Prognostic value of diagnostic scales in community-acquired sepsis mortality at an emergency service. Prognosis in community-adquired sepsis.

OBJECTIVES: To asses the prognostic value of diagnostic scales in mortality of community-adquired sepsis and added value of additional parameters. METHODS: Prospective observational study of patients with community-adquired sepsis in the Emergency Room of University Hospital. The study population were patients presented in the Emergency Room with confirmed infection and practicians sepsis diagnosis. Demographics, triage vital signs, inhaled oxygen fraction, inflammatory markers, biochemistry, all-cause mortality during hospitalization and three months after were recorded. Prognostic value of qSOFA, NEWS, SOFA, SIRS, and amplified scales were calculated by using logistic regression and ROC curves. RESULTS: 201 patients, 54% male, average age 77±11,2 years were included. Sixty-three (31.5%) died during hospitalization and 24 (12%) three months after discharge. At the time of admission vital signs related with in-hospital mortality were Glasgow Coma Scale <13, respiratory rate ≥22 bpm, temperature, oxygen desaturation, high flow oxygen therapy and heart rate. Patients dead in-hospital had lower PaCO2, higher lactate, glucose and creatinine. Greater predictive capacity of the scales, from higher to lower, was: qSOFA, NEWS2, SOFA and SIRS. Amplified scales with lactate >2mg/dl, glucose, blood level >190mg/dl and PaCO2 <35mmHg improved predictive value. CONCLUSION: Amplified-qSOFA and amplified-NEWS2 scales at Emergency Department may offer a better prognostic of septic patients mortality.

Actualización en el diagnóstico de la infección de orina y la bacteriuria asintomática. Consideraciones en el paciente geriátrico / No disponible

Diagnosticar correctamente patologías tan frecuentes como las infecciones del tracto urinario en población geriátrica, puede ser un reto, incluso para el médico más experimentado. En la última década diferentes sociedades científicas han revisado y actualizado antiguos conceptos para diagnosticar las infecciones urinarias correctamente, pero su aplicación en población geriátrica continúa siendo difícil debido a la presentación atípica de las enfermedades y a la falta de estudios en esta población. El objetivo de este artículo es revisar nuevos conceptos para diagnosticar correctamente las infecciones de orina, la bacteriuria asintomática y valorar su relación con la población geriátrica (AU)

Correct diagnosis of common pathologies like urinary tract infections in geriatric population may be a challenge, even for the most experienced physician. In the last decade, different scientific societies have reviewed and put into action old concepts in order to properly diagnose urinary tract infections. However, its application in older people is difficult due to atypical presentations and lack of studies in this age group. The objective of this article is to review these new concepts in order to correct diagnose urinary tract infections, asymptomatic bacteriuria and its relationship in a geriatric population (AU)