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1.
Nursing ; 50(7): 54-60, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32558792

RESUMO

The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.


Assuntos
Insuficiência de Múltiplos Órgãos/enfermagem , Choque Cardiogênico/enfermagem , Humanos , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/fisiopatologia , Avaliação em Enfermagem , Diagnóstico de Enfermagem , Testes Imediatos , Choque Cardiogênico/complicações
2.
Cytokine Growth Factor Rev ; 53: 38-42, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360420

RESUMO

Clinical intervention in patients with corona virus disease 2019 (COVID-19) has demonstrated a strong upregulation of cytokine production in patients who are critically ill with SARS-CoV2-induced pneumonia. In a retrospective study of 41 patients with COVID-19, most patients with SARS-CoV-2 infection developed mild symptoms, whereas some patients later developed aggravated disease symptoms, and eventually passed away because of multiple organ dysfunction syndrome (MODS), as a consequence of a severe cytokine storm. Guidelines for the diagnosis and treatment of SARS-CoV-2 infected pneumonia were first published January 30th, 2020; these guidelines recommended for the first time that cytokine monitoring should be applied in severely ill patients to reduce pneumonia related mortality. The cytokine storm observed in COVID-19 illness is also an important component of mortality in other viral diseases, including SARS, MERS and influenza. In view of the severe morbidity and mortality of COVID-19 pneumonia, we review the current understanding of treatment of human coronavirus infections from the perspective of a dysregulated cytokine and immune response.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/patologia , Síndrome da Liberação de Citocina/patologia , Citocinas/sangue , Insuficiência de Múltiplos Órgãos/mortalidade , Pneumonia Viral/patologia , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Terapia de Substituição Renal Contínua/métodos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/tratamento farmacológico , Citocinas/biossíntese , Feminino , Humanos , Interferon-alfa/uso terapêutico , Masculino , Insuficiência de Múltiplos Órgãos/imunologia , Insuficiência de Múltiplos Órgãos/patologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(20): e20188, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443339

RESUMO

INTRODUCTION: The Chinese herb da huang (DH) (Rhubarb) is commonly used for GIF intensive care unit (ICU)/pediatric intensive care unit (PICU) gastrointestinal failure (GIF) patients in China. However, the potential preventive and therapeutic effect of DH in these patients has not yet been studied systematically. OBJECTIVES: The aim of this study was to evaluate the preventive and therapeutic effects of DH in treating ICU/PICU GIF patients with the most recent evidence. METHODS: We systematically searched 7 databases from inception to March 30, 2018. RevMan 5.3 software was used to perform a meta-analysis. GRADE methodology was applied to evaluate the quality of evidence for each outcome. The review protocol was registered on PROSPERO (CRD42018092710) in advance. RESULTS: Seven studies comprising 788 pediatric or adult participants were included in this analysis. Three indicators, including GIF occurrence rates (gastrointestinal mucosal hemorrhage, enteroplegia), multiple organ dysfunction syndrome (MODS)-related items (occurrence rates of MODS, mortality rates of MODS) and duration in the ICU was analyzed. The GIF occurrence rate meta-analysis result was (RR 0.47, CI 95% 0.37-0.60; P = .95); MODS related items indicator result was (RR 0.44, CI 95% 0.33-0.59; P = .41); ICU duration ICU result was (RR -2.87, CI 95% -3.53--2.21; P = .40). The safety of Chinese herb DH (Rhubarb) remains unclear. CONCLUSION: Current evidence suggests that the Chinese herb rhubarb (DH) powder combined with Western medicine was inferior to Western medicine alone in terms of preventive and therapeutic effects in ICU/PICU patients in terms of decreasing GIF occurrence rates (gastrointestinal mucosal hemorrhage and enteroplegia), occurrence rates of MODS, mortality from MODS, and shortened duration time in the ICU/PICU. However, larger sample sizes and rigorously-designed studies are necessary to conclusively determine the association between DH powder and outcomes in ICU/PICU GIF patients.


