Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study.

OBJECTIVE: To evaluate procalcitonin clearance as a prognostic biomarker in septic shock. DESIGN: Prospective, observational pilot study. SETTING: Intensive care unit. PATIENTS: Patients admitted to the ICU due to septic shock and multiorgan dysfunction. INTERVENTIONS: Serum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. DATA COLLECTED: Demographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). RESULTS: Procalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4-83.8]% vs 22.7 [-331-58.4], p<0.05) and 48h (81.6 [71.6-91.3]% vs -7.29 [-108.2-82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54-0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69-1.0, p<0.05) at 48h. CONCLUSIONS: ICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker.

[Domestic violence: prevalence of suspected ill treatment of the elderly]. / Violencia doméstica: prevalencia de sospecha de maltrato a ancianos.

OBJECTIVE: To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables. DESIGN: Cross-sectional study.Setting. Les Planes (Sant Joan Despí, Barcelona). Urban Health District. PATIENTS: 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study. MEASUREMENTS AND RESULTS: The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p < 0.01), receiving social assistance 46% (p < 0.001), being a widow/widower 21% (p < 0.01), not having had paid employment 20% (p < 0.04) and having a rotating residence 28% (p < 0.003). On application of multivariate analysis, being a woman (OR 4.99) and receiving social assistance (OR 7.55) maintained their significance. The presumed perpetrators were son/daughter (57%), spouse (8%), son/daughter-in-law (23%). 19% of these were drug-dependent and 15% suffered psychiatric disorders. CONCLUSIONS: The high prevalence of ITE is clear. These results should alert doctors to a previously under-rated health problem.