Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities.

OBJECTIVE: In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN: This retrospective cohort study was conducted between 2016 and 2021. SETTING: Two university hospitals in Brazil. PARTICIPANTS: Patients with sepsis. INTERVENTIONS: Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST: In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS: A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS: Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.

Mielomeningocele rota em região lombar de recém nato: relato de um caso / Myelomeningocele in the lumbar region of a newborn: case report

Introdução:Mielomeningocele (MMC) é uma má formação congênita do sistema nervoso central decorrente de defeitos de fechamento do tubo neural nas primeiras semanas de gestação. Resulta numa abertura vertebral, musculofascial, cutânea e dural com protrusão e exposição da medula espinhal. Descrição do caso: Recém-nascido masculino, nascido via parto cesárea por malformação fetal. Presença de MMC rota em região lombar, com culturas negativas. Encaminhado à UTI neonatal. Submetido à correção de MMC rota. Orientado antibioticoterapia e posição Trendelemburg. Evolução sem intercorrências. Seguimento com neurocirurgia pediátrica e monitorização. Discussão: MMC ocorre quando meninges e medula espinhal herniam através do defeito ósseo produzido pela não fusão dos arcos vertebrais. Tratamento cirúrgico precoce é importante para correção da malformação, prevenção de infecções e diminuição de déficits neurológicos. Conclusão: Assistência precoce é importante para diminuir a incidência de sequelas, bem como adoção de medidas preventivas antes da concepção e na gestação

Introduction: Myelomeningocele (MMC) is a congenital malformation of the central nervous system arising from neural tube defects in the first weeks of gestation. It results in a vertebral, musculofascial, cutaneous and dural opening with protrusion and exposure of the spinal cord. Case report: Male newborn, born via cesarean because fetal malformation. Presence of MMC in the lumbar region, with negative cultures. Referred to neonatal ICU. Submitted to the MMC correction. Oriented antibiotic therapy and Trendelemburgposition. Evolution without intercurrences. Follow up with pediatric neurosurgery and monitoring. Discussion: MMC occurs when meninges and spinal cord herniated through the bone defect produced by non-fusion of the vertebral arches. Early surgical treatment is important for correcting malformation, preventing infections and reducing neurological deficits. Conclusion: Early care is important to decrease the incidence of sequelae, as well as adoption of preventive measures before the conception and in gestation