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Impact of COVID-19 pandemic on surgical volume and outcomes in a terciary care center in Brazil COVID19 COVID 19 COVID-1 COVID1 1 COVID-
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BITTENCOURT, PAULO LISBOA

; ARAGÃO, GABRIEL VIANNA PEREIRA

; VALVERDE FILHO, MURILO TAVARES

; AMORIM, GUILHERME ALMEIDA FARIAS

; CASTRO, IGOR LIMA VIEIRA DE

; SANTANA, JADE DE OLIVEIRA

; COSTA, LAIANE CAITANO

; MUNIZ, BEATRIZ SOARES MARQUES

; SILVA, VIVIAN ROBERTA SOARES

; CODES, LIANA

; ZOLLINGER, CLAUDIO CELESTINO

; ANDRAUS, WELLINGTON

Revista do Colégio Brasileiro de Cirurgiões

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2024, Volume 51 elocation e20243678

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: a pandemia COVID-19 levou a um importante declínio mundial no volume cirúrgico devido ao adiamento de procedimentos eletivos. Este estudo avaliou o impacto da pandemia COVID-19 nos volumes e nos resultados da cirurgia abdominal em pacientes criticos. Métodos: pacientes internados para cuidados pósoperatórios foram avaliados retrospectivamente. Dados relativos aos desfechos perioperatórios foram comparados em dois períodos: janeiro-2017 a dezembro-2019 e janeiro-2020 a dezembro-2022, respectivamente, antes (período I) e depois (período II) da pandemia COVID-19. Resultados: foram investigados 1.402 pacientes (897 mulheres, idade 62+17 anos). A maioria dos pacientes foi submetida a cirurgia colorretal (n=393) e pancreatobiliar (n=240), sendo 52% dos procedimentos eletivos. O volume cirúrgico foi significativamente menor no período II (n=514) quando comparado ao período I (n=888). Não foi observada recuperação no número de procedimentos cirúrgicos em 2022 (n=135) quando comparado a 2021 (n=211) e 2020 (n=168). Indivíduos submetidos à cirurgia abdominal no período II apresentaram maior índice de comorbidade de Charlson (4,85+3,0 vs. 4,35+2,8, p=0,002), mais procedimentos emergenciais/urgentes (51% vs. 45%, p =0,03) e mais feridas potencialmente contaminadas (73,5% vs. 66,8%, p=0,02). Observou-se diminuição significativa no volume de cirurgia colorretal (24% vs, 31%, p<0,0001) após o início da pandemia de COVID-19, com 125 (8,9%) óbitos, nenhuma morte por COVID-19. A mortalidade foi maior no período II quando comparada ao período I (11% vs. 8%, p=0,08). Conclusões: a pandemia de COVID-19 foi associada à diminuição do volume cirúrgico de pacientes de alto risco sem recuperação aparente nos últimos anos. Nenhuma influência da COVID-19 foi observada na mortalidade pósoperatória. Introdução COVID19 COVID 19 COVID-1 eletivos criticos Métodos retrospectivamente períodos janeiro2017 janeiro 2017 janeiro-201 dezembro2019 dezembro 2019 dezembro-201 janeiro2020 janeiro-202 dezembro2022, dezembro2022 2022, dezembro-2022 respectivamente COVID19. 19. Resultados 1402 1 402 1.40 897 (89 mulheres 6217 62 17 62+1 anos . anos) n=393 n393 n 393 (n=393 n=240, n240 n=240 , 240 (n=240) 52 n=514 n514 514 (n=514 n=888. n888 n=888 888 (n=888) 202 n=135 n135 135 (n=135 n=211 n211 211 (n=211 n=168. n168 n=168 168 (n=168) 4,85+3,0 48530 4 85 3 0 (4,85+3, vs 43528 35 2 8 4,35+2,8 p=0,002, p0002 p=0,002 002 p=0,002) emergenciaisurgentes emergenciais urgentes 51% 51 (51 45 45% =0,03 003 03 73,5% 735 73 5 (73,5 668 66 66,8% p=0,02. p002 p=0,02 02 p=0,02) Observouse Observou se 24% 24 (24 31 31% p<0,0001 p00001 0001 COVID19, 19, 12 8,9% 89 9 (8,9% óbitos 11% 11 (11 8% p=0,08. p008 p=0,08 08 p=0,08) Conclusões pósoperatória COVID1 COVID- janeiro201 201 janeiro-20 dezembro201 dezembro-20 janeiro202 dezembro202 dezembro-202 140 40 1.4 (8 621 6 62+ n=39 n39 39 (n=39 n24 n=24 (n=240 n=51 n51 (n=51 n88 n=88 88 (n=888 20 n=13 n13 13 (n=13 n=21 n21 21 (n=21 n16 n=16 16 (n=168 4,85+3, 4853 (4,85+3 4352 4,35+2, p000 p=0,00 00 (5 =0,0 73,5 7 (73, 66,8 p00 p=0,0 (2 p<0,000 p0000 000 8,9 (8,9 (1 janeiro20 janeiro-2 dezembro20 dezembro-2 14 1. ( n=3 n3 (n=3 n2 n=2 (n=24 n=5 n5 (n=5 n8 n=8 (n=88 n=1 n1 (n=1 (n=2 (n=16 4,85+3 485 (4,85+ 435 4,35+2 =0, 73, (73 66, p0 p=0, p<0,00 8, (8, janeiro2 janeiro- dezembro2 dezembro- n= (n= (n=8 4,85+ 48 (4,85 43 4,35+ =0 (7 p=0 p<0,0 (n 4,85 (4,8 4,35 = p= p<0, 4,8 (4, 4,3 p<0 4, (4 p<

