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[PMID]:29443733
[Au] Autor:Tee YS; Fang HY; Kuo IM; Lin YS; Huang SF; Yu MC
[Ad] Endereço:Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan.
[Ti] Título:Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis.
[So] Source:Medicine (Baltimore);97(7):e9654, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.
[Mh] Termos MeSH primário: APACHE
Mortalidade Hospitalar
Escores de Disfunção Orgânica
Pancreatite/mortalidade
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Idoso
Feminino
Seres Humanos
Unidades de Terapia Intensiva/estatística & dados numéricos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Reprodutibilidade dos Testes
Estudos Retrospectivos
Sensibilidade e Especificidade
Índice de Gravidade de Doença
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009654


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[PMID]:29419671
[Au] Autor:Tag-Adeen M; Omar MZ; Abd-Elsalam FM; Hasaneen A; Mohamed MA; Elfeky HM; Said EM; Abdul-Aziz B; Osman AH; Ahmed ES; Osman GS; Abdul-Samie T
[Ad] Endereço:Department of Internal Medicine, Qena School of Medicine, South Valley University, Qena.
[Ti] Título:Assessment of liver fibrosis in Egyptian chronic hepatitis B patients: A comparative study including 5 noninvasive indexes.
[So] Source:Medicine (Baltimore);97(6):e9781, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fibrosis assessment in chronic hepatitis B (CHB) is essential for prediction of long-term prognosis and proper treatment decision. This study was conducted to assess predictability of 5 simple noninvasive fibrosis indexes in comparison to liver biopsy in CHB patients.A total of 200 CHB adult Egyptian patients were consecutively included in this study, all were subjected to liver biopsy with staging of fibrosis using METAVIR scoring system. Fibrosis indexes including S-index, red cell distribution width to platelets ratio index (RPR), fibrosis-4 index (Fib-4), AST to platelets ratio index (APRI), and AST/ALT ratio index (AAR) were compared to biopsy result and their predictabilities for the different fibrosis stages were assessed using area under receiver operating characteristic curve (AUROC) analysis.S-index showed the highest AUROCs for predicting fibrosis among the studied indexes. AUROCs of S-index, RPR, Fib-4, APRI, and AAR were: 0.81, 0.67, 0.70, 0.68, and 0.60 for prediction of significant fibrosis (F2-F4), 0.90, 0.66, 0.68, 0.67, and 0.57 for advanced fibrosis (F3-F4), and 0.96, 0.62, 0.61, 0.57, and 0.53 for cirrhosis (F4), respectively. The optimal S-index cutoff for ruling in significant fibrosis was ≥0.3 with 94% specificity, 87% PPV, and 68% accuracy, while that for ruling out significant fibrosis was <0.1 with 96% sensitivity, 91% NPV, and 67% accuracy. Accuracy of S-index was higher for predicting cirrhosis (91%) than that for predicting advanced fibrosis (79%) and significant fibrosis (68%).S-index has the highest predictability for all fibrosis stages among the studied fibrosis indexes in HBeAg-negative CHB patients, with higher accuracy in cirrhosis than in the earlier fibrosis stages.
[Mh] Termos MeSH primário: Hepatite B Crônica/complicações
Cirrose Hepática
Fígado/patologia
[Mh] Termos MeSH secundário: Adulto
Biópsia/métodos
Egito/epidemiologia
Feminino
Hepatite B Crônica/epidemiologia
Seres Humanos
Cirrose Hepática/diagnóstico
Cirrose Hepática/etiologia
Cirrose Hepática/metabolismo
Cirrose Hepática/fisiopatologia
Testes de Função Hepática/métodos
Masculino
Escores de Disfunção Orgânica
Valor Preditivo dos Testes
Prognóstico
Curva ROC
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009781


