Poster Session : PS 0364 ; Epidemiology and Public Health : Association of Nonattendance and Emergency Assessments, Emergency Hospitalization and Mortality

( Diego Hernan Giunta ),( Analia Judith Baum ),( Bruno Rafael Boietti ),( Nora Angelicafuentes ),( Carolina Gabay ),( Fernan Gonzalez Bernaldo De Quiros ),( Maria Florencia Grande Ratti ),( Daniel Rob 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Nonattendance to scheduled outpatient appointments (SOA) produces ineffi ciency and discontinuity in care, although associated impact on mortality is unknown. Objetive: Evaluate association between SOA in primary care with emergency assessments (EA), emergency hospitalization (EH) and mortality (M) throughout a year. Methods: Retrospective cohort of adults affi liated to Hospital Italiano, with at least one SOA during 2012. We included all patients beginning from the last SOA of 2012 and followed them throughout a year, describing the events of EA, EH and M. We measured the number of SOA and the nonattendance proportion at the previous year before inclusion to the cohort. We used a Cox proportional hazards regression model, to estimate crude and adjusted Hazard Ratios (HR) and 95% confi dence interval. Results: 117327 patients were included, with a median age of 59 years (IQR:34), with a female frequency of 63. 3% (74300). Median of SOA was 8 appointments (IQR 9), the median of the nonattendance proportion of each patient was 28. 6% (IQR 39). 26% of patients had a proportion of nonattendance of 50% or more. EA was 13. 5% (15858); EH was of 3% (3551); and mortality was 1. 6% (1853) during follow up. Crude HR for each 10% increase in nonattendance proportion was 1. 031 (95%, IC:1. 025- 1. 037, p<0, 001) for EA; 1, 012 (95%, IC:1-1. 025, p=0. 051) for EH; and 1. 028 (95%, IC:1. 011-1, 045, p<0, 001) for M. Adjusted HR (by sex, age, diabetes, hypertension, cancer and coronary disease) for each 10% increment in nonattendance proportion was 1. 010 (95%, IC:1. 004-1. 017, p<0, 001);1. 099 (95%, IC:1. 084-1. 113, p<0, 001); and 1. 125 (IC95% 1, 105-1, 145, p<0, 001) for EA, EF and M respectively. Conclusions: Even though the nonattendance proportion effect on EA, EH and M is moderate, it could be relevant as a prognostic factor in high risk patients subgroups.

Poster Session : PS 0308 ; Geriatrics : HIP Fracture Prognosis in Patients with and Without Hyponatremia

( Nora Angelica Fuentes ),( Diego Hernan Giunta ),( Cristina Maria Elizondo ),( Fernan Gonzalez Bernaldo De Quiros ),( Gabriel Dario Waisman ),( Juan Carlos Ayus ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Hip Fracture (HF) is a leading cause of morbidity and mortality in elderly. Related complications are cardiovascular (CVD), sepsis and venous thromboembolism (VTE), deep venous thrombosis (DVT) and pulmonary embolism (PE). In recent studies, chronic hyponatremia was observed to be an independent risk factor for hip fracture, nevertheless there is no evidence on prognosis of these patients compared to patients without hyponatremia. Objective: To compare the prognosis and complications of HF in normonatremic patients (N) and hyponatremic patients (H). Methods: Retrospective cohort of hospitalized patients with HF, followed up to 30 days after diagnosis, at Hospital Italiano of Buenos Aires. Presence of complications (sepsis, DVT, PE, and CVD), hospital length of stay, mortality and readmission were evaluated. Results: 1571 patients were included, 76, 7% (1205) for N and 23, 3% (366) for H. Most patients were female, 82. 5% and 79. 8% for H and N respectively. H were older, 85 vs. 82 years (p<0. 001). Sepsis was the most frequent complication for H (OR 1. 7, 95% CI: 1. 13-2. 6). Length of stay was 7 days vs. 8 days (p=0. 053) for N and H. Readmissions were 12. 9% for N vs. 15. 8% for H (p=0. 14). Hospital mortality was minor for N than for H (14. 7% vs. 19. 9%; p=0. 016), crude OR was 1. 45 (1. 07-1. 96) and adjusted OR was 1. 15 (0. 84-1. 6). Survival was higher for N than for H (p<0. 001). Crude hazard ratio (HR) of death for H compared to N was 1. 8 (1. 4-2. 35) and adjusted HR was 1. 45 (1. 1-1. 9). Conclusions: Hyponatremic patients have higher risk of sepsis, hospital length of stay and mortality. Thus hyponatremia could represent a marker of severity of underlying diseases or be a consequence of treatments during the surgical procedures, it could serve as alert for potential risk on outcome of these patients.

