A new mass spectrometry-based method for the quantification of histones in plasma from septic shock patients.

The aim of this study was to develop a novel method to detect circulating histones H3 and H2B in plasma based on multiple reaction monitoring targeted mass spectrometry and a multiple reaction monitoring approach (MRM-MS) for its clinical application in critical bacteriaemic septic shock patients. Plasma samples from 17 septic shock patients with confirmed bacteraemia and 10 healthy controls were analysed by an MRM-MS method, which specifically detects presence of histones H3 and H2B. By an internal standard, it was possible to quantify the concentration of circulating histones in plasma, which were significantly higher in patients, and thus confirmed their potential as biomarkers for diagnosing septic shock. After comparing surviving patients and non-survivors, a correlation was found between higher levels of circulating histones and unfavourable outcome. Indeed, histone H3 proved a more efficient and sensitive biomarker for septic shock prognosis. In conclusion, these findings suggest the accuracy of the MRM-MS technique and stable isotope labelled peptides to detect and quantify circulating plasma histones H2B and H3. This method may be used for early septic shock diagnoses and for the prognosis of fatal outcomes.

Grado de adherencia al tratamiento antivírico recomendado durante la pandemia y periodo pospandémico de gripe A (H1N1) pdm09 en 148 unidades de cuidados intensivos españolas / Degree of adherence to recommended antiviral treatment during the pandemic and post-pandemic periods of influenza A (H1N1) pdm09 in 148 intensive care units in Spain

OBJETIVO: Evaluar el grado de adherencia a las recomendaciones sobre el tratamiento antivírico y su impacto en la mortalidad de pacientes críticos afectados por gripe A (H1N1) pdm09. DISEÑO: Análisis secundario de estudio prospectivo. ÁMBITO: Medicina intensiva (UCI). PACIENTES: Pacientes con gripe A (H1N1) pdm09 en el periodo pandémico 2009 y pospandémico 2010-11. Variables La adherencia a las recomendaciones se clasificó en: total (AT), parcial dosis (PD), parcial tiempo (PT) y no adherencia (NA). La neumonía vírica, obesidad y ventilación mecánica fueron considerados criterios de gravedad para el uso de dosificaciones elevadas de antivírico (CG). Análisis mediante «chi» cuadrado y t-test. Supervivencia mediante regresión de Cox. RESULTADOS: Se incluyeron 1.058 pacientes, 661(62,5%) en pandemia y 397 (37,5%) en pospandemia. La AT global del estudio fue del 41,6% (el 43,9% y el 38%, respectivamente; p = 0,07). Los pacientes con criterios de gravedad no fueron diferentes en ambos periodos (un 68,5% y un 62,8%; p = 0,06). En estos pacientes la AT fue del 54,7% durante el 2009 y del 36,4% en pospandemia (p < 0,01). La NA (19,7% vs. 11,3%; p < 0,05) y la PT (20,8% vs. 9,9%; p < 0,01) fueron más frecuentes durante la pospandemia. La mortalidad fue mayor en la pospandemia (30% vs. 21,8%; p < 0,001). El APACHE II(HR = 1,09) y la enfermedad hematológica (HR = 2,2) se asociaron a mortalidad y la adherencia (HR = 0,47) fue un factor protector. CONCLUSIONES: Se evidencia un bajo grado de adherencia al tratamiento en ambos periodos. La adherencia al tratamiento antivírico se asocia con menor mortalidad y debería ser recomendada en pacientes críticos afectados por gripe A (H1N1) pdm09

