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RISS 인기검색어
- 검색키워드
- 저자 : ( Nikesh Shrestha ) (검색결과 2 건)
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( Prahlad Karki ),( Hemant Shrestha ),( Pramod Acharya ),( Nikesh Shrestha ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Studies have shown that albuminuria is associated with increased risk of morbidity and mortality after an attack of acute coronary syndrome than non-albuminuric patients. Objective: To see the occurrence of albuminuria and its prognostic signifi cance for short term outcome during hospital stay in Acute coronary syndrome. Methods: Albuminuria was measured as urinary albumin to creatinine ratio on fi rst day of admission, and divided into three categories; normoalbuminuria (M0): 30mg/ gm, microalbuminuria (M1): 30-300mg/gm, macroalbuminuria (M2): 300mg/gm. Sample size of 124 was calculated with frequency of albuminuria of 30% in ACS (CI: 95%, alpha error-0.05, power of study = 80% i.e. beta error = 0.2 and odds ratio between case and control group- 3). Patients were monitored and followed up closely during hospital stay. Results: One hundred and seventeen (117) patients out of 134 enrolled had albuminuria (87%; M1:93, M2:24). Patients presenting with blood sugar of 140 mg/dl had signifi cantly high albuminuria. The complications were more in patients with albuminuria than those with normoalbuminuria (p=0.02). Complications increased as the level of albuminuria increased with highest in macroalbuminuric group (p=0.005). In multivariate analysis, the variables which signifi cantly affected the outcome were systolic blood pressure 140 mmHg, smoking, type 2 diabetes mellitus and age > 65 years. Though albuminuria was not signifi cant variable in multivariate analysis, it showed tendency to develop complications (OR - 3.28, 95% CI: 0.95-11.4). Total leucocyte count 11,000/ mm3, type 2 diabetes mellitus, smoking, and albuminuria were found to be associated with signifi cantly increased mortality after Acute coronary syndrome. Conclusion: Albuminuria is a useful variable for predicting short term outcome. It may provide simple assessment tools for predicting outcome in ACS in resource poor settings if validated further.
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( Kumar Krishna Agrawaal ),( Prahald Karki ),( Nikesh Shrestha ),( Madhab Lamsal ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Cardiac biomarkers provide a convenient and noninvasive means to gain insights into the underlying causes and consequences of ACS that mediate the risk of recurrent events and may be targets for specifi c treatment. The role of high sensitivity C reactive protein (hsCRP) for predicting the outcome has been established.There are studies to show the prognostic importance of estimated glomerular fi ltration rate. But our population differs genetically and environmentally as compared to west. Methods: It was a Prospective observational study. The Primary Outcome was taken as all cause mortality.Consecutive patients with the diagnosis of acute coronary syndrome giving consent for the study were enrolled and followed up at 6 weeks and 6 months. Mortality and the likely cause of death were recorded along with the day since admission. HS CRP was estimated on admission, at 6 weeks and at 6 months. The eGFR was calculated using the abbreviated MDRD formula at admission, at 6 weeks and 6 months. Results: There were 108 cases of ACS in duration of 6 months.The study showed 44% of patients had STEMI; 41% had NSTEMI and 23% had UA. The HS-CRP level of > 5mg/dl was highly signifi cant for predicting mortality during hospital stay and at 6 weeks (p-<0.001). There was 11% of in hospital mortality (p<0.001). At 6 months the overall mortality was 28% (p-<0.001). Arrhythmias were observed in 27% patients (p<0.001). Cardiogenic shock complicating STEMI resulted in high patient mortality (p-0.001). There was a statistical signifi cance with low eGFR (median eGFR 45 ml/ min/1.73 m2) levels during the admission. Illiteracy, Smoking and diabetes mellitus of duration more than 10 years was associated with increased risk of mortality. Conclusions: HS CRP> 5mg/dl, the eGFR levels =30ml/min/1.73 m2, Age >75 years, albuminuria and cardiogenic shock were signifi cant in predicting mortality in patients of ACS.
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