ERITROCITOSIS PATOLÓGICA DE ALTURA: Caracterización biológica, diagnóstico y tratamiento. HIGH ALTITUDE PATHOLOGICAL ERYTHROCYTOSIS. Diagnóstico y tratamiento | 23 DIC Eritrocitosis. Actualización de los métodos diagnósticos y el manejo de los pacientes con eritrocitosis. 3. original research. DOI: Secondary erythrocytosis due to hypoxemia as prognosis. in exacerbated chronic .
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Even though exacerbations are the main cause of emergency consultation in patients suffering from lung diseases, erythrocyte parameters are not assessed in their prognosis.
Thus, determining the implications of erythrocyte parameters might contribute to define the usefulness of phlebotomy or red blood cells transfusion in these patients. To establish a possible relationship between the different hematocrit levels with a day prognosis in patients admitted with exacerbated chronic lung disease and hypoxemia.
A study based on a day follow-up was conducted. Variables were described using an additional categorization by hematocrit levels and an adjustment in a multivariate model through logistic regression.
Follow-up was completed for Patients. The frequency of anemia was 7. This research could not determine any relationship between sritrocitosis parameters and prognosis of patients suffering from pulmonary diseases; nevertheless, extreme values of hematocrits tended to have adverse outcomes. Secondary erythrocytosis due to hypoxemia as prognosis in exacerbated chronic pulmonary diseases. La frecuencia de anemia fue de 7.
Chronic lung diseases are common and their exacerbations are the main cause of consultation in the emergency department since they impair the quality of life tratamiejto patients Different variables have been decisive for the prognosis of exacerbations; however, despite the pathophysiological correlation between chronic lung diseases with hypoxemia and erythrocytosis development, red blood cell parameters have not been evaluated as predictors of these events 2,5.
Erythrocytosis could affect the prognosis of an exacerbation by altering the microvascular rheology of patients and decreasing tissue perfusion and cardiac output 6,7. In long-term observations, anemia has been identified as a factor involved in the development of adverse events in patients with stable chronic lung disease, whereas erythrocytosis has shown its inference on a better prognosis Determining the virtual implications of red cell parameters in patients with pulmonary exacerbations could help defining the particular use of measures such as phlebotomy or red blood cell transfusion.
Currently, phlebotomy remains a measure of regular use in clinical practice, as it is economical and easy to perform; nonetheless, specifications around its technique are variable in studies and in usual clinical practice 7, There are limited data on its usefulness, as there are no works on proper methodology to evaluate its effectiveness Therefore, there is a big gap in the state of the art, which indicates the need to expand clinical research to achieve a better characterization of the risk and the need for treatment of secondary erythrocytosis in trratamiento and exacerbated chronic lung disease.
This study aimed to determine whether there is a relationship between the red cell prognostic parameters and adverse outcomes at 30 days in patients admitted under the diagnostic impression of an exacerbated chronic lung disease and secondary hypoxemia. The selection of the cohort was done in order to determine prognostic factors at 30 days of admission related to hospital stay, need for mechanical ventilation, need for transfer to intensive care unit ICUrehospitalization and death.
Demographic, clinical and paraclinical variables supported in the literature were included. Patients over 18 years of age, with a history of chronic lung eritrocifosis, hypoxemia at admission and diagnostic impression of exacerbation of, infectious or non-infectious, chronic lung disease were selected.
The following operating variables were established as admission and results analysis criteria:.
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Patients with congenital heart disease, for whom diagnosis of exacerbation of lung disease was discarded at discharge, and those eritroitosis did not wish to participate in the study were excluded from the study.
To define the entry of each individual to the study, the patient or caregiver was asked to sign an informed consent during the initial interview for authorization to collect data, accessing medical records, follow-up at 30 days and processing the information obtained.
After checking the study entry criteria and obtaining the authorization of the patients or eritrocitowis for inclusion, we proceeded to collect information through a survey to patients during their hospital stay. Demographic and clinical data were obtained directly from patients or their relatives, and were verified using the medical records, from where information eritroctiosis paraclinical was also extracted.
In the event that the patient underwent phlebotomy, blood count values at admission and the last blood count obtained after the last blood collection were taken for comparison. The survey was completed by telephone at 30 days after admission to hospital in order to assess the outcome.