Assuntos
Gastroenteropatias/tratamento farmacológico , Unidades de Terapia Intensiva Pediátrica/normas , Unidades de Terapia Intensiva/normas , Rheum/efeitos adversos , Adulto , Criança , China/epidemiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Gastroenteropatias/patologia , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Resultado do Tratamento
4.
Cell Metab ; 31(6): 1068-1077.e3, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32369736

RESUMO

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.


Assuntos
Glicemia/análise , Infecções por Coronavirus/mortalidade , Diabetes Mellitus Tipo 2/sangue , Índice Glicêmico/fisiologia , Hiperglicemia/sangue , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Diabetes Mellitus Tipo 2/complicações , Suscetibilidade a Doenças/patologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/complicações , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 99(19): e20130, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384493

RESUMO

To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ±â€Š8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.


Assuntos
Autopsia/métodos , Autopsia/estatística & dados numéricos , Causas de Morte , Tomografia Computadorizada por Raios X/métodos , Fatores Etários , Pré-Escolar , Feminino , Cardiopatias/diagnóstico , Mortalidade Hospitalar , Humanos , Lactente , Japão , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/mortalidade , Sensibilidade e Especificidade , Centros de Atenção Terciária
7.
Am J Cardiol ; 125(6): 840-844, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31932083

RESUMO

Patients with influenza infection are at increased risk of acute myocardial infarction (AMI). There are limited data on the short-term prognosis and management of patients with AMI and concomitant influenza. We examined the National Inpatient Sample from 2010 to 2014 for adult patients with a diagnosis of AMI. Patients were stratified into those with or without concomitant influenza. In-hospital therapies and outcomes were compared between groups in unadjusted and adjusted analyses. Standardized differences of >10% and p values <0.05 were considered significant. Propensity matching was performed using a caliper radius of 0.01*sigma. Of 4,285,641 patients with a discharge diagnosis of AMI, 12,830 had concomitant influenza. Patients with influenza were older, had a higher burden of co-morbidities, and more often presented with non-ST elevation AMI (90% vs 74%) as compared with those without influenza. Coronary angiography (23% vs 54%) and revascularization (11% vs 41%) were less often pursued in AMI patients with influenza. Patients with AMI and influenza had elevated in-hospital mortality (14%) and multiorgan failure (33%). In a propensity-matched analysis of 23,415 patients, in-hospital mortality (odds ratio [OR] 1.26; p = 0.01), acute kidney injury (OR 1.36; p <0.01), multiorgan failure (OR 1.81; p <0.01), length-of-stay, and hospital costs were significantly higher in those with influenza. In conclusion, patients with AMI and concomitant influenza have an adverse in-hospital prognosis as compared with those without influenza.


Assuntos
Influenza Humana/complicações , Influenza Humana/terapia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Admissão do Paciente , Lesão Renal Aguda/complicações , Lesão Renal Aguda/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Influenza Humana/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/terapia , Infarto do Miocárdio/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Pontuação de Propensão , Fatores de Risco , Estados Unidos
8.
JAMA ; 322(22): 2179-2190, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821429

RESUMO

Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial. Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded. Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death. Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34). Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells. Trial Registration: ClinicalTrials.gov Identifier: NCT01977547.


Assuntos
Preservação de Sangue , Estado Terminal/terapia , Transfusão de Eritrócitos , Insuficiência de Múltiplos Órgãos/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estado Terminal/mortalidade , Progressão da Doença , Transfusão de Eritrócitos/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Gravidade do Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Sepse/etiologia
9.
J. bras. nefrol ; 41(4): 526-533, Out.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056617

RESUMO

ABSTRACT Introduction: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. Results: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. Conclusions: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.