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[PMID]:29193197
[Au] Autor:Kuuliala K; Penttilä AK; Kaukonen KM; Mustonen H; Kuuliala A; Oiva J; Hämäläinen M; Moilanen E; Pettilä V; Puolakkainen P; Kylänpää L; Repo H
[Ad] Endereço:Department of Bacteriology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
[Ti] Título:Signalling Profiles of Blood Leucocytes in Sepsis and in Acute Pancreatitis in Relation to Disease Severity.
[So] Source:Scand J Immunol;87(2):88-98, 2018 Feb.
[Is] ISSN:1365-3083
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Intracellular signalling in blood leucocytes shows multiple aberrations in acute pancreatitis (AP) complicated by organ dysfunction (OD). We studied whether the aberrations associate with severity of AP and occur in sepsis complicated by OD. The study comprises 14 sepsis patients (11 with shock), 18 AP patients (nine mild; six moderately severe; three severe) and 28 healthy volunteers. Within 48 h after admission to hospital, phosphorylation of nuclear factor-ĸB (NF-ĸB), signal transducers and activators of transcription (STATs) 1,3, and extracellular signal-regulated kinases 1/2 were measured from stimulated or non-stimulated leucocytes using phosphospecific whole blood flow cytometry. In sepsis, as compared with healthy subjects, phosphorylated NF-ĸB levels of monocytes promoted by bacterial lipopolysaccharides, tumour necrosis factor or Escherichia coli cells were lower (P < 0.001 for all), pSTAT1 levels of monocytes promoted by IL-6 were lower (P < 0.05 for all), and STAT3 was constitutively phosphorylated in monocytes, neutrophils and lymphocytes (P < 0.001 for all). In AP, severity was associated with proportions of pSTAT1-positive monocytes and lymphocytes promoted by IL-6 (P < 0.01 for both), constitutive STAT3 phosphorylation in neutrophils (P < 0.05), but not with any of the pNF-ĸB levels. Monocyte pSTAT3 fluorescence intensity, promoted by IL-6, was lower in sepsis and AP patients with OD than in AP patients without OD (P < 0.001). Collectively, signalling aberrations in sepsis with OD mimic those described previously in AP with OD. Possibility that aberrations in STAT1 and STAT3 pathways provide novel markers predicting evolution of OD warrants studies including patients presenting without OD but developing it during follow-up.
[Mh] Termos MeSH primário: Infecções por Escherichia coli/imunologia
Escherichia coli/imunologia
Leucócitos Mononucleares/imunologia
Pancreatite Necrosante Aguda/imunologia
Sepse/imunologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Biomarcadores/metabolismo
Células Cultivadas
Progressão da Doença
Feminino
Seres Humanos
Lipopolissacarídeos/imunologia
Masculino
Meia-Idade
Escores de Disfunção Orgânica
Pancreatite Necrosante Aguda/diagnóstico
Prognóstico
Fator de Transcrição STAT1/metabolismo
Fator de Transcrição STAT3/metabolismo
Sepse/diagnóstico
Transdução de Sinais/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Lipopolysaccharides); 0 (STAT1 Transcription Factor); 0 (STAT1 protein, human); 0 (STAT3 Transcription Factor); 0 (STAT3 protein, human)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1111/sji.12630


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[PMID]:29267291
[Au] Autor:Müller M; Guignard V; Schefold JC; Leichtle AB; Exadaktylos AK; Pfortmueller CA
[Ad] Endereço:Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
[Ti] Título:Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia.
[So] Source:PLoS One;12(12):e0188913, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite on-going advances in medical treatment, the burden of disease of pneumonia remains high. We aimed to determine the association of the qSOFA score with in-hospital mortality, length of hospitalisation, and admission to the intensive care unit (ICU) in patients with pneumonia. Further, in a subgroup analysis, the outcomes were compared for qSOFA in comparison to other risk scores, including the CURB-65 and SIRS scores. METHODS: In a retrospective analysis, admission data from the ED of the Bern University Hospital, Switzerland, were screened to identify patients admitted for pneumonia. In addition to clinical characteristics, qSOFA and CURB-65 scores and SIRS criteria were assessed and evaluated with respect to the defined study outcomes. RESULTS: 527 patients (median age 66 IQR 50-76) were included in this study. The overall in-hospital mortality was 13.3% (n = 70); 22.0% (n = 116) were transferred to the ICU. The median length of hospitalisation was 7 days (IQR 4-12). In comparison to qSOFA-negative patients, qSOFA-positive patients had increased odds ratios for in-hospital mortality (OR 2.6, 95%:1.4, 4.7, p<0.001) and ICU admission (3.5, 95% CI: 2.0. 5.8, p<0.001) and an increased length of stay (p<0.001). For ICU admission, the specificity of qSOPA-positivity (≥2) was 82.1% and sensitivity 43.0%. For in-hospital mortality, the specificity of qSOPA-positivity (≤2) was 88.9% and sensitivity 24.4%. In the subgroup analysis (n = 366). The area under the receiver operating curve for ICU admission was higher for qSOFA than for the CURB-65 score (p = 0.013). The evaluated scores did not differ significantly in their prognostication of in-hospital mortality (p>0.05). CONCLUSIONS: The qSOFA score is associated with in-hospital mortality, ICU admission and length of hospitalisation in ED patients with pneumonia. Subgroup analysis revealed that qSOFA is superior to CURB-65 in respect to prognostication of ICU admission.
[Mh] Termos MeSH primário: Escores de Disfunção Orgânica
Pneumonia/fisiopatologia
Sepse/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Pneumonia/complicações
Sepse/complicações
Síndrome de Resposta Inflamatória Sistêmica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188913


