Spatial variation of cardiovascular mortality in Cali, Colombia, between 2010 and 2017.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide and in Colombia. The analysis of CVD mortality has been mainly relied on individual factors and rates, but occurrence is also related to contextual conditions. Understanding the distribution of CVD in a region will contribute to implement more focused-preventive and care interventions. METHODS: Using the national mortality register established by the Department of National Statistics, standardized rates and spatial distribution of CVD mortality were estimated for Cali, Colombia, between 2010-2017. Global and local spatial aggregation was assessed using the Geary's C test and for each district standardized mortality ratios smoothed by the Bayesian empirical were estimated. RESULTS: Over the period, CVD was the main cause of mortality with 28,804 deaths accounting for 23,8% of total deaths. The global CVD mortality rate varied from 235.9 to 257.4 per 100.000 habitants, with an average increase of 9.1% in the percentage change. The main cause of mortality were hypertensive diseases following by ischemic heart diseases and stroke. The standardized mortality ratios smoothed by the Bayesian empirical method showed that the districts 7, 13, 14, 15 and 16 located at the eastern area with the lowest socio-economic strata and the district 22 at the south of the city with the highest socio-economic strata had the high risks of CVD mortality. All these areas were at the boundary of the city. The the lowest risk was observed in districts 1 and 2 at the northwest area with the upper socio-economic strata. Over the study period, a spatial autocorrelation was found in the districts 1,9 10, 11, 12, 13, 14, 15, 19, and 21 by using the Geary's C test. The highest significant spatial association was found in the districts 1 and 21. CONCLUSION: Of 22 districts in Cali, the highest risk of CVD mortality was found in three at the lowest and one in the upper socio-economic strata between 2013 and 2017. Over the period a global spatial aggregation was identified due mainly to districts peripherical located suggesting that there could be contextual conditions influencing the risk. Therefore, there is a need for considering local conditions to prevent CVD mortality.

Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services.

Continuity of care (COC) has been associated with lower mortality and hospitalizations and higher high blood pressure (HBP) control rates. This evidence mainly came from high income countries. We aimed to identify conditions associated with controlled HBP, particularly COC, in primary care services (PCSs) affiliated to two health insurances in Colombia, a low-median income country. A longitudinal observational study was carried out using clinical records of hypertensive adults >18 years with ≥4 clinic visits attending a contributive and a subsidized PCS in Cali (Colombia) between 2013 and 2014. Subsidized PCSs were for unemployment people and those at low socio-economic position and contributive for formal workers. COC was measured using the Bice and Boxerman index. Logistic regression models were performed to quantify the relation between COC and controlled HBP (blood pressure <140/90 mmHg). Between 2013 and 2014, among 8797 hypertensive people identified, 1358 were included: 935 (68.8%) and 423 (31.1%) from the contributive and subsidized PCSs, respectively. 856 (62.3%) were women and had a mean age of 67.7 years (SD 11.7). All people were on antihypertensive treatment. Over the study period, 522 (38.4%) people had controlled HBP, 410 (43.9%) in the contributive and 112 (26.5%) in subsidized PCSs. An increase in 1 unit of the COC index is associated with a 161% higher probability of having HBP controlled (OR, 2.61; 95% CI, 1.25-5.44). The odds of having controlled HBP increased as the number of visits rose; for example, people at the fourth visit had a 34% (OR, 1.34; 95% CI, 1.08-1.66) higher probability of reaching the target. Continuity of care was positively associated with controlled HBP. The strengthening of COC can improve the observed low HBP control rates and reduce health inequalities.

Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia / SARS-coV-2 spatio - temporal analysis in Cali, Colombia

RESUMEN Objetivo Describir la distribución espacio-temporal del COVID-19 en la ciudad de Cali durante el primer mes de epidemia. Métodos Se realizó un análisis exploratorio de datos espaciales, compuesto por un análisis de densidad de Kernel y se verificó la presencia de patrones espaciales por medio de la función K de Ripley. Resultados La distribución espacial de los casos tiende a concentrarse inicialmente en el norte y sur de la ciudad, con una dinámica cambiante hacia el oriente y occidente. Conclusiones El patrón espacial identificado puede estar influenciado por las medidas de aislamiento tomadas a nivel local y nivel nacional, además no se puede descartar el efecto del poco acceso que tiene la población general a las pruebas diagnósticas, los retrasos y represamientos para conocer los resultados de las mismas y aun los posibles sesgos por dificultades en la técnica de toma de la muestra o su conservación.(AU)

