Sepsis - Retrospective Observational Study of Sepsisand Septic Shock treated in internal medicine wards / Sepsis - Estudo Observacional Retrospectivo de Sépsis e Choque Sépticona enfermaria de medicina interna

INTRODUCTION: Sepsis and septic shock are very relevant in clinical practice. Most studies focus on the treatment in Intensive Care Units. Out-side these units, the reality is largely unknown. The aim of this study is to epidemiologically characterize sepsis and septic shock patients admitted at internal medicine wards. MATERIAL AND METHODS: Retrospective observational study, involving patients admitted to internal medicine wards with the diagnosis of sepsis/septic shock during a year. RESULTS: A total of 308 patients were included in the study. 53% were female, with higher levels of comorbidities. Almost 40% were in septic shock, at admittance. Mortality rate was 29,87%. Overall, microbiologic documentation was possible in 92.2% of the cases, with higher prevalence of infection in the urinary (52.6%) and respiratory (34.8%) systems. Initial antibiotic therapy was appropriate in 50% of cases.Previous antibiotic therapy (OR 3.84; IC95% 2.4-6.2; p < 0.0001) and bedridden status (OR 3.15; IC95% 1.7-5.8; p < 0.0002) were independent risk factors to antimicrobial resistance. DISCUSSION: Sepsis outside intensive care units is an escalating reality with high rates of morbidity and mortality. Timely diagnosis and collecting cultures to appropriate treat are primordial to best results. CONCLUSION: This study provides data regarding sepsis/septic shock treated outside intensive care units, that allow a better knowledge of this reality so that it is possible to plan strategies to best attend these patients. Prospective analysis to consolidate criteria for diagnosis, follow-up and prognosis of these patients, as well as review of protocols of action are needed

INTRODUÇÃO: A sépsis e o choque séptico apresentam grande relevância na prática clínica. A maioria dos estudos abordam o tratamento em Unidades de Cuidados Intensivos. A realidade fora destas unidades é amplamente desconhecida. O objectivo deste estudo é caracterizar epidemiologicamente doentes com sépsis/choque séptico internados na enfermaria de medicina interna. MATERIAL E MÉTODOS: Estudo observacional, retrospectivo, dos doentes admitidos no serviço de Medicina Interna com o diagnóstico de sépsis/choque séptico durante um ano. RESULTADOS: Foram incluídos 308 doentes, 53% do sexo feminino, com maior grau de comorbilidades. Cerca de 40% apresentavam choque séptico à admissão. A taxa de mortalidade foi de 29,87%. Globalmente, foi possível documentação microbiológica em 92.2% dos casos, sendo as infecções dos aparelhos urinário (52.6%) e respiratório (34.8%) as mais prevalentes. A antibioterapia inicial foi adequada em 50% dos doentes.Antibioterapia prévia (OR 3.84; IC95% 2.4-6.2; p < 0.0001) e o estado de dependência (OR 3.15; IC95% 1.7-5.8; p < 0.0002) foram factores de risco independentes para a presença de resistência antimicrobiana. DISCUSSÃO: A sépsis fora das unidades de cuidados intensivos constitui uma realidade crescente com elevada morbimortalidade. O diagnóstico precoce e a colheita de exames culturais para tratar de forma dirigida são primordiais para melhores resultados. CONCLUSÃO: Este estudo fornece dados de sépsis/choque séptico tratados fora de unidades de cuidados intensivos, que permitem um melhor conhecimento desta realidade para planear estratégias para melhor tratar estes doentes. Análises prospectivas para consolidar critérios de diagnóstico, seguimento e prognóstico destes doentes, bem como a revisão de protocolos de actuação são necessárias

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Impact of frailty on hospital adverse outcomes in elderly admitted with acute coronary syndrome

BACKGROUND: Frailty represents a complex clinical syndrome of decreased physiological reserve and increased vulnerability to stressors. Little is known regarding interaction between frailty status and outcomes in patients with acute coronary syndrome. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged ≥ 75 years admitted for acute coronary syndromes. METHODS: In this retrospective, single centre, observational study were included patients aged ≥ 75 years admitted for acute coronary syndromes between January 2011 and December 2015. Frailty was assessed using the Fried criteria. The primary endpoint was all-cause in-hospital mortality. Secondary endpoints included the occurrence of re-infarction, stroke and major bleeding. RESULTS: Of the 502 patients included, 126 were classified as frail. These patients were older (mean age 78±5.5 vs. 76.2±5.5 years; p = 0.020), more often male (68.3%) and had a higher risk profile according to GRACE (151.4±18.8 vs. 132.1±16.8; p < 0.001), TIMI (4.3±1 vs. 3.1±1; p < 0.001) and CRUSADE (34.6±9.4 vs. 25.8±9.5; p < 0.001) scores at admission. All-cause in-hospital mortality was significantly more frequent in frail patients (11.9% vs. 5.6%; p < 0.001), as well as re-infarction (7.4% vs. 4.8%; p < 0.001), stroke (8.7% vs. 0.5%; p = 0.002) and major bleeding (7.9% vs. 1.6%; p = 0.002). On multivariate analysis, frailty remained independently associated with the primary endpoint (OR 5.63, [2.05-10.35]; p < 0.001). CONCLUSION: Frailty, identified by Fried criteria, is frequent in elderly patients with acute coronary syndromes, and it is an independent prognostic predictor for in-hospital mortality

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