RESUMO
Decompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important tool in the management of patients with cirrhosis, since it decreases for less than half the risk for post-paracentesis cardiocirculatory dysfunction and mortality associated with spontaneous bacterial infection, as well as, it triplicates the response to terlipressin in patients with hepatorenal syndrome. Recently, research on albumin has been a hot topic, with important new insights such as the characterization of the pleiotropic effects of albumin (which surpass its oncotic properties) and the concept of effective albumin concentration. In fact, patients with liver cirrhosis present posttranslational modifications on albumin that compromises its function. Those modified albumin forms were proved to have prognostic value and its knowledge may change the paradigm of albumin treatment. In this review, we critically summarize the latest evidence on the potential benefits of albumin in patients with end-stage liver disease.
Assuntos
Doença Hepática Terminal/tratamento farmacológico , Hipoalbuminemia/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Fígado/efeitos dos fármacos , Albumina Sérica Humana/uso terapêutico , Animais , Biomarcadores/sangue , Doença Hepática Terminal/sangue , Doença Hepática Terminal/diagnóstico , Humanos , Hipoalbuminemia/sangue , Hipoalbuminemia/diagnóstico , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Processamento de Proteína Pós-Traducional , Albumina Sérica Humana/metabolismo , Resultado do TratamentoRESUMO
El síndrome de Goldbloom es una rara entidad clínica de etiología desconocida que ocurre casi exclusivamente en pediatría. Consiste en un síndrome febril prolongado con hiperostosis perióstica y disproteinemia, que, con frecuencia, simula una patología hematooncológica o linfoproliferativa. El diagnóstico se hace por exclusión de las diferentes causas de dolor de los huesos y se asocia a hipergammaglobulinemia, hipoalbuminemia, eritrosedimentación acelerada e imágenes radiológicas de periostitis. La sintomatología, la radiología y los parámetros de laboratorio remiten en un tiempo variable, que va, habitualmente, de los 3 a los 12 meses. Se presenta a un paciente de 6 años con dolores óseos difusos, hiperostosis perióstica, síndrome febril prolongado de 8 meses de evolución, pérdida de peso y reactantes de fase aguda elevados con disproteinemia (hipergammaglobulinemia e hipoalbuminemia). Debe considerarse el síndrome de Goldbloom en un paciente con las manifestaciones descritas luego de la exclusión de la patología infecciosa, hematooncológica e inflamatoria de otra causa.
Goldbloom syndrome is a rare clinical entity, of unknown etiology that happens almost exclusively in pediatric population. It is a prolonged febrile syndrome with periosteal hyperostosis and dysproteinemia, and often simulates an hematooncology or lymphoproliferative disease. The diagnosis is to rule out the different causes of bone pain associated with hypergammaglobulinemia, hypoalbuminemia, high erythrocyte sedimentation rate and periostitis at the radiographies. Symptomatology, radiology and laboratory parameters refer in a variable time, usually from 3 to 12 months. We report the case of a six-year-old boy with diffuse bone pain, prolonged febrile syndrome (of 8 months of evolution), weight loss and elevated acute phase reactants with dysproteinemia (hypergammaglobulinemia and hypoalbuminemia). Goldbloom syndrome should be considered in patients with prolonged febrile syndrome and cortical hyperostosis after the exclusion of infectious, lymphoproliferative or inflammatory disease.
Assuntos
Humanos , Masculino , Criança , Hiperostose/diagnóstico , Febre/diagnóstico , Hipergamaglobulinemia/diagnóstico , Síndrome , Hipoalbuminemia/diagnóstico , Diagnóstico DiferencialRESUMO
Goldbloom syndrome is a rare clinical entity, of unknown etiology that happens almost exclusively in pediatric population. It is a prolonged febrile syndrome with periosteal hyperostosis and dysproteinemia, and often simulates an hematooncology or lymphoproliferative disease. The diagnosis is to rule out the different causes of bone pain associated with hypergammaglobulinemia, hypoalbuminemia, high erythrocyte sedimentation rate and periostitis at the radiographies. Symptomatology, radiology and laboratory parameters refer in a variable time, usually from 3 to 12 months. We report the case of a six-year-old boy with diffuse bone pain, prolonged febrile syndrome (of 8 months of evolution), weight loss and elevated acute phase reactants with dysproteinemia (hypergammaglobulinemia and hypoalbuminemia). Goldbloom syndrome should be considered in patients with prolonged febrile syndrome and cortical hyperostosis after the exclusion of infectious, lymphoproliferative or inflammatory disease.