ABSTRACT Backgrounds: COVID-19 pandemic led to a sharp decline in surgical volume worldwide due to the postponement of elective procedures. This study evaluated the impact of COVID-19 pandemic in surgical volumes and outcomes of abdominal surgery in high-risk patients requiring intensive care unit admission. Methods: patients admitted for postoperative care were retrospectively evaluated. Data concerning perioperative variables and outcomes were compared in two different periods: January 2017-December 2019 and January 2020-December 2022, respectively, before (period I) and after (period II) the onset of COVID-19 pandemic. Results: 1.402 patients (897 women, mean age 62+17 years) were investigated. Most of the patients underwent colorectal (n=393) and pancreato-biliary (n=240) surgery, 52% of elective procedures. Surgical volume was significantly lower in period II (n=514) when compared to period I (n= 888). No recovery was observed in the number of surgical procedures in 2022 (n=135) when compared to 2021(n=211) and 2020 (n=168). Subjects who underwent abdominal surgery in period II had higher Charlson comorbidity index (4,85+3,0 vs. 4,35+2,8, p=0,002), more emergent/urgent procedures (51% vs. 45%, p=0,03) and more clean-contaminated wounds (73,5% vs. 66,8%, p=0,02). A significant decrease in the volume of colorectal surgery was also observed (24% vs, 31%, p<0,0001) after the onset of COVID-19 pandemic, 125 (8,9%) died, no deaths due to COVID-19 infection. Mortality was higher in period II when compared to period I (11% vs. 8%, p=0,08). Conclusions: COVID-19 pandemic was associated with a decrease in surgical volume of high-risk patients without apparent recovery in recent years. No influence of COVID-19 was noted in postoperative mortality. Backgrounds COVID19 COVID 19 COVID-1 highrisk high risk admission Methods periods 2017December December 2017 201 2020December respectively Results 1402 1 402 1.40 897 (89 women 6217 62 17 62+1 years investigated n=393 n393 n 393 (n=393 pancreatobiliary pancreato biliary n=240 n240 240 (n=240 52 n=514 n514 514 (n=514 n= (n 888. 888 . 888) 202 n=135 n135 135 (n=135 2021n=211 2021n211 2021 n=211 211 2021(n=211 n=168. n168 n=168 168 (n=168) 4,85+3,0 48530 4 85 3 0 (4,85+3, vs 43528 35 2 8 4,35+2,8 p=0,002, p0002 p p=0,002 , 002 p=0,002) emergenturgent emergent urgent 51% 51 (51 45 45% p=0,03 p003 03 cleancontaminated clean contaminated 73,5% 735 73 5 (73,5 668 66 66,8% p=0,02. p002 p=0,02 02 p=0,02) 24% 24 (24 31 31% p<0,0001 p00001 0001 12 8,9% 89 9 (8,9% died infection 11% 11 (11 8% p=0,08. p008 p=0,08 08 p=0,08) Conclusions mortality COVID1 COVID- 20 140 40 1.4 (8 621 6 62+ n=39 n39 39 (n=39 n=24 n24 (n=24 n=51 n51 (n=51 88 n=13 n13 13 (n=13 2021n 2021n=21 2021n21 n211 n=21 21 2021(n=21 n16 n=16 16 (n=168 4,85+3, 4853 (4,85+3 4352 4,35+2, p000 p=0,00 00 (5 p=0,0 p00 73,5 7 (73, 66,8 (2 p<0,000 p0000 000 8,9 (8,9 (1 14 1. ( n=3 n3 (n=3 n=2 n2 (n=2 n=5 n5 (n=5 n=1 n1 (n=1 2021n=2 2021n2 n21 2021(n=2 (n=16 4,85+3 485 (4,85+ 435 4,35+2 p=0, p0 73, (73 66, p<0,00 8, (8, 2021n= 2021(n= 4,85+ 48 (4,85 43 4,35+ p=0 (7 p<0,0 2021(n 4,85 (4,8 4,35 p= p<0, 4,8 (4, 4,3 p<0 4, (4 p<

https://doi.org/10.1590/0100-6991e-20243678-en

LIVER HEALTH IS OVERLOOKED BY ALCOHOL DRINKERS IN BRAZIL
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CODES, Liana

; BITTENCOURT, Paulo Lisboa

; MUSSI, Fernanda Carneiro

; THIBES, Mariana

; FERRAZ, Maria Lucia Gomes

; ANDRADE, Arthur Guerra de

Arquivos de Gastroenterologia

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2024, Volume 61 elocation e23175

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Contexto: O uso crônico e excessivo de álcool é um importante fator de risco para diversos problemas sociais e de saúde. Métodos: Foi realizado um estudo transversal, numa amostra representativa da população brasileira, para avaliar a frequência do consumo de bebidas alcoólicas e comportamentos relativos às doenças hepáticas. Participantes foram entrevistados, prospectivamente, com um questionário sobre consumo de álcool e ações voltadas à saúde do fígado. O estudo aceitou erro amostral máximo de ±2 pontos percentuais e considerou intervalo de confiança de 95%. Resultados: Foram entrevistados 1995 indivíduos (1.048 mulheres, média de idade de 44 anos) de todas as regiões brasileiras. A maioria dos brasileiros (63-87%) acredita que o abuso de álcool é a principal causa de cirrose e câncer de fígado, no entanto, a maioria dos participantes (56%) nunca havia sido examinado para avaliar danos hepáticos relacionados ao consumo excessivo de álcool. Um total de 55% dos brasileiros consomem bebidas alcoólicas. Entre os brasileiros que consomem bebidas alcoólicas, 44% consomem três ou mais doses por vez, 11% consomem mais de 10 doses por dia. Entre aqueles que consomem 1 a 2 doses por dia, as mulheres (42%) consomem mais que os homens (32%) e mais que a média nacional (37%). Conclusão: Há elevada frequência de consumo de álcool, principalmente entre jovens e indivíduos de classes sociais mais baixas, com consumo frequente entre mulheres. Apesar do conhecimento sobre o impacto adverso na saúde do fígado, menos da metade dos brasileiros foram avaliados, em pelo menos uma ocasião, para doença hepática. Estratégias de educação e prevenção precisam ser implementadas para reduzir o uso nocivo do álcool. Contexto Métodos transversal brasileira hepáticas prospectivamente fígado ± 95 95% Resultados 199 1.048 1048 048 (1.04 4 anos brasileiras 6387% 6387 63 87% 87 (63-87% entanto 56% 56 (56% 55 vez 11 dia 42% 42 (42% 32% 32 (32% 37%. 37 37% . (37%) Conclusão baixas avaliados ocasião hepática 9 19 1.04 104 04 (1.0 638 6 8 (63-87 5 (56 (42 3 (32 (37% 1.0 0 (1. (63-8 (5 (4 (3 (37 1. (1 (63- ( (63 (6

