Estudo antropométrico e metabólico de pacientes após uso prolongado de antibióticos na endocardite infecciosa: um estudo caso-controle
Estudo antropométrico e metabólico de pacientes após uso prolongado de antibióticos na endocardite infecciosa: um estudo caso-controle
Data
2020-10
Autores
Costa, Glaucia da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: A endocardite infecciosa (EI) é uma condição grave em que
usualmente utilizam-se antibióticos durante 4-6 semanas. O número crescente de
indivíduos com sobrepeso e obesidade nas últimas décadas tem sido desafiador
para a saúde pública mundial. Estudos demostram uma relação entre
sobrepeso/obesidade e uso prolongado de antimicrobianos. Objetivos: Analisar a
variação da composição corporal e perfil bioquímico de pacientes com EI tratados
com antibióticos por tempo prolongado em comparação ao grupo controle.
Métodos: Estudo observacional, caso-controle. A coleta de dados foi realizada em
prontuários, e por entrevista com os pacientes. Pacientes caso, eram adultos, que
realizaram cirurgia cardíaca para o tratamento de endocardite infecciosa nos anos
de 2016 e 2017, e os controles foram pareados por gênero, idade, e tipo de cirurgia
realizada no mesmo ano que os casos. Após o seguimento de 1 ano, foram
coletados dados clínicos, sociodemográficos, medidas antropométricas, exames
bioquímicos e questionários de frequência alimentar e atividade física simplificado.
Composição corporal foi avaliada por bioimpedância octopolar InBody 720. Dados
foram analisados no programa Jamovi (Version 1.2) e R Core Team (2019).
Resultados: Foram incluídos um total de 69 pacientes para a realização da
pesquisa, sendo 23 casos e 46 controles. Houve maior prevalência de homens
n=46 (66,7%), com idade média geral de 52±14 anos. A maior parte dos pacientes
(n=56, 84,8%) tinha faixa salarial entre 1 a 2 salários mínimos. Os principais
esquemas antimicrobianos no tratamento da EI foi: Betalactâmicos com 7/23 (32%)
e Betalactâmicos + Aminoglicosídeos com 6/23 (27%).17% usaram glicopeptídeos,
associados ou não a outros antibióticos. O IMC após 1 ano de seguimento dos
casos foi de 27,3±5,9 e de controles de 29,3±6,03 (p=0,215). A obesidade
aumentou em ambos os grupos, caso com 9/23 (40,9%) e controle com 18/46
(39,1%) p=0,810. A obesidade central foi notada nos 2 grupos, com perímetro da
cintura (PC) de 91,8±15,1 e 95,1±15,0 (p=0,407) respectivamente. O percentual de
massa gorda foi de 32,9±13,3 nos casos vs 36,6±11,4 nos controles (p=0,255). Não
houve diferenças significativas estatisticamente entre casos e controles para todas
as variáveis antropométricas estudadas. Na análise bioquímica o LDL foi de
108±26,4 nos casos e 122±38,9 nos controles (p= 0,117), triglicerídeos 178±32,1
nos casos e 190±45,5 nos controles (p= 0,064), insulina de 7,45 [5,49-14,2] nos
casos e 13,2 [8,4-20,7] nos controles (p=0,024); HOMA IR de 1,75 [0,965-3,31] nos
casos e 3,06 [1,48-5,72] nos controles (p= 0,042). Preenchiam critérios de síndrome
metabólica 27/69 (39%) dos pacientes, mas de 80% das pessoas em ambos os
grupos não praticava qualquer atividade física e apenas 4/66 (6,1%) fizeram algum
acompanhamento nutricional. Conclusão: Não houve diferenças estatísticas entre
casos e controles, porem em ambos os grupos, os expostos ao tratamento com
antibióticos a longo prazo e os não expostos, obtiveram mudanças clinicamente
significativas em seus perfis, aumento de peso e IMC, perfil lipídico elevado e
resistência à insulina, circunferência da cintura e RCQ elevados. Isto sugere que
outros fatores, e não o uso prolongado de antibióticos, foram responsáveis pelo
ganho ponderal.
Palavras chaves: Obesidade; Antibiótico; Endocardite; Antropométrica; Síndrome
metabólica.