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[PMID]:29049184
[Au] Autor:Yang Y; Guo F; Kang Y; Zang B; Cui W; Qin B; Qin Y; Fang Q; Qin T; Jiang D; Cai B; Li R; Qiu H; China-SCAN Team
[Ad] Endereço:aNanjing Zhongda Hospital, Southeastern University School of Medicine, Nanjing bWest China Hospital of Sichuan University, Chengdu cShengjing Hospital of China Medical University, Shenyang dThe Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou eHenan Provincial People's Hospital, Zhengzhou fTianjin Third Central Hospital, Tianjin gThe First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou hGuangdong General Hospital, Guangzhou iDaping Hospital, Chongqing jMSD (China) Holding Co., Ltd. kResearch Center for Medical Mycology, Peking University First Hospital, Peking University, Beijing, China.
[Ti] Título:Epidemiology, clinical characteristics, and risk factors for mortality of early- and late-onset invasive candidiasis in intensive care units in China.
[So] Source:Medicine (Baltimore);96(42):e7830, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To identify the epidemiology, treatments, outcomes, and risk factors for patients with early- or late-onset invasive candidiasis (EOIC or LOIC) in intensive care units in China.Patients were classified as EOIC (≤10 days) or LOIC (>10 days) according to the time from hospital admission to IC onset to identify distinct clinical characteristics.There were 105 EOIC cases and 201 LOIC cases in this study. EOIC was related to more severe clinical conditions at ICU admission or prior to IC. Significantly, more cases of Candida parapsilosis infection were found in patients with LOIC than in those with EOIC. The mortality of EOIC was significantly lower than that for LOIC. Sequential Organ Failure Assessment (SOFA) score at ICI diagnosis in the EOIC group and the interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality. Susceptibility to the first-line agent was associated with a lower risk of mortality in the LOIC group.The mortality rate was significantly lower in the EOIC group, and there were more cases of non-albicans infection in the LOIC group. Susceptibility to the first-line agent was an important predictor of mortality in the LOIC group. SOFA score at ICI diagnosis in the EOIC group and interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality.
[Mh] Termos MeSH primário: Candida
Candidíase Invasiva/mortalidade
Infecção Hospitalar/mortalidade
Mortalidade Hospitalar
Unidades de Terapia Intensiva/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Candidíase Invasiva/microbiologia
Candidíase Invasiva/patologia
China/epidemiologia
Infecção Hospitalar/microbiologia
Infecção Hospitalar/patologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Escores de Disfunção Orgânica
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007830


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[PMID]:28953635
[Au] Autor:Zhang W; Danzeng Q; Feng X; Cao X; Chen W; Kang Y
[Ad] Endereço:aDepartment of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan bDepartment of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College cDepartment of Critical Care Medicine, First People's Hospital of Zunyi, Zunyi, Guizhou, China.
[Ti] Título:Sequential Organ Failure Assessment predicts outcomes of pulse indicator contour continuous cardiac output-directed goal therapy: A prospective study.
[So] Source:Medicine (Baltimore);96(39):e8111, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:According to the new sepsis definitions, septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. We evaluated the predictive efficacy of the Sequential Organ Failure Assessment (SOFA) score in critically ill patients with septic shock undergoing pulse indicator contour continuous cardiac output (PiCCO)-directed goal therapy (PDGT).We conducted a single-center, prospective, observational study of 52 patients with septic shock undergoing PDGT. The putative prognostic factors, including the severity scores (SOFA and Acute Physiology and Chronic Health Evaluation II [APACHE II] scores), were analyzed within 24 hours after diagnosis of septic shock. We assessed and compared the predictive efficacy of risk factors for 28-day mortality of patients with septic shock undergoing PDGT.Among the patients with septic shock undergoing PDGT, the SOFA scores of nonsurvivors were significantly higher than those of survivors (P < .001); the area under the receiver operating characteristics curve was higher for SOFA than for APACHE II (P = .005). The outcomes of the logistic regression analysis for 28-day mortality showed that the odds ratio, 95% confidence interval, and P-value of SOFA were 1.6, 1.2 to 2.1, and <.001, respectively.The predictive model of the SOFA score is able to accurately predict the outcomes of critically ill patients with septic shock undergoing PDGT.
[Mh] Termos MeSH primário: Débito Cardíaco
Estado Terminal/mortalidade
Escores de Disfunção Orgânica
Pulso Arterial
Choque Séptico/mortalidade
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Área Sob a Curva
Estado Terminal/terapia
Feminino
Metas
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Monitorização Fisiológica/métodos
Valor Preditivo dos Testes
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008111


