Prevalence and risck factors associated with thromboembolic events in patients hospitalized for the activity or complication of inflammatory bowel diseases

Orientador: Jazon Romilson de Souza AlmeidaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: As doenças inflamatórias intestinais (DII) são enfermidades crônicas caracterizadas por inflamação do trato gastrointestinal e aproximadamente metade dos pacientes pode apresentar manifestações sistêmicas, dentre elas a trombose. O objetivo deste estudo foi identificar a prevalência de eventos tromboembólicos (ETE) em pacientes com DII hospitalizados e pesquisar fatores de risco para sua ocorrência. Métodos: Trata-se de estudo retrospectivo unicêntrico longitudinal realizado em uma unidade de referência brasileira em DII, no período entre 2004 e 2014. Foram incluídos pacientes hospitalizados por mais de 48 horas por DII e, que não utilizaram profilaxia para prevenir ETE durante a internação. Os pacientes foram alocados em dois grupos: aqueles com ETE até 30 dias antes ou durante a internação (grupo ETE) e pacientes sem ETE (grupo controle). As características clínicas e laboratoriais dos pacientes foram analisadas. Resultados: Foram avaliados 53 pacientes, 66% com Doença de Crohn (DC) e 34% com Retocolite Ulcerativa (RCU). A prevalência de ETE, 30 dias antes ou durante a hospitalização, foi de 15,1%, 10,8% na DC e 25% na UC. No grupo ETE, a mediana da albumina sérica foi 2,05 (1,47-2,62) e no grupo controle 3,40 (2,72-3,90). Pacientes que apresentaram níveis de albumina menores ou iguais a 2,95g/dL (43,18%) tiveram maior risco de desenvolver ETE (RR 1,72; IC95%: 1,17-2,53) (p <0,001). Conclusões: Em pacientes com ETE, os níveis de albumina foram significativamente menores. Hipoalbuminemia foi considerada um fator de risco para o desenvolvimento de ETE nesta populaçãoAbstract: Background: Inflammatory bowel diseases (IBD) are chronic diseases characterized by inflammation of the gastrointestinal tract and approximately half of the patients may present with systemic manifestations, including thrombosis. The objective of this study was to identify the prevalence of thromboembolic events (TEE) in inpatients with IBD and to investigate risk factors for their occurrence. Methods: This was a retrospective single-center longitudinal study from a brazilian IBD referral unit between 2004 and 2014. Patients hospitalized for more than 48 hours, due to active IBD and who did not use prophylaxis for TEE during hospitalization were included. Patients were allocated in two groups: those with TEE up to 30 days or during the hospitalization (TEE-group) and patients without TEE (control-group). Clinical and laboratorial characteristics of the patients were analyzed. Results: 53 patients were evaluated, 66% with Crohn's disease (CD) and 34% with ulcerative colitis (UC). The prevalence of TEE, 30 days before or during hospitalization, was 15.1%, 10.8% in CD and 25% in UC. In the TEE group, median of serum albumin was 2.05 (1.47-2.62) and 3.40 (2.72-3.90) in the control group. Patients who had albumin levels less than or equal to 2.95g/dL (43.18%) had a higher risk of developing TEE (RR 1.72; 95% CI: 1.17-2.53) (p<0.001). Conclusions: In patients with TEE, albumin levels were significantly lower. Hypoalbuminemia was considered a risk factor for the development of TEE in this populationMestradoClinica MedicaMestre em Ciência

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Hypoalbuminemia as a risk factor for thromboembolic events in inflammatory bowel disease inpatients

Background/Aims Inflammatory bowel disease (IBD) are chronic entities characterized by local and systemic inflammation and may be associated with thrombosis. The aim of this study was to identify the prevalence of thromboembolic events (TEE) in hospitalized IBD patients and identify risk factors for their occurrence. Methods This retrospective, single-center study included patients treated at a Brazilian IBD referral unit between 2004 and 2014. Patients hospitalized for more than 48 hours due to active IBD and who did not receive prophylaxis for TEE during hospitalization were included. Patients were allocated to 2 groups: those with TEE up to 30 days or at the time of hospitalization (TEE-group) and patients without TEE (control-group). Clinical and laboratory characteristics were evaluated. Results Of 53 patients evaluated, 69,8% with Crohn’s disease (CD) and 30.2% with ulcerative colitis (UC). The prevalence of TEE 30 days before or during hospitalization was 15.1%, with 10.8% in CD and 25% in UC. In the TEE group, mean serum albumin was 2.06 g/dL versus 3.30 g/dL in the control group. Patients with albumin levels below 2.95 g/dL (43.18%) had a higher risk of developing TEE (relative risk, 1.72; 95% confidence interval, 1.17–2.53) (P<0.001). Conclusions Albumin levels were significantly lower in patients with TEE, and hypoalbuminemia was considered a risk factor for the development of TEE in this population

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom