Study of clinical profile of acute respiratory distress syndrome in pneumonia and outcome in intensive care unit

Background: ARDS is a progressive inflammatory lung injury in patients with hypoxemic respiratory failure. Aspiration pneumonia and pneumonia are the most common cause of ARDS in direct lung injury whereas sepsis is the most common cause of ARDS in Indirect lung injury. Methods: This was observational study conducted in Intensive care unit, Department of Medicine, CPR Hospital, Kolhapur, Maharashtra for 6 months from 1 June to 30 November 2023 in 41 patients. Results: Most common cause of ARDS secondary to pneumonia, in this study population is bacterial pneumonia, followed by viral and parasitic infections. Average day of hospital stay for bacterial pneumonia is 13 days and 11 and 10 days for viral and parasitic infections respectively. For bacterial pneumonia mortality was 36%, for viral pneumonia was 37% and parasitic pneumonia was 33.33%. Out of 41 patients,16 patients were in mild ARDS with the SOFA score range of 2 to 5 and 12 patients were in moderate ARDS with SOFA score range of 6 to 9 and 12 patients were in severe ARDS with SOFA score range of 12 to 14. Conclusions: With our study we would like to conclude that sofa score is a good predictor of mortality in c/o ARDS patients in ICU setting. Patients who had sofa score of equal or more than 9 and who were in the category of moderate to severe ARDS, had poorer outcomes and high mortality rate.

Complicaciones y mortalidad en pacientes neurocríticos / Complications and mortality in neurocritic patients

Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

Índice leucocitos/eosinófilos como marcador pronóstico del choque séptico / Leukocyte/eosinophil Ratio as a Prognostic Marker of Septic Choque

Introducción: Se ha reconocido mundialmente el choque séptico como causa de una alta incidencia en la mortalidad. La incorporación de nuevos biomarcadores posibilita la obtención de un diagnóstico rápido y preciso. Objetivo: Evaluar la utilidad del índice leucocitos/eosinófilos como marcador pronóstico del choque séptico. Métodos: Se realizó una investigación en dos etapas: la primera descriptiva en la cual se detallaron las características clínicas, epidemiológicas y las variaciones de los estudios de laboratorio y la segunda explicativa de cohorte para estimar el valor predictivo del biomarcador leucocitos/eosinopenia en el choque séptico. Se realizó el recuento de eosinófilos y se obtuvo la media aritmética. Se consideró eosinopenia relativa con valores por debajo de la media de eosinófilos. Resultados: En el estudio se demostró que la leucocitosis fue de (27,4 células*mm3), la disminución del hematocrito (32,2 por ciento) y el descenso del número plaquetario (125,6 célula*mm3) prevalecen en el choque séptico. Además se refleja el descenso de los eosinófilos (18,5 células/mcl), aumento del índice leucocitos/eosinófilos (148,1) y empeoramiento del SOFA (2,8). El aumento del índice leucocitos/eosinófilos se correlaciona con el aumento de la proteína C reactiva y la procalcitonina. Conclusiones: La correlación de la leucocitosis y la eosinopenia mostró la utilidad del índice leucocitos/eosinopenia como factor de predicción del choque séptico(AU)

Introduction: Septic shock has been recognized worldwide as a cause of high incidence of mortality. The incorporation of new biomarkers makes it possible to obtain a rapid and accurate diagnosis. Objective: To evaluate the usefulness of the leukocyte/eosinophil ratio as a prognostic marker of septic shock. Methods: An investigation was carried out in two stages: in the first (the descriptive phase) the clinical and epidemiological characteristics and variations of the laboratory studies were detailed and in the second (the explanatory cohort phase), the predictive value of the leukocytes/eosinopenia biomarker in septic shock was estimated. The eosinophil count was performed and the arithmetic mean was obtained. Relative eosinopenia was considered with eosinophil values below the average. Results: The study showed that leukocytosis was 27.4 cells*mm3, hematocrit decreased in 32.2percent and decreased platelet number (125.6 cells*mm3) prevail in septic shock. In addition, a decrease in eosinophils (18.5 cells/mcl), an increase in the leukocyte/eosinophil ratio (148.1) and worsening of SOFA (2.8) are reflected. The increase in the leukocyte/eosinophil ratio is correlated with the increase in C-reactive protein and procalcitonin. Conclusions: The correlation of leukocytosis and eosinopenia showed the usefulness of the leukocyte/eosinopenia index as a predictor of septic shock(AU)

Nuevas perspectivas en el estudio y tratamiento de la sepsis

La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

A study of predictors of outcome in paediatric intensive care unit with special reference to SOFA score

