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1.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 226-232, mayo 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-190574

RESUMO

OBJECTIVE: A comparison is made of the accuracy between severity models, based on different sepsis definitions (systemic inflammatory response syndrome (SIRS), predisposition, insult, response, organ dysfunction (PIRO), and sequential organ failure assessment (SOFA) concepts), in predicting outcomes among sepsis PATIENTS: DESIGN: A retrospective study was carried out. SETTING: The study was conducted in the Intensive Care Unit (ICU) of a university teaching hospital. PATIENTS: Septic patients admitted to the ICU during 2007-2016. Main variables of interest: The primary outcome was in-hospital mortality, with ICU mortality being the secondary outcome. RESULTS: A total of 2152 septic patient were identified, with ICU and in-hospital mortality rates of 33.3% and 45.9%, respectively. The Moreno PIRO (AUC, 95%CI) (0.835; 0.818-0.852) showed the highest discriminating capacity, followed by SOFA (0.828; 0.811-0.846), qSOFA (0.792; 0.775-0.809), Rubulotta PIRO (0.708; 0.687-0.730), Howell PIRO (0.706; 0.685-0.728) and SIRS (0.578; 0.556-0.600). The AUC of the SOFA score was comparable to that of the Moreno PIRO (p = 0.43), though the AUCs of both of these scores were significantly higher than those of the other scores (p < 0.001 for all other comparisons). However, the SOFA score showed the best discriminating capacity in predicting ICU mortality (0.838; 0.820-0.855), followed by Moreno PIRO (0.804; 0.785-0.823) and qSOFA (0.787; 0.770-0.805). The accuracy of the qSOFA in predicting ICU mortality was comparable to that of the Moreno PIRO score (p = 0.15). CONCLUSIÓN: The SOFA score and Moreno PIRO score showed the best accuracy in predicting in-hospital mortality among septic patients admitted to the ICU


OBJETIVO: Comparar la precisión entre varios modelos de intensidad, basándose en diferentes definiciones de la sepsis (síndrome de respuesta inflamatoria sistémica [SIRS, por sus siglas en inglés], predisposición, infección, respuesta, disfunción orgánica [PIRO por sus siglas en inglés] y puntuación de la evaluación del fallo orgánico secuencial [SOFA por sus siglas en inglés]) para predecir los desenlaces en los pacientes con sepsis. DISEÑO: Estudio retrospectivo. Ámbito: El estudio se llevó a cabo en la unidad de cuidados intensivos (UCI) de un hospital universitario. PACIENTES: Enfermos con sepsis ingresados en la UCI durante 2007-2016. Variables de interés principales: El desenlace principal fue la mortalidad hospitalaria, mientras que la mortalidad en la UCI fue el desenlace secundario. RESULTADOS: Se identificó un total de 2.152 pacientes con sepsis, con unas tasas de mortalidad en la UCI e intrahospitalaria del 33,3 y del 45,9%, respectivamente. El modelo Moreno-PIRO (AUC, IC del 95%) (0,835; 0,818-0,852) fue el que presentó una mayor capacidad de discriminación, seguido del modelo SOFA (0,828; 0,811-0,846), modelo qSOFA (0,792; 0,775-0,809), modelo Rubulotta-PIRO (0,708; 0,687-0,730), modelo Howell-PIRO (0,706; 0,685-0,728) y modelo SIRS (0,578; 0,556-0,600). El AUC de la puntuación SOFA fue comparable al de Moreno-PIRO (p = 0,43), si bien el AUC de ambas puntuaciones fue significativamente superior al de otras puntuaciones (p < 0,001 para todas las demás comparaciones). Sin embargo, la puntuación SOFA es la que presenta la mayor capacidad de discriminación para predecir la mortalidad en la UCI (0,838; 0,820-0,855), seguida de Moreno-PIRO (0,804; 0,785-0,823) y qSOFA (0,787; 0,770-0,805). La precisión de la puntuación qSOFA en cuanto a la predicción de la mortalidad en la UCI fue comparable a la de la puntuación Moreno-PIRO (p = 0,15). CONCLUSIÓN: La puntuación SOFA y la puntuación Moreno-PIRO mostraron la mejor precisión en la predicción Mortalidad intrahospitalaria entre pacientes sépticos ingresados en la UCI


Assuntos
Humanos , Escores de Disfunção Orgânica , Previsões , Mortalidade Hospitalar , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Unidades de Terapia Intensiva , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Choque Séptico/mortalidade
2.
Med Intensiva ; 44(4): 226-232, 2020 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30711242

