonstrated, enzymes also exist able to modify the performance and elimination of the different drugs. Conclusions: The identification of a coronary event in a person smaller than 60 years should indicate the urgent necessity of an active intervention in its children, looking for dietary changes, of physical exercises, and interventions to the blood pressure that should be continued and sustained to reduce factors of risk and to obtain better adhesion to the drugs.

Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale. / Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D.

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTS AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.