Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 643
Filtrar
1.
Int J Med Sci ; 17(9): 1281-1292, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-602629

RESUMO

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20µg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.


Assuntos
Betacoronavirus/isolamento & purificação , Causas de Morte , Infecções por Coronavirus/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/virologia , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oximetria , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/virologia
2.
Int J Med Sci ; 17(9): 1281-1292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547323

RESUMO

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19). Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course. Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20µg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group. Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.


Assuntos
Betacoronavirus/isolamento & purificação , Causas de Morte , Infecções por Coronavirus/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/virologia , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Oximetria , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Pró-Calcitonina/sangue , Prognóstico , Curva ROC , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/virologia
3.
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
4.
J Surg Res ; 249: 104-113, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31926397

RESUMO

BACKGROUND: Hemorrhagic shock (HS) caused by rapid loss of a large amount of blood is the leading cause of early death after severe injury. When cells are damaged during HS, many intracellular components including DNA are released into the circulation and function as endogenous damage-associated molecular patterns (DAMPs) that can trigger excessive inflammatory response and subsequently multiple organ dysfunction. We hypothesized that the administration of deoxyribonuclease I (DNase I) could reduce cell-free DNA and attenuate tissue damage in HS. METHODS: Eight-week-old male C57BL/6 mice underwent HS by controlled bleeding from the femoral artery for 90 min, followed by resuscitation with Ringer's lactate solution (vehicle) or DNase I (10 mg/kg BW). RESULTS: At 20 h after HS, serum levels of cell-free DNA were increased by 7.6-fold in the vehicle-treated HS mice compared with sham, while DNase I reduced its levels by 47% compared with the vehicle group. Serum levels of tissue injury markers (lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase) and proinflammatory cytokine interleukin 6 were significantly reduced in the DNase I-treated mice. In the lungs, messenger RNA levels of proinflammatory cytokines (interleukin 6 and interleukin 1 ß), chemoattractant macrophage inflammatory protein - 2, and myeloperoxidase activity were significantly decreased in HS mice after DNase I. Finally, DNase I significantly improved the 10-day survival rate in HS mice. CONCLUSIONS: Administration of DNase I attenuates tissue damage and systemic and lung inflammation, leading to improvement of survival in HS mice. Thus, DNase I may potentially serve as an adjunct therapy for managing patients with HS.


Assuntos
Ácidos Nucleicos Livres/sangue , Desoxirribonuclease I/administração & dosagem , Ressuscitação/métodos , Choque Hemorrágico/terapia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Animais , Ácidos Nucleicos Livres/metabolismo , Ácidos Nucleicos Livres/toxicidade , Desoxirribonuclease I/farmacologia , Modelos Animais de Doenças , Humanos , Masculino , Camundongos , Choque Hemorrágico/sangue , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Taxa de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Ferimentos e Lesões/complicações
5.
PLoS One ; 15(1): e0227652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968009

RESUMO

BACKGROUND: Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients. The second objective was to estimate associations between diagnostic procedures and time to antibiotic treatment, and to estimate associations between time to antibiotic treatment and mortality. METHODS: This observational study from 24 emergency departments in Norway included 1559 patients with infection and at least two systemic inflammatory response syndrome criteria. We estimated associations using linear and logistic regression analyses. RESULTS: Of the study patients, 72.9% (CI 70.7-75.1) had documented triage within 15 minutes of presentation to the emergency departments, 44.9% (42.4-47.4) were examined by a physician in accordance with the triage priority, 44.4% (41.4-46.9) were adequately observed through continual monitoring of signs while in the emergency department, and 25.4% (23.2-27.7) received antibiotics within 1 hour. Delay or non-completion of these key diagnostic procedures predicted a delay of more than 2.5 hours to antibiotic treatment. Patients who received antibiotics within 1 hour had an observed 30-day all-cause mortality of 13.6% (10.1-17.1), in the timespan 2 to 3 hours after admission 5.9% (2.8-9.1), and 4 hours or later after admission 10.5% (5.7-15.3). CONCLUSIONS: Key procedures for recognizing sepsis were delayed or not completed in a substantial proportion of patients admitted to the emergency department with sepsis. Delay or non-completion of key diagnostic procedures was associated with prolonged time to treatment with antibiotics. This suggests a need for systematic improvement in the initial management of patients admitted to emergency departments with sepsis.


