Análise de variáveis prognósticas pré-transplante cardíaco relacionados com a sobrevida pós-transplante no Instituto Nacional de Cardiologia
Análise de variáveis prognósticas pré-transplante cardíaco relacionados com a sobrevida pós-transplante no Instituto Nacional de Cardiologia
Data
2015
Autores
Baumworcel, Leonardo
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A insuficiência cardíaca é a via final da maior parte das doenças que acometem o coração e representa um desafio na gestão da saúde. O transplante cardíaco é uma estratégia viável para pacientes com doença cardíaca em fase terminal. A escassez de doadores requer um processo para assegurar a seleção apropriada do destinatário. No Brasil, existe uma lista única de candidatos em ordem cronológica de chegada. Análise dos fatores de risco relacionados com a mortalidade na população local é essencial para os processos de alocação deste recurso escasso. Objetivo: O objetivo deste estudo é avaliar os fatores de risco, exclusivamente com o receptor relacionado com a mortalidade de um ano. Metodologia: Esta pesquisa é uma coorte de todos os pacientes transplantados entre 2008 e 2013, no Instituto Nacional de Cardiologia. As variáveis gerais foram coletadas a partir de arquivos de paciente, que incluíam os resultados laboratoriais obtidos e resumos pré-transplante. As variáveis coletadas em fase pré-transplante incluíram: cor (branco ou preto); uso de betabloqueador; hipertensão; diabetes mellitus; dislipidemia; tabagismo; etilismo; cirurgia cardíaca prévia; peso; depuração da creatinina e bilirrubina total. Analisamos também a pontuação IMPACT que congregam quase todas as variáveis que foram analisadas de forma independente. O Comitê de Ética em Pesquisa do Instituto Nacional de Cardiologia aprovou este projeto, em conformidade com as recomendações do Conselho Nacional de Saúde. Quarenta e dois pacientes foram incluídos de ambos os sexos em nossa coorte. Nenhuma de nossas variáveis foi relacionada nas análises univariada, com a mortalidade. No entanto, uma análise exploratória da pontuação IMPACT, constatou que a dicotomização da pontuação em maior ou menor que 6 poderia ser usadas para diferenciar o risco de morte. No subgrupo que evoluiu para óbito, a proporção de pacientes com pontuação no escore IMPACT ≥ 6 (42,1%) foi maior que o grupo sobrevivente (8,7%), de forma estatisticamente significativa (p = 0,014). Discussão: Na população de pacientes de transplante de coração variáveis individuais não foram capazes de prever a mortalidade em um ano. No entanto, a pontuação do escore IMPACT o fez. Sugerimos que pesquisas futuras poderiam usar a hipótese que a pontuação do escore IMPACT pode também ser usada como uma das variáveis na prioridade da alocação de candidatos ao transplante cardíaco
Introduction: Heart failure is the final pathway of most diseases that involve the heart, fact that can prove a challenge in health management. Heart transplantation is a viable strategy for patients with end-stage heart disease. The donor shortage requires a process to ensure the appropriate selection of the recipient. In Brazil, there is a single list of candidates in chronological order of arrival. Analysis of the risk factor related to the mortality in the local population is essential for the allocation processes of this scarce resource. Objective: The purpose of this study is to assess the risk factors exclusively related to the receptor in one-year mortality. Methodology: This research is a cohort of all the transplanted patients between 2008 and 2013 at our National Institute in Brazil. The general variables were collected from patient files, including laboratory results and pre-transplant summaries. The pre-transplant variables were: race (white or black); use of beta-blocker; hypertension; diabetes mellitus; dyslipidemia smoking alcohol consumption previous cardiac surgery; weight; creatinine clearance; total bilirubin. We also analyzed the IMPACT score that congregate almost all the variable that we analyzed independently. The Research Ethics Committee of the Instituto Nacional de Cardiologia project approved this project, in compliance with the recommendations of the National Health Council. Forty-two patients were included from both sexes in our cohort. None of our variables was found related in the univariate analyzes to the mortality. However, an exploratory analysis of the IMPACT score, found that the IMPACT score > 6 could be used to differentiate the risk of death. It was observed that the subgroup, who died, had IMPACT Score ≥ 6 points (42.1%) significantly (p = 0.014) greater than that subgroup who lived (8.7%). Discussion: In the heart transplant patient population from this institute, single variables were not able to predict mortality at one year. However, the IMPACT score did. We suggest future research may use the hypothesis that the IMPACT score can be used as an allocation variable prioritizing candidates to be transplanted
Introduction: Heart failure is the final pathway of most diseases that involve the heart, fact that can prove a challenge in health management. Heart transplantation is a viable strategy for patients with end-stage heart disease. The donor shortage requires a process to ensure the appropriate selection of the recipient. In Brazil, there is a single list of candidates in chronological order of arrival. Analysis of the risk factor related to the mortality in the local population is essential for the allocation processes of this scarce resource. Objective: The purpose of this study is to assess the risk factors exclusively related to the receptor in one-year mortality. Methodology: This research is a cohort of all the transplanted patients between 2008 and 2013 at our National Institute in Brazil. The general variables were collected from patient files, including laboratory results and pre-transplant summaries. The pre-transplant variables were: race (white or black); use of beta-blocker; hypertension; diabetes mellitus; dyslipidemia smoking alcohol consumption previous cardiac surgery; weight; creatinine clearance; total bilirubin. We also analyzed the IMPACT score that congregate almost all the variable that we analyzed independently. The Research Ethics Committee of the Instituto Nacional de Cardiologia project approved this project, in compliance with the recommendations of the National Health Council. Forty-two patients were included from both sexes in our cohort. None of our variables was found related in the univariate analyzes to the mortality. However, an exploratory analysis of the IMPACT score, found that the IMPACT score > 6 could be used to differentiate the risk of death. It was observed that the subgroup, who died, had IMPACT Score ≥ 6 points (42.1%) significantly (p = 0.014) greater than that subgroup who lived (8.7%). Discussion: In the heart transplant patient population from this institute, single variables were not able to predict mortality at one year. However, the IMPACT score did. We suggest future research may use the hypothesis that the IMPACT score can be used as an allocation variable prioritizing candidates to be transplanted
Description
Palavras-chave
Escore de risco, Transplante cardíaco, Alocação de órgãos, Heart transplantation, Scarce resources, Health management
Citação
Baumworcel L. Análise de variáveis prognósticas pré-transplante cardíaco relacionados com a sobrevida pós-transplante no Instituto Nacional de Cardiologia. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2015.