OBJECTIVE: To determine the degree of antiviral treatment recommendations adherence and its impact to critical ill patients affected by influenza A (H1N1) pdm09 mortality. DESIGN: Secondary analysis of prospective study. SETTING: Intensive care (UCI). PATIENTS: Patients with influenza A(H1N1)pdm09 in the 2009 pandemic and 2010-11 post-Pandemic periods. Variables Adherence to recommendations was classified as: Total (AT); partial in doses (PD); partial in time (PT), and non-adherence (NA). Viral pneumonia, obesity and mechanical ventilation were considered severity criteria for the administration of high antiviral dose. The analysis was performed using t-test or «chi» square. Survival analysis was performed and adjusted by Cox regression analysis. RESULTS: A total of 1,058 patients, 661 (62.5%) included in the pandemic and 397 (37.5%) in post-pandemic period respectively. Global adherence was achieved in 41.6% (43.9% and 38.0%; P = .07 respectively). Severity criteria were similar in both periods (68.5% vs. 62.8%; P = .06). The AT was 54.7% in pandemic and 36.4% in post-pandemic period respectively (P <.01). The NA (19.7% vs. 11.3%; P <.05) and PT (20.8% vs. 9.9%, P < .01) was more frequent in the post-pandemic period. The mortality rate was higher in the post-pandemic period (30% vs. 21.8%, P <.001). APACHE II (HR=1.09) and hematologic disease (HR = 2.2) were associated with a higher mortality and adherence (HR=0.47) was a protective factor. CONCLUSIONS: A low degree of adherence to the antiviral treatment was observed in both periods. Adherence to antiviral treatment recommendations was associated with lower mortality rates and should be recommended in critically ill patients with suspected influenza A(H1N1)pdm09

Degree of adherence to recommended antiviral treatment during the pandemic and post-pandemic periods of influenza A(H1N1)pdm09 in 148 intensive care units in Spain.

OBJECTIVE: To determine the degree of antiviral treatment recommendations adherence and its impact to critical ill patients affected by influenza A(H1N1)pdm09 mortality. DESIGN: Secondary analysis of prospective study. SETTING: Intensive care (UCI). PATIENTS: Patients with influenza A(H1N1)pdm09 in the 2009 pandemic and 2010-11 post-Pandemic periods. VARIABLES: Adherence to recommendations was classified as: Total (AT); partial in doses (PD); partial in time (PT), and non-adherence (NA). Viral pneumonia, obesity and mechanical ventilation were considered severity criteria for the administration of high antiviral dose. The analysis was performed using t-test or «chi¼ square. Survival analysis was performed and adjusted by Cox regression analysis. RESULTS: A total of 1,058 patients, 661 (62.5%) included in the pandemic and 397 (37.5%) in post-pandemic period respectively. Global adherence was achieved in 41.6% (43.9% and 38.0%; P=.07 respectively). Severity criteria were similar in both periods (68.5% vs. 62.8%; P=.06). The AT was 54.7% in pandemic and 36.4% in post-pandemic period respectively (P<.01). The NA (19.7% vs. 11.3%; P<.05) and PT (20.8% vs. 9.9%, P<.01) was more frequent in the post-pandemic period. The mortality rate was higher in the post-pandemic period (30% vs. 21.8%, P<.001). APACHE II (HR=1.09) and hematologic disease (HR=2.2) were associated with a higher mortality and adherence (HR=0.47) was a protective factor. CONCLUSIONS: A low degree of adherence to the antiviral treatment was observed in both periods. Adherence to antiviral treatment recommendations was associated with lower mortality rates and should be recommended in critically ill patients with suspected influenza A(H1N1)pdm09.

Macrolide-based regimens in absence of bacterial co-infection in critically ill H1N1 patients with primary viral pneumonia.