ABSTRACT Background: Chronic excessive use of alcohol is an important risk factor for several health and social conditions. Methods: A cross-sectional survey, in a sample representative of the Brazilian population,was conducted to evaluate the frequency of consumption of alcoholic beverages and behaviors concerning liver diseases. Participants were prospectively interviewed using a questionnaire regarding alcohol consumption and actions toward liver health. The study accepted at most one sampling error of ±2 percentage points and considered a 95% confidence interval. Results: One thousand nine hundred ninety-five subjects (1.048 women, mean age 44 years) from all Brazilian regions were interviewed. Most of the Brazilian subjects believe that alcohol abuse (63-87%) is the leading cause of cirrhosis and liver cancer, however, most responders (56%) had never been screened to assess liver damage related to alcohol consumption. A total of 55% of Brazilians drink alcoholic beverages. Among Brazilians who drink alcoholic beverages, 44% consume three or more drinks at a time, 11% consume more than 10 doses a day. Among those who consume 1 to 2 drinks a day, women (42%) consume more than men (32%) and more than the national average (37%). Conclusion: There is a high frequency of alcohol consumption, especially among young people, and individuals from lower social classes, with frequent consumption among women. Despite the knowledge of its adverse impact on liver health, less than half of the Brazilians have been evaluated at least once for liver disease. Education and prevention strategies need to be implemented to reduce theharmful use of alcohol. Background conditions Methods crosssectional cross sectional survey populationwas population was diseases ± 95 interval Results ninetyfive ninety five 1.048 1048 048 (1.04 4 years 6387% 6387 63 87% 87 (63-87% cancer however 56% 56 (56% 55 time 11 day 42% 42 (42% 32% 32 (32% 37%. 37 37% . (37%) Conclusion people classes disease 9 1.04 104 04 (1.0 638 6 8 (63-87 5 (56 (42 3 (32 (37% 1.0 0 (1. (63-8 (5 (4 (3 (37 1. (1 (63- ( (63 (6

https://doi.org/10.1590/s0004-2803.24612023-175

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR SYSTEMIC TREATMENT OF HEPATOCELLULAR CARCINOMA
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CHAGAS, Aline Lopes

; LEAL, Cassia Regina Guedes

; MELLO, Vivianne Barreto de

; BARROS, Fábio Marinho Do Rego

; BITTENCOURT, Paulo Lisboa

; MATTOS, Angelo A

; AROUCHA, Dayse

; FONSECA, Leonardo G da

; SILVA, Joyce Roma Lucas de

; DOTTORI, Mariana Fonseca

; TEIXEIRA, Rosangela

; MENDES, Liliana Sampaio Costa

; REZENDE, Rosamar Eulira Fontes

; FILGUEIRA, Norma Arteiro

; COUTINHO, Anelisa K

; ARAÚJO NETO, João Marcello de

; COELHO, Henrique Sergio Moraes

; PESSOA, Mario Guimarães

; CHEINQUER, Hugo

; PARISE, Edison Roberto

; FRANÇA, Alex

; ÁLVARES-DA-SILVA, Mário Reis

; CARRILHO, Flair José

; CORAL, Gabriela P

; PINTO, Paulo de Tarso Aparecida

; PEREIRA, Leila M M Beltrão

; PARANÁ, Raymundo

; ALVES, Rogério Camargo Pinheiro

; BRANDÃO-MELLO, Carlos Eduardo

Arquivos de Gastroenterologia

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jan 2023, Volume 60 N. 1 Pages 106 - 131

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC. (CHC mundo (SBH 202 então médica consenso online on line atualizadas revisado saúde 20 2

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC. (HCC cancerrelated cancer worldwide (SBH 202 then time singletopic single professionals policymakers, policymakers policy makers, makers policy-makers decisionmaking decision making 20 2

https://doi.org/10.1590/s0004-2803.202301000-14

ACUTE ABDOMEN IN INTENSIVE CARE UNIT: ETIOLOGY, COMORBIDITY AND SEVERITY OF 1,523 PATIENTS UNIT ETIOLOGY 1523 1 523 1,52 152 52 1,5 15 5 1,
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ALMEIDA FILHO, Geraldo Fernandes de

; SILVA, Pedro Paulo Costa e

; VALVERDE FILHO, Murilo Tavares

; MORAIS, Maria Clara Alves

; CHAGAS, Paulo Bravo de Oliveira

; D’OLIVEIRA, Ricardo Azevedo Cruz

; CODES, Liana

; BITTENCOURT, Paulo Lisboa

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2023, Volume 36 elocation e1778