RESUMO Introdução: Crianças com síndrome nefrótica apresentam maior risco de infecções devido ao próprio status da doença e ao uso de vários agentes imunossupressores. Em grande parte, as infecções desencadeiam recidivas que exigem hospitalização, com risco aumentado de morbidade e mortalidade. Este estudo teve como objetivo determinar a incidência, o espectro e os fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefrótica. Métodos: Todas as crianças hospitalizadas consecutivamente entre 1 e 12 anos de idade com síndrome nefrótica foram incluídas no estudo. Crianças com nefrite aguda, síndrome nefrótica secundária, bem como aquelas admitidas para biópsia renal diagnóstica e infusão intravenosa de ciclofosfamida ou rituximabe foram excluídas. Resultados: Foram cadastradas 148 crianças com 162 internações. A incidência de infecções graves em crianças hospitalizadas com síndrome nefrótica foi de 43,8%. A peritonite foi a infecção mais comum (24%), seguida por pneumonia (18%), infecção do trato urinário (15%) e celulite (14%), contribuindo com dois terços das principais infecções. Streptococcus pneumoniae (n = 9) foi o organismo predominantemente isolado em crianças com peritonite e pneumonia. Na análise de regressão logística, a albumina sérica < 1,5gm / dL foi o único fator de risco independente para todas as infecções (OR 2,6; 95% CI, 1,2-6; p = 0,01), especialmente para peritonite (OR 29; IC95% 3 -270, p = 0,003). Houve quatro mortes (2,5%) em nosso estudo, todas devido a sepse e falência de múltiplos órgãos. Conclusões: A infecção continua sendo uma importante causa de morbimortalidade em crianças com síndrome nefrótica. Como o Pneumococo foi a causa mais prevalente de infecção nessas crianças, deve-se atentar para a imunização pneumocócica em crianças com síndrome nefrótica.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Hospitalização/estatística & dados numéricos , Infecções/mortalidade , Infecções/epidemiologia , Síndrome Nefrótica/complicações , Peritonite/sangue , Celulite (Flegmão)/complicações , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/epidemiologia , Incidência , Albuminas/análise , Hospitalização/tendências , Imunossupressores/efeitos adversos , Índia/epidemiologia , Infecções/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/epidemiologia , Síndrome Nefrótica/diagnóstico
10.
Yale J Biol Med ; 92(4): 629-640, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31866778

RESUMO

Sepsis is a highly complex and lethal syndrome with highly heterogeneous clinical manifestations that makes it difficult to detect and treat. It is also one of the major and most urgent global public health challenges. More than 30 million people are diagnosed with sepsis each year, with 5 million attributable deaths and long-term sequalae among survivors. The current international consensus defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Over the past decades substantial research has increased the understanding of its pathophysiology. The immune response induces a severe macro and microcirculatory dysfunction that leads to a profound global hypoperfusion, injuring multiple organs. Consequently, patients with sepsis might present dysfunction of virtually any system, regardless of the site of infection. The organs more frequently affected are kidneys, liver, lungs, heart, central nervous system, and hematologic system. This multiple organ failure is the hallmark of sepsis and determines patients' course from infection to recovery or death. There are tools to assess the severity of the disease that can also help to guide treatment, like the Sequential Organ Failure Assessment (SOFA) score. However, sepsis disease process is vastly heterogeneous, which could explain why interventions targeted to directly intervene its mechanisms have shown unsuccessful results and predicting outcomes with accuracy is still elusive. Thus, it is required to implement strong public health strategies and leverage novel technologies in research to improve outcomes and mitigate the burden of sepsis and septic shock worldwide.


Assuntos
Insuficiência de Múltiplos Órgãos/complicações , Insuficiência de Múltiplos Órgãos/mortalidade , Sepse/complicações , Sepse/mortalidade , Efeitos Psicossociais da Doença , Humanos , Microcirculação , Insuficiência de Múltiplos Órgãos/sangue , Oxigênio , Perfusão , Sepse/sangue
11.
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689826

RESUMO

Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.


