The role of lactate-to-albumin ratio to predict 30-day risk of death in patients with sepsis in the emergency department: a decision tree analysis.

BACKGROUND: Accurately estimating the prognosis of septic patients on arrival in the emergency department (ED) is clinically challenging. The lactate-to-albumin ratio (LAR) has recently been proposed to improve the predictive performance of septic patients admitted to the ICU. OBJECTIVES: This study aims to assess whether the LAR could be used as an early prognostic marker of 30-day mortality in patients with sepsis in the ED. METHODS: A prospective observational study was conducted in the ED of the Hospital of Merano. All patients with a diagnosis of sepsis were considered. The LAR was recorded on arrival in the ED. The primary outcome measure was mortality at 30 days. The predictive role of the LAR for mortality was evaluated with the area under the ROC curve, logistic regression adjusted for the Charlson Comorbidity Index value, National Early Warning Score, and Sequential Organ Failure score, and with decision tree analysis. RESULTS: 459 patients were enrolled, of whom 17% (78/459) died at 30 days. The median LAR of the patients who died at 30 days (0.78 [0.45-1.19]) was significantly higher than the median LAR of survivors (0.42 [0.27-0.65]) (p < 0.001). The discriminatory ability of the LAR for death at 30 days was 0.738, higher than that of lactate alone (0.692), and slightly lower than that of albumin alone (0.753). The decision trees confirmed the role of the LAR as an independent risk factor for mortality. CONCLUSION: The LAR can be used as an index to better predict the 30-day risk of death in septic patients.

Chemical salivary composition and its relationship with periodontal disease and dental calculus

Aim: To determine the relationship between the chemical composition of saliva, periodontal disease and dental calculus. Methods: An observational analytical cross-sectional study was conducted with patients over 55 years of age. Ethical principles of autonomy and risk protection were applied according to the international standards. Sociodemographic and diagnosis variables (presence of dental calculus and periodontal status) were considered to measure salivary concentrations of glucose (by the glucose oxidase/peroxidase method, amylase (by the colorimetric test), urea (by the amount of indophenol), total protein (by the Bradford method) and albumin (by the nephelometric method). Patients chewed a sterile rubber band and 3 mL of stimulated saliva were collected. The samples were stored at -5 °C, centrifuged at 2,800 rpm for 10 min, and the supernatant was removed and stored at -20 °C. Data were presented as frequencies and proportions for qualitative variables and measures of central tendency and dispersion for quantitative variables. Data were analyzed by either analysis of variance or Kruskal Wallis test . A p value <0.05 was considered statistically significant. Results: Significant relationships were observed between the concentration of salivary urea and periodontal status (p = 0.03) and the presence of dental calculus and urea (p = 0.04) was demonstrated. Conclusions: A relationship between the salivary urea concentration and the presence of periodontal disease and dental calculus is suggested.

La Mini Encuesta Nutricional del Anciano en la práctica de un Servicio hospitalario de Geriatría: Introducción, validación y características operacionales / The Mini Nutritional Assessment of the elderly in the practice of a hospital geriatrics service: inception, validation and operational characteristics