PURPOSE: To determine whether macrolide-based treatment is associated with mortality in critically ill H1N1 patients with primary viral pneumonia. METHODS: Secondary analysis of a prospective, observational, multicenter study conducted across 148 Intensive Care Units (ICU) in Spain. RESULTS: Primary viral pneumonia was present in 733 ICU patients with pandemic influenza A (H1N1) virus infection with severe respiratory failure. Macrolide-based treatment was administered to 190 (25.9 %) patients. Patients who received macrolides had chronic obstructive pulmonary disease more often, lower severity on admission (APACHE II score on ICU admission (13.1 ± 6.8 vs. 14.4 ± 7.4 points, p < 0.05), and multiple organ dysfunction syndrome less often (23.4 vs. 30.1 %, p < 0.05). Length of ICU stay in survivors was not significantly different in patients who received macrolides compared to patients who did not (10 (IQR 4-20) vs. 10 (IQR 5-20), p = 0.9). ICU mortality was 24.1 % (n = 177). Patients with macrolide-based treatment had lower ICU mortality in the univariate analysis (19.2 vs. 28.1 %, p = 0.02); however, a propensity score analysis showed no effect of macrolide-based treatment on ICU mortality (OR = 0.87; 95 % CI 0.55-1.37, p = 0.5). Moreover, the sensitivity analysis revealed very similar results (OR = 0.91; 95 % CI 0.58-1.44, p = 0.7). A separate analysis of patients under mechanical ventilation yielded similar results (OR = 0.77; 95 % CI 0.44-1.35, p = 0.4). CONCLUSION: Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia.

[Consensus document on vaccination against influenza in health care workers]. / Consenso sobre la vacunación frente a la gripe en el personal sanitario.

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary.

Consenso sobre la vacunación frente a la gripe en el personal sanitario / No disponible

El personal sanitario se encuentra incluido cada año entre los grupos de riesgo con indicación para vacunarse frente a la gripe. No obstante, las coberturas vacunales entre el personal sanitario en nuestro país son muy bajas, no superando el 25%. Convencidos de que una de las mejores herramientas para aumentar estas coberturas entre los profesionales de nuestro país son las evidencias científicas, 19 Sociedades Científicas y Asociaciones Profesionales que agrupan a los profesionales sanitarios más directamente relacionados con la gripe como problema de salud, así como el Consejo General de Enfermería, se han reunidopara debatir y elaborar este documento de consenso con el objetivo de concienciar al personal sanitario sobre la conveniencia de su vacunación frente a la gripe y de los beneficios que de ella se derivan para sí mismos, para sus pacientes y para el resto de la población. Esta recomendación está basada en 3 pilares básicos: argumento de necesidad, de ética y de ejemplaridad

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tolos to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary

Vacuna neumocócica en fumadores / No disponible

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Infecciones comunitarias que requieren ingreso en UCI / Community infections that require admission to the ICU

Se analizan las características clínicas, diagnóstico y tratamiento de las infecciones comunitarias más graves y frecuentes en la UCI: neumonías comunitarias graves, meningitis, encefalitis e infecciones del tracto urinario. Con respecto a las neumonías se hace hincapié en la utilización de las escalas de gravedad para valorar el ingreso en las unidades de críticos, así como en la monitorización evolutiva mediante los marcadores biológicos y en la importancia de instaurar un tratamiento antibiótico precoz adecuado. Se resalta la importancia del Gram de líquido cefalorraquídeo en el diagnóstico etiológico de la meningitis, así como de las técnicas de amplificación por reacción en cadena de polimerasa a tiempo real y de la RM en el diagnóstico etiológico de las encefalitis. Asimismo, se expresa la preocupación por el aumento del porcentaje de cepas de Escherichia coli y Klebsielella pneumoniae productoras de betalactamasas de espectro extendido en nuestro país (AU)

The clinical and diagnostic characteristics and treatment of the most severe and frequent community-acquired infections in the Intensive Care Units are analyzed. These are serious community-acquired pneumonias, meningitis, encephalitis and urinary tract infections. Regarding the pneumonias, emphasis is placed on the use of the severity scales to evaluate admission in the critical units, on evolutive monitoring using biological markers and on the importance of initiating adequate early antibiotic treatment. The importance of the Gram staining of the cerebral spinal fluid in the etiological diagnosis of meningitis, of the polymerase chain reaction amplification techniques in real time and of the magnetic resonance imaging in the etiological diagnosis of the encephalitis. Furthermore, concern is expressed regarding the increase of the percentage of the strains of extended spectrum betalactamase-producing Escherichia coli and Klebsiella pneumoniae in our country (AU)

[Community infections that require admission to the ICU]. / Infecciones comunitarias que requieren ingreso en UCI.