Background: Multi-organ dysfunction syndrome (MODS) is the leading cause of morbidity and mortality for patients admitted in Pediatric Intensive care unit. The Sequential organ failure assessment (SOFA) score is an objective score that allows for calculation of both the number and the severity of organ dysfunction in six organ systems. It is a six-organ dysfunction score measuring multiple organ failure daily. Each organ is graded from 0 (normal) to 4 (the most abnormal). This scoring system guides the efficient utilization of hospital resources, especially in a resource starved setting and useful to evaluate the prognostication, to counsel the guardians and to decide therapeutic interventions. The score can also be a useful in clinical research tool to evaluate various therapeutic interventions in MODS. The aim of the study was to predict outcome in pediatric intensive care unit with special reference to SOFA score in patients admitted to civil hospital, Ahmedabad.Methods: We have randomly selected 120 patients who were admitted in pediatric intensive care unit of tertiary care hospital and full-filing inclusion and exclusion criteria included in our study.Results: There are multiple factors responsible for predicting the outcome in critically ill patients admitted in pediatric intensive care unit. Patients with complete immunization status have better outcome as compared to patients with incomplete immunization and unimmunized status. Patients with higher socioeconomic class have slightly better outcome as compared to patients with lower socioeconomic class.Conclusions: SOFA score is a good objective score as a predictor of mortality in critically ill patients. But, if SOFA is calculated at the time of admission, then it has poor diagnostic accuracy in prediction of outcome. So, SOFA score at 72 hours of admission (T72) and delta SOFA (T72-T0) are better predictors of poor outcome as compared to SOFA score at admission (T0).

Predictive value of mechanical power on the in-hospital mortality in critical ill patients with mechanical ventilation in emergency department / 中华急诊医学杂志

Objective:To evaluate the predictive value of mechanical power (MP) on the risk of in-hospital mortality in critical ill patients in emergency department.Methods:A total of 105 critical ill patients with invasive mechanical ventilation in the Department of Emergency of Second Affiliated Hospital of Guangzhou Medical University between December 1, 2017 and October 31, 2020 were retrospectively analyzed. Based on the clinical prognosis, the patients were divided into the in-hospital survival group (80 patients) and the in-hospital death group (25 patients). The clinical data and ventilator parameters were recorded, and the MP of the two groups was calculated in order to assess the predictive efficacy of MP on in-hospital death.Results:Compared to the in-hospital death group, the oxygenation index PaO 2/FiO 2 was significantly higher (271 mmHg vs. 217 mmHg, P=0.020) and blood lactate (1.59 mmol/L vs. 2.56 mmol/L, P<0.001) and procalcitonin (0.31 ng/mL vs. 3.55 ng/mL, P=0.028), minute ventilation (7.03 L/min vs.8.32 mmol/L, P=0.013), MP (14.37 J/min vs. 16.12 J/min, P=0.041), SOFA score (5 vs. 8, P=0.001) and APACHE II score (16 vs. 22, P=0.041) were significantly lower in the in-hospital survival group. Multivariate Logistic regression analysis showed that PaO 2/FiO 2( OR=1.015, P=0.044), MP ( OR=1.813, P=0.039) and SOFA score( OR=2.651, P=0.010) were independent risk factors for predicting hospital mortality in patients with mechanical ventilation. The areas under the ROC curves (AUC) were 0.62, 0.63 and 0.75, respectively. Moreover, the MP combined with SOFA score for predicting in-hospital death was significantly higher than that of MP alone (0.77 vs. 0.63, P<0.05). Conclusions:MP is associated with in-hospital death in patients with invasive mechanical ventilation in emergency department. MP combined with SOFA score can enhance its predictive efficacy

Riesgo nutricional y ultrasonido muscular en el paciente críticamente enfermo / Assessment of nutritional risk and muscle in critically ill patients / Risco nutricional e ultrassom muscular no paciente em estado crítico

Resumen: Se ha propuesto el uso de la escala nutritional risk in the critically ill (NUTRIC) como una herramienta para la valoración nutricional en el paciente crítico. Una de las principales desventajas es que dicha escala no considera variables críticas en la determinación de desnutrición como el desgaste muscular. El objetivo del presente estudio es evaluar la importancia del músculo valorado por ultrasonido del recto femoral y vasto intermedio, en conjunto con el riesgo nutricional por la escala NUTRIC en los resultados clínicos de pacientes críticamente enfermos. Se realizó ultrasonido muscular dentro de las primeras 48 horas de ingreso a pacientes adultos. A su vez se calculó el riesgo nutricional con la escala NUTRIC, y se dio seguimiento detectando mortalidad hospitalaria. Se incluyeron 43 pacientes, 21 presentaron riesgo nutricional (48.8%) sin mostrar diferencia en el grosor muscular. En el modelo de regresión ajustado por la escala NUTRIC, ventilación mecánica mayor de 48 horas, índice de masa corporal y grosor muscular, este último se mostró como un factor protector de mortalidad (OR: 0.21, IC 95%: 0.03-0.83). El presente estudio resalta la necesidad de una valoración integral considerando la masa muscular como variable cardinal en la detección de desnutrición en pacientes críticamente enfermos.

Abstract: Nutritional Risk in the critically ill score, it has been used like tool to asses nutritional state in critically ill patient. A mayor limitation of this score is that not include important variables in the assessment of malnutrition, like muscular wasting. The main goal of this study is to evaluate the relevance of the muscle, by measuring the femoral quadriceps, along with NUTRIC score of critically ill patients results. An ultrasound in the first 48 hours of admission to ICU was made plus NUTRIC score and a follow up detecting in-hospital mortality. We included 43 patients, with 21 with nutritional risk (48.8%) showing no difference in muscular thickness. The NUTRIC score adjusted regression model, mechanical ventilation longer than 48 hours, body weight index and muscular thickness. The muscular thickness shows as mortality protector factor (OR: 0.21, 95% CI: 0.03-0.83). This study remarks the need for integral assessment considering muscular mass as a main variable in the malnutrition detection in critically ill patients.

