Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Oct 2021
Acidic urine as a novel risk factor for diuretic resistance and worse in-hospital prognosis in acute heart failure.
Introduction: Loop diuretic resistance (LDR) is a risk factor for poor prognosis in patients with acute heart failure (AHF). Acidic urine (pH <6) might be associated with diminished effect of diuretics and worse in-hospital course in this patient population. Objectives: The aim of the study was to assess the influence of acidic urine on in-hospital prognosis and diuretic efficacy in patients with AHF. Patients and methods: This was a retrospective analysis of hospitalizations due to AHF in patients with ejection fraction of 50% or less. Analyzed end points were: in-hospital death and composite end point (death, myocardial infarction, stroke, unplanned revascularization, or catecholamine infusion). ⋯ Acidic urine was found to be an independent risk factor for the composite end point. The threshold for LDR was set at 691.45 ml of diuresis/40 mg of intravenous furosemide. Low urine pH was found to be an independent risk factor for LDR. Conclusions: Low urine pH might be a useful marker identifying patients at high risk for LDR and adverse in-hospital outcome.
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Pol. Arch. Med. Wewn. · Oct 2021
The ratio of furosemide dosage to urinary sodium concentration predicts mortality in patients with chronic stable heart failure.
The urinary sodium (UNa) concentration is associated with outcomes in patients with acute heart failure (HF). Its impact in individuals with chronic HF is unknown. ⋯ Combining the diuretic dosage and measurement of UNa excretion can be used to refine risk stratification in chronic HF. The furosemide‑to‑UNa ratio can be a surrogate marker for diuretic resistance and has a prognostic impact in chronic HF.
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Pol. Arch. Med. Wewn. · Oct 2021
Time-to-treatment failure and peripheral eosinophils in non-small cell lung cancer patients treated with immune checkpoint inhibitors.
Introduction: There is an unmet clinical need to identify biomarkers predicting which patients with non–small cell lung cancer (NSCLC) would benefit from treatment with immune checkpoint inhibitors (ICPIs). Objectives: The purpose of this study was to draw a detailed time to treatment failure (TTF) curve with information on the changes in peripheral eosinophil expression during ICPI treatment for NSCLC, and to clarify whether eosinophil expression can predict prolonged TTF. Patients and methods: In 259 patients with NSCLC treated with ICPI therapy, peripheral eosinophil counts and percentages at the time of each ICPI administration were evaluated from the beginning of ICPI treatment up to TTF. Univariable and multivariable analyses were performed to identify clinical factors associated with TTF. Results: Patients receiving ICPI monotherapy (n = 180) were divided into 3 groups (TTF ≤6 weeks, TTF >6 weeks and ≤24 weeks, and TTF >24 weeks) and the number of patients with an eosinophil percentage of 5% or more within 6 weeks of ICPI therapy initiation was significantly different among these groups. ⋯ In patients treated with combination therapy of ICPI and chemotherapy (n = 79), the number of patients with an eosinophil percentage of 5% or more within 12 weeks of therapy initiation was significantly different between patients with a TTF of up to 12 weeks and those with a more prolonged TTF. However, the only significant favorable factor for TTF was female sex. Conclusions: In NSCLC patients treated with ICPI therapy, particularly ICPI monotherapy, eosinophil measurements during treatment might be useful for predicting prolonged TTF.
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Pol. Arch. Med. Wewn. · Oct 2021
Thromboprophylaxis in hospitalized COVID-19 patients: the efficacy and safety of the approved hospital protocol.
Introduction: Prothrombotic coagulopathy in COVID-19 has led to a strong recommendation for thromboprophylaxis in all hospitalized patients, although there are large differences in the dosage regimens among hospitals and their outcomes remain uncertain. Objectives: We aimed to determine the incidence of thrombotic events and bleeding in patients with COVID-19 using the approved local thromboprophylaxis protocol. Patients and methods: We adapted a self-developed pharmacological thromboprophylaxis protocol based on clinical and laboratory risk assessment of thrombosis in 350 consecutive patients (median age, 67 years) with confirmed COVID-19, treated in designated wards at a single center in Kraków, Poland from October 10, 2020, to April 30, 2021. We recorded in-hospital venous and arterial thromboembolic events, major or clinically relevant bleeding, and deaths along with other complications related to heparin administration. Results: Thromboprophylaxis with low-molecular-weight heparin was administered in 99.7% of patients, 57 (16%) were treated in the intensive care unit. As many as 92% of patients followed the protocol for more than 85% of hospitalization time. ⋯ Hemorrhagic complications were observed in 31 patients (9%), including fatal bleeds (n = 3; 0.9%). The overall mortality was 13.4%. The prophylactic, intermediate, and therapeutic anticoagulation preventive strategies with heparin were not related to any of the outcomes. Conclusions: The thromboprophylaxis protocol approved in our institution was associated with a relatively low risk of thromboembolism and bleeding, which provides additional evidence supporting the adoption of institutional strategies to improve outcomes in hospitalized patients with COVID-19.
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Pol. Arch. Med. Wewn. · Oct 2021
Fetuin-A and sodium concentrations are independently associated with all-cause mortality in patients awaiting heart transplantation.
End‑stage heart failure (HF) is a clinical condition with complex pathophysiology and poor prognosis. ⋯ Lower levels of CS and PB fetuin‑A, as well as lower sodium levels, are associated with an increased risk of death in patients with end‑stage HF.