ABSTRACT
Background: Recently Pediatric Sequential Organ Failure Assessment (pSOFA) score was adapted and validated in critically ill children to predict the clinical outcome. This study was aimed to evaluate the lactate level association with the outcome and thereby formulating pSOFA-L score to predict the clinical outcome better in critically ill children.Methods: This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka. Requirement of oxygen, inotrope support and other parameters were studied and compared the score with clinical outcome. A total of 75 cases were studied.Results: In this study total of 51 children had high serum lactate levels (68%). Out of 28 expired children 23 children had higher serum lactate levels that accounts for about 82.14% which is statistically significant (p<0.001). ROC curve of pSOFA-L score in predicting the mortality yielded AUC: 0.92 and cut off value: 10.5 which is statistically significant (p<0.001). In the present study mortality rate was 26.09% in children whose pSOFA-L score was less than 9 and mortality rate of 38.89% and 50.00% in children whose pSOFA-L score was 9 to 11 and more than 11 respectively.Conclusions: In this study increase in pSOFA-L score is associated with high mortality and poor outcome. The findings of the present study validate and emphasize that, pSOFA-L score helps in accurate prediction of mortality of critically ill children.
ABSTRACT
Scrub typhus is one of the leading causes of acute febrile illness in India. This study aimed to determine the best diagnostic tool for the identification of scrub typhus and study the possible association between diagnostics and clinical characteristics. Patients with fever of ?15 days admitted to the hospital satisfying the case definition of 47 kDa quantitative polymerase chain reaction (qPCR) positivity OR scrub typhus IgM ELISA positivity along with the presence of eschar OR Scrub typhus IgM ELISA positivity along with defervescence of fever within 72 h of initiation of specific therapy were recruited. Of the 116 patients satisfying the case definition, 47 kDa qPCR was positive in 43 (37%) patients, whereas IgM ELISA was positive in 104 (90%) patients and eschar was seen in 59 (51%) patients. The median duration of fever was 7.5 days (interquartile range 6� days). Multiorgan dysfunction syndrome (MODS) was described in 44 (37.9%) patients. Two patients (1.8%) succumbed to the illness. Presence of eschar and IgM ELISA positivity were detected in 106 (91%) cases. Scrub typhus, even with MODS, has low mortality because of immediate institution of specific therapy due to physician awareness. The presence of eschar and IgM ELISA positivity can be used to detect a majority of cases of scrub typhus.
ABSTRACT
Objective To investigate the changes of thyroid hormone levels and its relationship with prognosis in old patients with sepsis. Methods APACHE Ⅱ score and SIRS score were documented in 140 old patients with sepsis,who were divided into Multiorgan dysfunction syndrome (MODS) group and non MODS group. Results The levels of FT3 and FT4 descended obviously and APACHE Ⅱ score and SIRS score increased remarkably in old patients with severe sepsis(P <0.05 or P <0.01). The level of FT3 and FT4 in death group and MODS group was much lower than that in the survival group (P < 0.05). Conclusion Inflammatory resction and eytokines may effect the hypothalamic- pituitary-thyroid axis. The levels of thyroid hormone can reflect old patients with sepsis condition. The patients with severer conditions may have lower levels of thyroid hormone who will be more likely to died of MODS.
ABSTRACT
Objective To study the role of low-dose glucocorticoids in improving prognosis and adjusting septic shock. Methods A total of 46 patients with a confirmed diagnosis of septic shock were retrospaetivley analyzed. 24 patients without glucocorticoids treatment were taken as control group; 22 patients with glucocorticoids as therapy group (n = 22). The two group received standard treatment for septic shock. Results The percentage of shock reversal on day 7 was higher in therapy group than that in control group (P <0.05). However,there were notstatistical significances in the duration of mechanical ventilation, the length of ICU stay, the incidence of multiple or-gan dysfunction syndrome (MODS) and mortality between the two groups (P > 0.05). Conclusion Low-dose glucocorticoids can effectively accelerate refractory septic shock reversal and vasopreasor withdrawal. This seems to be related to the reduced production of CRP but the beneficial effects of low-dose steroids regimens on long-term outcome have not yet be determined.