El síndrome de Goldbloom es una rara entidad clínica de etiología desconocida que ocurre casi exclusivamente en pediatría. Consiste en un síndrome febril prolongado con hiperostosis perióstica y disproteinemia, que, con frecuencia, simula una patología hematooncológica o linfoproliferativa. El diagnóstico se hace por exclusión de las diferentes causas de dolor de los huesos y se asocia a hipergammaglobulinemia, hipoalbuminemia, eritrosedimentación acelerada e imágenes radiológicas de periostitis. La sintomatología, la radiología y los parámetros de laboratorio remiten en un tiempo variable, que va, habitualmente, de los 3 a los 12 meses. Se presenta a un paciente de 6 años con dolores óseos difusos, hiperostosis perióstica, síndrome febril prolongado de 8 meses de evolución, pérdida de peso y reactantes de fase aguda elevados con disproteinemia (hipergammaglobulinemia e hipoalbuminemia). Debe considerarse el síndrome de Goldbloom en un paciente con las manifestaciones descritas luego de la exclusión de la patología infecciosa, hematooncológica e inflamatoria de otra causa.
Assuntos
Febre/diagnóstico , Hipergamaglobulinemia/diagnóstico , Hiperostose/diagnóstico , Hipoalbuminemia/diagnóstico , Criança , Diagnóstico Diferencial , Humanos , Masculino , SíndromeRESUMO
BACKGROUND: The reduction of liver transplant wait list mortality remains a priority for transplant programs and depends on the accurate stratification of patients by mortality risk. Although estimation of 90-day mortality by Model for End-Stage Liver Disease (MELD) score has improved wait list survival, it is unclear how contemporary wait list mortality can best be diminished given the preponderance of listed patients with low MELD scores and long wait times. METHODS: In this intention-to-treat analysis of 289 consecutively listed patients with over 5 years of follow-up, we aimed to determine the contribution of late mortality to overall wait list outcome and identify clinical predictors that would help discriminate long-term survivors from fatalities. RESULTS: Seventy percent of wait list deaths occurred in patients listed with MELD scores less than 20, and 40% of deaths occurred in patients waiting longer than 1 year. Hypoalbuminemia at listing was a significant predictor of late mortality in all patients in both univariate and multivariate analyses, and it was most discriminatory among patients with MELD scores of 20 or less. CONCLUSION: Our data suggest that hypoalbuminemia at listing reveals a vulnerable population of low MELD patients who are underserved by their MELD score over time. Such patients comprise almost 40% of the contemporary wait list and contribute substantially to list mortality given their poor access to transplantation. Targeting these at-risk patients with grafts from living or extended criteria donors may thus significantly diminish overall list mortality, and future initiatives to decrease overall wait list mortality must focus on improved risk stratification for low MELD patients.
Assuntos
Hipoalbuminemia/sangue , Hipoalbuminemia/mortalidade , Hepatopatias/sangue , Hepatopatias/mortalidade , Transplante de Fígado , Albumina Sérica/análise , Listas de Espera/mortalidade , Biomarcadores/sangue , Técnicas de Apoio para a Decisão , Regulação para Baixo , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Hepatopatias/diagnóstico , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Albumina Sérica Humana , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Introducción: Durante los procesos de desnutrición (DNT), se encuentran déficit de macro y micronutrientes. En Colombia la cifra de DNTsevera en niños de 1 a 2 años corresponde al 2% en el año 2000. Objetivo: Determinar los niveles de albúmina (ALB) y hemoglobina (HB), en niños menores de 24 meses con DNT severa, que ingresaron a un Hospital Universitario de Tercer Nivel de Atención del nororiente colombiano, en un periodo de 6 años. Pacientes y métodos: Estudio retrospectivo y comparativo de 134 niños con DNT severa, se diagnosticaron según signos cl ínicos y bioquímicos característicos de Kwashiorkor (KW) y Marasmo (MAR). La muestra fue dividida en tres grupos: DNT severos tipo KW, MAR y grupo control. Conclusiones: Los niveles de ALB y HB, se encuentran disminuidos en los procesos de DNT severa. El comportamiento de los tres grupos estudiados coincide con lo que reporta la literatura hasta el día de hoy.