Resumo: A utilização da escala de Nutritional Risk in the Critically Ill tem sido proposta como uma ferramenta para avaliação nutricional em pacientes em estado crítico. Uma das principais desvantagens é que esta escala não considera variáveis críticas na determinação da desnutrição, como a perda de massa muscular. O objetivo do presente estudo é avaliar a importância do músculo, avaliado por ultrassom do reto femoral e vasto intermediário, em conjunto com o risco nutricional por NUTRIC score nos resultados clínicos de pacientes em estado crítico. O ultrassom muscular foi realizado nas primeiras 48 horas de internação em pacientes adultos. Paralelamente, calculou-se o risco nutricional pelo NUTRIC, bem como o seguimento detectando a mortalidade hospitalar. Incluíram-se 43 pacientes, 21 apresentando risco nutricional (48.8%) sem diferença na espessura muscular. No modelo de regressão ajustado pelo NUTRIC, ventilação mecânica maior a 48 horas, índice de massa corporal e espessura muscular, esta última se mostrou fator protetor para mortalidade (OR: 0.21, IC 95%: 0.03-0.83). Este estudo destaca a necessidade de uma avaliação abrangente considerando a massa muscular como uma variável cardinal na detecção de desnutrição em pacientes em estado crítico.

Evaluación del polimorfismo TLR2 Arg753Gln como posible marcador de riesgo para el desarrollo de sepsis

Objetivo: Evaluar el polimorfismo TLR2 Arg753Gln como posible marcador de riesgo para el desarrollo de sepsis Materiales y métodos: Estudio de asociación, el cual incluyó 183 individuos venezolanos no relacionados, agrupados en individuos sépticos (n=50), hospitalizados en el área de emergencia del Hospital Central del Instituto Venezolano de los Seguros Sociales -Dr. Miguel Pérez Carreño-, e individuos aparentemente sanos (n=133). El polimorfismo TLR2 Arg753Gln se determinó utilizando la técnica reacción en cadena de la polimerasa con iniciadores de secuencias específicas. Resultados: Se observó en el grupo de pacientes con escala SOFA en el rango entre 6-9 una mayor frecuencia de fallecimientos con respecto al grupo de pacientes con escala SOFA en el rango entre 0-5 (OR: 8.5; IC 95%: 2.33-30.90, p= 0,000357). El polimorfismo Arg753Gln del gen TLR2 está ausente en los pacientes con diagnóstico de sepsis. Conclusión: Se verificó que la escala SOFA es un sistema que permite predecir la mortalidad. La ausencia del polimorfismo Arg753Gln del gen TLR2 en el grupo de pacientes sépticos y una baja frecuencia del mismo en los individuos aparentemente sanos, sugiere la rareza de este polimorfismo en la población venezolana. Consecuentemente, se requiere incrementar el tamaño de la muestra para poder comprobar si es un marcador de riesgo para el desarrollo de sepsis en nuestra población.

Objective: To evaluate the TLR2 Arg753Gln polymorphism as a possible risk marker for sepsis development. Materials and Methods: Association study which included 183 unrelated Venezuelan individuals, divided into two groups: patients with sepsis (n = 50), hospitalized in the emergency area of the Central Hospital of the Venezuelan Institute of Social Security "Dr. Miguel Pérez Carreño", and apparently healthy individuals (n = 133). The TLR2 Arg753Gln polymorphism was determined using the polymerase chain reaction technique with specific sequence primers. Results: A higher death rate was observed among the group of patients with the SOFA scale range between 6-9, compared to the group of patients with the SOFA scale range between 0-5 (OR: 8.5; 95% CI: 2.33-30.90, p = 0.000357). The Arg753Gln polymorphism of the TLR2 gene is absent in patients diagnosed with sepsis. Conclusion: It was verified that the SOFA scale is a useful system to predict the mortality rate associated with sepsis. The absence of the Arg753Gln polymorphism of the TLR2 gene among the group of patients with sepsis diagnosis and its low frequency in apparently healthy individuals suggests the rarity of this polymorphism in the Venezuelan population. Consequently, it is necessary to increase the size of the sample to be able to evaluate whether it can be considered as a risk marker for sepsis development in our population.

