RAFAEL OLIVEIRA XIMENES
Projetos de Pesquisa
Unidades Organizacionais
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Early predictors of acute kidney injury in patients with cirrhosis and bacterial infection: urinary neutrophil gelatinase-associated lipocalin and cardiac output as reliable tools(2015) XIMENES, Rafael O.; FAD, Alberto Q.; HELOU, Claudia M. B.Background: Hemodynamic abnormalities and acute kidney injury (AKI) are often present in infected cirrhotic patients. Hence, an early diagnosis of AKI is necessary, which might require the validation of new predictors as the determinations of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and cardiac output. Methods: We evaluated 18 infected cirrhotic patients subdivided into two groups at admission (0 hours). In Group I, we collected urine samples at 0 hours, 6 hours, 24 hours, and 48 hours for uNGAL and fractional excretion of sodium determinations. In Group II. we measured cardiac output using echocardiography. Results: The age of patients was 55.0 +/- 1.9 years, and 11 patients were males. The Model for End-Stage Liver Disease score was 21 +/- 1. whereas the Child-Pugh score was C in 11 patients and B in 7 patients. Both patients in Group 1 and Group II showed similar baseline characteristics. In Group I, we diagnosed AKI in 5 of 9 patients, and the mean time to this diagnosis by measuring serum creatinine was 5.4 days. Patients with AKI showed higher uNGAL levels than those without AKI from 6 hours to 48 hours. The best accuracy using the cutoff values of 68 ng uNGAL/mg creatinine was achieved at 48 hours when we distinguished patients with and without AKI in all cases. In Group II, we diagnosed AKI in 4 of 9 patients, and cardiac output was significantly higher in patients who developed AKI at 0 hours. Conclusion: Both uNGAL and cardiac output determinations allow the prediction of AKI in infected cirrhotic patients earlier than increments in serum creatinine.
- beta-Blocker therapy for cirrhotic cardiomyopathy: a randomized-controlled trial(2018) SILVESTRE, Odilson M.; FARIAS, Alberto Q.; RAMOS, Danusa S.; FURTADO, Meive S.; RODRIGUES, Ana C.; XIMENES, Rafael O.; MAZO, Daniel F. de Campos; ZITELLI, Patricia M. Yoshimura; DINIZ, Marcio A.; ANDRADE, Jose L.; STRUNZ, Celia; FRIEDMANN, Antonio A.; LEE, Samuel S.; CARRILHO, Flair J.; D'ALBUQUERQUE, Luiz A. C.; BACAL, FernandoBackground Cirrhotic cardiomyopathy is characterized by an attenuated contractile response to stress. Long-term exposure of beta-adrenergic receptors to persistently high levels of catecholamines has been implicated in its pathogenesis. We hypothesized that beta-blockade with metoprolol could reverse the changes in heart function and morphology in cirrhotic cardiomyopathy. Patients and methods In this prospective randomized trial, we included 78 patients aged between 18 and 60 years with abnormal cardiac output response under dobutamine stress echocardiography, without primary cardiac disease or a history of alcohol intake. Patients were assigned randomly to receive metoprolol or placebo for 6 months. The primary endpoint was the improvement in cardiac output response to stress, measured by an increase in the left ventricle stroke volume more than 30%. Results Three (7.3%) patients in the metoprolol group and nine (24.3%) patients in the placebo group showed improved stroke volume (P=0.057). Diastolic dysfunction was found in two (4.8%) patients before and in five (15.6%) patients after therapy in the metoprolol group, and in 10 (27%) patients before and nine (31%) patients after therapy in the placebo group (P=0.67). After treatment, no echocardiography parameter of morphology was significantly different between metoprolol or placebo groups. No significant differences were observed in noradrenaline, plasma renin activity, and troponin levels between groups. Cirrhosis-related clinical events, including hospitalizations and mortality, were not significantly different between the two groups. Six months of therapy with beta-blocker did not ameliorate heart function and morphology in patients with cirrhotic cardiomyopathy.
- Patients with cirrhosis in the ED: early predictors of infection and mortality(2016) XIMENES, Rafael Oliveira; FARIAS, Alberto Queiroz; SCALABRINI NETO, Augusto; DINIZ, Marcio Augusto; KUBOTA, Gabriel Taricani; IVO, Mauricio Menezes Aben-Athar; COLACIQUE, Caroline Gracia Plena Sol; D'ALBUQUERQUE, Luiz Augusto Carneiro; DIAS, Roger DagliusBackground: Patients with cirrhosis have high risk of bacterial infections and cirrhosis decompensation, resulting in admission to emergency department (ED). However, there are no criteria developed in the ED to identify patients with cirrhosis with bacterial infection and with high mortality risk. Study objective: The objective of the study is to identify variables from ED arrival associated with bacterial infections and in hospital mortality. Methods: This is a retrospective single-center study using a tertiary hospital's database to identify consecutive ED patients with decompensated cirrhosis. Clinical variables and laboratory results were obtained by chart review. Logistic regression models were built to determine variables independently associated with bacterial infection and mortality. Scores using these variables were designed. Results: One hundred forty-nine patients were enrolled, most of them males (77.9%) with alcoholic cirrhosis (53%) and advanced liver disease (Child-Pugh C, 47.2%). Bacterial infections were diagnosed in 72 patients (48.3%), and 36 (24.2%) died during hospital stay. Variables independently associated with bacterial infection were lymphocytes less than or equal to 900/mm(3) (odds ratio [OR], 3.85 [95% confidence interval {CI}, 1.47-10]; P = .006) and C-reactive protein greater than 59.4 mg/L (OR, 5.05 [95% CI, 1.93-13.2]; P = .001). Variables independently associated with mortality were creatinine greater than 1.5 mg/dL (OR, 4.35 [95% CI, 1.87-10.1]; P = .001) and international normalized ratio greater than 1.65 (OR, 3.71 [95% CI, 1.6-8.61]; P = .002). Scores designed to predict bacterial infection and mortality (Mortality in Cirrhosis Emergency Department Score) had an area under the receiver operating characteristic curve of 0.82 and 0.801, respectively. The Mortality in Cirrhosis Emergency Department Score performed better than Model for End-Stage Liver Disease score. Conclusions: In this cohort of ED patients with decompensated cirrhosis, lymphopenia and elevated C-reactive protein were related to bacterial infections, and elevated creatinine and international normalized ratio were related to mortality. Scores built with these variables should be prospectively validated.