Profil faktora rizika od oštećenja jetre kod hospitalizovanih kardioloških bolesnika

  • Jovan Jovanović Clinical Center “Kragujevac”, Clinic for Cardiology, Kragujevac, Serbia
  • Dragan R. Milovanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Predrag Sazdanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Maja Sazdanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Milan Radovanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Ljiljana Novković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Vladimir Zdravković Clinical Center “Kragujevac”, Clinic for Cardiology, Kragujevac, Serbia
  • Nemanja Zdravković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Ivan Simić Clinical Center “Kragujevac”, Clinic for Cardiology, Kragujevac, Serbia
  • Dejana Ružić Zečević University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Slobodan M. Janković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP180702171J
Ključne reči: alkohol, pijenje, amjodaron, kardiovaskularne bolesti, jetra, oštećenje, hemijsko i lekovima izazvano, lekovi, toksičnost, hospitalizacija, gojaznost, faktori rizika

Sažetak


Uvod/Cilj. Oštećenje jetre, sa potencijalno ozbiljnim posledicama, nije retka pojava kod hospitalizovanih kardioloških bolesnika. Cilj studije bio je ispitivanje profila faktora rizika od oštećenja jetre kod bolesnika hospitalizovanih zbog pogoršanja akutne ili hronične kardiološke bolesti. Metode. Studija je bila opservacionog dizajna, tipa slučaj-kontrola, uz retrospektivno prikupljanje podataka uvidom u istorije bolesti odraslih bolesnika lečenih u tercijarnoj zdravstvenoj ustanovi. Slučajevi (n = 140) su bili bolesnici sa novonastalim oštećenjem jetre (koja se razvila tokom hospitalizacije), a po tri kontrolna bolesnika (n = 420), komparabilna po godinama i datumu hospitalizacije, pridruženi su svakom slučaju. Primarni ishod je bila hepatotoksičnost (simptomatska ili asimptomatska), a nezavisne varijable su bile predložene kao faktori rizika. Statistička analiza je uključivala deskriptivne metode, ispitivanje hipoteze i univarijantnu i multivarijantnu binarnu logističku regresiju, sa p ≤ 0.05. Rezultati. Od ukupne studijske populacije, 432 (77,1%) osobe su bile ženskog pola, a srednja vrednost godina bolesnika iznosila je 64,1 godina [standardna devijacija (SD) = 10,7; opseg 24–85]. Najčešće bolesti su bile koronarna bolest (n = 385), hipertenzija (n = 334) i aritmija (n = 115). Srednja vrednost Charlson Comorbidity Index-a (CCI) bila je 3.8 (SD = 1,7; opseg 1–10), što je bilo u skladu sa procenjenim CCI 10-ogodišnjim preživljavanjem od 54,4% (SD = 33,5%). U grupi slučajeva, 114 (81.4%) bolesnika imalo je hepatocelularni tip, 9 (6,4%) holestatski tip, a 17 (12,2%) mešoviti tip oštećenja jetre. Nezavisni prediktori hepatotoksičnog događaja su bili: prethodna povremena konzumacija alkohola [odds ratio (OR) 96,47; 95% interval poverenja (IP) 28,95–321,43; p < 0,001], upotreba amiodarona (OR 3,70; 95% IP 1,82–7,53; p < 0,001), enoksaparina (OR 3,29; 95% IP 1,79–6,05; p < 0,001) i atorvastatina (OR 2,67; 95% IP 1,33–5,38; 0,006), gojaznost (OR 2,78; 95% IP 1,15–6,71; 0,023) i ukupni CCI skor (OR 1,89; 95% IP 1,53–2,34; p < 0,001). Zaključak. Glavni faktori povezani sa akutnim oštećenjem jetre kod bolesnika hospitalizovanih na kardiološkom odeljenju u institucijama tercijarne zdravstvene nege su konstitucionalne karakteristike i navike bolesnika (povremeni unos alkohola, gojaznost, CCI skor) i lekovi za koje se zna da imaju hepatotoksični potencijal (amjodaron, enoksaparin, atorvastatin).

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2021/03/04
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Vol. 77 Br. 9 (2020): Vojnosanit pregl
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