The clinical and diagnostic characteristics and treatment of the most severe and frequent community-acquired infections in the Intensive Care Units are analyzed. These are serious community-acquired pneumonias, meningitis, encephalitis and urinary tract infections. Regarding the pneumonias, emphasis is placed on the use of the severity scales to evaluate admission in the critical units, on evolutive monitoring using biological markers and on the importance of initiating adequate early antibiotic treatment. The importance of the Gram staining of the cerebral spinal fluid in the etiological diagnosis of meningitis, of the polymerase chain reaction amplification techniques in real time and of the magnetic resonance imaging in the etiological diagnosis of the encephalitis. Furthermore, concern is expressed regarding the increase of the percentage of the strains of extended spectrum betalactamase-producing Escherichia coli and Klebsiella pneumoniae in our country.

Neumonía en la población mayor de 70 años y con estado funcional limitado: estudio caso-control de pacientes institucionalizados / Pneumonia in the elderly population over 70 year with limited functional condition: case-control study of institutionalized patients

Objetivo. La neumonía adquirida en la comunidad (NAC) de los ancianos supone un problema sanitario de importancia creciente por su prevalencia y mortalidad. Entre los factores que habitualmente se relacionan con una mala evolución destacan la edad avanzada, el mal estado funcional y la procedencia de una institución sociosanitaria como las residencias de ancianos. En este estudio hemos seleccionado una población mayor de 70 años con una capacidad funcional limitada (índice de Barthel < 50) con el objetivo de conocer si el proceder de una residencia de ancianos es un factor aislado que se asocia a un peor pronóstico de la NAC. Pacientes y método. Seleccionamos 87 pacientes mayores de 70 años de un estudio longitudinal prospectivo y multicéntrico de las NAC hospitalizadas durante un año. Analizamos la evolución y el curso de la NAC en función de su lugar de procedencia y realizamos después un estudio caso-control de los ancianos mayores de 70 años con índice de Barthel inferior a 50, incluyendo 21 ancianos procedentes de residencia y 21 procedentes de su domicilio particular. Resultados. En la NAC de los pacientes mayores de 70 años, los que proceden de residencia presentan con más frecuencia cuadro confusional y llegan a Urgencias con menores cifras de presión arterial sistólica y diastólica, menor saturación arterial de oxígeno, mayor afectación radiológica y peor índice de Fine, a lo que se suma que fallecen con más frecuencia. Cuando limitamos la población a mayores de 70 años con índice de Barthel menor de 50, no encontramos diferencias en los pacientes institucionalizados frente al resto. Conclusión. En los ancianos mayores de 70 años con NAC, aquéllos que proceden de residencias asistidas tienen mayor mortalidad, sin embargo cuando la capacidad funcional es mala (Barthel < 50) el lugar de procedencia (comunidad o residencia de ancianos) pierde importancia y se convierte en una variable que no influye más que otras en la evolución y el curso clínico de la NAC (AU)

