PRISCILA GHERARDI GOLDSTEIN

Índice h a partir de 2011
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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor e Coautores FMUSP-HC Normalizados: DANIELLE MENOSI GUALANDRO ×

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  • article 9 Citação(ões) na Scopus
    Incremental value of B-type natriuretic peptide for early risk prediction of infective endocarditis
    (2014) SICILIANO, Rinaldo Focaccia; GUALANDRO, Danielle Menosi; MUELLER, Christian; SEGURO, Luis Fernando Bernal da Costa; GOLDSTEIN, Priscila Gherardi; STRABELLI, Tania Mara Varejao; ARIAS, Vanessa; ACCORSI, Tarso Augusto Duenhas; GRINBERG, Max; MANSUR, Alfredo Jose; OLIVEIRA JR., Mucio Tavares de
    Background: Early and accurate risk prediction is an unmet clinical need in patients with infective endocarditis (IE). The aim of this study was to determine the value of B-type natriuretic peptide (BNP) levels obtained on admission for the prediction of in-hospital death in IE patients. Methods: Between 2009 and 2011, consecutive patients with IE diagnosed using the revised Duke criteria and admitted to the emergency department were evaluated prospectively. BNP levels were measured on admission. Death during hospitalization was the primary endpoint. Results: Among 104 consecutive patients with IE and with available BNP levels, 34 (32.7%) died in hospital. BNP levels were significantly higher in patients who died as compared to survivors (709.0 pg/ml vs. 177.5 pg/ml, p < 0.001). The accuracy of BNP to predict death as quantified by the area under the receiver operating characteristics curve was 0.826 (95% confidence interval (CI) 0.747-0.905). The value of BNP was additive to that provided by clinical, microbiological, and echocardiography assessment. On multivariate analysis, new heart failure (hazard ratio (HR) 2.02, 95% CI 1.15-3.57, p = 0.015), sepsis (HR 2.10, 95% CI 1.25-3.55, p = 0.005), Staphylococcus aureus endocarditis (HR 2.67, 95% CI 1.60-4.45, p < 0.001), left ventricular ejection fraction <= 55% (HR 1.63, 95% CI 1.00-2.65, p = 0.047), and BNP (HR 1.04, 95% CI 1.02-1.06, p < 0.001) were independent predictors of in-hospital mortality. Conclusion: Among patients with IE, BNP levels obtained on admission provide incremental value for early and accurate risk prediction. (C) 2014 The Authors.
  • conferenceObject
    The Role of B-type Natriuretie Peptide as a Prognostic Factor for Endocarditis at the Emergency Room
    (2012) GUALANDRO, Danielle M.; GOLDSTEIN, Priscila; SEGURO, Luis F.; SICILIANO, Rinaldo; STRABELLI, Tania; ARIAS, Viviane; MANSUR, Alfredo J.; ACCORSI, Tarso A.; GRINBERG, Max; OLIVEIRA, Mucio T.
  • conferenceObject
    The role of B-type netriuretic prptide (BNP) as a prognostic factor for endocarditis en the emergency room
    (2012) SICILIANO, R. F.; STRABELLI, T. M. V.; GUALANDRO, D. M.; SEGURO, L. F. B. C.; GOLDSTEIN, P.; ARIAS, V.; MANSUR, A. J.; ACCORSI, T. A. D.; GRINBERG, M.; OLIVEIRA, M. T.
    Background: Some prognostic factors for infective endocarditis (IE) are well established, but the role of B-type natriuretic peptide (BNP) at admission has not been well studied. Objective: The purpose of this study was to access the admission BNP value as a prognostic factor in patients with IE. Methods: Between July 2009 and January 2011, consecutive patients with IE admitted to the emergency room were prospectively enrolled. Patients were included if they met possible or definite Duke’s criteria for IE. The association between elevated BNP and in-hospital death was determined. Results: From 104 patients analysed, 67 were male (48%), the mean age was 52.6±19.1 years. During follow-up, 32 (30.8%) patients died. In univariated analysis, staphylococcal infection (P<0.001, HR 3.94; CI, 1.94-8.0), dyspnea at presentation (P=0.015, HR 2.41; CI, 1.20-4.86), sepsis at presentation (P=0.017, HR 2.34; CI, 1.16-4.72), left ventricular ejection fraction ≤55% (P<0.001, HR 3.97; CI, 1.86-8.43), C-reactive protein (CRP) >120 mg/L, (P<0.001, HR 4.04; CI, 1.91-8.55) creatinine >1mg/dL(P=0.006, HR 2.92; CI, 1.26-6.76) and BNP >200 pg/mL (P<0.001, HR 12.51; CI, 2.98-52.48) were associated with in-hospital mortality. In multivariate analysis, BNP values >200 pg/ml (P<0.001, HR 2.41; CI, 1.20-4.86), staphylococcal infection (P=0.006, HR 2.89; CI, 1.39-6.02), dyspnea at presentation (P=0.003, HR 3.17; CI, 1.49-6.76), and CRP>120 mg/L, (P<0.001, HR 3.86; CI, 1.76-8.46) were independent predictors of in-hospital mortality. Conclusion: As important as the classic prognostic factors, elevated BNP levels on admission were related to fatal outcomes in IE patients.