Assuntos
Serviço Hospitalar de Emergência , Sepse/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Diagnóstico Precoce , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Sepse/tratamento farmacológico , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Tempo para o Tratamento , Triagem , Adulto Jovem
6.
Am Heart J ; 220: 192-202, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855716

RESUMO

For decades, physicians have administered corticosteroids in the perioperative period to infants undergoing heart surgery with cardiopulmonary bypass (CPB) to reduce the postoperative systemic inflammatory response to CPB. Some question this practice because steroid efficacy has not been conclusively demonstrated and because some studies indicate that steroids could have harmful effects. STRESS is a randomized, placebo-controlled, double-blind, multicenter trial designed to evaluate safety and efficacy of perioperative steroids in infants (age < 1 year) undergoing heart surgery with CPB. Participants (planned enrollment = 1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered into the CPB pump prime versus placebo. The trial is nested within the existing infrastructure of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The primary outcome is a global rank score of mortality, major morbidities, and hospital length of stay with components ranked commensurate with their clinical severity. Secondary outcomes include several measures of major postoperative morbidity, postoperative hospital length of stay, and steroid-related safety outcomes including prevalence of hyperglycemia and postoperative infectious complications. STRESS will be one of the largest trials ever conducted in children with heart disease and will answer a decades-old question related to safety and efficacy of perioperative steroids in infants undergoing heart surgery with CPB. The pragmatic "trial within a registry" design may provide a mechanism for conducting low-cost, high-efficiency trials in a heretofore-understudied patient population.


Assuntos
Anti-Inflamatórios/uso terapêutico , Ponte Cardiopulmonar/efeitos adversos , Cardiopatias Congênitas/cirurgia , Metilprednisolona/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Método Duplo-Cego , Humanos , Hiperglicemia/epidemiologia , Lactente , Recém-Nascido , Infecções/epidemiologia , Tempo de Internação , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Placebos/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Projetos de Pesquisa , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Estados Unidos
7.
Best Pract Res Clin Haematol ; 32(4): 101111, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31779977

RESUMO

Acute graft-versus-host disease (GVHD) is the major complication of allogeneic hematopoietic cell transplantation and is the primary cause of early non-relapse mortality (NRM) after transplant. GVHD of the gastrointestinal (GI) tract fuels the systemic inflammatory reaction and consequently is the principal driver of mortality. Recently, the MAGIC algorithm probability (MAP) that is computed from two biomarkers of GI GVHD has been validated to accurately predict risk of NRM throughout the course of early acute GVHD. This review focuses on the biology, clinical evidence, and practical application of the biomarkers in the measurement of acute GVHD.


Assuntos
Algoritmos , Doença Enxerto-Hospedeiro/metabolismo , Doença Enxerto-Hospedeiro/mortalidade , Transplante de Células-Tronco Hematopoéticas , Doença Aguda , Biomarcadores/metabolismo , Gastroenteropatias/metabolismo , Gastroenteropatias/mortalidade , Humanos , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Transplante Homólogo
8.
Scand J Trauma Resusc Emerg Med ; 27(1): 103, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718708