Objective. Community acquired pneumonia (CAP) of the elderly is an increasingly important growing health problem due to its prevalence and mortality. Among the factors that are usually related with poor evolution are advanced age, poor functional status and coming from a socio-health care institution such as residential homes for the elderly. In this study, we have chosen a population over 70 years of age with limited functional capacity (Barthel Index < 50) in order to know if coming from a residential home for the elderly is an isolated factor that is associated to worse prognosis of CAP. Patients and methods. We selected 87 patients over 70 years from a prospective and multicenter study of the hospitalized CAPs during one year. We analyzed the evolution and course of the CAP based on place or origin and then conducted a case-control study of the elderly over 70 years with the Barthel under 50, including 21 elderly from residences and 21 from the own home. Results. In elderly patients over 70 years with CAP, those coming from the residence have a confusional picture more often and come to emergency with lower values of systolic and diastolic blood pressure, lower arterial oxygen saturation, greater involvement on the x-ray, Fine Index is worse and die more often. When we limit the population to those over 70 years with Barthel under 50, we do not find differences in institutionalized patients versus the others. Conclusion. In the elderly over 70 years with CAP, patients from assisted living residences have greater mortality. However, when functional capacity is bad (Barthel < 50), place or origin (community or elderly residence) loses importance and becomes a variable that has no more influence than others in the clinical evolution and course of the CAP (AU)

[Pneumonia in the elderly population over 70 years with limited functional condition: case-control study of institutionalized patients]. / Neumonía en la población mayor de 70 años y con estado funcional limitado: estudio caso-control de pacientes institucionalizados.

OBJECTIVE: Community acquired pneumonia (CAP) of the elderly is an increasingly important growing health problem due to its prevalence and mortality. Among the factors that are usually related with poor evolution are advanced age, poor functional status and coming from a socio-health care institution such as residential homes for the elderly. In this study, we have chosen a population over 70 years of age with limited functional capacity (Barthel Index < 50) in order to know if coming from a residential home for the elderly is an isolated factor that is associated to worse prognosis of CAP. PATIENTS AND METHODS: We selected 87 patients over 70 years from a prospective and multicenter study of the hospitalized CAPs during one year. We analyzed the evolution and course of the CAP based on place or origin and then conducted a case-control study of the elderly over 70 years with the Barthel under 50, including 21 elderly from residences and 21 from the own home. RESULTS: In elderly patients over 70 years with CAP, those coming from the residence have a confusional picture more often and come to emergency with lower values of systolic and diastolic blood pressure, lower arterial oxygen saturation, greater involvement on the x-ray, Fine Index is worse and die more often. When we limit the population to those over 70 years with Barthel under 50, we do not find differences in institutionalized patients versus the others. CONCLUSION: In the elderly over 70 years with CAP, patients from assisted living residences have greater mortality. However, when functional capacity is bad (Barthel < 50), place or origin (community or elderly residence) loses importance and becomes a variable that has no more influence than others in the clinical evolution and course of the CAP.

Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival.

BACKGROUND: The purpose of our study was to analyze prognostic factors associated with mortality for patients with severe community-acquired pneumonia (CAP). METHODS: We conducted a prospective multicenter study including all patients with CAP admitted to the intensive care unit during a 15-month period in 33 Spanish hospitals. Admission data and data on the evolution of the disease were recorded. Multivariate analysis was performed using the SPSS statistical package (SPSS). RESULTS: A total of 529 patients with severe CAP were enrolled; the mean age (+/-SD) was 59.9+/-16.1 years, and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/-SD) was 18.9+/-7.4. Overall mortality among patients in the intensive case unit was 27.9% (148 patients). The rate of adherence to Infectious Diseases Society of America (IDSA) guidelines was 57.8%. Significantly higher mortality was documented among patients with nonadherence to treatment (33.2% vs. 24.2%). Multivariate analysis identified age (odds ratio [OR], 1.7), APACHE II score (OR, 4.1), nonadherence to IDSA guidelines (OR, 1.6), and immunocompromise (OR, 1.9) as the variables present at admission to the intensive care unit that were independently associated with death in the intensive care unit. In 15 (75%) of 20 cases of Pseudomonas aeruginosa infection, the antimicrobial treatment at admission was inadequate (including 8 of 15 cases involving patients with adherence to IDSA guidelines). Chronic obstructive pulmonary disease (OR, 17.9), malignancy (OR, 11.0), previous antibiotic exposure (OR, 6.2), and radiographic findings demonstrating rapid spread of disease (OR, 3.9) were associated with P. aeruginosa pneumonia. CONCLUSIONS: Better adherence to IDSA guidelines would help to improve survival among patients with severe CAP. Pseudomonas coverage should be considered for patients with chronic obstructive pulmonary disease, malignancy, or recent antibiotic exposure.

