Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study.

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Epidemiologia e distribuição de lesões extrarrenais de uremia em 161 cães / Epidemiology and distribution of extrarenal lesions of uremia in 161 dogs

Com o objetivo de determinar a epidemiologia e as características morfológicas, incluindo a localização anatômica, das lesões extrarrenais de uremia, bem como determinar as principais lesões do sistema urinário associadas à ocorrência de uremia, foram revisados os protocolos de necropsias de cães realizadas no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria de janeiro de 1996 a dezembro de 2012 (17 anos). Nesse período foram necropsiados 4.201 cães, sendo que 161 (3,8%) apresentaram lesões extrarrenais de uremia. Em 134 cães (83,2%) foram descritos sinais clínicos associados à uremia. As lesões extrarrenais mais frequentes, em ordem decrescente, foram: gastrite ulcerativa e hemorrágica (56,5%), mineralização de tecidos moles (55,9%), edema pulmonar (47,2%), estomatite e/ou glossite ulcerativa (30,4%), endocardite/trombose atrial e aórtica (28,6%), hiperplasia das paratireoides (9,3%), osteodistrofia fibrosa (8,1%), anemia (6,2%), laringite ulcerativa (5%), enterite ulcerativa/hemorrágica (3,7%), esofagite fibrinonecrótica (1,9%) e pericardite fibrinosa (1.9%). Na maioria dos casos as lesões extrarrenais de uremia foram decorrentes de azotemia prolongada por lesões renais graves, sendo as mais prevalentes a nefrite intersticial e a glomerulonefrite.(AU)

The aim of this study was to determine the epidemiology and the morphological characteristics (including the anatomic localization) of the extrarenal uremic lesions, as well as to describe the main lesions of the urinary system associated with the occurrence of uremia, through analysis of the protocols of necropsies performed in dogs from January 1996 to December 2012 (17 years) at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria. A total of 4,201 dogs were necropsied and 161 (3.8%) had extrarenal uremic lesions. In 134 dogs (83.2%) clinical signs associated with uremia were reported. The extrarenal lesions more often observed, in descending order of prevalence, were ulcerative and hemorrhagic gastritis (56.5%), soft-tissue mineralization (55.9%), pulmonary edema (47.2%), ulcerative stomatitis and/or glossitis (30.4%), endocarditis/atrial and aortic thrombosis (28.6%), parathyroid hyperplasia (9.3%), fibrous osteodystrophy (8.1%), anemia (6.2%), ulcerative laryngitis (5%), ulcerative and hemorrhagic enteritis (3.7%), fibrinonecrotic esophagitis (1.9%), and fibrinous pericarditis (1.9%). In most of the cases, the extrarenal lesions of uremia were due to prolonged azotemia secondary to severe renal lesions, such as interstitial nephritis and glomerulonephritis (the most prevalent ones).(AU)

Epidemiologia e distribuição de lesões extrarrenais de uremia em 161 cães / Epidemiology and distribution of extrarenal lesions of uremia in 161 dogs

Com o objetivo de determinar a epidemiologia e as características morfológicas, incluindo a localização anatômica, das lesões extrarrenais de uremia, bem como determinar as principais lesões do sistema urinário associadas à ocorrência de uremia, foram revisados os protocolos de necropsias de cães realizadas no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria de janeiro de 1996 a dezembro de 2012 (17 anos). Nesse período foram necropsiados 4.201 cães, sendo que 161 (3,8%) apresentaram lesões extrarrenais de uremia. Em 134 cães (83,2%) foram descritos sinais clínicos associados à uremia. As lesões extrarrenais mais frequentes, em ordem decrescente, foram: gastrite ulcerativa e hemorrágica (56,5%), mineralização de tecidos moles (55,9%), edema pulmonar (47,2%), estomatite e/ou glossite ulcerativa (30,4%), endocardite/trombose atrial e aórtica (28,6%), hiperplasia das paratireoides (9,3%), osteodistrofia fibrosa (8,1%), anemia (6,2%), laringite ulcerativa (5%), enterite ulcerativa/hemorrágica (3,7%), esofagite fibrinonecrótica (1,9%) e pericardite fibrinosa (1.9%). Na maioria dos casos as lesões extrarrenais de uremia foram decorrentes de azotemia prolongada por lesões renais graves, sendo as mais prevalentes a nefrite intersticial e a glomerulonefrite.