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[PMID]:28945774
[Au] Autor:Warmerdam M; Stolwijk F; Boogert A; Sharma M; Tetteroo L; Lucke J; Mooijaart S; Ansems A; Esteve Cuevas L; Rijpsma D; de Groot B
[Ad] Endereço:Emergency Department, Leiden University Medical Centre, Leiden, Zuid-Holland, the Netherlands.
[Ti] Título:Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age.
[So] Source:PLoS One;12(9):e0185214, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Due to atypical symptom presentation older patients are more prone to delayed sepsis recognition. We investigated whether initial disease severity before emergency department (ED) treatment (including treatable acute organ dysfunction), quality of ED sepsis care and the impact on mortality was different between patients older and younger than 70 years. If differences exist, improvements are needed for ED management of older patients at risk for sepsis. METHODS: In this observational multicenter study, ED patients who were hospitalized with a suspected infection were stratified by age <70 and ≥70 years. The presence of treatable and potentially reversible acute organ dysfunction was measured by the RO components of the Predisposition, Infection, Response and Organ dysfunction (PIRO) score, reflecting acute sepsis-related organ dysfunction developed before ED presentation. Quality of care, as assessed by the full compliance with nine quality performance measures and the standardized mortality ratio (SMR: observed/expected in-hospital mortality), was compared between older and younger patients. RESULTS: The RO-components of the PIRO score were 8 (interquartile range; 4-9) in the 833 older patients, twice as high as the 4 (2-8; P<0.001) in the 1537 younger patients. However, full compliance with all nine quality performance measures was achieved in 34.2 (31.0-37.4)% of the older patients, not higher than the 33.0 (30.7-35.4)% in younger patients (P = 0.640). In-hospital mortality was 9.2% (95%-CI, 7.3-11.2) in patients ≥70, twice as high as the 4.6% (3.6-5.6) in patients <70 years, resulting in an SMR (in study period) of ~0.7 in both groups (P>0.05). CONCLUSION: Older sepsis patients are sicker at ED presentation but are not treated more expediently or reliably despite their extra acuity The presence of twice as much treatable acute organ dysfunction before ED treatment suggests that acute organ dysfunction is recognized relatively late by general practitioners or patients in the out of hospital setting.
[Mh] Termos MeSH primário: Sepse/terapia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Serviço Hospitalar de Emergência
Feminino
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Países Baixos/epidemiologia
Escores de Disfunção Orgânica
Avaliação de Resultados (Cuidados de Saúde)
Estudos Prospectivos
Melhoria de Qualidade
Qualidade da Assistência à Saúde
Sepse/diagnóstico
Sepse/mortalidade
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170926
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185214


