ABSTRACT
Abstract Background and objectives: Subarachnoid hemorrhage is an important cause of morbidity and mortality. The aim of the study was to determine predictors of mortality among patients with subarachnoid hemorrhage hospitalized in an Intensive Care Unit. Methods: This is a retrospective study of patients with subarachnoid hemorrhage admitted to the Intensive of our institution during a 7 year period (2009-2015). Data were collected from the Intensive Care Unit computerized database and the patients' chart reviews. Results: We included in the study 107 patients with subarachnoid hemorrhage. A ruptured aneurysm was the cause of subarachnoid hemorrhage in 76 (71%) patients. The overall mortality was 40% (43 patients), and was significantly associated with septic shock, midline shift on CT scan, inter-hospital transfer, aspiration pneumonia and hypernatraemia during the first 72 hours of Intensive Care Unit stay. Multivariate analysis of patients with subarachnoid hemorrhage following an aneurysm rupture revealed that mortality was significantly associated with septic shock and hypernatremia during the first 72 hours of Intensive Care Unit stay, while early treatment of aneurysm (clipping or endovascular coiling) within the first 72 hours was identified as a predictor of a good prognosis. Conclusions: Transferred patients with subarachnoid hemorrhage had lower survival rates. Septic shock and hypernatraemia were important complications among critically ill patients with subarachnoid hemorrhage and were associated increased mortality.
Resumo Justificativa e objetivos: A hemorragia subaracnoidea é uma causa importante de morbidade e mortalidade. O objetivo do estudo foi determinar os preditivos de mortalidade entre os pacientes com hemorragia subaracnoidea internados em uma Unidade de Terapia Intensiva. Métodos: Estudo retrospectivo de pacientes com hemorragia subaracnoidea internados na Unidade de Terapia Intensiva de nossa instituição de 2009 a 2015. Os dados foram coletados do banco de dados eletrônico da Unidade de Terapia Intensiva e de revisões dos prontuários dos pacientes. Resultados: Incluímos no estudo 107 pacientes com hemorragia subaracnoidea. A ruptura de aneurisma foi a causa da hemorragia subaracnoidea em 76 pacientes (71%). A mortalidade geral foi de 40% (43 pacientes) e esteve significativamente associada ao choque séptico, desvio da linha média na tomografia computadorizada, transferência inter-hospitalar, pneumonia por aspiração e hipernatremia durante as primeiras 72 horas de internação na Unidade de Terapia Intensiva. A análise multivariada dos pacientes com hemorragia subaracnoidea pós-ruptura de aneurisma revelou que a mortalidade esteve significativamente associada ao choque séptico e hipernatremia nas primeiras 72 horas de permanência na Unidade de Terapia Intensiva, enquanto o tratamento precoce do aneurisma (clipagem ou embolização endovascular) nas primeiras 72 horas foi identificado como preditivo de um bom prognóstico. Conclusões: Os pacientes com hemorragia subaracnoidea transferidos apresentaram taxas menores de sobrevivência. Choque séptico e hipernatremia foram complicações importantes entre os pacientes gravemente enfermos com hemorragia subaracnoidea e foram associados ao aumento da mortalidade.
Subject(s)
Humans , Male , Female , Aged , Subarachnoid Hemorrhage/mortality , Prognosis , Retrospective Studies , Risk Factors , Intensive Care Units , Middle AgedABSTRACT
Introducción: las bacterias con enzimas carbapenemasas (KPC) tienen una gran capacidad de diseminación, son causantes de brotes nosocomiales y se asocian a mayor mortalidad y estancia hospitalaria. Objetivos: determinar la frecuencia de KPC en el Servicio de Clínica Médica del Hospital Nacional y determinar los factores de riesgo asociados. Materiales y método: estudio observacional, descriptivo, prospectivo, de corte transversal, que se realizó mediante hisopado rectal a 63 pacientes internados en el Servicio de Clínica Médica del Hospital Nacional entre octubre y noviembre del 2014. Resultados: la edad media de la muestra fue 51±15 años, el 50% de sexo masculino. En 13% de los pacientes se obtuvo un resultado positivo para KPC, el tiempo promedio de internación de éstos fue de 30±33 días vs 27±26 días de los pacientes KPC negativo. El único factor de riesgo significativo fue la cohabitación con otros pacientes con KPC. Conclusiones: la frecuencia de KPC en el Servicio de Clínica Médica del Hospital Nacional de Itauguá fue 13%. El principal factor de riesgo para adquirir KPC es la cohabitación con un paciente colonizado por el mismo germen.
Introduction: Carbapenemase producing bacteria (KPC) have great capacity of spreading, are causative agents of nosocomial outbreaks and are associated to higher mortality and longer hospital stay. Objectives: To determine the frequency of KPC in the Medical Clinic Service of the National Hospital and associated risk factors. Materials and method: This was a prospective descriptive cross-sectional study that performed rectal swab to 63 patients admitted into the Medical Clinic Service of the National Hospital between October and November, 2014. Results: Mean age of the sample was 51±15 years, and 50% was men. In 13% of the patients, a positive result for KPC was found and the mean time of hospitalization of these patients was 30±33 days vs 27±26 days of KPC negative patients. The only significant risk factor was daily contact with other KPC patients. Conclusions: The frequency of KPC in the Medical Clinic Service of the National Hospital of Itauguá was 13%. The main risk factor to acquire KPC was daily contact with a patient colonized by the same germ.