RESUMO

OBJECTIVE: A comparison is made of the accuracy between severity models, based on different sepsis definitions (systemic inflammatory response syndrome (SIRS), predisposition, insult, response, organ dysfunction (PIRO), and sequential organ failure assessment (SOFA) concepts), in predicting outcomes among sepsis patients. DESIGN: A retrospective study was carried out. SETTING: The study was conducted in the Intensive Care Unit (ICU) of a university teaching hospital. PATIENTS: Septic patients admitted to the ICU during 2007-2016. MAIN VARIABLES OF INTEREST: The primary outcome was in-hospital mortality, with ICU mortality being the secondary outcome. RESULTS: A total of 2152 septic patient were identified, with ICU and in-hospital mortality rates of 33.3% and 45.9%, respectively. The Moreno PIRO (AUC, 95%CI) (0.835; 0.818-0.852) showed the highest discriminating capacity, followed by SOFA (0.828; 0.811-0.846), qSOFA (0.792; 0.775-0.809), Rubulotta PIRO (0.708; 0.687-0.730), Howell PIRO (0.706; 0.685-0.728) and SIRS (0.578; 0.556-0.600). The AUC of the SOFA score was comparable to that of the Moreno PIRO (p=0.43), though the AUCs of both of these scores were significantly higher than those of the other scores (p<0.001 for all other comparisons). However, the SOFA score showed the best discriminating capacity in predicting ICU mortality (0.838; 0.820-0.855), followed by Moreno PIRO (0.804; 0.785-0.823) and qSOFA (0.787; 0.770-0.805). The accuracy of the qSOFA in predicting ICU mortality was comparable to that of the Moreno PIRO score (p=0.15). CONCLUSION: The SOFA score and Moreno PIRO score showed the best accuracy in predicting in-hospital mortality among septic patients admitted to the ICU.

3.
Lupus ; 24(1): 98-106, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25149601

RESUMO

In this retrospective study, we described demographic information, reasons for admission, APACHE II severity scores, complications, mortality rate, causes of death and prognostic factors in 61 Thai patients with systemic lupus erythematosus (SLE) who were admitted to the medical intensive care unit (ICU) over a six-year period. The overall mortality rate during ICU hospitalization was 57% and the most common cause of death was infection, especially in the lower respiratory tract. The mean (SD) APACHE II score was 24.8 (10.8). SLE patients who had an APACHE II score of 20 or more were up to 65% of the patient population and had a significantly lower probability of survival based on Kaplan-Meier results (p = 0.004). The need for vasopressor therapy was significantly higher in patients who did not survive (OR = 6.98, 95% CI = 1.91-25.49). The patients who developed ventilator-associated pneumonia had a numerically higher mortality, which was not statistically significant (OR = 4.17, 95% CI = 0.91-19.03). The use of azathioprine as a steroid-sparing agent for SLE was associated with lower mortality rates (OR = 0.08, 95% CI = 0.01-0.58). Our findings emphasize that Thai SLE patients admitted to the medical ICU has a high mortality rate and early aggressive treatments are warranted.


Assuntos
APACHE , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/mortalidade , Adulto , Azatioprina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Mortalidade Hospitalar , Humanos , Imunossupressores/uso terapêutico , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Taxa de Sobrevida , Tailândia/epidemiologia , Vasoconstritores/uso terapêutico
4.
Minerva Anestesiol ; 79(3): 257-63, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23254165

RESUMO

BACKGROUND: The aim of this study was to validate and compare the performance of Simplified Acute Physiology Score 3 Predisposition, Infection, Response and Organ failure (SAPS 3 PIRO) score with Acute Physiology and Chronic Health Evaluation (APACHE) II, SAPS II and SAPS 3 scores in predicting hospital outcome in septic shock patients. METHODS: A prospective cohort study was conducted over a six-year period in the mixed medical-coronary care unit of a tertiary referral university teaching hospital. The performance of the severity scores was evaluated by discrimination, calibration and overall performance. RESULTS: Eight hundred and eighty patients with septic shock were enrolled. Hospital mortality rate was 57.4%. Community-acquired infections accounted for 57.2%. The SAPS 3 PIRO showed the best discrimination with an area under the receiver operating characteristic curve (AUC) of 0.863 (95% confidence intervals, 0.838-0.889). The AUC of SAPS 3 PIRO score was statistically greater than APACHE II (0.82, P=0.001), SAPS II (0.819, P=0.001) and SAPS 3 (0.817, P=0.003). The calibration of all scores was poor, with the Hosmer-Lemeshow (H-L) goodness-of-fit H and C statistics <0.05. The SAPS 3 PIRO score was the best overall performance by a Brier score of 0.167. CONCLUSION: The SAPS 3 PIRO score provided better discrimination than the APACHE II, SAPS II and SAPS 3 but had poor calibration in our septic shock patients. SAPS 3 PIRO could be used regarding risk stratification in septic shock patients, however, this score needed to be adapted and modified with new parameters for improving the performance.