ABSTRACT Objective To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. Methods An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. Results The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. Conclusions The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.(AU)

Objetivo: Descrever a distribuição espaço-temporal do COVID-19 na cidade de Cali durante o primeiro mês da epidemia. Métodos: Foi realizada uma análise exploratória de dados espaciais, consistindo em uma análise de densidade de kernel e a presença de padrões espaciais foi verificada pela função K-Ripley. Resultados: A distribuição espacial dos casos tende a se concentrar inicialmente no norte e no sul da cidade, com uma dinâmica mutante para o leste e oeste. Conclusões: O padrão espacial identificado pode ser influenciado pelas medidas de isolamento tomadas a nível local e nacional, mas não se pode descartar o efeito do baixo acesso da população em geral aos exames diagnósticos, atrasos e limitações para conhecer os resultados e mesmo possíveis vieses devido às dificuldades na técnica de coleta da amostra ou na sua conservação.(AU)

[SARS-coV-2 spatio - temporal analysis in Cali, Colombia]. / Análisis espacio-temporal del SARS-COV-2 en Cali, Colombia.

OBJECTIVE: To describe the spatio-temporal distribution of the COVID-19 in the city of Cali during the first month of the epidemic. METHODS: An exploratory analysis of spatial data was carried out, consisting of a kernel density analysis and the presence of spatial patterns was verified by the K-Ripley function. RESULTS: The spatial distribution of the cases tends to initially concentrate in the north and south of the city, with a changing dynamic towards the east and west. CONCLUSIONS: The identified spatial pattern may be influenced by the isolation measures taken at the local and national level, but the effect of the low access of the general population to diagnostic tests, delays and restraints to know the results cannot be ruled out and even possible biases due to difficulties in the technique of taking the sample or its conservation.

Prevalence, awareness, treatment and control of high blood pressure in the elderly according to the ethnic group. Colombian survey.

INTRODUCTION: High blood pressure (HBP) is the main cardiovascular risk factor, it is more prevalent in the older adult population, and the prevalence can vary between ethnic groups. OBJECTIVE: To estimate the prevalence of HBP, knowledge, treatment and control in population aged ≥60 years, resident in Colombia, according to their ethnic condition. METHODS: Population sample selected by multistage sampling. Ethnicity was defined based on skin color. HBP was defined as systolic blood pressure ≥140, and/or diastolic blood pressure ≥90 mm Hg, and/or the participants' self-report. Controlled HBP at a blood pressure value <140/90, knowledge and treatment were identified by self-report. RESULTS: 23,694 adults aged ≥ 60 years were included, of which 54.5%, 34.5% and 10.9% were respectively identified as having light, medium or dark skin color; 54.5% were women, and 78.1% resided in urban areas. The standardized prevalence of HBP, by age, was 57.7% (95% CI: 55.2 - 60.2); 51.4% (95% CI: 47.3-55. 5), in men; and 62.9% (60.9-64.9), in women. The standardized prevalence for light, medium and dark skin in men was 53.2% (95% CI: 48.7-57.7), 49.6% (44.5-54.7), and 49.4% (95% CI: 41.0-57.8) respectively; and in women was 62.5% (95% CI: 60.5-64 , 5), 61.7% (95% CI: 57.8-65.6), and 69.9% (95% CI: 63.6-76.2) respectively. 98% of the population received treatment, and 93.9% were aware of HBP diagnosis. 42.5% of men and 55.5% of women with HBP were under control. Only 21.8% performed regular physical activity. CONCLUSION: Half of the adult population aged over 60 years suffers from HBP; the prevalence is higher in women particularly in dark-skinned women. It is necessary to develop policies to increase physical activity in the elderly.