The aim of this study was to determine the epidemiology and the morphological characteristics (including the anatomic localization) of the extrarenal uremic lesions, as well as to describe the main lesions of the urinary system associated with the occurrence of uremia, through analysis of the protocols of necropsies performed in dogs from January 1996 to December 2012 (17 years) at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria. A total of 4,201 dogs were necropsied and 161 (3.8%) had extrarenal uremic lesions. In 134 dogs (83.2%) clinical signs associated with uremia were reported. The extrarenal lesions more often observed, in descending order of prevalence, were ulcerative and hemorrhagic gastritis (56.5%), soft-tissue mineralization (55.9%), pulmonary edema (47.2%), ulcerative stomatitis and/or glossitis (30.4%), endocarditis/atrial and aortic thrombosis (28.6%), parathyroid hyperplasia (9.3%), fibrous osteodystrophy (8.1%), anemia (6.2%), ulcerative laryngitis (5%), ulcerative and hemorrhagic enteritis (3.7%), fibrinonecrotic esophagitis (1.9%), and fibrinous pericarditis (1.9%). In most of the cases, the extrarenal lesions of uremia were due to prolonged azotemia secondary to severe renal lesions, such as interstitial nephritis and glomerulonephritis (the most prevalent ones).

Follow-up of kidney donors who developed uremia and went on the waiting list for a transplant: should they have allocation priority?

BACKGROUND: The increasing use of living kidney donors requires knowledge about long-term effects, especially number and causes of donors with chronic renal failure (CRF), and discussion about a regular follow-up program for donors, policies giving priority to kidney donors on the waiting list for a kidney, and a national record of donors. METHODS: We performed a Retrospective analysis of 470 records of our kidney donors from the kidney transplantation unit between 1977 and 1997. RESULTS: Five out of the 470 donors developed CRF (1.1%), with a calculated incidence of 610 per million people a year. CONCLUSION: The data showed that the risk of a donor developing CRF may be higher than in the in general population. These results showed the necessity of creating an effective follow-up program for donors and a national record.

Risk factors for delirium in the elderly after coronary artery bypass graft surgery.

OBJECTIVE: To investigate the risk factors for delirium in the elderly during the post-operative period of coronary artery bypass graft surgery (CABG). METHODS: A total of 220 inpatients submitted to CABG were evaluated prior to and after surgery. In order to investigate the possible risk factors, data were collected from pre- intra- and post-operative periods. INSTRUMENTS: The patients were assessed using the Mini-mental State Examination and to the Geriatric Depression Scale. The diagnosis of delirium was determined according to DSM-IV criteria. RESULTS: Delirium was detected in 74 (33.6%) patients. Increasing age, blood urea level, cardio-thoracic index, hypertension, smoking habits, blood replacement during bypass, atrial fibrillation (AF), pneumonia and blood balance in the post-operative period were the risk factors for delirium selected by the logistic regression analysis. No specific factor associated with the CABG (perfusion pressure, number of grafts) was correlated with an increased risk for delirium post-operatively. The length of stay was twice as long in the delirious group (p<0.001). CONCLUSIONS: Delirium in the elderly after CABG is a multifactorial disorder. Nine factors taken together can identify patients at great risk for delirium. No specific factor associated with bypass procedure could be identified as a risk factor for delirium. The control of the risk factors should bring a decrease in delirium morbidity and mortality.

[Restless legs syndrome: a clinical study in adult general population and in uremic patients]. / Síndrome de piernas inquietas: estudio clínico en población general adulta y en pacientes urémicos.

BACKGROUND: The restless legs syndrome (RLS) is a movement disorder characterized by an imperative urge to move the legs, associated with paraesthesias, motor restlessness and worsening of symptoms at night with at least partial relief by activity. Its prevalence ranges between 2-15% of general adult population and 20-30% of uremic patients. AIM: To evaluate the frequency and the clinical features of RLS in a sample of general adult population and in uremic patients, in Chile, correlating it with biochemical parameters. METHOD: 100 relatives of outpatients and 166 uremic patients undergoing chronic haemodialysis were interviewed assessing the presence and severity of RLS according to current diagnostic criteria. Biochemical parameters assessed were hematocrit, serum ferritin, phosphate, intact parathyroid hormone (iPTH) levels. RESULTS: 13% of the general population sample was affected, 15% of them were severe. Forty three cases were found among uremic patients (25.9%) (p < 0.01 vs general population), 60% of them were severe and women were affected with higher frequency (p < 0.05) and severity (p < 0.01). Four patients presented RLS even during hemodialysis. No correlation was found with biochemical parameters. Most RLS cases had not been diagnosed previously. CONCLUSIONS: In our population RLS is common and undetected. It is especially prevalent and severe in uremic patients: we found no evidence that anaemia, iron deficiency or iPTH level play a major pathogenic role. Our findings emphasize the need of greater medical awareness of RLS because available therapy may improve the quality of life.