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[PMID]:28866970
[Au] Autor:Jonsson N; Nilsen T; Gille-Johnson P; Bell M; Martling CR; Larsson A; Mårtensson J
[Ad] Endereço:Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. niklas.jonsson@karolinska.se.
[Ti] Título:Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment.
[So] Source:Crit Care Resusc;19(3):205-213, 2017 Sep.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Calprotectin is the most abundant protein in the cytosolic fraction of neutrophils, and neutrophil degranulation is a major response to bacterial infections. OBJECTIVES: To assess the value of plasma calprotectin as an early marker of bacterial infections in critically ill patients and compare it with the corresponding values for procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC). METHODS: We measured daily plasma calprotectin levels in 110 intensive care unit patients using a newly developed turbidimetric assay run on clinical chemistry analysers. The likelihood of infection was determined according to the International Sepsis Forum criteria. RESULTS: Overall, 58 patients (52.7%) developed a suspected or confirmed bacterial infection. Plasma calprotectin predicted such infections within 24 hours with an area under the receiver operating characteristics curve (ROC area) of 0.78 (95% CI, 0.68-0.89). The ROC area for calprotectin was significantly greater than the corresponding ROC areas for WBC (P < 0.001) and PCT (P = 0.02) but only marginally better than the ROC area for CRP (0.71; 95% CI, 0.68-0.89). CONCLUSION: Plasma calprotectin appears to be a useful early marker of bacterial infections in critically ill patients, with better predictive characteristics than WBC and PCT.
[Mh] Termos MeSH primário: Infecções Bacterianas/metabolismo
Calcitonina/metabolismo
Estado Terminal
Complexo Antígeno L1 Leucocitário/metabolismo
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Infecções Bacterianas/diagnóstico
Infecções Bacterianas/epidemiologia
Biomarcadores/metabolismo
Proteína C-Reativa/metabolismo
Estudos de Coortes
Diagnóstico Precoce
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Contagem de Leucócitos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Escores de Disfunção Orgânica
Curva ROC
Medição de Risco
Índice de Gravidade de Doença
Suécia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Leukocyte L1 Antigen Complex); 9007-12-9 (Calcitonin); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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[PMID]:28847411
[Au] Autor:Kruser JM; Rakhra SS; Sacotte RM; Wehbe FH; Rademaker AW; Wunderink RG; Kruser TJ
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Intensive Care Unit Outcomes Among Patients With Cancer After Palliative Radiation Therapy.
[So] Source:Int J Radiat Oncol Biol Phys;99(4):854-858, 2017 Nov 15.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To inform goals of care discussions at the time of palliative radiation therapy (RT) consultation, we sought to characterize intensive care unit (ICU) outcomes for patients treated with palliative RT compared to all other patients with metastatic cancer admitted to the ICU. METHODS AND MATERIALS: We conducted a retrospective cohort study of patients with metastatic cancer admitted to an ICU in a tertiary medical center from January 2010 to September 2015. We compared in-hospital mortality between patients who received palliative RT in the 12 months before admission and all other patients with metastatic cancer. We used multivariable logistic regression to evaluate the association between receipt of palliative RT and in-hospital mortality, adjusting for patient characteristics and acute illness severity. RESULTS: Among 1424 patients with metastatic cancer, 11.3% (n=161) received palliative RT before ICU admission. In-hospital mortality was 36.7% for palliative RT patients, compared with 16.6% for other patients with metastatic cancer (P<.001). Receipt of palliative RT was associated with increased in-hospital mortality (odds ratio 2.08, 95% confidence interval 1.34-3.21, P=.001), after adjusting for patient characteristics and severity of critical illness. Only 34 patients (21.1%) treated with palliative RT received additional cancer-directed treatment after ICU admission. CONCLUSIONS: For patients with metastatic cancer, prior treatment with palliative RT is associated with increased in-hospital mortality after ICU admission. Nearly half of patients previously treated with palliative RT either died during hospitalization or were discharged with hospice care, and few received further cancer-directed therapy. Palliative RT referral may represent an opportunity to discuss end-of-life treatment preferences with patients and families.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Unidades de Terapia Intensiva
Neoplasias/mortalidade
Neoplasias/radioterapia
Cuidados Paliativos/métodos
Assistência Terminal
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos
Seres Humanos
Unidades de Terapia Intensiva/estatística & dados numéricos
Modelos Logísticos
Masculino
Meia-Idade
Neoplasias/patologia
Razão de Chances
Escores de Disfunção Orgânica
Cuidados Paliativos/estatística & dados numéricos
Estudos Retrospectivos
Assistência Terminal/estatística & dados numéricos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE


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[PMID]:28817480
[Au] Autor:Wang HE; Jones AR; Donnelly JP
[Ad] Endereço:1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL.2University of Alabama at Birmingham School of Nursing, Birmingham, AL.3Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
[Ti] Título:Revised National Estimates of Emergency Department Visits for Sepsis in the United States.
[So] Source:Crit Care Med;45(9):1443-1449, 2017 Sep.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN: Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING: U.S. emergency department visits, 2009-2011. PATIENTS: Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). CONCLUSIONS: Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated sepsis classifications may impact national estimates of emergency department sepsis epidemiology.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Sepse/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Pressão Sanguínea
Estudos Transversais
Escala de Coma de Glasgow
Seres Humanos
Intubação Intratraqueal
Meia-Idade
Escores de Disfunção Orgânica
Sepse/diagnóstico
Sepse/fisiopatologia
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170924
[Lr] Data última revisão:
170924
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002538



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