INTRODUCCIÓN: La presión arterial elevada (PAE) es el principal de factor de riesgo cardiovascular, es más prevalente en población adulta mayor y la prevalencia puede variar entre etnias. OBJETIVO: Estimar la prevalencia de PAE, conocimiento, tratamiento y control en población ≥60 años residente en Colombia de acuerdo con su condición étnica. MÉTODOS: Muestra poblacional seleccionada mediante un muestreo multietápico. La etnia se definió con base en el color de piel. La PAE se definió como presión arterial sistólica ≥140 y/o presión arterial diastólica ≥90 mm Hg y/o el autoreporte del participante. La PAE controlada a un valor de presión arterial <140/90, el conocimiento y el tratamiento se identificaron por autoreporte. RESULTADOS: Fueron incluidos 23,694 adultos con edad ≥ 60 años, de los cuales, 54.5%, 34.5% y 10.9% se identificaron con color de piel claro, medio u oscuro respectivamente, El 54.5%, eran mujeres y el 78.1% residía en zona urbana, La prevalencia estandarizada por edad de PAE fue 57,7% (IC 95%: 55.2-60.2), 51.4% (IC 95%: 4.3-55.5) en hombres y 62.9% (60.9-64.9) en mujeres, La prevalencia estandarizada en hombres claros, medios y oscuros fue 53.2%(IC 95%: 48.7-57.7), 49.6% (44.5-54.7) y 49.4% (IC 95%: 41.0-57.8) respectivamente y en mujeres 62.5% (IC 95%: 60.5-64.5), 61.7% (IC 95%: 57.8-65.6) y 69.9% (IC 95%: 63.6-76.2) respectivamente, El 98% de la población recibía tratamiento y el 93.9% conocía el diagnóstico de PAE, El 42.5% de los hombres y el 55.5% de las mujeres se encontraban con PAE controlada, El 21.8% realizaba actividad física regularmente. CONCLUSIÓN: La mitad de la población adulta mayor a 60 años sufre PAE, mayor prevalencia en mujeres y particularmente mujeres oscuras. Se requiere desarrollar políticas para incrementar la actividad física en el adulto mayor.

Prevalence, awareness, treatment and control of high blood pressure in the elderly according to the ethnic group. Colombian survey / Prevalencia, conocimiento, tratamiento y control de la presión arterial elevada en el adulto mayor de acuerdo con el grupo étnico. Encuesta colombiana salud, bienestar y envejecimiento 2015

Abstract Introduction: High blood pressure (HBP) is the main cardiovascular risk factor, it is more prevalent in the older adult population, and the prevalence can vary between ethnic groups. Objective: To estimate the prevalence of HBP, knowledge, treatment and control in population aged ≥60 years, resident in Colombia, according to their ethnic condition. Methods: Population sample selected by multistage sampling. Ethnicity was defined based on skin color. HBP was defined as systolic blood pressure ≥140, and/or diastolic blood pressure ≥90 mm Hg, and/or the participants' self-report. Controlled HBP at a blood pressure value <140/90, knowledge and treatment were identified by self-report. Results: 23,694 adults aged ≥60 years were included, of which 54.5%, 34.5% and 10.9% were respectively identified as having light, medium or dark skin color; 54.5% were women, and 78.1% resided in urban areas. The standardized prevalence of HBP, by age, was 57.7% (95% CI: 55.2-60.2); 51.4% (95% CI: 47.3-55.5), in men; and 62.9% (60.9-64.9), in women. The standardized prevalence for light, medium and dark skin in men was 53.2% (95% CI: 48.7-57.7), 49.6% (44.5-54.7), and 49.4% (95% CI: 41.0-57.8) respectively; and in women was 62.5% (95% CI: 60.5-64 , 5), 61.7% (95% CI: 57.8-65.6), and 69.9% (95% CI: 63.6-76.2) respectively. 98% of the population received treatment, and 93.9% were aware of HBP diagnosis. 42.5% of men and 55.5% of women with HBP were under control. Only 21.8% performed regular physical activity. Conclusion: Half of the adult population aged over 60 years suffers from HBP; the prevalence is higher in women particularly in dark-skinned women. It is necessary to develop policies to increase physical activity in the elderly.

