Testosterone and ischemic stroke

Serum testosterone levels have already been related to endothelial function, vascular aging and hemathological factors, possibly contributing to thrombus formation. As aging progresses, epidemiological data shows declining testosterone levels, impaired vascular function and an increasing incidence of vascular diseases like stroke. Objective: The aim of present paper is to describe studies with a possible relation of testosterone levels with stroke prevention, clinical presentation, and prognosis. Methods: A research and selection of articles, filtering for humans studies only, was conducted in three different eletronic scientific databases, (MEDLINE, SCIELO, LILACS), using related and registered terms (english and portuguese) about "stroke" and "testosterone". Only studies that encompasses the role of testosterone in stroke and its different clinical aspects were included in the present review. Results: The search retrieved 12 relevant studies for analysis and discussion relating testosterone and stroke (7 observational, 3 cross sectional, 2 experimental). Observational studies verified a preventive role of testosterone levels on stroke incidence, cross-sectional studies verified endocrinologial alterations like hypogonadism on acute stroke phase and better clinical presentation (severity, brain lesion size). Experimental controled studies observed clinical benefits of testosterone supplementation in rehabilitation patients. Conclusion: Despite the potential benefits of higher levels of testosterne in stroke spectrum, more studies that systematically aproach the role of testosterone in stroke prevention, severity, clinical features, prognosis, rehabilitation and mortality will be welcome to better elaborate future medical management and otimization in stroke spectrum.Níveis de testosterona sérica já foram relacionados a piora de fatores hematológicos, função e envelhecimento vascular, contribuindo potencialmente para formação de trombos. Com o envelhecimento, dados epidemiológicos mostram declínio dos níveis de testosterona, prejuízo da função vascular e aumento das incidências de doenças vasculares, como o AVE. Objetivo: Descrever estudos que abordaram a potencial relação dos níveis de testosterona com a prevenção, apresentação clínica e prognóstico do AVE. Métodos: Uma pesquisa e seleção de artigos foi conduzida em três diferentes bases de dados (MEDLINE, SCIELO, LILACS) utilizando termos relacionados a testosterona e AVE (inglês e português), filtrada para estudos em humanos. Apenas estudos que abordaram algum aspecto da relação entre testosterona e AVE foram incluídos para discussão no presente estudo. Resultados: A busca resultou em 12 estudos relevantes para análise e discussão (7 observacionais, 3 transversais, 2 experimentais). Estudos observacionais verificaram um papel protetor da testosterona na incidência de AVE. Estudos transversais verificaram alterações endocrinológicas, como o hipogonadismo, na fase aguda do AVE, bem como melhor apresentação clínica (gravidade, tamanho da lesão). Estudos experimentais controlados verificaram benefícios clínicos e funcionais da suplementação de testosterona em pacientes em reabilitação. Conclusão: Apesar dos potenciais diversos benefícios destacados de níveis mais altos de testosterona no AVE, mais estudos que abordem de forma sistematizada o papel da testosterona em aspectos preventivos, de apresentação clínica, e de reabilitação e prognóstico serão bem vindos, para melhor manejo e otimização do tratamento do AVE

Risk factors, mortality and acute kidney injury outcomes in cirrhotic patients in the emergency department

Abstract Background Acute kidney injury (AKI) is common in cirrhotic patients and is associated with negative outcomes. The aim of this study was to evaluate the presence of AKI and its progression according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria in cirrhotic patients admitted to the emergency department and to determine the association of AKI with hospital mortality. Methods This retrospective study included 258 cirrhotic patients admitted to the emergency department of a university hospital from March 2015 to February 2017. AKI was diagnosed and classified according to the KDIGO criteria. Results The overall incidence of AKI in cirrhotic patients was 53.9%, and the overall hospital mortality was 28.4%. Mortality was associated with the presence, stage, and progression of AKI. Patients with AKI stage 1 and sCr  1.5 mg/dl (KDIGO 1b). In the logistic regression analysis, three variables were independently associated with hospital mortality: cancer, AKI and progression of AKI. Conclusions According to the data presented, a single measure of creatinine is not enough, and there is a need for meticulous follow-up of the renal function of patients with hepatic cirrhosis hospitalized in an emergency unit. In addition, this study reinforces the need for subclassification of KDIGO 1 in cirrhotic patients, since patients with acute renal injury and creatinine greater than 1.5 mg/dL present a worse clinical outcome