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO RACIONAL: As características clínicas e os desfechos dos pacientes internados na unidade de terapia intensiva devido ao abdômen agudo são importantes serem investigados. OBJETIVOS: Avaliar os desfechos de indivíduos gravemente doentes com abdômen agudo de acordo com etiologia, gravidade e comorbidade. MÉTODOS: Os desfechos de 1.523 pacientes (878 mulheres, média de idade 66±18 anos) que foram previamente admitidos em uma unidade de terapia intensiva especializada em doenças gastrointestinais, com diferentes causas de abdômen agudo entre janeiro de 2012 e dezembro de 2019, foram avaliados retrospectivamente segundo etiologia, comorbidade e gravidade. RESULTADOS: As causas mais comuns de abdômen agudo foram obstrutivas e inflamatórias, com destaque para obstrução em colon (27%), em intestino delgado (18%) e pancreatite aguda (17%). A mortalidade geral foi de 13%. A cirurgia foi necessária em 34%. A média de permanência no hospital foi de 9 [1-101] dias. Na análise univariada a mortalidade foi significativamente associada à idade, APACHE II, índice de comorbidade de Charlson, necessidade de abordagem cirúrgica e presença de malignidade (p<0,0001), mas apenas APACHE II, índice de comorbidade de Charlson e intervenção cirúrgica permaneceram significativos na análise multivariada. CONCLUSÕES: Pacientes internados na unidade de terapia intensiva com abdômen agudo constituem um grupo heterogêneo de indivíduos com prognóstico diferente. A mortalidade está mais relacionada com a gravidade da doença, comorbidade e necessidade de cirurgia do que com a etiologia do abdome agudo. RACIONAL investigados OBJETIVOS MÉTODOS 1523 1 523 1.52 878 (87 mulheres 6618 66 18 66±1 anos gastrointestinais 201 2019 RESULTADOS inflamatórias 27%, 27 27% , (27%) 18% (18% 17%. 17 17% . (17%) 13 13% 34 34% 1101 101 [1-101 dias II p<0,0001, p00001 p p<0,0001 0 0001 (p<0,0001) multivariada CONCLUSÕES diferente doença 152 52 1.5 87 (8 661 6 66± 20 2 (27% (18 (17% 3 110 10 [1-10 p0000 p<0,000 000 (p<0,0001 15 5 1. 8 ( (27 (1 (17 11 [1-1 p000 p<0,00 00 (p<0,000 (2 [1- p00 p<0,0 (p<0,00 [1 p0 p<0, (p<0,0 [ p<0 (p<0, p< (p<0 (p< (p

ABSTRACT BACKGROUND: Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS: To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS: Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS: The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis. CONCLUSIONS: Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen. BACKGROUND investigated AIMS METHODS 1523 1 523 1,52 878 (87 women 6618 66 18 66±1 years 201 2019 RESULTS inflammatory 27%, 27 27% , (27%) 18% (18% 17%. 17 17% . (17%) 13 13% 34 1101 101 [1-101 days II p<0.0001, p00001 p p<0.0001 0 0001 (p<0.0001) CONCLUSIONS prognosis disease 152 52 1,5 87 (8 661 6 66± 20 2 (27% (18 (17% 3 110 10 [1-10 p0000 p<0.000 000 (p<0.0001 15 5 1, 8 ( (27 (1 (17 11 [1-1 p000 p<0.00 00 (p<0.000 (2 [1- p00 p<0.0 (p<0.00 [1 p0 p<0. (p<0.0 [ p<0 (p<0. p< (p<0 (p< (p

https://doi.org/10.1590/0102-672020230060e1778

FREQUENCY AND SEVERITY OF LIVER INVOLVEMENT IN HYPERTENSIVE DISORDERS OF PREGNANCY
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OLIVEIRA, Jade Castro de

; CODES, Liana

; LUCCA, Maria Magalhães Frenzel Brito de

; SOARES, Maria Alice Pires

; LYRIO, Leomar

; BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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sep 2022, Volume 59 N. 3 Pages 340 - 344

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Contexto Pré-eclâmpsia (PE) e eclâmpsia (E) estão entre as principais causas de morbimortalidade materna e fetal. Ambas estão associadas a comprometimento hepático com diferentes formas de evolução. Objetivo O objetivo deste estudo foi avaliar a frequência e a gravidade do envolvimento hepático em gestantes internadas em uma unidade de terapia intensiva (UTI) com PE/E e avaliar sua influência em desfechos maternos e fetais adversos. Métodos: Pacientes hospitalizados entre janeiro 2012 e março 2019 com PE/E foram avaliados retrospectivamente quanto às anormalidades clínicas e bioquímicas relacionadas ao fígado e suas frequências foram posteriormente correlacionadas com os resultados materno-fetais. Resultados: Um total de 210 mulheres (idade média 31±6,4 anos, idade gestacional média 33,8±4,1 semanas) com PE/E foram incluídas no estudo. A maioria delas apresentava hipertensão grave (n=184), sintomas de dor abdominal (48%) e cefaleia (40%). Anormalidades das enzimas hepáticas foram observadas em 49% dos indivíduos, geralmente menos de cinco vezes o limite superior do normal. Hemorragia subcapsular e ruptura hepática espontânea foram identificadas em uma mulher que faleceu. Nenhuma paciente teve diagnóstico definitivo de esteatose hepática aguda da gravidez, nem insuficiência hepática aguda grave. Um total de 62% dos partos ocorreu antes de 37 semanas. A mortalidade fetal foi observada em 6 (3%) casos. Não houve correlação entre os níveis médios de enzimas hepáticas e os resultados maternos e fetais. Conclusão Anormalidades bioquímicas hepáticas são frequentemente vistas em mulheres com PE/E, mas fora do contexto da síndrome HELLP, não estão associadas a resultados maternos e fetais adversos. As complicações relacionadas ao fígado são raras, mas podem ser fatais.

ABSTRACT Background: Pre-eclampsia (PE) and eclampsia (E) are among the leading causes of maternal and fetal morbidity and mortality. Both are associated with an evolving spectrum of liver disorders. Objective: The aim of this study was to evaluate the frequency and severity of liver involvement in pregnant women admitted to an intensive care unit with PE/E and to assess its influence on adverse maternal and fetal outcomes. Methods: All subjects, hospitalized between January 2012 and March 2019, were retrospectively evaluated for clinical and biochemical liver-related abnormalities and their frequencies were subsequently correlated with maternal-fetal outcomes. Results: A total of 210 women (mean age 31±6.4 years, mean gestational age 33.8±4.1 weeks) with PE/E were included in the study. Most of them had severe hypertension (n=184) and symptoms of abdominal pain (48%) and headache (40%). Liver enzymes abnormalities were seen in 49% of the subjects, usually less than five times the upper limit of normal. Subcapsular hemorrhage and spontaneous hepatic rupture were identified in one woman who died. No patient had definitive diagnosis for acute fatty liver of pregnancy, neither acute liver failure. A total of 62% of deliveries occurred before 37 weeks. Fetal mortality was observed in 6 (3%) cases. There was no correlation between mean levels of liver enzymes and maternal and fetal outcomes. Conclusion: Biochemical abnormalities of liver enzymes are frequently seen in women with PE/E, but outside the spectrum of HELLP syndrome, they are not associated with adverse maternal and fetal outcomes. Liver-related complications are rare but can be life-threatening.

https://doi.org/10.1590/s0004-2803.202203000-62

THE EVOLVING FIELD OF HEPATOLOGY IN BRAZIL
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BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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sep 2022, Volume 59 N. 3 Pages 325 - 326

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/s0004-2803.202203000-59

Brazilian registry for the elimination of hepatitis C in dialysis units: a call to action for Nephrology
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Moura-Neto, José A.

; Ferraz, Maria Lúcia Gomes

; Bittencourt, Paulo Lisboa

; Vieira Neto, Osvaldo Merege

Brazilian Journal of Nephrology

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mar 2022, Volume 44 N. 1 Pages 109 - 111

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A infecção pelo vírus da hepatite C é mais prevalente em pacientes em diálise do que na população geral no Brasil e implica um pior prognóstico. O tratamento atual para hepatite C é altamente eficaz, seguro e disponível no país, inclusive para a população de pacientes crônicos em diálise, o que torna a eliminação do vírus da hepatite C uma meta viável. A Sociedade Brasileira de Nefrologia, a Sociedade Brasileira de Hepatologia e o Instituto Brasileiro do Fígado desenvolveram o “Registro Brasileiro para Eliminação da Hepatite C nas Unidades de Diálise”. O projeto visa identificar pacientes em diálise crônica com vírus da hepatite C no Brasil, além de tratar e monitorar a resposta virológica após o tratamento. Este breve artigo apresenta o problema e convida os nefrologistas brasileiros a unirem forças nesse objetivo comum.

Abstract Infection by the hepatitis C virus is more prevalent in patients on dialysis than in the general population in Brazil, and has been associated with worse outcomes. Current therapy for hepatitis C is highly effective, safe, and widely available in Brazil, with coverage provided to dialysis patients with chronic kidney disease, which makes the elimination of hepatitis C a viable target. The Brazilian Society of Nephrology, the Brazilian Society of Hepatology, and the Brazilian Liver Institute developed the “Brazilian Registry for the Elimination of Hepatitis C in Dialysis Units”. This project aims to identify, treat, and monitor the response to treatment of patients on chronic dialysis infected with the hepatitis C virus in Brazil. This article presents the issue and invites Brazilian nephrologists to rally around the achievement of a significant goal.

https://doi.org/10.1590/2175-8239-jbn-2021-0050

ANALYSIS OF HEALTHCARE ASSOCIATED AND HOSPITAL ACQUIRED INFECTIONS IN CRITICALLY ILL PATIENTS WITH CIRRHOSIS
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D’OLIVEIRA, Ricardo Azevedo Cruz

; PEREIRA, Lívia Carolina Dourado

; CODES, Liana

; ROCHA, Mário de Seixas

; BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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mar 2022, Volume 59 N. 1 Pages 102 - 109

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Contexto As infecções bacterianas ocorrem em 43—59% dos pacientes cirróticos internados em unidade de terapia intensiva com impacto na morbimortalidade. Um aumento na frequência de bactérias multirresistentes e com resistência estendida foi descrito em infecções bacterianas em pacientes cirróticos, com um impacto adverso na sobrevida. Objetivo Caracterizar as infecções adquiridas na comunidade, relacionadas aos cuidados de saúde (RCS) e hospitalares em pacientes cirróticos e seu impacto na ocorrência de desfechos adversos. Métodos Este estudo incluiu todos os pacientes cirróticos internados em uma unidade de terapia intensiva especializada em doenças hepáticas e gastrointestinais no Brasil entre janeiro de 2012 e junho de 2018. A frequência e topografia das infecções foram avaliadas retrospectivamente, bem como a frequência de bactérias multirresistentes e resistência estendida, e seu impacto na ocorrência de lesão renal aguda, síndrome hepatorrenal, insuficiência hepática crônica agudizada, sepse e mortalidade. Resultados Um total de 374 infecções foram observadas e classificadas como infecções adquiridas na comunidade (22%), RCS (34%) e infecções hospitalares (44%). Oitenta e nove (54%) episódios de infecções hospitalares foram identificadas como segunda infecção. Peritonite bacteriana espontânea (32%) e infecção do trato urinário (23%) foram as infecções mais comuns. As infecções comprovadas por cultura foram positivas em 61% dos casos, principalmente ocasionadas por bactérias gram-negativas (73%). Lesão renal aguda, síndrome hepatorrenal e sepse foram observados respectivamente, em 48%, 15% e 53% dos casos. Bactérias multirresistentes e resistência estendida foram observadas respectivamente, em 35% e 16%, principalmente nos RCS (48% vs 26% em infecções adquiridas na comunidade, P=0,02) e infecções hospitalares (58% vs 26% em infecções adquiridas na comunidade, P=0,0009). Os resultados adversos foram observados com mais frequência em indivíduos com infecções nosocomiais em comparação com infecções relacionadas aos cuidados de saúde e comunitárias. Infecções hospitalares, RCS e ocorrência de uma segunda infecção foram independentemente associadas à mortalidade intra-hospitalar. Conclusão Infecções hospitalares, relacionadas aos cuidados de saúde e reinfecções estão cada vez mais associadas a bactérias multirresistentes e/ou resistência estendida e são preditores independentes de mortalidade intra-hospitalar. Seu reconhecimento e seleção adequada de regimes antibióticos empíricos apropriados são medidas importantes para reduzir a mortalidade intra-hospitalar.

