Lack of association of S100 and neuron-specific enolase with mortality in critically ill patients

Objective: To evaluate the relationship between brain damage biomarkers and mortality in the intensive care unit (ICU). Methods: The sample comprised 70 patients admitted to an ICU. Blood samples were collected from all patients on ICU admission, and levels of S100β and neuron-specific enolase (NSE) were determined by ELISA. Results: Acute Physiologic and Chronic Health Evaluation (APACHE II) score was associated with mortality, but NSE and S100β were not associated with this outcome. In contrast, S100β levels were significantly higher in delirious and non-delirious patients who required mechanical ventilation during ICU stay. Conclusion: Levels of brain biomarkers at the time of ICU admission did not predict mortality in critically ill patients. .

Enteral nutrition discontinuation and outcomes in general critically ill patients

OBJECTIVE: To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients. MATERIALS AND METHODS: All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed. RESULTS: The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality. CONCLUSION: The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score.

Desempenho do escore SAPS II em uma unidade de terapia intensiva / The SAPS II performance in an intensive care unit

Introdução: O Simplified Acute Physiology Score (SAPS) é um modelo desenvolvido na França por Le Gall et al. em 1983, modificado para SAPS II em 1993. É composto por 12 variáveis fisiológicas, idade, tipo de admissão e presença de doença crônica. Este estudo tem como objetivo analisar a predição de mortalidade do SAPS II nos pacientes internados na UTI do Hospital São José, Criciúma, SC. Métodos: Estudo prospectivo de coorte realizado entre julho de 2007 a fevereiro de 2008. Foram inclusos pacientes de ambos os sexos, com idade maior que 18 anos e tempo de internação na UTI superior a 24 horas. Resultados: 144 (59%) pacientes foram do sexo masculino e 97 (41%) do sexo feminino. A idade média foi de 55 ± 17 anos, 85 (35%) pacientes tiveram sua admissão devido a pós-operatório de cirurgias eletivas, 33 (14%) devido a pós-operatório de cirurgias de urgência e 123 (51%) devido à intercorrências clínicas. A média de pontos do SAPS II foi de 28,7 ± 14,3. Conclusão: O modelo estudado não foi adequado para o uso nesta amostra de pacientes, sendo que o escore SAPS II apresentou uma discriminação regular e subestimou a letalidade hospitalar. Além disso, o estudo foi realizado em uma única UTI, o que mostra somente um determinado perfil de pacientes.

Introduction: The Simplified Acute Physiology Score (SAPS) is a model developed in France By Le Gall et al. in 1983, modified for SAPS II in 1993. It consists of 12 physiological variables, age, type of admission and presence of chronic disease. This study aims to analyze the prediction of mortality of SAPS II in patients admitted to the ICU of São José Hospital, Criciúma, SC. Methods: Prospective cohort study conducted from July 2007 to February 2008. We included patients of both sexes, older than 18years and duration of ICU stay longer than 24 hours. Results: 144 (59%) patients were male and 97 (41%) were female. The average age was 55 ± 17 years, 85 (35%) patients had their admission due to postoperative elective surgery, 33 (14%) due to postoperative emergency surgery and 123 (51%) due to clinical complications. The average score on the SAPS II was 28,7 ± 14,3. Conclusion: ICU scoring systems has become an important tool to measure the performance of the ICU and may be used for resource allocation, selection of patients, quality assurance. The model studied was not suitable for use in this sample of patients. The SAPS II score had a regular discrimination and underestimated the mortality rate. In addition, the study was conducted in a single ICU, which shows only a certain profile of patients.