URG - Artigos publicados em revistas indexadas
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Browsing URG - Artigos publicados em revistas indexadas by Author "Cunha, L"
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- Cystatin C as a marker of acute kidney injury in the emergency departmentPublication . Soto, K; Coelho, S; Rodrigues, B; Martins, H; Frade, F; Lopes, S; Cunha, L; Papoila, A; Devarajan, PBACKGROUND AND OBJECTIVES: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n = 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria to AKI, prerenal azotemia, chronic kidney disease (CKD), and normal kidney function. RESULTS: Patients were adjudicated to have AKI in 21.1%, prerenal azotemia in 25.8%, CKD in 2.4%, and normal kidney function in 50.7%. For the diagnosis of AKI, the discriminatory ability of urinary creatinine and cystatin C was marginal. Both serum cystatin C and serum creatinine (at presentation and 6 hours later) showed high discriminatory ability for the diagnosis of AKI. However, only serum cystatin C attained a significant early predictive power (Hosmer-Lemeshow P value > 0.05). Serum cystatin C could differentiate between AKI and prerenal azotemia, but not between AKI and CKD. CONCLUSIONS: Serum cystatin C is an early, predictive biomarker of AKI, which outperforms serum creatinine in the heterogeneous emergency department setting. However, neither biomarker discriminated between AKI and CKD. Additional biomarkers continue to be needed for improved specificity in the diagnosis of community-acquired AKI.
- Is Manchester (MTS) more than a triage system? A study of its association with mortality and admission to a large Portuguese hospital.Publication . Martins, H; Cunha, L; Freitas, PTBACKGROUND: The Manchester Triage System (MTS) is a 5-point triage scale used to triage patients presenting to the emergency department. It was introduced in the UK in 1996 and is now widespread, especially in Europe, and has been in use in our hospital since 2000 via a computerised protocol. A study was undertaken to determine whether the subgroups created by the application of MTS have different propensities for indirect triage outcomes such as death in the A&E department or being admitted to hospital. METHODS: A database of 321 539 patients triaged during a 30-month period (from January 2005 to June 2007) was used. MTS codes, death outcomes, admission and admission route were used to estimate the proportions and association between MTS codes and the remaining variables by chi(2) univariate analysis. RESULTS: There was a clear association between the priority group and short-term mortality as well as with the proportion of patients admitted to hospital. CONCLUSIONS: The MTS provides information that extends beyond its immediate usefulness as a prioritisation mechanism. It is a powerful tool for distinguishing between patients with high and low unadjusted risk of short-term death as well as those who will stay in hospital for at least 24 h and those who will return home. Its discriminatory power is not equal for medical and surgical specialities, which may be linked to the nature of its inbuilt discriminators.