RESUMO

BACKGROUND: Severe accidental hypothermia (AH) is life threatening. Thus, prognostic prediction in AH is essential to rapidly initiate intensive care. Several studies on prognostic factors for AH are known, but none have been established. We clarified the prognostic ability of the Sequential Organ Failure Assessment (SOFA) score in comparison with previously reported prognostic factors among patients with AH. METHODS: The J-point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients who were treated at the intensive care unit (ICU) in various critical care medical centers. In-hospital mortality was the primary outcome. We investigated the discrimination ability of each candidate prognostic factor and the in-hospital mortality by applying the logistic regression models with areas under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI). RESULTS: Of the 572 patients with AH registered in the J-point registry, 220 were eligible for the analyses. The in-hospital mortality was 23.2%. The AUROC of the SOFA score (0.80; 95% CI: 0.72-0.86) was the highest among all factors. The other factors were serum potassium (0.65; 95% CI: 0.55-0.73), lactate (0.67; 95% CI: 0.57-0.75), quick SOFA (qSOFA) (0.55; 95% CI: 0.46-0.65), systemic inflammatory response syndrome (SIRS) (0.60; 95% CI: 0.50-0.69), and 5A severity scale (0.77; 95% CI: 0.68-0.84). DISCUSSION: Although serum potassium and lactate had relatively good discrimination ability as mortality predictors, the SOFA score had slightly better discrimination ability. The reason is that lactate and serum potassium were mainly reflected by the hemodynamic state; conversely, the SOFA score is a comprehensive score of organ failure, basing on six different scores from the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Meanwhile, the qSOFA and SIRS scores underestimated the severity, with low discrimination abilities for mortality. CONCLUSIONS: The SOFA score demonstrated better discrimination ability as a mortality predictor among all known prognostic factors in patients with AH.


Assuntos
Hipotermia/mortalidade , Escores de Disfunção Orgânica , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Japão/epidemiologia , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/mortalidade
9.
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
10.
Nutrients ; 11(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31590379

RESUMO

Advanced liver disease is associated with a persistent inflammatory state, derived from abnormal bacterial translocation from the gut, which may contribute to the development of sarcopenia in cirrhosis. We aim to document the association of chronic inflammation and bacterial translocation with the presence of sarcopenia in cirrhosis. We prospectively followed cirrhotic patients aged 18-70 years with medically refractory ascites at a single tertiary care center in Toronto, Canada. The baseline data included patient demographic variables, the presence of bacterial DNA in serum/ascitic fluid, systemic inflammatory response syndrome (SIRS) status, and nutritional assessment. Thirty-one patients were enrolled, 18 (58.1%) were sarcopenic, 9 (29%) had bacterial DNA in serum and ascites fluid. The mean MELD score was 11.5 ± 4.0 (6-23). Sarcopenic and non-sarcopenic patients did not differ significantly in their baseline MELD scores, caloric intake, resting energy expenditure, the incidence of bacterial translocation, or SIRS. While sarcopenia was not linked to increased hospital admissions or death, it was strongly associated with increased episodes of acute kidney injury (3 vs. 0, p = 0.05). This pilot study did not demonstrate an association between sarcopenia and SIRS or bacterial translocation. These results should be confirmed in future larger studies, encompassing a greater number of chronic inflammation events and quantifying levels of bacterial DNA.


Assuntos
Translocação Bacteriana , Cirrose Hepática/epidemiologia , Sarcopenia/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adolescente , Adulto , Idoso , Ascite/microbiologia , Composição Corporal , Ingestão de Energia , Metabolismo Energético , Feminino , Humanos , Incidência , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Ontário/epidemiologia , Projetos Piloto , Prognóstico , Estudos Prospectivos , Fatores de Risco , Sarcopenia/microbiologia , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/microbiologia , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Adulto Jovem
11.
Br J Hosp Med (Lond) ; 80(8): C120-C123, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437041

RESUMO

Sepsis-3, published in 2016, defined sepsis as 'life-threatening organ dysfunction caused by a dysregulated host response to infection'. Instead of systemic inflammatory response syndrome (SIRS), calculating the Sequential Organ Failure Assessment (SOFA) score was recommended. The complexity of SOFA also led to the introduction of quick SOFA (qSOFA) as a bedside tool. The simultaneous removal of SIRS and introduction of qSOFA belies their significant differences, with SIRS having a high sensitivity but very low specificity, and qSOFA being very specific for a poor outcome, but having a lower sensitivity than SIRS. In the UK, the variables within qSOFA are collected on a regular and repeated basis, along with additional variables, as part of the National Early Warning Score (NEWS). A knowledge of SIRS, qSOFA and NEWS is of value in assessing patients with suspected sepsis, as discussed in this article.