ABSTRACT Background Bacterial infections occur in 43—59% of cirrhotic patients admitted to the intensive care unit with impact in morbidity and mortality. An increase in the frequency of multidrug-resistant (MDRO) and extensively drug-resistant (XDRO) organisms has been described in bacterial infections in cirrhotic patients with an adverse impact on survival. Objective To characterize community-acquired (CA), healthcare-associated (HCA), and hospital-acquired (HA) infections in cirrhotic patients and their impact in the occurrence of adverse outcomes. Methods This study included all cirrhotic patients admitted in an intensive care unit specialized in liver and gastrointestinal diseases in Brazil between January 2012 and June 2018. Frequency and topography of infections were retrospectively evaluated, as well as the frequency of MDRO and XDRO organisms, and their impact in occurrence of acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, sepsis and mortality. Results A total of 374 infections were observed and classified as CA (22%), HCA (34%) and hospital-acquired (44%). Eighty-nine (54%) episodes of hospital-acquired infections were second infections. Spontaneous bacterial peritonitis (32%) and urinary tract infection (23%) were the most common infections. Culture-proven infections were positive in 61% of the cases, mainly gram-negative bacteria (73%). Acute kidney injury, hepatorenal syndrome and sepsis were observed, respectively, in 48%, 15% and 53% of the cases. MDRO and XDRO were seen, respectively, in 35% and 16%, mainly in HCA (48% vs 26% in CA infections, P=0.02) and hospital-acquired (58% vs 26% in CA infections, P=0.0009). Adverse outcomes were more frequently observed in subjects with hospital-acquired infections when compared to HCA and CA infections. Hospital-acquired, HCA and second infections were independently associated with in-hospital mortality. Conclusion Hospital-acquired, HCA and second infections are increasingly associated with either MDRO and/or XDRO and are independent predictors of in-hospital mortality. Their recognition and proper selection of appropriate empiric antibiotic regimens are important measures to reduce in-hospital mortality.

https://doi.org/10.1590/s0004-2803.202200001-18

Leukocyte ratios are useful early predictors for adverse outcomes of COVID-19 infection
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Farias, João Pedro

; Silva, Pedro Paulo Costa e

; Codes, Liana

; Vinhaes, Diana

; Amorim, Ana Paula

; D’Oliveira, Ricardo Cruz

; Farias, Alberto Queiroz

; Bittencourt, Paulo Lisboa

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e73

Abstract: En | Text: En | PDF: En

ABSTRACT Leukocyte biomarkers, including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte-(MLR), platelet-to-lymphocyte (PLR) ratios and systemic immune-inflammation index (SII) have been associated with severity and mortality of patients with COVID-19. The purpose of this study was to evaluate the association of baseline leukocyte biomarkers calculated in the emergency department (ED) with the disease severity and mortality. This was a retrospective cohort study that evaluated 1,535 (mean age 57+18 years) patients with SARS-CoV-2 infection in the ED of a single reference center. Outcomes were severity, defined as intensive care unit (ICU) admission requirement, and in-hospital mortality. All leukocyte biomarkers were calculated in the ED before the hospital admission. Their ability to predict the severity and mortality was measured using receiver operating characteristic (ROC) curves. Severity and mortality were observed in 30.9% and 12.6% of the patients, respectively, and were significantly correlated with NLR, MLR, PLR and SII, but only NLR was independently associated with both outcomes on multivariate analysis. Analysis of ROC curves revealed that NLR (0.78 for severity and 0.80 for mortality) and SII (0.77 for severity and 0.75 for mortality) had the best ability to predict mortality, when compared to other ratios. The highest AUC was observed for NLR, employing cut-off points of 5.4 for severity and 5.5 for mortality. Leukocyte biomarkers, particularly NLR, are capable of predicting the severity and mortality of patients with SARS-CoV-2 infection and could be important adjunct tools to identify patients in the ED that are more prone to develop adverse outcomes.

https://doi.org/10.1590/s1678-9946202264073

10.

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents
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Ferraz, Maria Lúcia Gomes

; Piccoli, Leonora de Zorzi

; Rezende, Rosamar

; Borba, Luiz Augusto

; Pissaia Junior, Alcindo

; Cheinquer, Hugo

; Silva, Giovanni Faria

; Ferreira, Paulo Roberto Abrão

; Villela-Nogueira, Cristiane Alves

; Mazo, Daniel Ferraz

; Souza, Fernanda Fernandes

; Codes, Liana

; Ivantes, Claudia Alexandra Pontes

; Gomide, Geisa Perez Medina

; Pereira, Gustavo Henrique Santos

; Pessôa, Mário Guimarães

; França, Alex Vianey Callado

; Pinto, Arlene dos Santos

; Teixeira, Rosângela

; Bittencourt, Paulo Lisboa

Brazilian Journal of Infectious Diseases

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2022, Volume 26 N. 4 elocation 102388

Abstract: En | Text: En | PDF: En

ABSTRACT Background and aims: Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs. Patients and methods: Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included. Results: As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions. Conclusion: The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

https://doi.org/10.1016/j.bjid.2022.102388

11.