These information handling procedures were verified, each and in full, ensuring that no inconsistencies or missing data were found.
At each step, the fulfillment of the criteria for inclusion and exclusion was verified. The outcome variable was a composite between death, length of hospital stay in floors, need for invasive or non-invasive ventilatory support, need to transfer to ICU and rehospitalization, provided that they were associated with chronic lung disease.
The evaluation began the day of admission of the patient to the institution until day 30 of follow-up. Guided by the value of prognostic factors evaluated during exacerbations, it is assumed that the presence of erythrocytosis may increase or decrease the risk twice for the combined outcome. A sample of subjects was estimated at two tails in Stata 9. In order eritrocitodis determine the normality assumption, the Kolmogorov-Smirnov test was performed for univariate analysis of quantitative variables.
Depending on the outcome, the abnormally distributed variables were reported by their median and interquartile range, traamiento those presenting normal distribution were reported by their mean and standard deviation. The qualitative variables were reported as absolute and relative frequencies. In addition, the distribution of variables was yratamiento by sex and hematocrit value, which was categorized into three groups according to the 25th and 75th percentiles of the distribution.
For bivariate analysis, the Mann-Whitney U test was performed. It differentiates the medians of independent samples in the analysis of quantitative variables that do not follow a normal distribution with the dependent variable. To establish the association between the independent qualitative variables and the dependent or outcome variable, the Chi square test of independence X 2 was used along with the Mantel-Haenszel method. Between March and Octobera cohort of patients was selected, out of which met the inclusion and follow-up criteria proposed for the study.
The collection of the sample was interrupted between Eritrocirosis and Tratamifnto due to issues in the attention of users in the institution, which affected the admission of patients.
The cohort was composed by subjects with a minimum age of 43 and a maximum age of 90, for a median of Demographic, clinical and paraclinical characteristics of patients included in the study. Own elaboration based on the data obtained in the study. The diagnosis of chronic lung disease was the most common chronic obstructive pulmonary disease eritrocitpsis Asthma cases had an exclusive distribution in women.
The most frequently used medications were short-acting bronchodilators, and their combination was the most common association, followed by association with inhaled steroids. While the minority of patients had a severe functional class IVthe use of long-acting bronchodilators was limited to only five cases, compared with the more extensive use of methylxanthines. There was no difference between sexes regarding erirocitosis type of prescription medications.
The presence of comorbidity was high, especially in women; among them, hypertension was the most prevalent comorbidity, followed by heart failure and diabetes tratamoento type 2. Almost half of patients had a history of smoking and it was two times eritrocitoss in men compared to women. During hospital stay, eight cases presented complications, four of them showed one of the outcomes assessed at 30 days, and only one included death.
Erythrocyte parameters showed an overall predilection of being within normal values, with a median of When assessing the data by dividing the sex distribution and the hematocrit levels in the 25th and 75th percentiles Table 2 in order to debug the virtual eritrocigosis of the different levels of red cell parameters with the characteristics of the cohort, no relationship between hematocrit values and NYHA functional class of patients, nor between severity of exacerbation according to the criteria of Anthonisen was evident.
No relationship between a history of use of home oxygen and hematocrit values was found. At admission, five patients had a history of phlebotomy and hematocrits were located preferentially in the last interquartile or near this range. In only one case phlebotomy was repeated. Regarding the outcomes, there was a predilection to higher length hospital stay in the presence of lower levels of hematocrit.
Other outcomes did not appear to have any relation to hematocrit levels, although no deaths were recorded in the group of patients with the highest levels of hematocrit. The variables in the bivariate analysis that were statistically significant to be included in the multivariate analysis were age, history of hypertension, history of heart tratamineto, use of short-acting anticholinergics, home oxygen, type of Anthonisen and hematocrits at admission, being blood pressure the factor with the greatest weight Table 3.
Regarding red blood cell parameters, a tendency to have ttratamiento protective effect when located in the core values of hematocrit against extreme values, this difference did not show a statistical significance. Only three of the patients underwent phlebotomy, and its indication included the hematocrit value in all cases, regardless of the clinical presentation.