Assuntos
Mortalidade Hospitalar/tendências , Escores de Disfunção Orgânica , Sepse/diagnóstico , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Causas de Morte , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/terapia , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/terapia
12.
Am J Med ; 132(7): 862-868, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30831065

RESUMO

PURPOSE: The objective of this study was to assess whether earlier antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) and evidence of organ dysfunction identified through electronic alerts improves patient mortality. METHODS: This is a retrospective observational cohort study of adult patients admitted across 5 acute-care hospitals. Mortality, Premier CareScienceTM Analytics Expected Mortality Score, and clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc, Charlotte NC) reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed. RESULTS: Of those with SIRS and organ dysfunction, 8146 patients were identified through the electronic Best Practice Alert (BPA). Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (P = 0.21) after adjusting for factors that could influence mortality, including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScienceTM Predicted Mortality Risk Score. Female gender (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.63) and facility were also independently associated with mortality. CONCLUSION: The use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender, and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridioides difficile infection in patients with BPA alerts.


Assuntos
Alarmes Clínicos , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Registros Eletrônicos de Saúde , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Retrospectivos , Sepse/tratamento farmacológico , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/mortalidade
13.
BMC Infect Dis ; 19(1): 139, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744579

RESUMO

BACKGROUND: In the new Sepsis-3 definition, sepsis is defined as "life-threatening organ dysfunction due to a dysregulated host response to infection." We tested the predictive validity of the systematic inflammatory response syndrome (SIRS) criteria in patients in the Sepsis-3 cohort. METHODS: Among 1243 electronic health records from 1 January to 31 December 2015 at Sichuan University West China Hospital, we identified patients with sepsis and septic shock according to the Sepsis-3 definition and divided them into 2 subsets: SIRS-positive and SIRS-negative. We compared their characteristics and outcomes as well as the predictive validity of the SIRS criteria for in-hospital mortality. RESULTS: Of the 1243 patients, 631 were enrolled. Among these, 538 (85.3%) patients had SIRS-positive sepsis or septic shock, 168 (31.2%) of whom died, and 93 (14.7%) had SIRS-negative sepsis or septic shock, 20 (21.5%) of whom died (p = 0.06). Over a 1-year period, these groups had similar characteristics and changes in mortality. Among patients of the Sepsis-3 cohort admitted to the intensive care unit, the predictive validity for in-hospital mortality was lower for the SIRS criteria (area under the receiver operating characteristic curve [AUROC], 0.53; 95% confidence interval [95% CI], 0.49-0.57) than for the sequential (sepsis-related) organ failure assessment (SOFA) criteria (AUROC, 0.70; 95% CI, 0.66-0.74; p ≤ 0.01 for both). The SIRS score had poor predictive validity for the risk of in-hospital mortality. CONCLUSIONS: In this cohort study of the new Sepsis-3 definition, we found that the SIRS criteria are weaker than the SOFA criteria with respect to their predictive efficacy for in-hospital death.


Assuntos
Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Adulto , Idoso , China , Estudos de Coortes , Registros Eletrônicos de Saúde , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Sepse/imunologia , Choque Séptico/diagnóstico , Choque Séptico/imunologia , Choque Séptico/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/imunologia
14.
Surg Infect (Larchmt) ; 20(4): 278-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30724713