Perception of Brazilian medical students toward organ donation
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Batista, Eduardo Luis de Oliveira

; Nascimento, Melissa Macedo Peixoto

; Castro, Alexia Rangel de

; Garcia, José Huygens Parente

; Hyppolito, Elodie Bomfim

; Codes, Liana

; Bittencourt, Paulo Lisboa

Revista da Associação Médica Brasileira

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2022, Volume 68 N. 12 Pages 1675 - 1680

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: Brazil ranks second in gross numbers of kidney and liver transplantations, but deceased organ donation is still far below the national demand for organs. Apart from a high family refusal rate, another significant barrier is healthcare workers’ inappropriate knowledge concerning organ donation and transplantation. Since most of them have recently graduated from university, this study aimed to evaluate the awareness and attitudes of medical students concerning organ donation. METHODS: Between August and September 2021, a web-based survey with 10 overlapping questions was sent to medical students from several Brazilian universities after advertisements on social media. RESULTS: A total of 391 (60% female, mean age: 23 [17–41] years) students answered the survey. Most of them (91%) would like to donate organs in case of death, and 75% have already notified their family. The main reasons for not becoming a donor were fear of body manipulation (n=3) or family reaction (n=2) and religious reasons (n=2). When inquired, 54% were unaware of brain death criteria, and half of them claimed to have never discussed the topic in medical classes. Except for Glasgow coma scale (97%), pupillary (72%), and corneal (53%) reflexes, less than 25% knew other reflexes required for brain death diagnosis. CONCLUSION: Most medical students declared themselves as organ donors, and most informed their families. However, many students have never learned about crucial steps toward organ donation, which may impact their adequate recognition of potential organ donors later in life.

https://doi.org/10.1590/1806-9282.20220695

12.

GUT MICROBIOTA, PREBIOTICS, PROBIOTICS, AND SYNBIOTICS IN GASTROINTESTINAL AND LIVER DISEASES: PROCEEDINGS OF A JOINT MEETING OF THE BRAZILIAN SOCIETY OF HEPATOLOGY (SBH), BRAZILIAN NUCLEUS FOR THE STUDY OF HELICOBACTER PYLORI AND MICROBIOTA (NBEHPM), AND BRAZILIAN FEDERATION OF GASTROENTEROLOGY (FBG)
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BARBUTI, Ricardo Correa

; SCHIAVON, Leonardo Lucca

; OLIVEIRA, Cláudia P

; ALVARES-DA-SILVA, Mário Reis

; SASSAKI, Lígia Yukie

; PASSOS, Maria do Carmo F

; FARIAS, Alberto Queiroz

; BARROS, Luisa Leite

; BARRETO, Bruno Paes

; ALBUQUERQUE, Gisela Bandeira de Melo Lins de

; ALVES, Amanda Mandarino

; NAVARRO-RODRIGUEZ, Tomás

; BITTENCOURT, Paulo Lisboa

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 381 - 398

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Nos últimos anos, um volume crescente de evidências indica que os microrganismos estão envolvidos na manutenção da saúde humana e também estão relacionados a várias doenças, tanto intestinais quanto extraintestinais. Alterações na microbiota intestinal parecem ser um elemento chave na patogênese de doenças hepáticas e gastrointestinais, incluindo doença hepática gordurosa não-alcoólica, doença hepática alcoólica, cirrose hepática, doenças inflamatórias intestinais, síndrome do intestino irritável e diarreia associada ao Clostridium difficile. Em 2019, a Sociedade Brasileira de Hepatologia (SBH) em colaboração com o Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM) e a Federação Brasileira de Gastroenterologia (FBG) realizaram um encontro exclusivamente voltado para a discussão sobre microbiota e uso de prebióticos, probióticos e simbióticos em doenças hepáticas e gastrointestinais. Este texto resume os principais pontos discutidos durante o evento, e tem a intenção de fornecer informações práticas sobre o assunto, abordando as descobertas mais recentes e indicando áreas para estudos futuros.

ABSTRACT Over the last years, there is growing evidence that microorganisms are involved in the maintenance of our health and are related to various diseases, both intestinal and extraintestinal. Changes in the gut microbiota appears to be a key element in the pathogenesis of hepatic and gastrointestinal disorders, including non-alcoholic fatty liver disease, alcoholic liver disease, liver cirrhosis, inflammatory bowel disease, irritable bowel syndrome, and Clostridium difficile - associated diarrhea. In 2019, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Nucleus for the Study of Helicobacter Pylori and Microbiota (NBEHPM), and Brazilian Federation of Gastroenterology (FBG) sponsored a joint meeting on gut microbiota and the use of prebiotics, probiotics, and synbiotics in gastrointestinal and liver diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to provide practical information about this topic, addressing the latest discoveries and indicating areas for future studies.

https://doi.org/10.1590/s0004-2803.202000000-72 2240 downloads

13.

Brazilian Society of Hepatology and Brazilian Society of Infectious Diseases Guidelines for the Diagnosis and Treatment of Hepatitis B
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Ferraz, Maria Lucia

; Strauss, Edna

; Perez, Renata Mello

; Schiavon, Leonardo

; Ono, Suzane Kioko

; Pessoa, Mario Guimarães

; Ferreira, Adalgisa Paiva

; Nabuco, Leticia

; Carvalho-Filho, Roberto

; Tovo, Cristiane

; Souto, Francisco

; Abrão, Paulo

; Reuter, Tania

; Dantas, Thor

; Vigani, Aline

; Porta, Gilda

; Ferreira, Marcelo Simão

; Paraná, Raymundo

; Cimerman, Sergio

; Bittencourt, Paulo Lisboa

Brazilian Journal of Infectious Diseases

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oct 2020, Volume 24 N. 5 Pages 434 - 451

Abstract: En | Text: En | PDF: En

Abstract Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified.Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment.The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc).Delta infection is also part of the guideline, since it is an important infection in some parts of the country.

https://doi.org/10.1016/j.bjid.2020.07.012 744 downloads

14.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil
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Silva Júnior, João Manoel

; Chaves, Renato Carneiro de Freitas

; Corrêa, Thiago Domingos

; Assunção, Murillo Santucci Cesar de

; Katayama, Henrique Tadashi

; Bosso, Fabio Eduardo

; Amendola, Cristina Prata

; Serpa Neto, Ary

; Malbouisson, Luiz Marcelo Sá

; Oliveira, Neymar Elias de

; Veiga, Viviane Cordeiro

; Rojas, Salomón Soriano Ordinola

; Postalli, Natalia Fioravante

; Alvarisa, Thais Kawagoe

; Lucena, Bruno Melo Nobrega de

; Oliveira, Raphael Augusto Gomes de

; Sanches, Luciana Coelho

; Silva, Ulysses Vasconcellos de Andrade e

; Nassar Junior, Antonio Paulo

; Réa-Neto, Álvaro

; Amaral, Alexandre

; Teles, José Mário

; Freitas, Flávio Geraldo Rezende de

; Bafi, Antônio Tonete

; Pacheco, Eduardo Souza

; Ramos, Fernando José

; Vieira Júnior, José Mauro

; Pereira, Maria Augusta Santos Rahe

; Schwerz, Fábio Sartori

; Menezes, Giovanna Padoa de

; Magalhães, Danielle Dourado

; Castro, Cristine Pilati Pileggi

; Henrich, Sabrina Frighetto

; Toledo, Diogo Oliveira

; Parra, Bruna Fernanda Camargo Silva

; Dias, Fernando Suparregui

; Zerman, Luiza

; Formolo, Fernanda

; Nobrega, Marciano de Sousa

; Piras, Claudio

; Piras, Stéphanie de Barros

; Conti, Rodrigo

; Bittencourt, Paulo Lisboa

; D’Oliveira, Ricardo Azevedo Cruz

; Estrela, André Ricardo de Oliveira

; Oliveira, Mirella Cristine de

; Reese, Fernanda Baeumle

; Motta Júnior, Jarbas da Silva

; Câmara, Bruna Martins Dzivielevski da

; David-João, Paula Geraldes

; Tannous, Luana Alves

; Chaiben, Viviane Bernardes de Oliveira

; Miranda, Lorena Macedo Araújo

; Brasil, José Arthur dos Santos

; Deucher, Rafael Alexandre de Oliveira

; Ferreira, Marcos Henrique Borges

; Vilela, Denner Luiz

; Almeida, Guilherme Cincinato de

; Nedel, Wagner Luis

; Passos, Matheus Golenia dos

; Marin, Luiz Gustavo

; Oliveira Filho, Wilson de

; Coutinho, Raoni Machado

; Oliveira, Michele Cristina Lima de

; Friedman, Gilberto

; Meregalli, André

; Höher, Jorge Amilton

; Soares, Afonso José Celente

; Lobo, Suzana Margareth Ajeje

Revista Brasileira de Terapia Intensiva

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mar 2020, Volume 32 N. 1 Pages 17 - 27

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

https://doi.org/10.5935/0103-507x.20200005 1048 downloads

15.

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA
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CHAGAS, Aline Lopes

; MATTOS, Angelo Alves de

; CARRILHO, Flair José

; BITTENCOURT, Paulo Lisboa

; VEZOZZO, Denise Cerqueira Paranaguá

; HORVAT, Natally

; ROCHA, Manoel de Souza

; ALVES, Venâncio Avancini Ferreira

; CORAL, Gabriela Perdomo

; ALVARES-DA-SILVA, Mario Reis

; BARROS, Fabio Marinho do Rego

; MENEZES, Marcos Roberto

; MONSIGNORE, Lucas Moretti

; COELHO, Fabricio Ferreira

; SILVA, Renato Ferreira da

; SILVA, Rita de Cássia Martins Alves

; BOIN, Ilka de Fatima Santana Ferreira

; D`ALBUQUERQUE, Luiz Augusto Carneiro

; GARCIA, José Huygens Parente

; FELGA, Guilherme Eduardo Gonçalves

; MOREIRA, Airton Mota

; BRAGHIROLI, Maria Ignez Freitas Melro

; HOFF, Paulo Marcelo Gehm

; MELLO, Vivianne Barretto de

; DOTTORI, Mariana Fonseca

; BRANCO, Tiago Pugliese

; SCHIAVON, Leonardo de Lucca

; COSTA, Thaisa de Fátima Almeida

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2020, Volume 57 Suppl. 1 Pages 1 - 20

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2015 suas primeiras recomendações sobre a abordagem do CHC. Desde então, novas evidências sobre o diagnóstico e tratamento do CHC foram relatadas na literatura médica, levando a diretoria da SBH a promover uma reunião monotemática sobre câncer primário de fígado em agosto de 2018 com o intuito de atualizar as recomendações sobre o manejo da neoplasia. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização baseada em evidências científicas visando que pudesse nortear a prática clínica multidisciplinar do CHC. O texto resultante foi submetido a avaliação e aprovação de todos membros da SBH através de sua homepage. O documento atual é a versão final que contêm as recomendações atualizadas e revisadas da SBH.

ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

https://doi.org/10.1590/s0004-2803.202000000-20 4088 downloads

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