Assuntos
Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Sepse/diagnóstico , Sífilis Congênita/diagnóstico , Sífilis/diagnóstico , Estudos de Casos e Controles , China , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Sepse Neonatal/microbiologia , Sepse Neonatal/mortalidade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/mortalidade , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Sífilis/microbiologia , Sífilis/mortalidade , Sorodiagnóstico da Sífilis , Sífilis Congênita/mortalidade
12.
Med. intensiva (Madr., Ed. impr.) ; 43(8): 464-473, nov. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185883

RESUMO

Purpose: To determine the differences in short- and long-term mortality in elderly septic patients with multiorgan dysfunction syndrome and establish the factors related to non-survival. Materials and methods: A retrospective cohort study was made of 206 patients over 65 years of age with septic and septic shock criteria admitted to the ICU of Rio Hortega Hospital between January 2011 and February 2017. Study variables were obtained from electronic database records. Results: A total of 206 patients were included, divided into three groups of age (65-74, 75-85, >85 years). There were no significant differences in mortality according to age group after 28 days, 90 days or one year (28.6%, 32.1% and 45.2% in the 65-74 years age group; 32.5%, 38.6% and 45.8% in the 75-85 years age group, 41%, 48.7% and 56.4% in the >85 years age group). The factors related to mortality were: chronic heart failure, non-haematological cancer, liver dysfunction and central nervous system dysfunction. Conclusions: The results indicate that there is no significant difference in mortality among the different age groups. About 50% of the elderly patients survive a septic process. There is a close relationship between the number of affected organs and days of dysfunction, the use of interventional techniques and long-term mortality


Objetivo: Determinar las diferencias en la mortalidad a corto y largo plazo en pacientes sépticos ancianos con síndrome de disfunción multiorgánica, y cuáles son los factores de riesgo determinantes de esta. Materiales y métodos: Estudio retrospectivo de cohortes de 206 pacientes mayores de 65 años con criterios de shock séptico y sepsis admitidos en la UCI del Hospital Río Hortega entre enero de 2011 y febrero de 2017. Los datos analizados se obtuvieron a través de los registros de bases de datos electrónicas de la unidad. Resultados: Se incluyeron 206 pacientes divididos en 3 grupos de edad (65-74; 75-85; >85). No encontramos diferencias estadísticas en la mortalidad por grupo de edad al cabo de 28 días, 90 días y un año (28,6, 32,1 y 45,2% en el grupo de 65-74 años; 32,5, 38,6 y 45,8% en el grupo de 75-85 años; 41, 48,7 y 56,4% en el grupo de edad >85) Los factores relacionados con la mortalidad fueron: insuficiencia cardíaca crónica, cáncer no hematológico, disfunción hepática y disfunción del sistema nervioso central. Conclusión: Los resultados indican que no hay una diferencia significativa en la mortalidad entre los diferentes grupos de edad. Alrededor del 50% de los pacientes ancianos sobreviven ante un proceso séptico. Existe una estrecha relación entre el número de órganos disfuncionantes, los días de disfunción, el uso de técnicas de intervención y la mortalidad a largo plazo


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Insuficiência de Múltiplos Órgãos/mortalidade , Fatores de Risco , Estudos de Coortes , Insuficiência de Múltiplos Órgãos/epidemiologia , Estudos Retrospectivos , Choque Séptico/diagnóstico , Sepse/complicações , Unidades de Terapia Intensiva , Registros de Mortalidade , Registros Eletrônicos de Saúde
13.
Artigo em Inglês | MEDLINE | ID: mdl-31605591

RESUMO

The aim of this study was to evaluate the usability of systemic inflammatory response syndrome (SIRS) and commonly used biochemical parameters as predictors for positive blood culture in patients with sepsis. The study included 313 patients aged ≥18 years with severe sepsis and septic shock consecutively admitted in the Intensive Care Unit (ICU) of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia. The study took place from January 1, 2011 to December 31, 2017. We recorded demographic variables, common laboratory tests, SIRS parameters, site of infection, comorbidities and Sequential Organ Failure Assessment (SOFA) score. Blood cultures were positive in 65 (20.8%) patients with sepsis. Gram-positive bacteria were isolated from 35 (53.8%) patients. From the evaluated variables in this study, only the presence of four SIRS parameters was associated with bacteremia, finding that will help to predict bacteremia and initiate early appropriate therapy in septic patients.


