Valor pronóstico de los niveles plasmáticos de sTREM-1 en pacientes con sepsis: un estudio de cohortes / Prognostic value of the sTREM-1 plasma values in patients with sepsis: A cohort study

Objetivo: Evaluar la asociación entre los niveles plasmáticos de soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) y la mortalidad de los pacientes con sepsis. Diseño: Estudio de cohortes prospectivo. Ámbito: Dos unidades de cuidados intensivos generales. Pacientes: Pacientes con sepsis en los que se determinaron los niveles plasmáticos de sTREM-1 durante los 3 primeros días de su presentación. Variables de interés principales: Mortalidad a los 28 días. Resultados: Se analizaron 121 pacientes (el 23% sepsis grave, el 44% shock séptico y el 33% sepsis no grave). La mortalidad a los 28 días fue del 24,8%. Los niveles de sTREM-1 iniciales fueron ligeramente más elevados en los fallecidos que en los supervivientes (mediana de 366,9 frente a 266,5pg/ml; p=0,2668). Una elevación de los niveles de sTREM-1 a lo largo de los 3 primeros días (delta-TREM) superior a 90pg/ml se asoció con un exceso de mortalidad (hazard ratio: 2,68; p=0,0047), con una sensibilidad del 47% y una especificidad del 78%. Este exceso de mortalidad de los pacientes desapareció al ajustar para gravedad mediante análisis de Cox (hazard ratio ajustado de 1,07; p=0,8665). Conclusiones: En pacientes críticos con sepsis, el aumento de los niveles de sTREM-1 a lo largo de los 3 primeros días de evolución se asocia con un exceso de mortalidad, que se explica por la mayor gravedad inicial de estos pacientes. La capacidad discriminativa de este hallazgo es insuficiente para ser útil en la clínica (AU)

Objective: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. Design: Prospective cohort study. Setting: Two general Intensive Care Units. Patients: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. Variables of interest: Mortality at 28 days. Results: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). Conclusions: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful (AU)

[Prognostic value of the sTREM-1 plasma values in patients with sepsis: a cohort study]. / Valor pronóstico de los niveles plasmáticos de sTREM-1 en pacientes con sepsis: un estudio de cohortes.

OBJECTIVE: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. DESIGN: Prospective cohort study. SETTING: Two general Intensive Care Units. PATIENTS: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. VARIABLES OF INTEREST: Mortality at 28 days. RESULTS: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5 pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90 pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). CONCLUSIONS: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.