Introduction: In the category of malnutrition (MNT), we find two main categories, macro and micronutrients deficiency. In Colombia severe MNT rates in children between the ages of 1 to 2 years, corresponded to 2 % according to 2000's statistics. Objective:To determine the levels of albumin and hemoglobin in children less than 2 years old with severe MNT that were treated at a Colombian Hospital University in a period of 6 years. Patients and Methods: Comparative and retrospective study of 134 children with severe,MNT, were diagnosis according to clinical and biochemical signals of Kwashiorkor (KW) and Marasmus (MAR). The children were divided in 3 groups: severe MNT type KW, MAR, and a control group.Conclusions:The albumin and hemoglobin levels are decreased in severe MNT processes. The results found in the 3 groups studied match with the reports showed by the literature today.
Assuntos
Humanos , Masculino , Feminino , Lactente , Desnutrição/diagnóstico , Kwashiorkor , Desnutrição Proteico-Calórica , Anemia/sangue , Hipoalbuminemia/classificação , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/epidemiologia , Hipoalbuminemia/sangue , Albumina SéricaRESUMO
Objetivo: Avaliar o efeito da ingestão protéica nos níveis de albumina sérica, na prevalência de complicações clínicas relacionadas à dieta, no estado nutricional e na mortalidade de pacientes politraumatizados. Método: Pacientes politraumatizados atendidos na Unidade de Terapia Intensiva entre janiero e setembro de 2006 foram divididos em 2 grupos, sendo o grupo 1 composto por aqueles que ingeriram diariamente quantidade de proteínas=1g/kg e o grupo 2 por aqueles que ingeriram diariamente quantidade de proteínas>1g/Kg, com suplementação protéica. Foram coletados semanalmente albumina sérica, leucócitos e bastonetes, dados clínicos das fichas médicas, e escore da avaliação subjetiva global, e compararam-se os dados iniciais e finais. Resultados: Pacientes do grupo 2 demonstraram tendência em apresentar níveis mais elevados de albumina sérica do que os indivíduos do grupo 1. As complicações clínicas relacionadas à dieta apresentadas pelos pacientes dos grupos 1 e 2, respectivamente, foram diarréia (41,37% vs. 30%; p>0,05), hiperglicemia (68,96% vs. 55%;p>0,05) e estase gástrica (58,6% vs.25%; p=0,04), sendo somente a última com diferença estatística significativa entre os grupos. No grupo 1,8% dos pacientes apresentaram desnutrição grave, e a prevalência de infecção foi maior que no grupo 2 (18,7% vs. 11,1%, respectivamente; p=0,02). Conclusões: Este estudo sugere que a ingestão protéica acima de 1g/kg/dia, associada à quantidades adequadas de energia, diminui a suscetibilidade às infecções, e pode estar relacionada com melhora do estado nutricional e dos níveis séricos de albumina.
Objetivo: Evaluar el efecto de la ingesta de proteínas de suero de los niveles de albúmina, la prevalencia de complicaciones clínicas relacionadas con la dieta, el estado nutricional y la mortalidad de los pacientes politraumatizados. Método: Los pacientes politraumatizados atendidos en la Unidad de Cuidados Intensivos entre septiembre de 2006 y Janiero se dividieron en dos grupos, un grupo que está compuesto por aquellos que consumían la cantidad diaria de proteínas y el grupo 2 = 1g/kg por los que tomaron la cantidad diaria de proteínas > 1g/kg con suplementos de proteína. Semanalmente, se recolectaron suero leucocitos albúmina, y las barras, los datos clínicos de los registros médicos, y la puntuación subjetiva de evaluación global, y compararon los datos iniciales y finales. Resultados: Los pacientes en el grupo 2 tienden a presentar niveles más altos de albúmina de suero de los pacientes en el grupo 1. La dieta de complicaciones relacionadas con la clínica que presentan los pacientes en los grupos 1 y 2, respectivamente, fueron: diarrea (41,37% frente al 30%, p> 0,05), hiperglucemia (68,96% frente al 55%, p> 0 , 05) y la estasis gástrica (58,6% vs.25%, p = 0,04), y sólo este último con una diferencia estadísticamente significativa entre los grupos. En el grupo de 1,8% de los pacientes padecían de desnutrición severa, y la prevalencia de infección fue superior en el grupo 2 (18,7% vs 11,1%, respectivamente, p = 0,02). Conclusiones: Este estudio sugiere que la ingesta de proteínas por encima de 1g/kg/day, junto con cantidades adecuadas de energía, disminuye la susceptibilidad a las infecciones, y pueden estar relacionados con la mejora del estado nutricional y la albúmina sérica.