Se presentan los resultados de la administración de la Mini Encuesta Nutricional del Anciano (MNA) a 197 pacientes (Mujeres: 62.5%; Edades entre 60 – 75 años: 55.4%; Mayores de 85 años: 9.7%; Blancos: 73.7%) que ingresaron consecutivamente en el Servicio de Geriatría del Hospital Clínico-Quirúrgico “Hermanos Ameijeiras” (La Habana, Cuba). El 69.6% de los pacientes tenía entre 2 – 7 problemas de salud concurrentes. Predominaron las neoplasias y los procesos linfoproliferativos (22.8%), las afecciones del corazón y los vasos sanguíneos (15.7%), y las infecciones (12.2%). El estado de los indicadores nutricionales antropométricos y bioquímicos fue como sigue: Indice de Masa Corporal < 21 kg.m2: 30.9%; Circunferencia del Brazo < 22 cm: 19.3%; Circunferencia de la Pantorrilla < 31 cm: 42.6%; Albúmina < 35 g.L-1: 20.3%. El 68.5% de los pacientes recibió puntajes < 24 después de administrada la MNA. Es de notar que el 19.3% de los encuestados estaba desnutrido al recibir puntajes < 17. Los puntajes < 24 se concentraron en: Afecciones neurológicas (80.0%), Neoplasias y procesos linfoproliferativos (77.8%), Corazón y vasos sanguíneos (74.2%), Enfermedades gastrointestinales (70.6%), Infecciones (69.7%), Diabetes mellitus (66.7%). Los pacientes con los puntajes nutricionales más bajos presentaron los valores más bajos de los indicadores antropométricos y bioquímicos. El puntaje nutricional fue independiente del sexo del enfermo, color de la piel o el número de problemas de salud concurrentes. La edad no influyó en el puntaje nutricional, pero se observaron puntajes más bajos entre los pacientes más ancianos. El puntaje asignado mediante la MNA coincidió en un 80.0% con el diagnóstico nutricional hecho independientemente mediante indicadores bioquímicos y antropométricos, utilizados por separado o combinados. El envejecimiento de la población cubana, unido a una geriatrización de las áreas hospitalarias, obligan a considerar el estado nutricional del paciente may...

The results of the administration of the Mini Nutritional Assessment (MNA) of the Elderly to 197 patients (Women: 62.5%; Ages between 60 – 75 years: 55.4%; Older than 85 years: 9.7%; Whites: 73.7%) consecutively admitted to the Geriatrics Service of the “Hermanos Ameijeiras” Hospital (La Habana, Cuba) are presented. Sixty-nine percent of the patients had between 2 – 7 concurrent health problems. Neoplasms and lymphoproliferative processes (22.8%), heart and blood vessels diseases (15.7%), and infections (12.2%) were prevalent. The state of nutritional anthropometric and biochemical markers was as follows: Body Mass Index < 21 kg.m-2: 30.9%; Mid-arm Circumference < 22 cm: 19.3%; Leg Circumference < 31 cm: 42.6%; Serum Albumin < 35 g.L-1: 20.3%. Sixty-eight percent of the patients received scores < 24 after administering the MNA. It is to be noticed that 19.3% of the patients was malnourished after receiving scores < 17. MNA scores < 24 were concentrated in: Neurological disorders (80.0%), Neoplasms and lymphoproliferative processes (77.8%), heart and blood vessels diseases (74.2%), gastrointestinal disorders (70.6%), infections (69.7%), Diabetes mellitus (66.7%). Patients with the lowest scores also exhibited the lowest values of anthropometric and biochemical markers. MNA score was independent from the patient’s sex, skin colour, or number of concurrent health problems. Age had not any influence upon MNA score, although lower scores were observed among the oldest patients. MNA scoring was 80.0% coincident with nutritional diagnosis independently done with anthropometric and biochemical markers used either separately or combined. Aging of the Cuban population, along with increased proportions of elder patients in hospital areas should lead to consider the nutritional status of patients older than 60 years as an important predictor of the success of medical interventions and the quality of medical assistance.

Los pirógenos y la albúmina / Pyrogens and albumin

Los pirógenos han sido y son en la actualidad uno de los principales problemas que presentan en la Industría Farmacéutica al nivel mundial y por eso varios han sido los intentos por estandarizar un método para su análisis y numerosos los esfuerzos por eliminarlos de las soluciones contaminadas. Pero sólo el método que emplea al conejo es el que se acepta internacionalmente como oficial. Con respecto a la eliminación del pirógeno podemos decir que resulta más conveniente evitarlo que suprimirlo. Los productos de origen biológico son de los que mayor complicación presentan a la hora de su análisis y en donde menos se ha profundizado. Este trabajo tiene por objetivo dar a conocer los aspectos fundamentales estudiados hasta el presente sobre los pirógenos e introducir el aspecto del mismo en la albúmina como tema que cobra en nuestro país gran actualidad