Unidades de cuidados respiratorios intermedios. Definición y características / Intermediate respiratory intensive care units: definitions and characteristics

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Guías para el manejo de la neumonía comunitaria del adulto que precisa ingreso en el hospital / Guidelines for the management of community pneumonia in adult who needs hospitalization

La neumonía adquirida en la comunidad (NAC) sigue siendo un problema sanitario de primer orden. En España, la incidencia de este tipo de infección es de 162 casos por cada 100.000 habitantes, lo que supone 53.000 hospitalizaciones al año y un coste de 115 millones de euros. Además, en los últimos años se han producido avances significativos en el conocimiento de la etiología y el diagnóstico de la enfermedad. Al mismo tiempo se está consiguiendo una mejor comprensión del problema derivado del aumento de las resistencias bacterianas, y han aparecido nuevas alternativas terapéuticas para el manejo de esta enfermedad. Por todo ello, un grupo de expertos pertenecientes a tres sociedades científicas de nuestro país (Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias - SEMICYUC; Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica - SEIMC; Sociedad Española de Neumología y Cirugía Torácica - SEPAR) se han reunido para, tras una revisión crítica de la literatura, elaborar las presentes Guías para el manejo de la NAC. En ellas se abordan aspectos de epidemiología, índices pronósticos, etiología, diagnóstico, tratamiento y prevención de la enfermedad. El objetivo que se persigue es ayudar a los clínicos en la toma de decisiones, sin olvidar destacar la importancia que tiene el conocer las características particulares de la NAC en cada zona

Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention

[Guidelines for the management of community pneumonia in adult who needs hospitalization]. / Guías para el manejo de la neumonía comunitaria del adulto que precisa ingreso en el hospital.

Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention.

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.

BACKGROUND: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

Sepsis and SOFA score: related outcome for critically ill renal patients.

AIMS: To evaluate the influence of sepsis in critically ill patients with acute renal failure (ARF), and to analyze the value of the sequential organ failure assessment (SOFA) score for assessing the morbidity and related mortality of these patients. MATERIAL AND METHODS: A prospective observational study developed in a medical intensive care unit (ICU) of a tertiary care university hospital. Data were collected from January 1, 2001 - July 31, 2002. The inclusion criterion was either a creatinine plasma level > or = 2 mg/dl on ICU admission or increases > or = 30% from its initial value. Sepsis was evaluated at the time of study inclusion, and patients were distributed into 2 groups (septic and nonseptic patients). RESULTS: Two hundred patients with ARF were prospectively enrolled in the study (91 (45.5%) septic and 109 (54.5%) nonseptic patients). Median age was 68 years in septic patients and 72 in nonseptic ones while the percentage of males in both groups was 66% vs 69%, respectively. Septic patients showed more organ failures and more respiratory, cardiovascular and coagulation failures at the time of study admission as well as a worse mean SOFA score during the first 4 days after inclusion (p < 0.01). Mortality rate at the ICU was significantly higher in the septic group when compared to the nonseptic one (55% vs 19.3%, OR = 2.21 (1.65 - 2.97)). Using stepwise logistic regression, acute tubular necrosis and oliguria in septic patients as well as cardiovascular failure (evaluated by SOFA score) in nonseptic patients were identified as independent risk factors for mortality. CONCLUSIONS: Septic and nonseptic ICU patients with ARF have an increased risk of ICU mortality depending on the type of organ failure. Although SOFA score does not predict outcome, it is a useful tool to categorize these patients and to describe a sequence of complications in critically ill patients.