Assuntos
Bacteriemia/complicações , Sepse/sangue , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/microbiologia , Adulto , Idoso , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Biomarcadores/sangue , Comorbidade , Feminino , Bactérias Gram-Positivas/crescimento & desenvolvimento , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , República da Macedônia do Norte/epidemiologia , Sepse/diagnóstico , Sepse/microbiologia , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/imunologia , Choque Séptico/microbiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade
14.
PLoS One ; 14(9): e0222599, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31568512

RESUMO

BACKGROUND: The Sequential Organ Failure Assessment (SOFA) score is commonly used in ICUs around the world, designed to assess the severity of the patient's clinical state based on function/dysfunction of six major organ systems. The goal of this work is to build a computational model to predict mortality based on a series of SOFA scores. In addition, we examined the possibility of improving the prediction by incorporating a new component designed to measure the performance of the gastrointestinal system, added to the other six components. METHODS: In this retrospective study, we used patients' three latest SOFA scores recorded during an individual ICU stay as input to different machine learning models and ensemble learning models. We added three validated parameters representing gastrointestinal failure. Among others, we used classification models such as Support Vector Machines (SVMs), Neural Networks, Logistic Regression and a penalty function used to increase model robustness in regard to certain extreme cases, which may be found in ICU population. We used the Area under Curve (AUC) performance metric to examine performance. RESULTS: We found an ensemble model of linear and logistic regression achieves a higher AUC compared related works in past years. After incorporating the gastrointestinal failure score along with the penalty function, our best performing ensemble model resulted in an additional improvement in terms of AUC metrics. We implemented and compared 36 different models that were built using both the information from the SOFA score as well as that of the gastrointestinal system. All compared models have approximately similar and relatively large AUC (between 0.8645 and 0.9146) with the best results are achieved by incorporating the gastrointestinal parameters into the prediction models. CONCLUSIONS: Our findings indicate that gastrointestinal parameters carry significant information as a mortality predictor in addition to the conventional SOFA score. This information improves the predictive power of machine learning models by extending the SOFA to include information related to gastrointestinal organ system. The described method improves mortality prediction by considering the dynamics of the extended SOFA score. Although tested on a limited data set, the results' stability across different models suggests robustness in real-time use.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/mortalidade , Humanos , Aprendizado de Máquina , Insuficiência de Múltiplos Órgãos/diagnóstico , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Máquina de Vetores de Suporte
15.
J Bras Nefrol ; 41(4): 526-533, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31528983

RESUMO

INTRODUCTION: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. METHODS: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. RESULTS: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. CONCLUSIONS: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções/epidemiologia , Infecções/mortalidade , Síndrome Nefrótica/complicações , Albuminas/análise , Celulite (Flegmão)/complicações , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/microbiologia , Criança , Pré-Escolar , Feminino , Hospitalização/tendências , Humanos , Imunossupressores/efeitos adversos , Incidência , Índia/epidemiologia , Infecções/etiologia , Masculino , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Síndrome Nefrótica/diagnóstico , Peritonite/sangue , Peritonite/complicações , Peritonite/epidemiologia , Peritonite/microbiologia , Pneumonia/complicações , Pneumonia/epidemiologia , Pneumonia/microbiologia , Estudos Prospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/mortalidade , Streptococcus pneumoniae/isolamento & purificação , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
16.
Khirurgiia (Mosk) ; (9): 58-65, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532168