RESUMO

Background: Our center initiated an electronic Sepsis Best Practice Alert (sBPA) protocol to aid in early sepsis detection and treatment. However, surgery alters peri-operative physiology, which may trigger an sBPA for noninfectious causes. This study aimed to provide early evaluation of automated sBPA utility in surgical patients. Methods: This study was a retrospective review of the outcomes of patients admitted to the University of Minnesota Medical Center (but not to the intensive care unit) from August 2015-March 2016 and compared how the sBPA performed in those having and not having surgery. An sBPA prompted nursing to draw blood for an immediate lactate assay if two modified systemic inflammatory response syndrome (mSIRS) criteria or three mSIRS criteria within 24 hours after surgery were met. Physicians were notified if the lactate concentration was >2 mmol/L. Further review was performed of data collected prospectively on the surgical patients. Results: A total of 10,335 patients were admitted (2,158 surgery and 8,177 non-surgery). Of these, 33% of the surgery patients and 35% of the patients not having surgery triggered sBPAs. In surgery patients, 13% of lactate concentrations were >2 mmol/L versus 25% in patients not having surgery. An sBPA was triggered more frequently after procedures with a wound class of 4 (5% vs. 2%), emergency operation (23% vs. 10%), and longer operations (280 min vs. 222 min (p < 0.05 for all). Surgery patients triggering sBPAs had longer hospital stays (9.6 vs. 4.4 days; p < 0.05), more surgical site infections (7% vs. 2%; p < 0.05), and a similar mortality rate (3% vs. 4%; p = 0.15) than those who did not trigger an sBPA. Conclusion: An sBPA fired in a third of all inpatients, and an sBPA that prompted lactate measurements was less likely to be abnormal in surgery patients than in those not having surgery. There was no difference in the mortality rate in surgical patients who fired and those who did not; however, the sBPA did identify patients with a more complicated post-operative course. Further refinements of the electronic trigger should increase BPA specificity.


Assuntos
Automação Laboratorial/métodos , Técnicas de Laboratório Clínico/métodos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto , Idoso , Cuidados Críticos , Feminino , Hospitais Universitários , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Minnesota , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Adulto Jovem
15.
Am J Emerg Med ; 37(8): 1490-1497, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30470600

RESUMO

OBJECTIVES: The increasing use of sepsis screening in the Emergency Department (ED) and the Sepsis-3 recommendation to use the quick Sepsis-related Organ Failure Assessment (qSOFA) necessitates validation. We compared Systemic Inflammatory Response Syndrome (SIRS), qSOFA, and the National Early Warning Score (NEWS) for the identification of severe sepsis and septic shock (SS/SS) during ED triage. METHODS: This was a retrospective analysis from an urban, tertiary-care academic center that included 130,595 adult visits to the ED, excluding dispositions lacking adequate clinical evaluation (n = 14,861, 11.4%). The SS/SS group (n = 930) was selected using discharge diagnoses and chart review. We measured sensitivity, specificity, and area under the receiver-operating characteristic (AUROC) for the detection of sepsis endpoints. RESULTS: NEWS was most accurate for triage detection of SS/SS (AUROC = 0.91, 0.88, 0.81), septic shock (AUROC = 0.93, 0.88, 0.84), and sepsis-related mortality (AUROC = 0.95, 0.89, 0.87) for NEWS, SIRS, and qSOFA, respectively (p < 0.01 for NEWS versus SIRS and qSOFA). For the detection of SS/SS (95% CI), sensitivities were 84.2% (81.5-86.5%), 86.1% (83.6-88.2%), and 28.5% (25.6-31.7%) and specificities were 85.0% (84.8-85.3%), 79.1% (78.9-79.3%), and 98.9% (98.8-99.0%) for NEWS ≥ 4, SIRS ≥ 2, and qSOFA ≥ 2, respectively. CONCLUSIONS: NEWS was the most accurate scoring system for the detection of all sepsis endpoints. Furthermore, NEWS was more specific with similar sensitivity relative to SIRS, improves with disease severity, and is immediately available as it does not require laboratories. However, scoring NEWS is more involved and may be better suited for automated computation. QSOFA had the lowest sensitivity and is a poor tool for ED sepsis screening.


