To analyze whether urinary catheterization in a hospital emergency department (ED) affects short-term prognosis in patients with acute heart failure (AHF).
We prospectively recorded baseline and ...other clinical data in a consecutive cohort of ED patients treated for AHF. Crude and adjusted associations were calculated between catheterization and a primary composite outcome (30-day readmission for AHF and/or death) and secondary outcomes (in-hospital mortality, urinary tract infection UTI, and duration of hospital stay.).
Nine hundred ninety-one patients were admitted for AHF. The mean (SD) age was 66 (10.5) years; 71% were women. Catheterization was required for 29.2% in the ED. The primary composite outcome was observed in 7.7% of the patients who were not catheterized and 12.8% of the catheterized patients (P = .02). In-hospital mortality occurred in 5.9% and 9.7% of non-catheterized and catheterized patients, respectively (P = .04), and UTIs occurred in 19.1% and 26.6% (P = .01). Twelve of the non-catheterized patients (1.7%) were readmitted for AHF (vs 11 (3.8%) of the catheterized patients (P = .06), and there were no differences between the groups in hospital stay (11 vs 10.9 days, P = .78). In the adjusted analysis of associations between catheterization and the primary outcome the odds and hazard ratios (OR and HR, respectively) were OR, 1.7 (95% CI, 1.1-2.7) (P = .02) and HR, 1.6 (95% CI, 1.1-2.5) (P = .03). For secondary outcomes, significant associations emerged between catheterization and UTIs (OR, 1.8 95% CI, 1.1-2.2; P = .008) and readmission for AHF (OR, 2.9 95% CI, 1.2-7.3; P = .02).
Routine insertion of a urinary catheter in patients with AHF in the ED is associated with worse 30-day clinical outcomes.
Inflammation and oxidative stress take part in the development of the pathogenesis of acute coronary syndromes (ACS). The aim of this study was to analyze serum concentrations of high sensitivity ...C-reactive protein (PCR-as) and malondialdehyde (MDA) in cocaine consumer patients and ACS.
We carried out a retrospective analysis of 43 patients with ACS and a positive urine test for cocaine, who were compared to a sample of 49 patients with this diagnosis and a negative test. We evaluated the clinical, laboratory, electrocardiographic and hemodynamic features.
Both groups were similar in clinical, laboratory, electrocardiographic and hemodynamic features, except those patients with ACS and a positive cocaine test who were younger and had a predominantly transient ST-segment elevation. PCR-as values were lower in the ACS and cocaine positive group (4.82+/-0.67 versus 5.34+/-0.81mg/L, p <0.0035). In contrast, MDA concentrations were higher (0.66+/-0.50 versus 0.31+/-0.09nmol/ml, p <0.0001). Likewise, in the multivariate analysis, patients with ACS and cocaine positive test were related, on an independent form, to oxidative stress.
Oxidative stress plays a major role on inflammation in the different mechanisms involving cocaine in the pathogenesis of ACS, independently of the age and cardiovascular risk factors.
The midazolam vs morphine (MIMO) trial showed that patients treated with midazolam had fewer serious adverse events than those treated with morphine. In many patients with acute pulmonary edema, the ...left ventricular ejection fraction (LVEF) is preserved, at 50% or higher. We aimed to determine whether left ventricular (LV) systolic dysfunction (D), defined by an LVEF of less than 50%, modifies the protective effect of midazolam vs morphine.
The MIMO trial randomized 111 patients with acute pulmonary edema to receive intravenous midazolam in 1-mg doses to a maximum of 3 mg (n = 55) or morphine in 2- to 4-mg doses to a maximum of 8 mg (n= 56). We calculated the relative risk (RR) for a serious adverse event in patients with and without systolic LVD.
LVEF was preserved in 84 (75.7%) of the patients with acute pulmonary edema. In patients with systolic LVD, 4 patients (26.9%) in the midazolam arm vs 6 (50%) in the morphine arm developed serious adverse events (RR, 0.53; 95% CI, 0.2-1.4). In patients without systolic LVD, 6 patients (15%) in the midazolam arm vs 18 (40.9%) in the morphine arm experienced such events (RR, 0.37; 95% CI, 0.16-0.83). The presence of systolic LVD did not modify the protective effect of midazolam on serious adverse effects (P=.57).
The effect of midazolam vs morphine in protecting against the development of serious adverse events or death is similar in patients with and without systolic LVD.
Currently air pollution is considered as an emerging risk factor for cardiovascular disease. Our objective was to study the concentrations of particulate matter in ambient air and analyze their ...relationship with cardiovascular risk factors in patients admitted to a cardiology department of a tertiary hospital with the diagnosis of heart failure or acute coronary syndrome (ACS).
We analyzed 3950 consecutive patients admitted with the diagnosis of heart failure or ACS. We determined the average concentrations of different sizes of particulate matter (<10, <2.5, and <1
μm and ultrafine particles) from 1 day or up to 7 days prior to admission (1 to 7 days lag time).
There were no statistically significant differences in mean concentrations of particulate matter <10, <2.5 and <1
μm in size in both populations. When comparing the concentrations of ultrafine particles of patients admitted due to heart failure and acute coronary syndrome, it was observed that the former had a tendency to have higher values (19 845.35±8 806.49 vs 16 854.97
±
8005.54
cm
−3,
P <.001). The multivariate analysis showed that ultrafine particles are a risk factor for admission for heart failure, after controlling for other cardiovascular risk factors (odds ratio
=
1.4; confidence interval 95%, from 1.15 to 1.66
P
=
.02).
In our study population, compared with patients with ACS, exposure to ultrafine particles is a precipitating factor for admission for heart failure.
Actualmente se considera la contaminación atmosférica como un factor de riesgo emergente de enfermedades cardiovasculares. Nuestro objetivo fue comparar las concentraciones de partículas atmosféricas en aire ambiente y analizar su relación con los factores de riesgo cardiovascular en pacientes que ingresan en un servicio de cardiología de un hospital terciario con el diagnóstico de insuficiencia cardiaca y síndrome coronario agudo (SCA).
Analizamos a un total de 3.950 pacientes ingresados de forma consecutiva con el diagnóstico de insuficiencia cardiaca y SCA. Se determinaron las concentraciones medias de material particulado con tamaño < 10, 2,5 y 1
μm y partículas ultrafinas, desde el día anterior hasta los 7 días previos al ingreso (1 a 7 días de retardo).
No se observaron diferencias estadísticamente significativas en las concentraciones medias de material particulado con tamaño < 10, 2,5 y 1 μm en ambos grupos de población. Cuando se compararon las concentraciones de partículas ultrafinas de los pacientes ingresados por insuficiencia cardiaca y SCA, se observó que los primeros tenían tendencia a valores más altos (19.845,35
±
8.806,49 frente a 16.854,97
±
8.005,54/cm
−
3
; p
<
0,001). El análisis multivariable muestra que las partículas ultrafinas son un factor de riesgo para ingresar por insuficiencia cardiaca, tras controlar por los distintos factores de riesgo cardiovascular (
odds ratio
=
1,4; intervalo de confianza del 95%, 1,15-1,66; p
=
0,02).
En nuestra población de estudio, comparada con pacientes con SCA, la exposición a partículas ultrafinas constituye un factor precipitante del ingreso por insuficiencia cardiaca.
There is a hyperoxidative state in sepsis. The objective of this study was to determine serum malondialdehyde (MDA) levels during the first week of follow up, whether such levels are associated with ...severity during the first week and whether non-surviving patients showed higher MDA levels than survivors during the first week.
We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in 328 patients (215 survivors and 113 non-survivors) with severe sepsis at days one, four and eight of diagnosis, and in 100 healthy controls. The primary endpoint was 30-day mortality and the secondary endpoint was six -month mortality. The association between continuous variables was carried out using Spearman's rank correlation coefficient. Cox regression analysis was applied to determine the independent contribution of serum MDA levels on the prediction of 30-day and 6-month mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated as measures of the clinical impact of the predictor variables.
We found higher serum MDA in septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001) of diagnosis than in healthy controls. Serum MDA was lower in surviving than non-surviving septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001). Serum MDA levels were positively correlated with lactic acid and SOFA during the first week. Finally, serum MDA levels were associated with 30-day mortality (HR = 1.05; 95% CI = 1.02-1.09; p = 0.005) and six-month mortality (hazard ratio (HR) = 1.05; 95% CI = 1.02-1.09; p = 0.003) after controlling for lactic acid levels, acute physiology and chronic health evaluation (APACHE)-II, diabetes mellitus, bloodstream infection and chronic renal failure.
To our knowledge, this is the largest series providing data on the oxidative state in septic patients to date. The novel finding is that high serum MDA levels sustained throughout the first week of follow up were associated with severity and mortality in septic patients.
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