Objective: To evaluate the effect of protein intake on serum albumin levels, the prevalence of clinical complications related to diet, nutritional status and mortality of polytrauma patients. Method: polytrauma patients treated at the Intensive Care Unit between September 2006 and janiero were divided into two groups, one group being composed of those who ate the daily amount of protein and group 2 = 1g/kg by those who took daily amount of protein > 1g/kg with protein supplementation. Were collected weekly serum albumin, leukocytes and rods, clinical data from medical records, and subjective global assessment score, and compared the initial and final data. Results: Patients in group 2 tended to present higher levels of serum albumin than patients in group 1. The diet-related clinical complications presented by patients in groups 1 and 2, respectively, were diarrhea (41.37% vs. 30%, p> 0.05), hyperglycemia (68.96% vs. 55%, p> 0 , 05) and gastric stasis (58.6% vs.25%, p = 0.04), and only the latter with a statistically significant difference between groups. In group 1.8% of patients had severe malnutrition, and prevalence of infection was higher than in group 2 (18.7% vs. 11.1%, respectively, p = 0.02). Conclusions: This study suggests that protein intake above 1g/kg/day, coupled with adequate amounts of energy, decreases the susceptibility to infections, and may be related with improvement of nutritional status and serum albumin.
Assuntos
Humanos , Masculino , Feminino , Adulto , Estado Nutricional , Hipoalbuminemia/diagnóstico , Proteínas Alimentares/uso terapêutico , Traumatismo Múltiplo/dietoterapia , Traumatismo Múltiplo/mortalidadeRESUMO
Seventy-four dogs from the State of Rio de Janeiro with ulcerated cutaneous lesions were submitted to clinical, dermatological, parasitological, mycological, histopathological and cytopathological exams, a leishmanin skin test, an indirect immunofluorescence (IIF) test for leishmaniosis, and nonspecific laboratory tests such as blood count and serum biochemistry. Sporothrix schenckii was isolated from 41 dogs and Leishmania (Viannia) braziliensis was isolated from 33 animals. Most dogs with sporotrichosis were from the municipality of Rio de Janeiro (53.7%) and presented ulcerated cutaneous lesions on the head (68.3%). Laboratory alterations in these animals included anemia (58.5%), hypoalbuminemia (83%) and hyperglobulinemia (75.6%). Histopathology revealed the predominance of a chronic granulomatous inflammatory infiltrate (70.7%), and yeast-like structures were detected in 17% of the histopathological exams and in 32% of the cytological exams. Three of 41 dogs with sporotrichosis were seropositive by IIF for leishmaniosis and 2 of 20 animals tested within this group had a positive leishmanin skin test. Similarly, most of the 33 dogs with leishmaniosis were from the municipality of Rio de Janeiro (69.7%) and had ulcerated cutaneous lesions on the head (84.8%). Laboratory alterations in these animals included anemia (66.7%), hypoalbuminemia (100%) and hyperglobulinemia (91%). Histopathology showed the predominance of a chronic granulomatous inflammatory infiltrate (63.6%) and amastigote forms were detected in 30.3% of the histopathological exams and in 31.8% of the 22 cytological exams performed. About 72.7% of the dogs were seropositive by IIF and five of seven animals had a positive skin test. Due to the clinical similarities, histopathological and nonspecific laboratory results similarities, the serological and skin tests for leishmaniosis positive in dogs with sporotrichosis, and the overlapping endemic areas in Rio de Janeiro, the differential diagnosis between the two diseases requires the demonstration of their respective etiological agents.