Assuntos
Escores de Disfunção Orgânica , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Centros de Atenção Terciária , Triagem , Wisconsin
16.
Eur J Trauma Emerg Surg ; 45(2): 255-261, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29318345

RESUMO

PURPOSE: Patients with multiple injuries are particularly susceptible to accidental hypothermia which is correlated with an increased risk of post-traumatic complications and mortality; however, its impact on neurological outcome in cases where there is concomitant traumatic brain injury is underexplored. METHODS: We analyzed severely injured patients (ISS ≥ 16) including a moderate-to-severe traumatic brain injury (AISHead ≥ 3). The primary endpoint was objective neurological recovery, expressed as Glasgow Outcome Scale (GOS) score at time of discharge. Secondary endpoints were mortality, systemic inflammatory response syndrome (SIRS), sepsis, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS). Statistical analysis included logistic regression (odds ratio). The significance level in all analyses was p = 0.05. RESULTS: We analyzed 278 patients (M age = 43 years, SD 19; M ISS = 32.8, SD 10.7). Mortality was 17% (n = 14). 102 patients (37%) were hypothermic on admission. Hypothermic patients were more severely injured (ISS 35.6 ± 11.1 vs. 31.2 ± 10.1, p = 0.001; APACHE II 18.1 ± 7.4 vs. 16.2 ± 7.3, p = 0.045) and had a higher transfusion requirement. Mortality rate in hypothermic patients was increased (23.5 vs. 13.1%, p = 0.03); however, hypothermia was not an independent predictor of mortality. Median GOS at discharge was 3 (IQR 3); in 47% of patients the outcome was favorable (GOS 4 or 5) and 36% it was poor (GOS 2 or 3). There were no differences in post-traumatic complications. Analysis of 73 matched pairs of hypothermic and normothermic patients could not prove hypothermia as an independent predictor of poor neurological outcome (OR 1.7, 95% CI 0.8-3.6, p = 0.1) in the total population. However, older patients (> 41 years) had a 4.2-times higher risk (95% CI 1.4-12.7; p = 0.01) of poor neurological outcome, if they were hypothermic on admission. CONCLUSIONS: Accidental hypothermia seems to have a negative impact on neurological recovery in older patients with multiple injuries including traumatic brain injury which outweighs potential benefits.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Hipotermia/fisiopatologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Sepse/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Adulto , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Hipotermia/etiologia , Hipotermia/mortalidade , Escala de Gravidade do Ferimento , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Fatores de Tempo , Adulto Jovem
17.
Eur J Emerg Med ; 26(5): 323-328, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30048262

RESUMO

OBJECTIVE: The aim of this study was to compare quick Sepsis-related Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) scores for predicting mortality. PATIENTS AND METHODS: A single-center, retrospective study of adult patients with suspected infection was conducted. Area under the curve (AUC) and multivariate analyses were used to explore associations between the qSOFA and SIRS scores and mortality. RESULTS: Of the 69 115 patients enrolled, 1798 died within 72 h and 5640 within 28 days. The qSOFA scores were better than SIRS scores at predicting 72-h mortality (AUC: 0.77 vs. 0.64). However, the discriminatory power of both scores was low in terms of 28-day mortality (AUC: 0.69 vs. 0.60). Patients with qSOFA score of at least 2 had a higher hazard ratio for 72-h mortality than for 28-day mortality (2.64 vs. 1.91). CONCLUSION: The qSOFA scores are more accurate than SIRS scores for predicting 72-h mortality and are better at predicting 72-h mortality than 28-day mortality.


Assuntos
Causas de Morte , Mortalidade Hospitalar , Escores de Disfunção Orgânica , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Triagem , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/mortalidade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Taiwan , Fatores de Tempo
18.
Int J Infect Dis ; 78: 1-7, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267939

RESUMO

AIMS: Evaluating the use of sequential organ failure assessment (SOFA) ≥ 2 compared to quick SOFA (qSOFA) and to systemic inflammatory response syndrome (SIRS) in assessing 28-days mortality in medical patients with acute infection. METHODS: In total, 323 patients with verified infection were stratified in accordance to Sepsis-3. SOFA, qSOFA and SIRS were calculated using registered variables. Adverse outcome was death within 28-days of admission. RESULTS: In total, 190 (59%) patients had a SOFA score≥2 and the overall in-hospital mortality was 21 (6%). Scores of SOFA and qSOFA were both significantly elevated in non-survivors. SOFA showed good accuracy (Area under the receiver operating characteristic (AUROC)=0.83, 95% CI, 0.76 - 0.90) for 28-days mortality compared with qSOFA (AUROC=0.67, 95% CI, 0.54 - 0.80) and SIRS (AUROC=0.62, 95% Cl 0.49 - 0.74). SOFA was≥2 in all patients who died, while qSOFA and SIRS was≥2 in 8 (38%) and 17 (81%) of the patients who died, respectively. CONCLUSION: SOFA score≥2 was better than SIRS and qSOFA to predict mortality within 28-days of admission among patients with acute infectious disease.


