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Os parâmetros do hemograma na predição da recorrência vascular precoce após AIT
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Introdução: Após um Acidente Isquémico Transitório (AIT), definido como episódio de disfunção neurológica transitória (< 24 horas) atribuível a causa vascular, existe risco de ocorrência de eventos vasculares, particularmente nos 30 dias seguintes.
Objetivo: Analisar se os valores do hemograma de doentes com AIT contribuem para identificar doentes com maior risco de ocorrência de um evento vascular (AVC, AIT, enfarte agudo miocárdio ou morte vascular) aos 30 dias. Métodos: Estudo de tipo coorte retrospetivo, incluindo doentes de forma consecutiva na Consulta de AIT do Hospital de Santa Maria (HSM), referenciados do Serviço de Urgência do HSM, entre 2004 e 2011. Efetuou-se uma análise univariada para avaliar a associação entre os dados do hemograma (hematócrito, hemoglobina, contagem de plaquetas (CP), volume plaquetário médio (VPM), razão VPM/CP, contagem de neutrófilos e linfócitos) e a ocorrência do prognóstico (qualquer evento vascular) aos 30 dias. Realizou-se uma análise de regressão logística ajustada para as outras variáveis associadas ao prognóstico.
Resultados: O estudo incluiu 337 doentes com o diagnóstico de AIT. Verificou-se a ocorrência de 43 eventos vasculares (12,8%, IC 95% 9,7-16,8), a maioria AVC (7,8%, IC 95% 5,4 – 11,2) ou AIT (4,8%, IC 95% 2,9-7,6) até aos 30 dias após AIT. Na análise de regressão logística, observou-se uma relação negativa significativa entre a contagem total de linfócitos e a recorrência de eventos vasculares (Odds ratio (OR) = 0,630, IC 95% 0,405 – 0,981; p=0,041). Embora sem significado estatístico, documentou-se a tendência de uma relação positiva entre o VPM e a recorrência de eventos vasculares (OR=1.332, 95% IC 0.997 - 1.780; p=0.053).
Conclusões: Este estudo exploratório sugere que marcadores do hemograma, simples de obter na admissão dos doentes com AIT, poderão merecer futura investigação para incorporar escalas ou pontuações de predição de risco precoce em doentes com AIT.
Palavras-chave: acidente isquémico transitório, hemograma, recorrência vascular.
Introduction: After a Transient Ischemic Attack (TIA), defined as an episode of transient neurological dysfunction (< 24 hours) attributable to a vascular cause, there is a risk of vascular events, particularly in the following 30 days. Aim: To evaluate whether analysis of the hemogram values of patients who suffered a TIA is useful in identifying patients at a higher risk of vascular events (stroke, TIA, acute myocardial infarction or vascular death) at 30 days. Methods: Retrospective cohort study, including consecutive patients attending a TIA Clinic at Hospital de Santa Maria (HSM), referred from the HSM Emergency Department, between 2004 and 2011. We first performed univariate analysis to evaluate the association between hemogram values (hematocrit, hemoglobin, platelet count (PC), mean platelet volume (MPV), neutrophil and lymphocyte count) and the prognosis (any vascular event) at 30 days. We subsequently performed a logistic regression to adjust to variables associated with the prognosis. Results: There were 43 vascular events (12.8%, 95% CI 9.7-16.8), mostly stroke (7.8%, 95% CI 5.4 - 11.2) or TIA (4.8%, 95% CI 2.9-7.6) within 30 days after a TIA. In the logistic regression analysis, a significant negative relationship was observed between the total lymphocyte count and the recurrence of vascular events (Odds ratio (OR) = 0.630, 95% CI 0.405 - 0.981; p=0.041). Although without statistical significance, a trend towards a positive relationship between MPV and the recurrence of vascular events was documented (OR=1.332, 95% CI 0.997 - 1.780; p=0.053). Conclusions: This exploratory study suggests that hemogram markers, easy to obtain on the admission of patients who suffered a TIA, might require future investigation to incorporate scales or scores for early risk prediction in patients with a TIA.
Introduction: After a Transient Ischemic Attack (TIA), defined as an episode of transient neurological dysfunction (< 24 hours) attributable to a vascular cause, there is a risk of vascular events, particularly in the following 30 days. Aim: To evaluate whether analysis of the hemogram values of patients who suffered a TIA is useful in identifying patients at a higher risk of vascular events (stroke, TIA, acute myocardial infarction or vascular death) at 30 days. Methods: Retrospective cohort study, including consecutive patients attending a TIA Clinic at Hospital de Santa Maria (HSM), referred from the HSM Emergency Department, between 2004 and 2011. We first performed univariate analysis to evaluate the association between hemogram values (hematocrit, hemoglobin, platelet count (PC), mean platelet volume (MPV), neutrophil and lymphocyte count) and the prognosis (any vascular event) at 30 days. We subsequently performed a logistic regression to adjust to variables associated with the prognosis. Results: There were 43 vascular events (12.8%, 95% CI 9.7-16.8), mostly stroke (7.8%, 95% CI 5.4 - 11.2) or TIA (4.8%, 95% CI 2.9-7.6) within 30 days after a TIA. In the logistic regression analysis, a significant negative relationship was observed between the total lymphocyte count and the recurrence of vascular events (Odds ratio (OR) = 0.630, 95% CI 0.405 - 0.981; p=0.041). Although without statistical significance, a trend towards a positive relationship between MPV and the recurrence of vascular events was documented (OR=1.332, 95% CI 0.997 - 1.780; p=0.053). Conclusions: This exploratory study suggests that hemogram markers, easy to obtain on the admission of patients who suffered a TIA, might require future investigation to incorporate scales or scores for early risk prediction in patients with a TIA.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Acidente isquémico transitório Hemograma Recorrência vascular Neurologia