RESUMO

OBJECTIVE: To define the informative value of qSOFA score in the prediction of outcomes in surgical patients admitted to the Intensive Care Units. STUDY DESIGN: Post hoc analysis of multicenter prospective observational study RISES. The following patient information was analyzed: gender, age, diagnosis, presence of infection, SIRS criteria, qSOFA and SOFA scores, outcomes. RESULTS: The study included data of 331 patients with surgical diseases. Infection was not observed in 174 (52.6%) cases, 157 (47.4%) patients had infection. In the group of patients without infection, area under ROC-curve for SIRS criteria was 0.519 (95% CI 0.429-0.610) and similar to that qSOFA (p=0.535). Area under ROC-curve for SOFA scale was 0.619 (95% CI 0.511-0.726) and did not significantly differ from this value for QSOFA (p=0.241). In the group of surgical patients with infection, area under ROC-curve for SIRS was 0.490 (95% CI 0.419-0.561), that was significantly lower than area under ROC-curve for qSOFA (p=0.016). Area under ROC-curve for SOFA scale was 0.803 (95% CI 0.681-0.924), that significantly exceeded area under ROC-curve for qSOFA (p=0.017). CONCLUSION: qSOFA scale is important in surgical patients with infection admitted to ICUs. Increased qSOFA score is associated with augmentation of mortality rate. qSOFA scale significantly exceeds the SIRS criteria, but is inferior to the SOFA in the prognosis of mortality in these patients.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Procedimentos Cirúrgicos Operatórios/mortalidade , Humanos , Insuficiência de Múltiplos Órgãos/terapia , Prognóstico , Estudos Prospectivos , Federação Russa , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (9): 73-79, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532170

RESUMO

Modern surgical and intensive care achievements did not result decrease of mortality in patients with acute small bowel obstruction (ASBO). Direct cause of mortality in ASBO patients is peritonitis followed by multiple organ failure syndrome including acute failure of liver, kidneys, lungs and other organs. Publications devoted to the problem of acute liver failure and its complicationsare reviewed in the article. Mechanisms of pathogenesis and clinical manifestations of multiple organ failure syndrome in patients with acute small bowel obstruction are analyzed.


Assuntos
Obstrução Intestinal/mortalidade , Falência Hepática/mortalidade , Insuficiência de Múltiplos Órgãos/mortalidade , Peritonite/mortalidade , Doença Aguda , Humanos , Obstrução Intestinal/etiologia , Intestino Delgado , Falência Hepática/diagnóstico , Falência Hepática/etiologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Peritonite/etiologia
18.
Lupus ; 28(12): 1480-1487, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31558101

RESUMO

INTRODUCTION: Thrombocytopaenia and autoimmune haemolytic anaemia (AIHA) have considerable impact on prognosis in systemic lupus erythematosus (SLE). We investigated the frequencies of these haemocytopaenias, along with their associations and effect on outcome in a single-centre cohort of patients with SLE. METHODS: Demographic characteristics, clinical features, autoantibody profiles, damage and mortality data were compared between patients with and without each haematological abnormality. Variables displaying significant differences between the groups were entered into logistic regression. RESULTS: Ninety-three patients had AIHA and 215 had thrombocytopaenia. Both were associated with neuropsychiatric (NP) involvement, with each other, leucopaenia, antiphospholipid syndrome (APS) and antiphospholipid antibodies. More patients in both groups had organ damage, and their damage scores were higher. Association to NP damage was discernible. In addition, cardiovascular and renal damage and diabetes were more pronounced in patients with thrombocytopaenia. At logistic regression analysis, younger age, anticardiolipin antibody IgM positivity, leucopaenia and thrombocytopaenia were associated with AIHA whilst lupus anticoagulant activity, AIHA, leucopaenia, APS and NP involvement were associated with thrombocytopaenia. Among damage items, peripheral vascular damage, diabetes, NP damage, renal and ocular damage displayed significant associations with thrombocytopaenia, whereas none of the items did with AIHA. Patients with AIHA had significantly reduced survival rates at 10 and 20 years. CONCLUSIONS: We observed that AIHA and thrombocytopaenia were associated with severe lupus, affecting major organs and causing end organ damage. Thus, they may be considered as prognostic markers. Furthermore, AIHA and especially thrombocytopaenia may also be a marker for a subgroup of lupus patients who have or may develop APS.


Assuntos
Anemia Hemolítica Autoimune/complicações , Síndrome Antifosfolipídica/sangue , Lúpus Eritematoso Sistêmico/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Trombocitopenia/complicações , Adolescente , Adulto , Anticorpos Anticardiolipina/metabolismo , Anticorpos Antifosfolipídeos/metabolismo , Síndrome Antifosfolipídica/diagnóstico , Autoanticorpos/sangue , Feminino , Humanos , Leucopenia/diagnóstico , Leucopenia/etiologia , Inibidor de Coagulação do Lúpus/imunologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/mortalidade , Vasculite Associada ao Lúpus do Sistema Nervoso Central/diagnóstico , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Prognóstico , Índice de Gravidade de Doença , Taxa de Sobrevida , Turquia/epidemiologia , Adulto Jovem
19.
BMC Res Notes ; 12(1): 497, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405369

RESUMO

OBJECTIVE: Sporadic fatal adverse events have been reported during treatment of multiple sclerosis with alemtuzumab. To provide a systematic overview, we searched the centralized European Medicines Agency database of suspected adverse reactions related to medicinal products (EudraVigilance) for fatal adverse events associated with treatment with alemtuzumab (Lemtrada®) for multiple sclerosis. Four independent reviewers with expertise on MS, clinical immunology, infectious diseases and clinical pharmacology reviewed the reports, and scored the likelihood for causality. RESULTS: We identified nine cases with a probable and one case with a possible causal relationship between alemtuzumab treatment and a fatal adverse event. Six of these patients died within one month after treatment; one from intracerebral hemorrhage, two from acute multiple organ failure and septic shock, one from listeriosis, one from pneumonia and one from agranulocytosis. Four patients died several months after administration of alemtuzumab from either autoimmune hepatitis, immune-mediated thrombocytopenia, autoimmune hemolytic anemia or agranulocytosis. Four of the 10 cases had been published previously in case reports or congress abstracts. Fatal adverse events related to treatment with alemtuzumab occur more frequently than previously published in the literature. A significant proportion occurs in the first month after treatment.


Assuntos
Agranulocitose/induzido quimicamente , Alemtuzumab/efeitos adversos , Hemorragia Cerebral/induzido quimicamente , Fatores Imunológicos/efeitos adversos , Listeriose/induzido quimicamente , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Pneumonia/induzido quimicamente , Adulto , Agranulocitose/mortalidade , Agranulocitose/patologia , Alemtuzumab/administração & dosagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/patologia , Evolução Fatal , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Listeriose/microbiologia , Listeriose/mortalidade , Listeriose/patologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/patologia , Esclerose Múltipla Recidivante-Remitente/patologia , Pneumonia/microbiologia , Pneumonia/mortalidade , Pneumonia/patologia
20.
Am J Trop Med Hyg ; 101(4): 941-945, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31407657

RESUMO

This study aimed to identify the clinical and laboratory manifestations that affect outcome of scorpion envenomation in children. It included 154 children admitted with scorpion sting envenomation over a period of 2 years. The epidemiological, clinical, and laboratory findings of patients were recorded, and grading of severity was performed based on local and systemic involvement. Organ failure was determined according to diagnostic criterion of multiple organ dysfunction syndrome, and severity of illness was assessed by the Pediatric Risk of Mortality (PRISM III) score. Of studied children, 58.4% were males and 41.6% were females. Children aged > 5 years suffered more scorpion stings (79.9%) than others did. The place of residence was rural more than urban, outdoor stings more than indoors, nocturnal more than diurnal, and most stings were on the exposed areas of the limbs. Based on clinical evaluation, 37.7% of patients were classified as class I severity followed by class II (48.7%) and class III (13.6%). Among studied cases, 21 deaths (13.6%) were registered; all of them belonged to class III severity. Mortality was significantly higher in children with agitation, coma, convulsions, arrhythmia, heart failure, pulmonary edema, and priapism. There were significantly higher values of leukocytes, platelets, creatinine, liver enzymes, glucose, and creatine phosphokinase in non-survivors than in survivors. The presence of organ failure was associated with mortality. In addition, the need for mechanical ventilation and inotropic support were at increased risk of mortality. Moreover, a significant association was found between PRISM score and the number of failed organs with fatal outcome.


Assuntos
Unidades de Terapia Intensiva Pediátrica , Picadas de Escorpião/mortalidade , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Retrospectivos , Picadas de Escorpião/complicações , Índice de Gravidade de Doença
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