Desempeño de PSI/PORT y SOFA para predicción de ventilación mecánica invasiva en neumonía por SARS-CoV-2 / Performance of PSI/PORT and SOFA in predicting mechanical invasive ventilation in SARS-CoV-2 pneumonia / Desempenho de PSI/PORT e SOFA para prever ventilação mecânica invasiva na pneumonia por SARS-CoV-2

Resumen Introducción: Son escasas las publicaciones sobre aplicación de escalas pronósticas para predecir el uso de ventilación mecánica invasiva (VMI) en neumonía por SARS-CoV-2. El objetivo del estudio fue evaluar el desempeño de las escalas PSI/PORT y SOFA para predecir el uso de VMI en pacientes con neumonía por SARS-CoV-2. Material y métodos: Estudio retrospectivo que incluyó pacientes hospitalizados con neumonía por SARS-CoV-2 del 01 de abril al 31 de mayo de 2020. Se realizó análisis de curvas ROC, calculando el área bajo la curva de las escalas PSI/PORT y SOFA, así como sensibilidad, especificidad y valores predictivos. Resultados: Se incluyó a 151 pacientes, con edad de 52 años (IQR 45-64); 69.5% eran hombres. Del total, 102 pacientes necesitaron VMI (67.5%). Las áreas bajo las curvas ROC para predecir VMI fueron: SOFA 0.71 (IC 95% 0.64-0.78) y PSI/PORT 0.78 (IC 95% 0.71-0.85). Al compararlas, no hubo significancia estadística (p = 0.08). Conclusiones: Las escalas SOFA y PSI/PORT pueden infraestimar la necesidad de VMI en la neumonía por SARS-CoV-2. En nuestro estudio, SOFA y PSI/PORT no tuvieron un buen desempeño para predecir el uso de VMI en pacientes hospitalizados con neumonía por SARS-CoV-2.

Abstract Introduction: There are few publications on the application of prognostic scales to predict the use of invasive mechanical ventilation (IMV) in SARS-CoV-2 pneumonia. Therefore, the study's objective was to evaluate the performance of PSI/PORT and SOFA in predicting the use of IMV in patients with SARS-CoV-2 pneumonia. Material and methods: A retrospective study that included hospitalized patients with SARS-CoV-2 pneumonia from April 01, 2020, to May 31, 2020. Analysis of ROC curves was performed, calculating the area under the curve for PSI/PORT and SOFA scores, as well as sensitivity, specificity, and predictive values. Results: 151 patients were included, aged 52 years (IQR 45-64); 69.5% were men. Of the total, 102 patients required IMV (67.5%). Area under the curve to predict IMV were: SOFA 0.71 (95% CI 0.64-0.78) and PSI/PORT 0.78 (95% CI 0.71-0.85). When comparing them, there was no statistical significance (p = 0.08). Conclusions: In patients with SARS-CoV-2 infection, SOFA and PSI/PORT may underestimate the need for IMV. In our study, SOFA and PSI/PORT score performed fair in predicting IMV use in hospitalized patients with SARS-CoV-2 pneumonia.

Resumo Introdução: Existem poucas publicações sobre a aplicação de escalas prognósticas para prever o uso de ventilação mecânica invasiva (VMI) na pneumonia por SARS-CoV-2. O objetivo do estudo foi avaliar o desempenho do PSI/PORT e SOFA para prever o uso de IMV em pacientes com pneumonia por SARS-CoV-2. Material e métodos: Estudo retrospectivo que incluiu pacientes internados com pneumonia por SARS-CoV-2 entre 1o de abril de 2020 e 31 de maio de 2020. Foi realizada análise da curva ROC, calculando a área sob a curva PSI/PORT e SOFA, bem como a sensibilidade, especificidade e valores preditivos. Resultados: Foram incluídos 151 pacientes, com idade de 52 anos (IQR 45-64); 69.5% eram homens. Do total, 102 pacientes necessitaram de VMI (67.5%). As áreas sob as curvas ROC para predizer VMI foram: SOFA 0.71 (IC 95% 0.64-0.78) e PSI/PORT 0.78 (IC 95% 0.71-0.85). Ao compará-los, não houve significância estatística (p = 0.08). Conclusões: SOFA e PSI/PORT podem subestimar a necessidade de VMI na pneumonia por SARS-CoV-2. Em nosso estudo, SOFA e PSI/PORT não tiveram bom desempenho na previsão do uso de VMI em pacientes hospitalizados com pneumonia por SARS-CoV-2.

Relación entre intensidad de la ventilación mecánica y agravamiento de la disfunción multiorgánica por la COVID-19 / Relationship between intensity of mechanical ventilation and multiple organ dysfunction worsening by COVID-19

RESUMEN Introducción: La intensidad de la ventilación mecánica está reflejada por la presión de conducción dinámica y el poder mecánico. Es un predictor de lesión pulmonar inducida por el ventilador y está asociada a la mortalidad. Objetivo: Determinar si existe relación entre intensidad de la ventilación mecánica y el ΔSOFA>0 (agravamiento) en los pacientes con la COVID-19 a las 72 horas después de la intubación. Material y Métodos: Grupo de estudio conformado por 35 pacientes diagnosticados con la COVID-19 que estuvieron ventilados por más de 72 horas. Se empleó la prueba de Chi cuadrado (X 2 ) o test exacto de Fisher para comparar variables cualitativas; para las cuantitativas se empleó la prueba t de Student o U de Mann-Whitney. Se realizó una Regresión Logística Binaria Simple para encontrar relación de las variables con ΔSOFA dicotomizada para ΔSOFA≤0 y ΔSOFA>0. La capacidad discriminativa de los modelos se evaluó mediante la Curva ROC. Resultados: Presentaron SOFA>0 21 pacientes (60 %). No se encontraron diferencias significativas de la Presión de Conducción entre ambos grupos (15 vs. 18, U=94.00, z= -1,795, p=0,77). Fueron buenas predictoras de ΔSOFA>0 el Poder Mecánico (OR 3,421 [95 % IC1,510 a 7,750, p=0,003]) y el Volumen Tidal (OR 1,03 [95 % IC 1,012 a 1,068], p=0,005). El Modelo Predictivo de ΔSOFA>0 en función del Poder Mecánico (AUC 0,888 [95 % IC 0,775 a 1], p<0,001) mostró una buena capacidad discriminatoria. Conclusiones: El Poder Mecánico está relacionado con el agravamiento de la disfunción multiorgánica en pacientes sometidos a ventilación mecánica por la COVID-19.

