A Simple System to Predict Mortality in Medical Intensive Care Unit.

Background: Advances in critical care have increased survival chances and the demand for a scientific approach to outcome prediction. The present study aimed to investigate the associations of clinical information, demographic and laboratory data with mortality; and to elaborate and validate a regression equation for mortality prediction in a medical intensive care unit (ICU). Methods: This study included 202 patients and took place in a medical ICU at the Botucatu Medical School Hospital, Brazil. In Phase 1, 123 patients admitted to ICU between September 2003 and October 2004 was retrospectively analyzed and allowed equation elaboration. In Phase 2, the mortality equation was prospectively applied in 79 patients consecutively admitted to ICU between August and December 2006. Results: Among Phase 1 patients, 55% were males and mean age was 58±19 years. Mortality rate was 29%. Multivariate analysis revealed that shock (p=0.002) and hypoalbuminemia (p=0.024) were associated with higher mortality rate. When regression equation was applied in Phase 2 patients, higher equation values were shown for nonsurvivors (0.512; -1.008 -0.512) than for survivors (-1.008; -1.290 -1.008) (p=0.03). The equation also had good precision, 1.8% (IC95%; 1.1-4.7), and low bias, -3.1% (IC95%; -27.1 -20.8). Areas under the receiver operating characteristic (ROC) curve showed no statistical differences between APACHE II (0.75±0.06) and the equation (0.66±0.07) (p=0.27). Conclusions: Our data suggest that a simple and accurate prognostic equation can be used to predict ICU mortality.

Experimental assessment of the effects of a Neotropical nocturnal piscivore on juvenile native and invasive fishes

We experimentally examined the predator-prey relationships between juvenile spotted sorubim Pseudoplastystoma corruscans and young-of-the-year invasive and native fish species of the Paraná River basin, Brazil. Three invasive (peacock bass Cichla piquiti, Nile tilapia Oreochromis niloticus, and channel catfish Ictalurus punctatus) and two native (yellowtail tetra Astyanax altiparanae and streaked prochilod Prochilodus lineatus) fish species were offered as prey to P. corruscans in 300 L aquaria with three habitat complexity treatments (0%, 50% and 100% structure-covered). Prey survival was variable through time and among species (C. piquiti < O. niloticus < A. altiparanae < P. lineatus < I. punctatus), depending largely on species-specific prey behavior but also on prey size and morphological defenses. Habitat complexity did not directly affect P. corruscans piscivory but some prey species changed their microhabitat use and shoaling behavior among habitat treatments in predator's presence. Pseudoplatystoma corruscans preyed preferentially on smaller individuals of those invasive species with weak morphological defensive features that persisted in a non-shoaling behavior. Overall, our results contrast with those in a companion experiment using a diurnal predator, suggesting that nocturnal piscivores preferentially prey on different (rather diurnal) fish species and are less affected by habitat complexity. Our findings suggest that recovering the native populations of P. corruscans might help controling some fish species introduced to the Paraná River basin, particularly C. piquiti and O. niloticus, whose parental care is expected to be weak or null at night.

A relação predador-presa entre juvenis de pintado Pseudoplatystoma corruscans (piscívoro nativo) e jovens do ano de espécies nativas e invasoras de peixes da bacia do rio Paraná, Brasil, foi testada experimentalmente. Três espécies de peixe invasoras (o tucunaré Cichla piquiti, a tilápia do Nilo Oreochromis niloticus e o bagre do canal Ictalurus punctatus) e duas nativas (o lambari do rabo amarelo Astyanax altiparanae e o curimbatá Prochilodus lineatus) foram oferecidas como presa para P. corruscans em microcosmos, com três tratamentos de complexidade de habitat (0%, 50% e 100% de cobertura por estruturas submersas). A sobrevivência de presas variou ao longo do tempo e entre espécies (C. piquiti < O. niloticus < A. altiparanae < P. lineatus < I. punctatus), sendo governada, em grande parte, por diferenças espécies-específicas no comportamento das presas, mas também pelo tamanho e defesas morfológicas das mesmas. A complexidade de habitat não afetou diretamente a piscivoria de P. corruscans, mas, na presença do predador, algumas espécies-presa alteraram seu comportamento quanto ao uso de micro-habitat e grau de agregação entre os níveis de complexidade de habitat. Pseudoplatystoma corruscans predou preferencialmente sobre os indivíduos menores das espécies invasoras que apresentaram estruturas morfológicas defensivas pouco desenvolvidas e que não formavam cardume. Em geral, os resultados obtidos contrastam com os de um experimento análogo, no qual foi usado um piscívoro diurno, sugerindo que piscívoros noturnos predam preferencialmente sobre espécies de peixes diferentes (de hábitos mais diurnos) e que são menos afetados pela complexidade estrutural de habitats. Os resultados obtidos sugerem que a recuperação de populações nativas de P. corruscans poderia contribuir para o controle de algumas espécies de peixes introduzidas no rio Paraná, especialmente C. piquiti e O. niloticus, dos quais se espera que o cuidado parental seja reduzido ou nulo à noite.