Blood volumes extracted and the number of sessions were variable in each of the procedures and did not correlate with the magnitude of change in the red blood cell values in the subsequent blood count control Table 5. None of these patients presented any of the outcomes assessed at 30 days. This study attempted to establish the relationship between red blood cell parameters and the development of adverse outcomes at 30 days in patients with exacerbated chronic lung disease. The results showed that exacerbations of chronic lung diseases afflicted, with very little difference in frequency, both men and women and appeared at similar ages, without any difference in the severity of the disease, although comorbidities are more often associated with women.
In Colombia, eritrlcitosis bronchodilator and inhaled steroids remain the mainstay of treatment; although, despite guideline recommendations for management of chronic obstructive pulmonary diseases, only a few cases of patients receive long-acting bronchodilator Erythrocytosis frequency was There are several observations that have found a worse prognosis of mortality and need for hospitalization in patients with lower red cell mass compared to those with higher values 9,10, The prognostic value of this variable in the exacerbation has not been evaluated to date.
Since the NYHA functional class and the use of medications did not differ due to hematocrit levels, erythrocyte parameters in this cohort did not appear to have any relation to the severity of chronic lung disease in patients. On the other hand, the presence of the exacerbation did not differ according to the Anthonisen criteria, but did show a trend to greater affectation of oxygenation and hypercapnia in the presence of higher hematocrit levels.
Adverse outcomes were more likely to occur at the extremes of the distribution of hematocrit values, also with longer hospital stay when hematocrit values were lower. The multivariate analysis did not include erythrocyte parameters given the lack of statistical significance of the data provided by these variables with the outcome. The variables that were statistically significant showed some unusual associations, particularly with the Anthonisen classification and the presence of a history of heart failure, the latter being a protective factor, without defining a coherent explanation for this finding and without any publication report with a similar result that could be used to infer that protective effect.
By contrast, other prognostic factors found to be related with exacerbations in other studies, such as age, use of home oxygen, the etitrocitosis of signs of respiratory distress at admission, the number of Anthonisen criteria present and blood gases, could not be validated in this cohort 2,5,22,23, Phlebotomy was performed in only three patients; indications focused on the hematocrit value and the technique used was variable in each case without having a direct relationship between the volume of blood extracted and the change of red cell values, in fact, in one patient no changes were seen.
These data, although scarce, revalidated the limitation on the approach to a patient with erythrocytosis in the emergency room, as well as the absence of protocols editrocitosis clarify the possible indications and phlebotomy techniques. Clinical and paraclinical characteristics of patients included in the study by sex and hematocrit levels in percentiles. Bivariate analysis of prognostic factors for the composite outcome. Multivariate analysis of prognostic factors for the composite outcome.
Erythrocyte parameters before and after performing phlebotomy in the recorded cases. It is also probable that there were cases of patients eritrocitowis exacerbation who died during hours not available for sample collection and, therefore, could not be included.
Another limitation of the study was establishing definitions accepted for inclusion criteria and data analysis. The definition of chronic lung disease that was coined sought to be sensible, considering that few patients have pulmonary physiology studies and that some of those who actually had them were not available at the eritroctiosis of the survey or follow-up.
This is why the diagnosis reported by the patient and relatives was chosen, making it difficult to determine which patients actually had a chronic lung disease and which type. For this, oxygen saturation was chosen tratamienho the dissociation curve of hemoglobin and the values of red blood cell parameters of studies that have determined normal values in high altitudes 18, Determining which patients had chronic hypoxemia at admission was difficult because, in most cases, there were no erihrocitosis, and for those who received home oxygen its indication was unknown.
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The results suggest the need for further studies to clarify the relevance of erythrocyte parameters in exacerbations of chronic lung disease, both at sea level and in populations located at higher altitudes, as in this case. Studies that include phlebotomy in the prognosis of exacerbation should also evaluate the proper adherence to treatment, including supplemental oxygen as a primary factor to prevent recurrence of erythrocytosis. In conclusion, this study could not determine a statistically significant association between red blood cell parameters and prognosis of patients with exacerbation of chronic lung disease; however, there is a tendency for extreme values to have adverse outcomes.
Exacerbation rate, health status and mortality in COPD – a review of potential interventions. Chronic obstructive pulmonary disease exacerbations in emergency departments: Acute exacerbations of chronic obstructive pulmonary etitrocitosis.
In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Hemorheology in the erythrocytoses.