Assuntos
APACHE , Infecções/diagnóstico , Infecções/fisiopatologia , Escores de Disfunção Orgânica , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/terapia , Adulto , Idoso , Estudos de Coortes , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Choque Séptico/fisiopatologia
5.
Minerva Anestesiol ; 77(3): 305-12, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21441885

RESUMO

BACKGROUND: Recently, the Simplified Acute Physiology Score (SAPS) 3 was developed. The objective of this study was to compare the performance of SAPS 3 with those of SAPS II, the Acute Physiology and Chronic Health Evaluation (APACHE) II and customized scores in predicting hospital mortality in critically ill mixed medical-coronary patients. METHODS: A prospective cohort study was conducted over a 2.5-year period in a 10-bed mixed medical-coronary care unit of a tertiary referral university teaching hospital in Thailand. The probabilities of hospital mortality of SAPS 3, SAPS II and APACHE II were calculated using standard equations. RESULTS: A total of 2022 patients were enrolled. The performance of SAPS 3 was similar to those of the old standard severity scores. All three scores had excellent discrimination, with areas under the receiver operating characteristic curve of 0.916 for SAPS 3, 0.914 for SAPS II and 0.936 for APACHE II. All scores overestimated hospital mortality, with standardized mortality ratios of 0.81, 0.78 and 0.80 for SAPS 3, SAPS II and APACHE II, respectively. The calibration of all scores was poor as demonstrated by the Hosmer-Lemeshow goodness-of-fit H and C statistics, which were <0.05. The calibration of all scores was improved by first-level customization. CONCLUSION: The SAPS 3 score provided excellent discrimination but poor calibration, as did the SAPS II and APACHE II scores in our critically ill mixed medical patients. The customization of the severity score improved the calibration performance, and thus this customization may serve as a tool for adjusting the equation of the score to predict mortality and quality assessment in intensive care units (ICUs).


Assuntos
APACHE , Unidades de Cuidados Coronarianos/normas , Monitorização Fisiológica/métodos , Índice de Gravidade de Doença , Idoso , Estudos de Coortes , Cuidados Críticos , Estado Terminal/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos Testes
6.
Anaesth Intensive Care ; 37(5): 784-90, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19775043

RESUMO

The aim of this study was to evaluate and compare the performance of customised Acute Physiology and Chronic Health Evaluation HII (APACHE II) and Simplified Acute Physiology Score HII (SAPS II) in predicting hospital mortality of mixed critically ill Thai patients in a medical intensive care unit. A prospective cohort study was conducted over a four-year period. The subjects were randomly divided into calibration and validation groups. Logistic regression analysis was used for customisation. The performance of the scores was evaluated by the discrimination, calibration and overall fit in the overall group and across subgroups in the validation group. Two thousand and forty consecutive intensive care unit admissions during the study period were split into two groups. Both customised models showed excellent discrimination. The area under the receiver operating characteristic curve of the customised APACHE II was greater than the customised SAPS II (0.925 and 0.892, P < 0.001). Hosmer-Lemeshow goodness-of-fit showed good calibration for the customised APACHE II in overall populations and various subgroups but insufficient calibration for the customised SAPS II. The customised SAPS II showed good calibration in only the younger, postoperative and sepsis patients subgroups. The overall performance of the customised APACHE II was better than the customised SAPS II (Brier score 0.089 and 0.109, respectively). Our results indicate that the customised APACHE II shows better performance than the customised SAPS II in predicting hospital mortality and could be used to predict mortality and quality assessment in our unit or other intensive care units with a similar case mix.


Assuntos
APACHE , Estado Terminal/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Adulto , Idoso , Estudos de Coortes , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tailândia/epidemiologia
7.
Epidemiol Infect ; 137(9): 1333-41, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19192320

RESUMO

This study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49.7% and comorbidities were found in 40.3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55.6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Choque Séptico/mortalidade , Adulto , Idoso , Cateteres de Demora , Infecção Hospitalar/mortalidade , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto , Fatores de Risco , Choque Séptico/epidemiologia , Tailândia/epidemiologia
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