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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-31082021-141002
Document
Author
Full name
Rafael Rafaini Lloret
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Issa, Victor Sarli (President)
Bacal, Fernando
Brito, Flavio de Souza
Ramires, Felix José Alvarez
Title in Portuguese
Estudo da função renal em pacientes internados por episódio de descompensação de Insuficiência Cardíaca
Keywords in Portuguese
hospitalização
Insuficiência cardíaca
insuficiência renal
mortalidade
saúde suplementar
Abstract in Portuguese
INTRODUÇÃO. A piora da função renal é um achado comum em pacientes internados por insuficiência cardíaca descompensada. Porém, dados atuais ainda não permitem estabelecer com precisão a natureza da relação entre a piora da função renal e o prognóstico dos pacientes. O objetivo desse estudo foi investigar a ocorrência da disfunção renal em pacientes internados por insuficiência cardíaca em serviço de saúde suplementar e sua influência no prognóstico desses pacientes. O desfecho primário foi a ocorrência de óbito ou transplante cardíaco ao longo da internação e os secundários foram o tempo para nova internação, o número de novas internações, a necessidade de implantação de outros dispositivos de assistência ventricular, a realização de terapia de substituição renal ou a ocorrência de óbito após a internação. Nos 718 pacientes estudados, o desfecho primário ocorreu em 5,7% dos pacientes enquanto a mortalidade em 180 dias foi de 13%. Reinternações foram frequentes na população estudada, sendo que 41,5% dos pacientes apresentaram 3 ou mais reinternações, porém as novas internações ocorreram tardiamente, com 60,9% delas ocorrendo após 60 dias desde a alta. Os pacientes com valores menores no ritmo de filtração glomerular permaneceram mais tempo internado (9 versus 8 versus 8 p: 0,042) e tiveram maior mortalidade intrahospitalar (12% versus 5% versus 3,8% p: 0,005).Quando analisada a taxa de filtração glomerular, além de outros fatores de risco para Insuficiência Cardíaca , a idade (OR:1,054; IC95% 0,0995 1,116, p:0,071), o nível de sódio sérico (OR:0,911; IC95% 0,823 1 1,009, p:0,074) e o ritmo de filtração glomerular (OR: 1,033 IC 95% 1,001 1,067 p:0,045) estiveram independentemente associados ao prognóstico hospitalar. Quando avaliado a taxa de evento em 180 dias após a alta, a taxa de filtração glomerular também se mostrou um fator independente (OR: 0,993 IC95% 0,988 0,999, p: 0,013). Nossos dados mostram que a níveis mais baixos no ritmo de filtração glomerular na admissão hospitalar estão relacionados com maiores taxas de desfechos intra-hospitalares e em 180dias após a alta.
Title in English
Influence of renal function in patients hospitalized for decompensated heart failure in supplementary health service
Keywords in English
Heart failure
hospitalization
mortality
renal failure
supplementary health
Abstract in English
INTRODUCTION. The worsening of renal function is a common finding in patients hospitalized for decompensated heart failure. However, current data still do not allow to establish accurately the nature of the relationship between worsening of kidney function and prognosis of patients. The objective of this study was to investigate the occurrence of renal dysfunction in patients hospitalized for heart failure in a supplementary health service and its influence on the prognosis of these patients. The primary endpoint was the occurrence of death or heart transplantation throughout hospitalization and the secondary endpoints were the time for new hospitalization, the number of new hospitalizations, the need for implantation of other ventricular assist devices, the performance of renal replacement therapy or the occurrence of death after hospitalization. In the 718 patients studied, the primary outcome occurred in 5.7% of patients while mortality in 180 days was 13%. Re-hospitalization was frequent in the studied population, with 41.5% of the patients presenting 3 or more re-hospitalizations but the new hospitalizations occurred late, with 60.9% of them occurring after 60 days since discharge. Patients with lower values in the glomerular filtration rhythm remained longer hospitalized (9 versus 8 versus 8 p: 0.042) and had higher intrahospital mortality (12% versus 5% versus 3.8% p: 0.005). When analyzed the glomerular filtration rate, besides other risk factors for Cardiac Failure , the age (OR:1.054; 95% CI 0.0995 - 1.116, p:0.071), the serum sodium level (OR: 0.911; 95% CI 0.823 -1 1.009, p:0.074) and the glomerular filtration rate (OR: 1.033 CI 95% 1.001 - 1.067 p:0.045) were independently associated with hospital prognosis. When the event rate at 180 days after discharge was evaluated, the glomerular filtration rate was also shown to be an independent factor (OR: 0.993 CI 95% 0.988 - 0.999, p:0.013). Our data show that at lower levels in the glomerular filtration rate at hospital admission are related to higher intra-hospital and 180-day outcomes after discharge.
 
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Publishing Date
2021-09-21
 
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