Resumen Introducción: La presión arterial elevada (PAE) es el principal de factor de riesgo cardiovascular, es más prevalente en población adulta mayor y la prevalencia puede variar entre etnias. Objetivo: Estimar la prevalencia de PAE, conocimiento, tratamiento y control en población ≥60 años residente en Colombia de acuerdo con su condición étnica. Métodos: Muestra poblacional seleccionada mediante un muestreo multietápico. La etnia se definió con base en el color de piel. La PAE se definió como presión arterial sistólica ≥140 y/o presión arterial diastólica ≥90 mm Hg y/o el autoreporte del participante. La PAE controlada a un valor de presión arterial <140/90, el conocimiento y el tratamiento se identificaron por autoreporte. Resultados: Fueron incluidos 23,694 adultos con edad ≥ 60 años, de los cuales, 54.5%, 34.5% y 10.9% se identificaron con color de piel claro, medio u oscuro respectivamente, El 54.5%, eran mujeres y el 78.1% residía en zona urbana, La prevalencia estandarizada por edad de PAE fue 57,7% (IC 95%: 55.2-60.2), 51.4% (IC 95%: 4.3-55.5) en hombres y 62.9% (60.9-64.9) en mujeres, La prevalencia estandarizada en hombres claros, medios y oscuros fue 53.2%(IC 95%: 48.7-57.7), 49.6% (44.5-54.7) y 49.4% (IC 95%: 41.0-57.8) respectivamente y en mujeres 62.5% (IC 95%: 60.5-64.5), 61.7% (IC 95%: 57.8-65.6) y 69.9% (IC 95%: 63.6-76.2) respectivamente, El 98% de la población recibía tratamiento y el 93.9% conocía el diagnóstico de PAE, El 42.5% de los hombres y el 55.5% de las mujeres se encontraban con PAE controlada, El 21.8% realizaba actividad física regularmente. Conclusión: La mitad de la población adulta mayor a 60 años sufre PAE, mayor prevalencia en mujeres y particularmente mujeres oscuras. Se requiere desarrollar políticas para incrementar la actividad física en el adulto mayor.

Síndrome de Tolosa-hunt: reporte de caso y revisión de la literatura / Tolosa-Hunt Syndrome: Case Report And Literature Review

El Síndrome de Tolosa-Hunt es una patología poco frecuente, definida como una inflamación granulomatosa idiopática del seno cavernoso o de la fisura orbitaria superior, caracterizado clínicamente por oftalmoplejía unilateral dolorosa, de evolución aguda o subaguda, asociada a anormalidades en la resonancia magnética de cerebro como el aumento en el volumen y la hipercaptación del medio de contraste del seno cavernoso comprometido. A continuación presentamos el caso de un paciente masculino de 23 años de edad quien consultó al Hospital Universitario del Valle por oftalmoplejía dolorosa de su ojo izquierdo, y en quien se concluyó la existencia de un Síndrome de Tolosa Hunt después de la realización estudios diagnósticos diferenciales exhaustivos.

The Tolosa-Hunt syndrome is an uncommon disease, described as an idiopathic granulomatous inflammation of the cavernous sinus or the superior orbital fissure. Its diagnosis is based on the presence of unilateral ophtalmoplegia associated with the enlargement and the enhanced contrast of the affected cavernus sinus in the MRI. We present the case of a 23-year-old man with ophthalmoplegia of the left eye, who was admitted to the Hospital Universitario del Valle. After performing extensive diagnostic studies, the Tolosa-Hunt syndrome was considered the cause of symptoms.

Epidemiology of sepsis in Colombian intensive care units.

INTRODUCTION: Currently, there is not enough data available concerning sepsis in developing countries, especially in Latin America. OBJECTIVE: We developed a study aimed at determining the frequency, clinical and epidemiological characteristics, and the consequences of sepsis in patients requiring admission to intensive care units in Colombia. MATERIALS AND METHODS: This was a secondary analysis of a prospective cohort study carried out over a six-month period, from September 1, 2007, to February 28, 2008, in ten medical/surgical intensive care units in four Colombian cities. Patients were considered eligible if they had a probable or confirmed diagnosis of infection according to medical records. We recorded demographic characteristics, first admission diagnosis and co-morbidities, clinical status, and sepsis, severe sepsis or septic shock. RESULTS: During the study period, 826 patients were admitted to the intensive care units. From these patients, 421 (51%) developed sepsis in the community, 361 (44%) in the ICU, and 44 (5%) during hospitalization in the general ward. Two hundred and fifty three patients (30.6%) had involvement of one organ system: 20% had respiratory involvement, followed by kidney and central nervous system involvement with 3.4% and 2.7%, respectively. CONCLUSIONS: In our cohort of septic patients, the prevalence of sepsis treated in ICU is similar to that reported in other studies, as well as the overall mortality.