ABSTRACT Introduction: The intensity of mechanical ventilation is reflected by driving pressure and mechanical power. It is a predictor of ventilator-induced lung injury and it can be associated with mortality. Objective: To determine if there is a relationship between intensity of mechanical ventilation and ΔSOFA>0 (worsening) in patients with COVID-19 at 72 h after intubation. Material and Methods: Study group composed of 35 COVID-19 patients who were ventilated for more than 72 hours. Chi-square test (X 2 ) or Fisher's exact test was used to compare qualitative variables; Student t test or Mann-Whitney U test was employed for quantitative ones. A Simple Binary Logistic Regression Model was performed in order to find the relationship between variables and dichotomized ΔSOFA for ΔSOFA≤0 and ΔSOFA>0. The discriminatory capacity of the models was tested by using ROC Curve. Results: A total of 21 patients (60 %) presented ΔSOFA>0 (worsening). No significant differences related to Driving Pressure were found between the two groups (15 vs. 18, U=94,00, z= -1,795, p=0,77). Mechanical Power (OR 3,421 [95 % CI 1,510 a 7,750, p=0,003]) and Tidal Volume (OR 1,03 [95 % CI 1,012 a 1,068], p=0,005) were good predictors of ΔSOFA>0. The Predictive Model of ΔSOFA>0 depending on Mechanical Power (AUC 0,888 [95 % CI 0,775 a 1], p<0,001) showed a good discriminatory capacity. Conclusions: Mechanical Power is related to multi-organ dysfunction worsening in mechanically ventilated patients with COVID-19.

Research progress on liver transplantation for drug-induced liver injury / 器官移植

Drug-induced liver injury (DILI) is a type of necrotizing and inflammatory liver disease caused by certain commonly-used drugs, Chinese herbal medicines or dietary supplements. In severe cases, it may lead to acute liver failure. Without liver transplantation, the fatality could reach up to 80%. It is of significance to master the indications of liver transplantation. Several prognostic scoring systems have been developed to help clinicians to decide which patients need urgent liver transplantation, such as King's College criteria (KCC) and model for end-stage liver disease (MELD) scoring systems. However, these scoring methods have been developed for a long period of time and lack of modifications. Therefore, scholars have proposed several new scoring systems, such as acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scoring systems, which provide novel ideas for the evaluation of liver transplantation. As an important treatment measure for drug-induced acute liver failure, urgent liver transplantation has greatly improved the survival rate of patients. In this article, the classification, clinical diagnosis, liver transplantation evaluation and prognosis of DILI were summarized, aiming to provide reference for the treatment of DILI by liver transplantation.

Effect of the timing of peripancreatic fluid drainage on prognosis in patients with severe acute pancreatitis: a two-center clinical retrospective study / 中华急诊医学杂志

Objective:To evaluate the effect of the timing of peripancreatic drainage on the survival outcome of patients with severe acute pancreatitis (SAP).Methods:This retrospective study included 271 patients with SAP admitted to two tertiary hospitals from January 2015 to December 2019. The Acute Physiology and Chronic Health EvaluationⅡ score (APACHEⅡ), Sequential Organ Failure Assessment score (SOFA), computed tomography (CT) grade, peripancreatic drainage situations, and survival outcome of patients were recorded. Patients were divided into the early and non-early peripancreatic catheter drainage groups (EPCD and non-EPCD). The data were analyzed using the Cox proportional hazard model for propensity score matching (PSM) and stratification.Results:After PSM, the 30-day and 90-day risk of death between the EPCD and non-EPCD groups were significantly different (0.134, 95% CI: 0.029-0.576, P=0.007; 0.166, 95% CI: 0.044-0.631, P=0.008, respectively). Furthermore, stratified analysis revealed significant differences in 30-day and 90-day risk of death between the EPCD and non-EPCD groups when the SOFA score was≥4 or the APACHEⅡ score was ≥8. Conclusions:For patients with SAP with SOFA score ≥4 or APACHEⅡ score≥8, early peripancreatic drainage can reduce the risk of death, but CT grading is not helpful for the decision-making of drainage timing in patients with SAP.