Slide Session : OS-HEM-09 ; Hematology : Prevalence and Mortality of Cardiac Involvement in Patients with Amyloidosis of an Institutional Registry Amyloidosis

( Maria Adela Aguirre ),( Maria Lourdes Posadas Martinez ),( Melisa Blomberg ),( Dorotea Beatriz Fantl ),( Diego Hernan Giunta ),( Fernan Gonzalez Bernaldo De Quiroz ),( Maria Florencia Grande Ratti ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Cardiac involvement is the leading cause of morbidity and mortality of amy-loidosis, especially due to light-chain (AL) and transthyretin, both wild and hereditary types. Objectives: To estimate the prevalence and mortality of patients with evidence of cardiac involvement in patients diagnosed with amyloidosis. Methods: Ambispective cohort study, with data obtained from all patients included between 01/2007 and 03/2013 with evidence of amyloidosis in the Institutional Regis-try Amyloidosis of the Hospital Italiano de Buenos Aires. The diagnostic criteria of cardiac amyloidosis were predefined. Mortality from cardiac amyloidosis was measured using a combination of active and passive assessment. Survival time was evaluated using the Kaplan-Meier estimator. SPSS 19.0 was used. Results: The registry included 126 patients and the prevalence of cardiac amyloidosis was 40% (95%, CI:31-49%). Among the 40% (50/126) of patients with confirmed amyloidosis and suspected of cardiac involvement, the median age was 72 years (IQR 79-81) and 26% were women (13/50). Suspected diagnosis of cardiac involvement was: clinical 82.4% (42/50), from complementary studies 67% (34/50), and diagnosed from another hospital 6% (3/50). From all patients with suspected cardiac involvement, 47% had con- firmed biopsy. Overall mortality of patients with cardiac involvement was 20% (11/50), the median survival was 1782 days of follow up (CI 95% 1365-2199). Conclusions: The prevalence of cardiac involvement and mortality in patients with amyloidosis was high. Advances in diagnosis of the possible causes of amyloidosis in the future will allow the detection of patients with high risk of death from cardiac causes in our country.

Poster Session : PS 0467 ; Genetics ; Quality of Life in Patients with Hereditary Hemorrhagic Telangiectasia

( Cristina Maria Elizondo ),( Carla Scarano ),( Constanza Franceschini ),( Nora Angelica Fuentes ),( Hernan Diego Giunta ),( Liliana Rojas ),( Marcelo Martin Serra ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant systemic disorder that affects 1/5000-8000 individuals worldwide. It is characterized by recurrent epistaxis, mucocutaneous telangiectasias and arteriovenous malformations (AVMs) in organs such as lung, liver, central nervous system (CNS) and gastrointestinal tract (GI); their clinical manifestations and possible complications added, frequently alters quality of life of these patients. Objective: To identify associated factors with lower quality of life in adult patients with HHT. Methods: Cross-sectional study, from 2010 to 2013, of prospectively evaluated patients, from the institutional registry of HHT at Hospital Italiano, Buenos Aires. Quality of life (QoL) was measured with the EuroQol and visual analog scale (AVS) validated for the country. Presence of epistaxis, anemia, AVMs in CNS, lung, liver, GI tract, symptoms and related complications were evaluated. Results: 127 patients were included: 33% were men, with a median age of 47 years (IQR:16). Median for QoL measured by the VAS was 69 (ICR:20.3). From the total, 96,1% presented epistaxis, from which 33,9% had severe epistaxis; 60% had anemia, 65,15% pulmonary AVMs, 39,4% were symptomatic; 19,6% had AVMs in CNS; 73,5% had hepatic AVMs and 63% had GI AVMs from which 27,6% presented symptoms. Signifi cant association was found between de median of QoL measured by VAS with: anemia (62 vs. non-anemic 77.8, p=0.001), pulmonary AVMs (62.3 vs. 71.27 without pulmonary AVMs, p=0.056), hepatic AVMs (64.67 vs. 78.15 without AVMs, p=0.012), GI AVMs (60 vs. 70 without AVMs, p=0.043) and correlation coefficient age was -0.349 age (p<0.001). Conclusions: Factors associated to decrease QoL in HHT were anemia and hepatic, pulmonary and GI AVMs. There was no difference in QoL related to epistaxis, but this could be attributed to the low number of patients without epistaxis.

Slide Session : OS-HEM-02 ; Hematology : Incidence and Hospital Mortality of Venous Thrombo-embolic Disease Among Clinical and Surgical Inpatients

( Maria Lourdes Posadas Martinez ),( Fernando Javier Vazquez ),( Fernan Gonzalez Bernaldo De Quiros ),( Liliana Paloma Rojas ),( Gabriel Dario Waisman ),( Diego Hernan Giunta ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Venous thromboembolism (VTE) is the most common cause of preventable mortality in hospitalized patients. On plus, pulmonary embolism (PE) is responsible for 5-10% of all hospital deaths. Objective: To estimate the incidence density (ID) and hospital mortality of VTE among clinical and surgical inpatients. Methods: Prospective cohort, during a period of 7 years, of incident cases of VTE, PE, and deep venous thrombosis (DVT), in patients of 17 years and older, hospitalized at the internal medicine and surgery department of a tertiary care hospital in Buenos Aires. Fatality rate of patients with VTE was calculated. Results: 2042 episodes of VTE were registered. Sixty two percent (1258) were patients from the Internal Medicine Service: 635 cases (95%, CI:601-671) presented VTE, 446 cases (95%, CI:418-476) presented DVT and 286 cases (95% CI:264-311) presented PE per 1000 person-days of hospitalization. For patients hospitalized at surgery department: 102 cases (95%, CI:96-110), 83 (95%, CI: 77-90) and 31 cases (95%, CI: 27-35) per 1000 person-days of hospitalization presented VTE, DVT and PE respectively. The VTE represented between 3 to 9 % of hospital deaths, it increases with age independently of being clinical or surgical inpatients. Conclusions: In Argentina, there are few data of incidences of VTD and hospital mortality in patients with VTE. This information may be important when assessing the need for resources for prevention, diagnosis and treatment in hospitals.