Assuntos
Doenças Transmissíveis/mortalidade , Escores de Disfunção Orgânica , Sepse/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Doença Aguda , Adulto , Idoso , Doenças Transmissíveis/diagnóstico , Feminino , Seguimentos , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
19.
J Virol ; 92(24)2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30258005

RESUMO

Pseudorabies virus (PRV) is an alphaherpesvirus that infects the peripheral nervous system (PNS). The natural host of PRV is the swine, but it can infect most mammals, including cattle, rodents, and dogs. In these nonnatural hosts, PRV always causes a severe acute and lethal neuropathy called the "mad itch," which is uncommon in swine. Thus far, the pathophysiological and immunological processes leading to the development of the neuropathic itch and the death of the animal are unclear. Using a footpad inoculation model, we established that mice inoculated with PRV-Becker (virulent strain) develop a severe pruritus in the foot and become moribund at 82 h postinoculation (hpi). We found necrosis and inflammation with a massive neutrophil infiltration only in the footpad and dorsal root ganglia (DRGs) by hematoxylin and eosin staining. PRV load was detected in the foot, PNS, and central nervous system tissues by quantitative reverse transcription-PCR. Infected mice had elevated plasma levels of proinflammatory cytokines (interleukin-6 [IL-6] and granulocyte colony-stimulating factor [G-CSF]) and chemokines (Gro-1 and monocyte chemoattractant protein 1). Significant IL-6 and G-CSF levels were detected in several tissues at 82 hpi. High plasma levels of C-reactive protein confirmed the acute inflammatory response to PRV-Becker infection. Moreover, mice inoculated with PRV-Bartha (attenuated, live vaccine strain) did not develop pruritus at 82 hpi. PRV-Bartha also replicated in the PNS, and the infection spread further in the brain than PRV-Becker. PRV-Bartha infection did not induce the specific and lethal systemic inflammatory response seen with PRV-Becker. Overall, we demonstrated the importance of inflammation in the clinical outcome of PRV infection in mice and provide new insights into the process of PRV-induced neuroinflammation.IMPORTANCE Pseudorabies virus (PRV) is an alphaherpesvirus related to human pathogens such as herpes simplex virus 1 and varicella-zoster virus (VZV). The natural host of PRV is the swine, but it can infect most mammals. In susceptible animals other than pigs, PRV infection always causes a characteristic lethal pruritus known as the "mad itch." The role of the immune response in the clinical outcome of PRV infection is still poorly understood. Here, we show that a systemic host inflammatory response is responsible for the severe pruritus and acute death of mice infected with virulent PRV-Becker but not mice infected with attenuated strain PRV-Bartha. In addition, we identified IL-6 and G-CSF as two main cytokines that play crucial roles in the regulation of this process. Our findings give new insights into neuroinflammatory diseases and strengthen further the similarities between VZV and PRV infections at the level of innate immunity.


Assuntos
Fator Estimulador de Colônias de Granulócitos/sangue , Herpesvirus Suídeo 1/patogenicidade , Interleucina-6/sangue , Pseudorraiva/virologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Animais , Proteína C-Reativa/metabolismo , Quimiocina CXCL1/sangue , Herpesvirus Suídeo 1/genética , Camundongos , Pseudorraiva/mortalidade , Suínos , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Carga Viral , Virulência
20.
PLoS One ; 13(9): e0204608, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30256855

RESUMO

Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.


Assuntos
Escores de Disfunção Orgânica , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Árvores de Decisões , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Turquia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA