RESUMO
No disponible
Assuntos
Humanos , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Suporte Vital Cardíaco Avançado/ética , Padrões de Prática Médica , Cuidados para Prolongar a VidaAssuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/ética , Reanimação Cardiopulmonar/normas , Fármacos Cardiovasculares/uso terapêutico , Terapia Combinada , Contraindicações de Procedimentos , Hidratação , Hospitalização , Humanos , Guias de Prática Clínica como Assunto , Assistência Terminal/ética , Assistência Terminal/métodos , Assistência Terminal/normas , Suspensão de Tratamento/ética , Suspensão de Tratamento/normasRESUMO
Fundamento y objetivo: Ver la influencia de la interleucina 6 (IL-6) como mediador inflamatorio en pacientes con criterios de systemic inflammatory response syndrome (SIRS, «síndrome de respuesta inflamatoria sistémica») y sepsis valorando si su determinación plasmática durante el ingreso en la unidad de cuidados intensivos (UCI) sirve como marcador precoz de mortalidad. Material y métodos: Estudio observacional prospectivo de cohortes con 203 pacientes ingresados en UCI de un Hospital de tercer nivel. Se efectuó análisis descriptivo comparando las variables cualitativas con el test X2, las cuantitativas con la T-Student. También análisis multivariante tipo regresión logística al ingreso, tercer y séptimo día con variable dependiente mortalidad e independientes edad, sexo, niveles plasmáticos de IL-6, lactato, proteína C reactiva, scores APACHE II y SOFA. La exactitud pronóstica de los biomarcadores se efectuó mediante curvas ROC con su sensibilidad y especificidad. Por último, se llevó a cabo curva de supervivencia a los 28 días. Resultados: De 203 pacientes fallecieron 52 (26%) y sobrevivieron 151 (74%). Noventa y ocho (48,3%) presentaron SIRS de etiología infecciosa (sepsis). No hubo diferencias significativas entre edad, sexo y mortalidad. Más pacientes fallecidos en el grupo sepsis. La persistencia de cifras elevadas de IL-6 se relacionó con la mortalidad. Al tercer día, la IL-6 fue la variable con mayor significación en relación con la mortalidad, con sensibilidad del 75% y especificidad del 86%. Los pacientes que al 3tercer día mantuvieron una cifra de IL-6 mayor de 124,14pg/ml tuvieron 6,1 veces mayor probabilidad de fallecer que los de niveles inferiores. Conclusiones: Los pacientes con SIRS-sepsis que fallecieron presentaron cifras de IL-6 más elevadas que los que sobrevivieron. La IL-6 fue un marcador pronóstico precoz de mortalidad intra-UCI (AU)
Background and objective: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker. Material and methods: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X2 test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days. Results: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels. Conclusions: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Interleucina-6/sangue , Sepse/mortalidade , Sepse/sangue , Sepse/diagnóstico , Estudos Prospectivos , Estudos Longitudinais , Biomarcadores/sangue , Modelos Logísticos , Prognóstico , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND OBJECTIVE: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker MATERIAL AND METHODS: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X(2) test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers' prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days RESULTS: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels CONCLUSIONS: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality.
Assuntos
Interleucina-6/sangue , Sepse/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Sepse/sangue , Sepse/diagnóstico , Índice de Gravidade de DoençaRESUMO
No disponible
Assuntos
Humanos , Ressuscitação/métodos , Morte Súbita Cardíaca , Reanimação Cardiopulmonar/métodos , Estatísticas HospitalaresRESUMO
No disponible
Assuntos
Humanos , Reanimação Cardiopulmonar/métodos , Suporte Vital Cardíaco Avançado/métodos , Parada Cardíaca/terapia , Cardioversão Elétrica , Dano Encefálico Crônico/epidemiologiaAssuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Insuficiência Respiratória/terapia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Protocolos Clínicos , Cardioversão Elétrica , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Hospitais , Humanos , Guias de Prática Clínica como Assunto , Insuficiência Respiratória/mortalidadeRESUMO
La endocarditis infecciosa es una enfermedad grave que puede conllevar un pronóstico ominoso en caso de no tratarse adecuadamente. En otras ocasiones, el cuadro clínico evoluciona desfavorablemente a pesar de un tratamiento médico óptimo, y los antibióticos no llegan a esterilizar la sangre; la cirugía en estos pacientes tiene un papel importante para extraer el foco de infección o realizar un recambio valvular. La sorprendente evolución de los pacientes intervenidos en circunstancias desesperadas ha llevado a un análisis del papel de la cirugía precoz. Nosotros, como clínicos, debemos conocer el riesgo de estos pacientes y ser conscientes de la importancia de establecer unas indicaciones quirúrgicas adecuadas (AU)
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients risks and to establish the adequate surgical indications (AU)
Assuntos
Humanos , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/microbiologia , Insuficiência Cardíaca/complicações , Infecções Relacionadas à Prótese , Sepse/complicações , Marca-Passo Artificial/microbiologia , Aneurisma Infectado , Abscesso Abdominal , Anticoagulantes/uso terapêuticoRESUMO
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients' risks and to establish the adequate surgical indications.
Assuntos
Endocardite/microbiologia , Endocardite/cirurgia , HumanosRESUMO
No disponible
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