Georeferencing of deaths from sepsis in the city of São Paulo

Abstract Objective The aim of the present study was to obtain information about deaths due to sepsis in São Paulo from 2004 to 2009 and their relationship with geographical distribution. Methods Causes of death, both main and secondary, were defined according to the codes of the International Classification of Disease version 10 (ICD-10) contained in the database. Sepsis, septic shock, multiple organ failure, pneumonia, urinary tract infection, peritonitis and other intraabdominal infections, skin and soft tissue infections (including surgical wound infection) and meningitis were considered as immediate cause of death or as the condition leading to the immediate cause of death related or associated to sepsis. Results In the analyzed period, there was a 15.3% increase in the absolute number of deaths from sepsis in São Paulo. The mean number of deaths during this period was 28,472 ± 1566. Most deaths due to sepsis and sepsis-related diseases over the studied period occurred in a hospital or health care facility, showing that most of the patients received medical care during the event that led to death. We observed a significant concentration of deaths in the most populous regions, tending more toward the center of the city. Conclusions Georeferencing data from death certificates or other sources can be a powerful tool to uncover regional epidemiological differences between populations. Our study revealed an even distribution of sepsis all over the inhabited areas of São Paulo.

Modelo de análise gradiente boosted do impacto do índice de massa corporal nos desfechos em curto prazo de pacientes clínicos gravemente enfermos / A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients

RESUMO Objetivo: Avaliar o impacto do índice de massa corporal no prognóstico em curto prazo de pacientes gravemente enfermos não cirúrgicos, ao mesmo tempo em que se controla em relação a performance status e comorbidades. Métodos: Análise retrospectiva da base de dados referente a 2 anos de um único centro, incluindo 1.943 pacientes. Avaliamos o impacto do índice de massa corporal na mortalidade hospitalar, utilizando um modelo gradiente boosted, que também incluiu comorbidades, analisadas pelo índice de comorbidades de Charlson; performance status; e gravidade da doença, que foi observada pelo escore SAPS3. O escore SAPS3 foi ajustado para evitar a inclusão duplicada de uma mesma variável no modelo. Também avaliamos o impacto do índice de massa corporal na duração da permanência no hospital, após a permanência na unidade de terapia intensiva, utilizando múltiplas regressões lineares. Resultados: Um valor baixo do índice de massa corporal (< 20kg/m2) se associou com um aumento abrupto na mortalidade hospitalar. A mortalidade subsequentemente tendeu a diminuir, à medida que o índice de massa corporal aumentou, mas o impacto de um índice alto de massa corporal na definição da mortalidade foi baixo. A mortalidade aumentou conforme aumentou o ônus de comorbidades e o performance status diminuiu. O índice de massa corporal interagiu com o impacto do SAPS3 no desfecho dos pacientes, mas não houve interação significante entre índice de massa corporal, performance status e comorbidades. Não houve associação aparente entre o índice de massa corporal e a duração da permanência no hospital após a admissão à unidade de terapia intensiva. Conclusão: O índice de massa corporal não pareceu influenciar nos desfechos em curto prazo de pacientes clínicos gravemente enfermos, que geralmente estão abaixo do peso. Essa associação foi independente de comorbidades e performance status. .

ABSTRACT Objective: To evaluate the impact of body mass index on the short-term prognosis of non-surgical critically ill patients while controlling for performance status and comorbidities. Methods: We performed a retrospective analysis on a two-year single-center database including 1943 patients. We evaluated the impact of body mass index on hospital mortality using a gradient-boosted model that also included comorbidities and was assessed by Charlson’s comorbidity index, performance status and illness severity, which was measured by the SAPS3 score. The SAPS3 score was adjusted to avoid including the same variable twice in the model. We also assessed the impact of body mass index on the length of stay in the hospital after intensive care unit admission using multiple linear regressions. Results: A low value (< 20kg/m2) was associated with a sharp increase in hospital mortality. Mortality tended to subsequently decrease as body mass index increased, but the impact of a high body mass index in defining mortality was low. Mortality increased as the burden of comorbidities increased and as the performance status decreased. Body mass index interacted with the impact of SAPS3 on patient outcome, but there was no significant interaction between body mass index, performance status and comorbidities. There was no apparent association between body mass index and the length of stay at the hospital after intensive care unit admission. Conclusion: Body mass index does appear to influence the shortterm outcomes of critically ill medical patients, who are generally underweight. This association was independent of comorbidities and performance status. .