Epidemiology of sepsis in Colombian intensive care units / Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

Introduction: Currently, there is not enough data available concerning sepsis in developing countries, especially in Latin America. Objective: We developed a study aimed at determining the frequency, clinical and epidemiological characteristics, and the consequences of sepsis in patients requiring admission to intensive care units in Colombia. Materials and methods: This was a secondary analysis of a prospective cohort study carried out over a six-month period, from September 1, 2007, to February 28, 2008, in ten medical/surgical intensive care units in four Colombian cities. Patients were considered eligible if they had a probable or confirmed diagnosis of infection according to medical records. We recorded demographic characteristics, first admission diagnosis and co-morbidities, clinical status, and sepsis, severe sepsis or septic shock. Results: During the study period, 826 patients were admitted to the intensive care units. From these patients, 421 (51%) developed sepsis in the community, 361 (44%) in the ICU, and 44 (5%) during hospitalization in the general ward. Two hundred and fifty three patients (30.6%) had involvement of one organ system: 20% had respiratory involvement, followed by kidney and central nervous system involvement with 3.4% and 2.7%, respectively. Conclusions: In our cohort of septic patients, the prevalence of sepsis treated in ICU is similar to that reported in other studies, as well as the overall mortality.

Introducción. Actualmente no se cuenta con muchos datos disponibles sobre la sepsis en los países en desarrollo y especialmente en América Latina. Objetivo. Este estudio tuvo como objetivo determinar la frecuencia, las características clínicas y epidemiológicas y las consecuencias de la sepsis en una población de pacientes que requirieron ingreso en algunas unidades colombianas de cuidados intensivos. Materiales y métodos. Este fue un análisis secundario de un estudio prospectivo realizado en un período de seis meses contados a partir del 1° de septiembre de 2007 hasta el 28 de febrero del 2008 en diez unidades médico-quirúrgicas de cuidados intensivos de cuatro ciudades de Colombia. Los pacientes se consideraron elegibles si tenían un diagnóstico probable o confirmado de infección según los registros médicos. Se registraron las características demográficas, los diagnósticos de primer ingreso y las enfermedades concomitantes, el estado clínico y la sepsis, sepsis grave o choque séptico. Resultados. Durante el período de estudio, 826 pacientes fueron ingresados en las unidades de cuidados intensivos seleccionadas para el estudio. De estos pacientes, 421 (51 %) desarrollaron sepsis en la comunidad, 361 (44 %) en la unidad de cuidados intensivos y 44 (5 %) durante la hospitalización en la sala general; 253 pacientes (30,6 %) presentaron afectación de un órgano del sistema: 20 % tuvo problemas respiratorios, seguido por problemas en los riñones y el sistema nervioso central con 3,4 % y 2,7 %, respectivamente. Conclusiones. En la muestra de pacientes sépticos, la prevalencia de la sepsis, así como de la mortalidad global, en los pacientes tratados en la unidad de cuidados intensivos fue similar a la reportada en otros estudios.

Impact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: a longitudinal study.

BACKGROUND: In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. METHODS: A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. RESULTS: From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12-0.21) and older non-black patients (OR 0.49, 95% CI 0.37-0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19-1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17-1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46-0.74). CONCLUSION: The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.

Lactato sérico en urgencias como factor pronóstico en pacientes con sepsis sin hipotensión / Serum lactate in the emergency department as a prognostic factor in patients with sepsis without hypotension

Fundamento y objetivo: La relación del lactato y la mortalidad en sepsis no ha sido explorada adecuadamente en el paciente normotenso. Nuestro objetivo fue determinar la utilidad del lactato como factor pronóstico de mortalidad a los 28 días en pacientes admitidos en el Servicio de Urgencias con diagnóstico clínico de sepsis y sin shock séptico. Pacientes y método: Análisis secundario del estudio La epidemiología de la sepsis en Colombia, una cohorte prospectiva de pacientes en 10 hospitales generales de 4 ciudades de Colombia. Se incluyeron en este análisis los pacientes sin hipotensión, con disponibilidad de lactato y admitidos con infecciones adquiridas en la comunidad confirmadas con los criterios de los Centers for Disease Control and Prevention. Se realizó una regresión logística controlando para la edad, el sexo, las comorbilidades y la puntuación de gravedad. Resultados: Se incluyeron 961 pacientes, con edad media (DE) de 57,2 (21,0) años, el 54,2% eran mujeres, la puntuación SOFA (Sequential Organ Failure Assessment) promedio fue de 3,0 (2,3) y el APACHE (Acute Physiologic and Chronic Health Evaluation) de 11,1 (6,4). Se observó un buen ajuste al modelo lineal entre el lactato y el riesgo de muerte, y al ajustar por los factores de confusión el lactato se asoció de manera significativa con la mortalidad (odds ratio 1,16, intervalo de confianza del 95% 1,02-1,33). Conclusión: El valor de lactato se asocia de forma independiente y significativa con la mortalidad a los 28 días entre los pacientes con infección que se presentan en el Departamento de Urgencias sin hipotensión. Además, la mortalidad se incrementa de manera lineal con los valores de lactato sérico a partir de cualquier valor detectable (AU)

