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Abstract(s)
Introdução: As doenças cardiovasculares representam a principal causa de morte em todo o mundo. Sabe-se que a presença de comorbilidades é um fator preditor negativo, mas não é conhecido o impacto específico das comorbilidades cardíacas. Este trabalho tem como objetivo identificar as comorbilidades cardíacas mais comuns nos doentes admitidos em unidades de cuidados intensivos polivalentes, por etiologia não cardíaca, e perceber como essas patologias influenciam a evolução clínica dos doentes.
População e Métodos: Estudo caso-controlo, observacional e retrospetivo. Selecionaram-se dois grupos: doentes com antecedentes cardíacos (Grupo A) e doentes sem doença cardíaca conhecida prévia (Grupo B), de entre os doentes internados por etiologia não cardíaca nas unidades de cuidados intensivos do Centro Hospitalar Cova da Beira e Hospital das Forças Armadas, entre dezembro de 2013 e janeiro de 2015. Foram revistos os registos clínicos, que posteriormente foram analisados estatisticamente.
Resultados: Estudaram-se um total de 71 indivíduos, 50 no grupo A e 21 no grupo B. A idade média foi de 75,4 ± 9,2 anos no grupo A e 56,8 ± 16,2 anos no grupo B (p<0,001). Os doentes do grupo A tiveram uma maior mortalidade (44% grupo A vs 9,5% grupo B; p=0,006). Entre as comorbilidades apresentadas no grupo A, salientam-se as disritmias, que aumentam em cerca de 47 vezes o risco de morte no internamento (56,2% faleceram vs 43,8% não faleceram, p=0,001; OR=46,8; 95%CI 4,7-63,9). A classificação NYHA (OR=3,1; 95%CI 1,3-7,4) e o score APACHE II (OR=1,1; 95%CI 1-1,2) demonstraram ser preditores de mortalidade. De entre as intercorrências, destacam-se a fibrilhação auricular, que aumenta cerca de 8 vezes o risco de morte (47,4% faleceram vs 52,6% não faleceram, p=0,005; OR=7,5; 95%CI 1,8–30,7), e o choque, principalmente o séptico, que condiciona um risco de morte 9 vezes superior (40% faleceram vs 60% não faleceram, p<0,001; OR=9,1; 95%CI 2-41,2). Verificou-se um uso significativamente superior de agentes inotrópicos no grupo A (30% grupo A vs 4,8% grupo B, p=0,027).
Conclusões: Os doentes com comorbilidades ou intercorrências cardíacas, principalmente disrítmicas (como a fibrilhação auricular), apresentaram uma maior mortalidade. Esta deveu- -se principalmente a choque séptico, acompanhando-se de um maior uso de agentes inotrópicos neste grupo.
Introduction: Cardiovascular diseases are the main cause of death in the world. It is known that comorbidities impact negatively on prognosis, however it is still undetermined the specific importance of cardiac comorbidities. The main goal of this study is to identify the most common cardiac comorbidities in patients admitted in medical intensive care units for non-cardiac entities, and to determine how these pathologies influence the clinical evolution of the patients. Population and Methods: For a retrospective, observational case-control study, two groups were selected: patients with known cardiac disease (Group A) and patients without cardiac diseases (Group B), from a population of intensive care patients, admitted sequentially for a non-cardiac entity. This study took place in Centro Hospitalar Cova da Beira and Hospital das Forças Armadas between December 2013 and January 2015. The clinical records were reviewed and the data was statistically analyzed. Results: A total of 71 individuals were studied: 50 included in group A and 21 from group B. The mean age in group A was 75,4 ± 9,2 years versus group B 56,8 ± 16,2 years (p<0,001). Patients from group A had a greater mortality rate (44% in group A vs 9,5% in group B; p=0,006). Group A comorbidities included arrhythmic events, that increased by 47 times the risk of in-hospital death (56,2% of mortality vs 43,8% of survival, p=0,001; OR=46,8; 95%CI 4,7-63,9). NYHA classification (OR=3,1; 95%CI 1,3-7,4) and APACHE II score (OR=1,1; 95% CI 1-1,2) have shown to be good mortality predictors. From the in-hospital complications, we emphasize atrial fibrillation, that increases by 8 times the risk of in-hospital death (47,4% of mortality vs 52,6% of survival, p=0,002; OR=7,5; 95%CI 1,8–30,7), and shock (mainly septic), that results in a 9 times higher in-hospital mortality risk (40% of mortality vs 60% of survival, p=0,001; OR=9,1; 95%CI 2-41,2). Group A patients prompted an increased use of inotropic agents in group A (30% group A vs 4,8% group B, p=0,027). Conclusions: Patients with cardiac comorbidities or complications, especially dysrhythmias, showed a higher mortality rate. This was mostly due to septic shock, what explains the higher use of inotropic agents in this group.
Introduction: Cardiovascular diseases are the main cause of death in the world. It is known that comorbidities impact negatively on prognosis, however it is still undetermined the specific importance of cardiac comorbidities. The main goal of this study is to identify the most common cardiac comorbidities in patients admitted in medical intensive care units for non-cardiac entities, and to determine how these pathologies influence the clinical evolution of the patients. Population and Methods: For a retrospective, observational case-control study, two groups were selected: patients with known cardiac disease (Group A) and patients without cardiac diseases (Group B), from a population of intensive care patients, admitted sequentially for a non-cardiac entity. This study took place in Centro Hospitalar Cova da Beira and Hospital das Forças Armadas between December 2013 and January 2015. The clinical records were reviewed and the data was statistically analyzed. Results: A total of 71 individuals were studied: 50 included in group A and 21 from group B. The mean age in group A was 75,4 ± 9,2 years versus group B 56,8 ± 16,2 years (p<0,001). Patients from group A had a greater mortality rate (44% in group A vs 9,5% in group B; p=0,006). Group A comorbidities included arrhythmic events, that increased by 47 times the risk of in-hospital death (56,2% of mortality vs 43,8% of survival, p=0,001; OR=46,8; 95%CI 4,7-63,9). NYHA classification (OR=3,1; 95%CI 1,3-7,4) and APACHE II score (OR=1,1; 95% CI 1-1,2) have shown to be good mortality predictors. From the in-hospital complications, we emphasize atrial fibrillation, that increases by 8 times the risk of in-hospital death (47,4% of mortality vs 52,6% of survival, p=0,002; OR=7,5; 95%CI 1,8–30,7), and shock (mainly septic), that results in a 9 times higher in-hospital mortality risk (40% of mortality vs 60% of survival, p=0,001; OR=9,1; 95%CI 2-41,2). Group A patients prompted an increased use of inotropic agents in group A (30% group A vs 4,8% group B, p=0,027). Conclusions: Patients with cardiac comorbidities or complications, especially dysrhythmias, showed a higher mortality rate. This was mostly due to septic shock, what explains the higher use of inotropic agents in this group.
Description
Keywords
Arritmias Choque Comorbilidade Cardíaca Cuidados Intensivos Valvulopatia