Experiencia en el cuadro clínico, diagnóstico y tratamiento de COVID-19 / Experience in the clinical picture, diagnosis and treatment of COVID-19 / Experiência no quadro clínico, diagnóstico e tratamento da COVID-19

Resumen: Introducción: La infección por SARS-CoV-2 en Wuhan, China, ocasionó una pandemia de tal magnitud que ha provocado la muerte por neumonía a causa de enfermedad infecciosa por coronavirus 19 (COVID-19) de millones de personas. Nos dimos a la tarea de recolectar todas las características de los pacientes que estuvieron hospitalizados por esta enfermedad en nuestra UCI adultos. Material y métodos: Se realizó un estudio de tipo analítico, descriptivo, observacional y retrospectivo en pacientes con diagnóstico de COVID-19 ingresados en la Unidad de Cuidados Intensivos (UCI) del Hospital Ángeles Clínica Londres en la Ciudad de México, evaluados en el periodo del 23 de marzo de 2020 al 10 de mayo de 2020. Se revisaron los expedientes y se tomaron los datos de los mismos, se describieron variables de tipo demográfico, factores de riesgo, signos y síntomas, tratamiento médico y atención respiratoria. Se revisaron escalas de mortalidad SAPS III, APACHE II, SOFA y CALL-score. Se formaron dos grupos con y sin mortalidad realizándose análisis bivariado y multivariado de las variables significativas. El análisis estadístico se efectuó con el programa SPSS 25. Resultados: En el periodo considerado, 25 expedientes cumplieron con los criterios de inclusión, de ellos la demografía y factores de riesgo, 18 (72%) correspondieron a hombres y siete (38%) a mujeres con una mortalidad de 10 (40%). Los factores de riesgo más frecuentes fueron diabetes mellitus (DM) en siete (38%) pacientes, hipertensión arterial (HAS) en seis (24%), obesidad en cuatro (16%), enfermedad pulmonar obstructiva crónica (EPOC) en uno (4%), tabaquismo en 11 (44%) y alcoholismo en siete (28%). Se encontraron diferencias estadísticamente significativas en los grupos sin mortalidad y con mortalidad, 15 y 10 pacientes, respectivamente, observando las siguientes significancias: glucosa 105 mg/dL (percentil [PE 88]) versus 171 mg/dL (PE 125) p = 0.012, urea 33 mg/dL (PE 22) versus 95 mg/dL (PE 57) p = 0.03, BUN 15.3 mg/dL (PE 11) versus 44.2 mg/dL (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 U/L (PE 260) p = 0.003, triglicéridos 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritina 446 mg/L (PE 238) versus 1,030 mg/L (PE 665) p = 0.007. Se realizó un análisis bivariado con regresión logística binaria, con la variable mortalidad dicotómica, no resultando significativa con esta prueba. Conclusiones: Se entiende que ninguna variable es predominantemente importante para explicar la mortalidad y que se recurre a muchos factores que se conjugan para explicar este desenlace, uno de éstos es la severidad misma del problema respiratorio en que se encuentre el paciente.

Abstract: Introduction: The SARS-CoV-2 infection in Wuhan, China caused a pandemic of such magnitude that it has caused the death of millions of people from pneumonia due to infectious disease caused by coronavirus 19 (COVID-19). We took on the task of collecting all the characteristics of the patients who were hospitalized for this disease in our Adult Intensive Care Unit. Material and methods: An analytical, descriptive, observational and retrospective study was carried out in patients with a diagnosis of COVID-19 admitted to the Intensive Care Unit (ICU) of the Hospital Ángeles Clínica Londres in Mexico City, evaluated in the period of March 23 from 2020 to May 10, 2020. The files were reviewed and the data taken from them, demographic variables, risk factors, signs and symptoms, medical treatment and respiratory care were described. SAPS III, APACHE II, SOFA and CALL-score mortality scales were reviewed. Two groups were formed with and without mortality, performing bivariate and multivariate analyzes of the significant variables. Statistical analysis was performed with the SPSS 25 program. Results: In the period considered, 25 files met the inclusion criteria for them: demographics and risk factors were 18 (72%) corresponding to men and seven (38%) to women. With a mortality of 10 (40%). The most frequent risk factors are diabetes mellitus (DM) in seven (38%), arterial hypertension (SAH) six (24%), obesity four (16%), chronic obstructive pulmonary disease (COPD) one (4%), smoking 11 (44%) and alcoholism seven (28%). Statistically significant differences were found in the groups without mortality and with mortality 15 and 10 patients respectively, observing the following significance: glucose 105 mg/dL (percentil [PE] 88) versus 171 mg/dL (PE 125) p = 0.012, urea 33 mg/dL (PE 22) versus 95 mg/dL (PE 57) p = 0.03, BUN 15.3 mg/dL (PE 11) versus 44.2 mg/dL (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 U/L (PE 260) p = 0.003, triglycerides 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritin 446 mg/L (PE 238) versus 1,030 mg/L (PE 665) p = 0.007. A bivariate analysis with binary logistic regression was performed, with the dichotomous mortality variable, not resulting in this significant test. Conclusions: It is understood that no variable is predominantly important to explain mortality and that many factors are involved that are combined to explain this outcome, one of these being the same severity of the respiratory problem in which the patient is.