Introduction: Infective Endocarditis (IE) is a serious condition in which antibiotics are usually used for 4-6 weeks. There is an increasing number of individuals who are overweight or obese in the last decades has been challenging for global public health. Overweight and obesity are associated with adverse cardiovascular outcomes. Studies show a relationship between overweight/obesity and prolonged use of antimicrobials. Objectives: To analyze the variation in body composition and biochemical profile of patients with IE who were treated with antibiotics compared to the control group. Methods: Observational, case-control study. Data were collected from patients’ notes and interviews. Case patients were adults who underwent cardiac surgery for the treatment of infective endocarditis in 2016 and 2017, and control patients were matched by gender, age, and type of surgery performed in the same year as the cases. After a 1-year follow-up, clinical and sociodemographic data, anthropometric measurements, biochemical tests and simplified food frequency and physical activity questionnaires were collected. Body composition was evaluated by InBody 720 octopolar bioimpedance. Data were analyzed using the Jamovi program (Version 1.2) and R Core Team (2019). Results: A total of 69 patients were included , 23 cases and 46 controls. There was a higher prevalence of men n=46 (66.7%), with a mean age of 52±14 years. Most patients (n=56, 84.8%) had a salary range between 1 and 2 minimum wages. The main antimicrobial regimens in the treatment of IE were: Beta-lactams with 7/23 (32%) and Beta-lactams + Aminoglycosides with 6/23 (27%);17% used glycopeptides, associated or not with other antibiotics. The BMI after 1 year of follow-up for the cases was 27.3±5.9 and for controls it was 29.3±6.03 (p=0.215). Obesity increased in both groups, cases with 9/23 (40.9%) and controls with 18/46 (39.1%), p=0.810. Central obesity was noted in both groups, with waist circumferences (WC) of 91.8±15.1 and 95.1±15.0 (p=0.407), respectively, in cases and controls. The % of fat mass was 32.9±13.3 in cases vs 36.6±11.4 in controls (p=0.255). There were no statistically significant differences between cases and controls for all anthropometric variables studied. In the biochemical analysis, LDL was 108±26.4 in cases and 122±38.9 in controls (p=0.117), triglycerides 178±32.1 in cases and 190±45.5 in controls (p=0.064), insulin of 7.45 [5.49-14.2] in cases and 13.2 [8.4-20.7] in controls (p=0.024); HOMA IR of 1.75 [0.965-3.31] in cases and 3.06 [1.48-5.72] in controls (p=0.042). The metabolic syndrome was presente in 27/69 (39%) of the patients. Over 80% of study participants had no regular physical activities, and only 4/66 (6.1%) had nutritional follow up. Conclusion: There were no statistical differences between cases and controls, but in both groups, those exposed to long-term antibiotic treatment and those not exposed, there was a clinically significant change in their metabolic profiles, weight gain and BMI, changes in lipid profile and resistance to insulin, waist circumference and high WHR. This suggests that factors other than prolonged antibiotic use were responsible for the weight gain. Keywords: Obesity; Antibiotic prophylaxis; Endocarditis; Anthropometric; Metabolic syndrome.
Introduction: Infective Endocarditis (IE) is a serious condition in which antibiotics are usually used for 4-6 weeks. There is an increasing number of individuals who are overweight or obese in the last decades has been challenging for global public health. Overweight and obesity are associated with adverse cardiovascular outcomes. Studies show a relationship between overweight/obesity and prolonged use of antimicrobials. Objectives: To analyze the variation in body composition and biochemical profile of patients with IE who were treated with antibiotics compared to the control group. Methods: Observational, case-control study. Data were collected from patients’ notes and interviews. Case patients were adults who underwent cardiac surgery for the treatment of infective endocarditis in 2016 and 2017, and control patients were matched by gender, age, and type of surgery performed in the same year as the cases. After a 1-year follow-up, clinical and sociodemographic data, anthropometric measurements, biochemical tests and simplified food frequency and physical activity questionnaires were collected. Body composition was evaluated by InBody 720 octopolar bioimpedance. Data were analyzed using the Jamovi program (Version 1.2) and R Core Team (2019). Results: A total of 69 patients were included , 23 cases and 46 controls. There was a higher prevalence of men n=46 (66.7%), with a mean age of 52±14 years. Most patients (n=56, 84.8%) had a salary range between 1 and 2 minimum wages. The main antimicrobial regimens in the treatment of IE were: Beta-lactams with 7/23 (32%) and Beta-lactams + Aminoglycosides with 6/23 (27%);17% used glycopeptides, associated or not with other antibiotics. The BMI after 1 year of follow-up for the cases was 27.3±5.9 and for controls it was 29.3±6.03 (p=0.215). Obesity increased in both groups, cases with 9/23 (40.9%) and controls with 18/46 (39.1%), p=0.810. Central obesity was noted in both groups, with waist circumferences (WC) of 91.8±15.1 and 95.1±15.0 (p=0.407), respectively, in cases and controls. The % of fat mass was 32.9±13.3 in cases vs 36.6±11.4 in controls (p=0.255). There were no statistically significant differences between cases and controls for all anthropometric variables studied. In the biochemical analysis, LDL was 108±26.4 in cases and 122±38.9 in controls (p=0.117), triglycerides 178±32.1 in cases and 190±45.5 in controls (p=0.064), insulin of 7.45 [5.49-14.2] in cases and 13.2 [8.4-20.7] in controls (p=0.024); HOMA IR of 1.75 [0.965-3.31] in cases and 3.06 [1.48-5.72] in controls (p=0.042). The metabolic syndrome was presente in 27/69 (39%) of the patients. Over 80% of study participants had no regular physical activities, and only 4/66 (6.1%) had nutritional follow up. Conclusion: There were no statistical differences between cases and controls, but in both groups, those exposed to long-term antibiotic treatment and those not exposed, there was a clinically significant change in their metabolic profiles, weight gain and BMI, changes in lipid profile and resistance to insulin, waist circumference and high WHR. This suggests that factors other than prolonged antibiotic use were responsible for the weight gain. Keywords: Obesity; Antibiotic prophylaxis; Endocarditis; Anthropometric; Metabolic syndrome.
Description
Palavras-chave
Obesidade, Antibiótico, Endocardite, Antropométrica, Síndrome
metabólica., Obesity, Antibiotic prophylaxis, Endocarditis, Anthropometric, Metabolic
syndrome
Citação
Costa GS. Estudo antropométrico e metabólico de pacientes após uso prolongado de antibióticos na endocardite infecciosa: um estudo caso-controle. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2022.