Influencia de la diálisis peritoneal aguda en la evolución clínica y laboratorial de pacientes urémicos, Hospital Regional Honorio Delgado, oct. 93 a set. 95

La insuficiencia renal crónica terminal es un cuadro grave, que denota una función renal muy deteriorada o ausente, que es irreversible y conlleva a la muerte si no se trata oportuna y adecuadamente. En el HRHD se está realizando diálisis peritoneal aguda como forma de tratamiento a estos pacientes, desconociéndose los resultados. Siendo el motivo de nuestro estudio precisamente determinar la influencia de la DPA en la evolución clínica y laboratorial de los pacientes urémicos crónicos. Para lograr esto se desarrolló un trabajo multivariado, retrospectivo, transversal y analítico. Encontrándose una frecuencia de 0.66 por ciento de pacientes, con predominio de mujeres(varones/mujeres=0.78) y con una edad promedio de 57,88 años DS=17.30. La etiología no pudo definirse en el 24.39 por ciento, siendo las causas más frecuentes la nefropatía diabética y la uropatía obstructiva. Las principales manifestaciones urémicas: anemia crónica, acidosis metabólica, hiperkalemia, encefalopatía urémica, hipertensión, hiperfosfatemía e insufeciencia cardíaca congestiva. Se realizaron 14 procedimientos de diálisis, con un tiempo medio de 103 hrs(DS=ñ55.3) por paciente, acumulándose 1442 hrs de experiencia. Realizándose 43.5 recambios(DS=ñ34.7), utilizándose 2000 ml por recambio; en todos los casos se utilizó catéter rígido, para DPA y el acceso fue infraumbilical. Se obtuvo una ultrafiltración promedio de 96.6 ml por recambio(DS=ñ64). Se logró una disminución significativa p=0.001 de los valores de urea, creatinina, potasio, pH, bicarbonato y CO2T; PCO2, P=0.001; así como una mejoría clínica significativa. Las principales complicaciones de diálisis peritoneal fueron dolor abdominal(64.29 por ciento), dificultad en la salida de líquido(42.86 por ciento), hipokalemia(35.71 por ciento) y alcalosis respiratoria(28.57 por ciento). Ningún paciente falleció durante el procedimiento, sólo en dos pacientes la diálisis no fue efectiva, falleciendo 1 y 7 días de terminada esta. La causa más frecuente de muerte fue el edema agudo de pulmón. En conclusión podemos decir que la diálisis peritoneal aguda influyó favorablemente en la evolución de los pacientes urémicos con una efectividad inmediata del 85.7 por ciento

[Gastroduodenitis and Helicobacter pylori in uremic patients]. / Gastroduodenitis y Helicobacter pylori en pacientes urémicos.

We studied 26 patients (p) with end stage renal failure (RF) and 26 healthy volunteers (HV) to investigate the prevalence of Helicobacter pylori (Hp) and its relation with chronic gastritis (CG) and chronic duodenitis (CD). We analyzed 312 gastric and duodenal mucosal biopsies stained with H & E and Giemsa. Categorical data were assessed by the X2 and Fisher's exact test. Probability values of p < 0.05 were considered significant. Endoscopic lesions correlated with histological gastritis and duodenitis and Hp was positive in antrum of 6/8p (75%) (p < 0.05). The prevalence of Hp was 54.5% (15/26p) in RF and 47.2% (12/26s) in HV. Hp was found more frequently in pathological mucosa (p < 005.). CG of the antrum and CD were more commonly in RF (88.5% vs 69.5% and 42.3% vs 23.1% respectively). HP was more frequently located in the antrum than in body and duodenum in both groups (p < 0.05). Chronic gastritis of the body was more frequently in HV (p < 0.05). Active chronic antral gastritis and superficial gastritis were more frequently associated to Hp. Hp was associated to chronic inflammatory gastroduodenal diseases in both groups and may be a cofactor in its pathogenesis. We recommended Hp treatment before renal transplantation.

Paediatric dialysis and renal transplantation in the state of Rio Grande do Sul, Brazil.

Renal replacement therapy (RRT) for Brazilian children with uraemia has been utilized since 1970 in the state of Rio Grande do Sul. One hundred and eighty patients receiving this therapy between 1970 and 1988 have been reviewed. The annual acceptance rate of new paediatric patients in this period increased from 0.6 to 6.5 patients per million child population. Glomerulonephritis (36.1%) and pyelonephritis including urological anomalies (31.7%) were the most frequent causes of end-stage renal disease. Outpatient hospital haemodialysis was the primary form of dialytic treatment in patients 5-15 years of age. Continuous ambulatory peritoneal dialysis was more often used in patients less than 5 years of age. The survival after 1 year on dialysis was 79.9% for children aged 5-15 years starting dialysis during the period 1985-1988. Fluid overload with congestive heart failure and infection were the main causes of death in children on dialysis. Eighty-four children received 93 grafts; only 14 (15%) were from cadaveric donors. One-year patient and graft survival of first living-related donor transplants were 92.2% and 78.5% respectively during the period 1985-1988. Infection accounted for 43.5% of deaths after transplantation. We conclude that RRT is becoming increasingly successful for children in our region but that greater emphasis upon patient compliance with all forms of RRT and upon cadaver kidney donation is needed.