Resumo: Introdução: A infecção por SARS-CoV-2 em Wuhan China causou uma pandemia de tal magnitude que causou a morte de milhões de pessoas por pneumonia devido a doença infecciosa causada pelo coronavírus 19 (COVID-19). Assumimos a tarefa de coletar todas as características dos pacientes internados por essa doença em nossa unidade de terapia intensiva adulto. Material e métodos: Realizou-se um estudo analítico, descritivo, observacional e retrospectivo em pacientes com diagnóstico de COVID-19 internados na Unidade de Terapia Intensiva (UTI) do Hospital Ángeles Clínica Londres na Cidade do México, validado para o período de 23 de março de 2020 a 10 de maio de 2020. Os prontuários médicos foram revisados e seus dados coletados, as variáveis do tipo demográficas foram descritas, fatores de risco, sinais e sintomas, tratamento médico e cuidados respiratórios. Foram revisadas as escalas de mortalidade SAPS III, APACHE II, SOFA e CALL-score. Dois grupos foram formados com e sem mortalidade, realizando análises bivariadas e multivariadas das variáveis significativas. A análise estatística foi realizada com o programa SPSS 25. Resultados: No período considerado, 25 prontuários atenderam aos critérios de inclusão para os mesmos: dados demográficos e fatores de risco foram 18 (72%) correspondentes a homens e 7 (38%) a mulheres. Com mortalidade de 10 (40%). Os fatores de risco mais frequentes são diabetes mellitus (DM) em 7 (38%), hipertensão arterial (HAS) 6 (24%), obesidade 4 (16%), doença pulmonar obstrutiva crônica (DPOC) 1 (4%), tabagismo 11 (44%) e alcoolismo 7 (28%). Encontrou-se diferenças estatisticamente significativas nos grupos sem mortalidade e com mortalidade de 15 e 10 pacientes respectivamente, observando a seguinte significância: glicose 105 mg/dL (percentil [PE] 88) versus 171 mg/dL (PE 125) p = 0.012, uréia 33 mg/L (PE 22) versus 95 mg/L (PE 57) p = 0.03, BUN 15.3 mg/L (PE 11) versus 44.2 mg/L (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 (PE 260) p = 0.003, triglicerídeos 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritina 446 mg/L (PE 238) versus 1030 mg/L (PE 665) p = 0.007. Realizou-se análise bivariada com regressão logística binária, com a variável mortalidade dicotômica, não resultando em teste significativo. Conclusões: Entende-se que nenhuma variável é predominantemente importante para explicar a mortalidade e que usamos muitos fatores que se conjugam para explicar esse desfecho, sendo um deles a mesma gravidade do problema respiratório em que o paciente se encontra.

Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas / Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases

INTRODUCCIÓN: La sepsis es una entidad grave siendo su sospecha y tratamiento precoces claves para el pronóstico. OBJETIVO: Analizar la utilidad pronóstica de la escala qSOFA en pacientes que ingresan por infección en un servicio de Medicina Interna. PACIENTES Y MÉTODOS: Estudio descriptivo, tranversal, de los pacientes ingresados con infección en el Hospital General de Castellón (España) de noviembre de 2017 a febrero de 2018. Criterio de inclusión: pacientes admitidos por la sospecha de un proceso infeccioso. Variable principal dependiente: mortalidad. Variable principal independiente: qSOFA. Variables secundarias: tiempo hasta primera valoración médica y hasta inicio de antibioterapia empírica en Urgencias (minutos), características demográficas del paciente, analíticas y evolutivas. RESULTADOS: Se analizó un total de 311 pacientes, 145 varones, edad media 78 años (DE 16,23). Setenta y cinco (24%) presentaron qSOFA ≥ 2. Se observó una mayor mortalidad en aquellos pacientes con qSOFA ≥ 2 (36 vs 11%, p = 0,00). CONCLUSIÓN: En pacientes admitidos con enfermedades infecciosas, un valor de qSOFA > = 2 se asoció a mayor mortalidad. Se requieren futuros estudios para comprobar su potencial utilidad diagnóstica.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. Inclusion criteria: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.

Epidemiology of sepsis and its various characteristics in a tertiary care adult-multidisciplinary ICU in South India: a retrospective study

Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.

Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children

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.

C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.

Prevalence and Correlation of Intra-abdominal Hypertension with Incidence of Acute Kidney Injury in ICU Patients: A Cohort Study from A Tertiary Care Centre

Introduction: Intra-abdominal hypertension (IAH), asustained and repeated steady state rise in intra-abdominalpressure (IAP) above 12 mmHg, was reported as a hiddencause contributing to morbidity and mortality in criticallyill patients. This study was aimed to find out the possiblerelationship between IAH and acute kidney injury (AKI) inICU patients.Material and methods: Prospective cohort study wasconducted among patients admitted in medical and surgicalICU. Consecutive patients coming under the inclusioncriteria were selected and IAH was measured using pressuretransducer technique. IAP was measured at the time ofadmission, at 24 hours, 48hours and also at the end of 72hours.Other parameters were collected based on a standard proformaprepared.Results: Eighty patients were included in our study, of which24 patients had IAH. Mean age in patients with IAH wasobtained as 63.08 ± 12.37 years with a male predominance.Maximum patients were belonging to age group of 61-70yrs (25%), 9 patients were below 40 yrs and 14 patientswere above 81yrs. Mean IAP was calculated to be 11.65 ±3.15. Only 9 patients were in grade IV (11.3%). Risk factorsassociated were found to be ascites, upper GI bleed andmetabolic encephalopathy. IAH and AKI were found to besignificantly correlated (odds ratio=2.666 with CI 0.98-7.25).Conclusion: Rising intra-abdominal pressure is found to havehigher incidence of renal failure than those with establishedIAH. IAH has been found to be a clinically significant riskfactor for development of AKI in ICU patients.