Background and objective: The relationship between lactate and mortality in patients without hypotension has not been appropriately explored. Our aim was to determine the usefulness of serum lactate as a prognostic factor of 28-day mortality in patients admitted to the Emergency Department with clinical diagnosis of sepsis without septic shock. Patients and methods: We performed a secondary analysis of the study The epidemiology of sepsis in Colombia, a prospective cohort of patients from 10 general hospitals in 4 Colombian cities. We analyzed patients without hypotension with serum lactate available and admitted with community-acquired infections, which were confirmed according to the Centers for Disease Control and Prevention CDC criteria. A logistical regression was performed adjusting for age, sex, comorbidities and severity scores. Results: We included 961 patients aged 57.2 ± 21.0 years, 54.2% were females, mean SOFA score was 3.0 ± 2.3 and APACHE score was 11.1 ± 6.4. We observed a linear relationship between serum lactate and the odds of death, and after adjustment there was a significant and independent association between lactate and mortality (odds ratio 1,16, 95% confidence interval 1.02-1.33). Conclusion: Serum lactate is independently and significantly associated with 28-day mortality among patients with infection who present to the Emergency Department without hypotension. Besides, mortality increases in a linear way with serum lactate from any detectable value (AU)

Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals.

BACKGROUND: Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality. METHODS: This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively. RESULTS: In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores. CONCLUSIONS: Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.

[Serum lactate in the emergency department as a prognostic factor in patients with sepsis without hypotension]. / Lactato sérico en urgencias como factor pronóstico en pacientes con sepsis sin hipotensión.

BACKGROUND AND OBJECTIVE: The relationship between lactate and mortality in patients without hypotension has not been appropriately explored. Our aim was to determine the usefulness of serum lactate as a prognostic factor of 28-day mortality in patients admitted to the Emergency Department with clinical diagnosis of sepsis without septic shock. PATIENTS AND METHODS: We performed a secondary analysis of the study The epidemiology of sepsis in Colombia, a prospective cohort of patients from 10 general hospitals in 4 Colombian cities. We analyzed patients without hypotension with serum lactate available and admitted with community-acquired infections, which were confirmed according to the Centers for Disease Control and Prevention CDC criteria. A logistical regression was performed adjusting for age, sex, comorbidities and severity scores. RESULTS: We included 961 patients aged 57.2 ± 21.0 years, 54.2% were females, mean SOFA score was 3.0 ± 2.3 and APACHE score was 11.1±6.4. We observed a linear relationship between serum lactate and the odds of death, and after adjustment there was a significant and independent association between lactate and mortality (odds ratio 1,16, 95% confidence interval 1.02-1.33). CONCLUSION: Serum lactate is independently and significantly associated with 28-day mortality among patients with infection who present to the Emergency Department without hypotension. Besides, mortality increases in a linear way with serum lactate from any detectable value.

Differences in the classification of hypertensive controlled patient in primary care: Cross sectional study.

OBJECTIVES: To examine differences in blood pressure control using the 2006 National Institute for Health and Clinical Excellence (NICE) guidelines and the 2007 Quality and Outcome Framework (QOF) standards. DESIGN: Cross-sectional study. SETTING: 28 general practices located in Wandsworth, London. PARTICIPANTS: Hypertensive patients aged 17 years and over. MAIN OUTCOMES MEASURES: Percentage of hypertensive patients classified as a hypertensive controlled patient (HCP) by each standard. RESULTS: 79.5% of patients were classified as a HCP by the QOF target and 60.7% by the NICE target. 93% and 14% of practices had more than 70% of patients classified as a HPC by using the QOF and NICE targets respectively. By applying the QOF target, men aged 45-64 years and 65 years and over had significantly higher probability of being classified as a HCP compared to those aged 17-44 years, OR 1.34 (1.08-.165) and OR 2.15 (1.61-2.87) respectively. Regardless of the target, for men the probability of being classified as a HCP increased with age. CONCLUSION: Better achievement of blood pressure control targets is present when the less stringent QOF target is used. Men aged 65 years and over were more likely to be classified as a HCP. Greater consistency is needed between the clinical targets in QOF and NICE guidance.