Comparison of two simplified SOFA scores for predicting the prognosis of patients with sepsis / 解放军医学杂志

Objective To compare the prognostic value of electronic SOFA (eSOFA) scores and simplified SOFA (sSOFA) scores in evaluating the prognosis of patients with sepsis. Methods A retrospective analysis was conducted of clinical data of 245 patients with sepsis admitted to the Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital from August 2016 to August 2019. Clinical end points were survival status 28 days after hospital admission. eSOFA score, sSOFA score, qSOFA score and SOFA score were evaluated to predict patient prognosis using the area under the receiver operating characteristic curve (AUC). Results AUC of eSOFA score, sSOFA score, qSOFA score and SOFA score for predicting the prognosis of the patients was 0.757 (95% CI 0.686-0.828), 0.721 (95% CI 0.665-0.787), 0.662 (95% CI 0.586-0.738), 0.806 (95% CI 0.747-0.866, respectively. The eSOFA score was superior to the sSOFA score (Z=2.317, P=0.021) in terms of AUC. Conclusions The eSOFA and sSOFA scores have predictive value for the prognosis of sepsis, and eSOFA score is better than sSOFA score.

Sensibilidad y especificidad de los puntajes Evaluación de Insuficiencia Orgánica Secuencial Rápida vs Síndrome de Respuesta Inflamatoria Sistémica en la predicción de mortalidad intrahospitalaria / Quick sequential organ failure assessment vs systemic inflammatory response syndrome scores sensitivity and specificity for predicting in-hospital mortality

Resumen: OBJETIVO: Comparar la capacidad predictiva de mortalidad intrahospitalaria de los puntajes Evaluación de Insuficiencia Orgánica Secuencia Rápida (qSOFA) y Síndrome de Respuesta Inflamatoria Sistémica (SIRS) en pacientes adultos ingresados con diagnóstico de infección. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, con diseño no experimental, efectuado de enero a julio de 2017 en pacientes adultos ingresados con infección de origen diferente al Hospital General del Sur Dr. Pedro Iturbe de la ciudad de Maracaibo, Venezuela, seleccionados mediante un muestreo no probabilístico intencional. A los pacientes se les cuantificaron los puntajes qSOFA y SIRS, se compararon las características al ingreso, días de hospitalización y mortalidad intrahospitalaria en los dos grupos. RESULTADOS: Se incluyeron 60 sujetos, 51.6% eran hombres; el foco infeccioso más frecuente fue el urinario con 43.3%, la administración de agentes vasoactivos fue necesaria en 40% de los pacientes, mientras que la mortalidad intrahospitalaria ocurrió en 45% de los casos. El puntaje qSOFA se asoció con mayor porcentaje de mortalidad intrahospitalaria en comparación con el puntaje SIRS, también mostró mayor capacidad predictiva con sensibilidad de 96%, especificidad de 33%, valor predictivo positivo de 54%, valor predictivo negativo de 92%, razón de verosimilitud positiva de 1.4, razón de verosimilitud negativa de 0.1 y área bajo la curva de 0.77 (0.65-0.89). CONCLUSIÓN: El puntaje qSOFA tiene mayor sensibilidad y especificidad de mortalidad intrahospitalaria en comparación con el SIRS.

Abstract: OBJECTIVE: To compare in-hospital mortality predictive capacity of quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) in adult patients admitted with suspected infection. MATERIAL AND METHOD: A descriptive, cross-sectional study was carried out from January to July 2017 with a non-experimental design in adult patients admitted with infection of different source to the Hospital General del Sur Dr. Pedro Iturbe from Maracaibo city, Venezuela, selected by an intentional sampling. We quantified the qSOFA and SIRS scores, comparing the characteristics of admission, days of stay and in-hospital mortality in the two groups. RESULTS: There were included 60 subjects, 51.6% were men; the most frequent infectious source was the urinary tract with 43.3%, the use of vasoactive agents was necessary in 40% of the patients, while in-hospital mortality occurred in 45% of cases. The quick SOFA score was associated with a greater percentage of in-hospital mortality compared to the SIRS score, also exhibiting a greater predictive capacity with sensitivity of 96%, specificity of 33%, positive predictive value of 54%, negative predictive value of 92%, positive likelihood ratio: 1.4, negative likelihood ratio: 0.1 and area under the curve of 0.77 (0.65-0.89). CONCLUSION: The quick SOFA score showed greater sensitivity and specificity for in-hospital mortality compared to the SIRS.