Lipoproteína de Alta Densidade (HDL) como Biomarcador de Prognóstico de Mortalidade em Pacientes Sépticos em Hospital da Região Metropolitana de Porto Alegre/RS / High-Density Lipoprotein (HDL) as a Prognostic Biomarker of Mortality in Septic Patients in a Hospital in the Metropolitan Region of Porto Alegre/RS

Introdução: Pacientes com quadro de sepse ocupam 30% dos leitos das Unidades de Terapia Intensiva (UTI) no Brasil, com letalidade de 55%, impactando diretamente a saúde e economia brasileiras. A Lipoproteína de Alta Densidade (HDL) expressa funções imunomoduladoras, previne liberação de citocinas e neutraliza toxinas bacterianas. Dosagens de HDL abaixo de 20mg/ dL em pacientes sépticos estão associadas a maior mortalidade. Objetivos: Analisar a correlação dos níveis séricos de HDL com o prognóstico de mortalidade em pacientes sépticos admitidos na UTI do Hospital Universitário de Canoas (HU). Objetivos específicos incluem a correlação dos níveis de HDL com marcadores clássicos de gravidade lactato, proteína C reativa (PCR), albumina e escore SOFA. Métodos: Estudo observacional analítico de coorte prospectiva, que incluiu 292 pacientes admitidos na UTI do HU diagnosticados com Sepse, conforme diretriz SEPSIS3: ≥ 2 pontos no SOFA (Sequential Organ Failure Assesment Score) no período de 1º de agosto de 2019 a 30 de agosto de 2020. Resultados: Óbitos foram estatisticamente mais frequentes nos indivíduos que apresentaram HDL <20mg/dL (47,5%) do que naqueles com valores de HDL ≥20mg/dL (32,80%). Conclusão: Embora não haja na literatura relação de causalidade entre baixos níveis de HDL e sepse, é verificado na literatura e corroborado neste estudo que pacientes sépticos com níveis baixos de HDL tiveram pior desfecho quando comparados a pacientes com níveis normais. Também foi encontrada associação significativa de maiores níveis séricos de PCR e lactato com baixos níveis de HDL, sendo esses marcadores de pior prognóstico na sepse.

Introduction: Septic patients occupy 30% of the beds in the Brazilian intensive care units (ICU), with a mortality rate of 55%, strongly impacting Brazilian health and the economy. High-density lipoprotein (HDL) has immunomodulatory functions, prevents cytokine release, and neutralizes bacterial toxins. HDL levels below 20mg/dL in septic patients are associated with higher mortality. Objectives: To analyze the correlation of serum HDL levels with mortality prognosis in septic patients admitted to the Canoas University Hospital (Hospital Universitário de Canoas [HU]) ICU. The specific objectives include the correlation of HDL levels with classic markers of severity - lactate, C-reactive protein (CRP), albumin, and SOFA score. Methods: an observational analytical prospective cohort study, which included 292 patients admitted to the HU ICU diagnosed with sepsis - as per SEPSIS-3 guideline: ≥ 2 points in SOFA (Sequential Organ Failure Assessment Score) - in the period from August 1, 2019, to August 30, 2020. Results: deaths were statistically more frequent in individuals who had HDL <20mg/dL (47.5%) than in those with HDL values ≥ 20mg/dL (32.80%). Conclusion: Although there is no causal relationship, in the literature, between low HDL levels and sepsis, it is verified in the literature and corroborated in this study that septic patients with low HDL levels had worse outcomes compared to patients with normal levels. It was also found a significant association of higher serum levels of CRP and lactate with low HDL levels, these being markers of worse prognosis in sepsis.

Effect of D-glucose feeding on mortality induced by sepsis

Sepsis is the life-threatening response to infection which can lead to tissue damage, organ failure, and death. In the current study, the effect of orally administered D-glucose on the mortality and the blood glucose level induced by D-Galactosamine (GaLN)/lipopolysaccharide (LPS)-induced sepsis was examined in ICR mice. After various amounts of D-glucose (from 1 to 8 g/kg) were orally fed, sepsis was induced by injecting intraperitoneally (i.p.) the mixture of GaLN /LPS. Oral pre-treatment with D-glucose dose-dependently increased the blood glucose level and caused a reduction of sepsis-induced mortality. The oral post-treatment with D-glucose (8 g/kg) up to 3 h caused an elevation of the blood glucose level and protected the mortality observed in sepsis model. However, D-glucose post-treated at 6, 9, or 12 h after sepsis induction did not affect the mortality and the blood glucose level induced by sepsis. Furthermore, the intrathecal (i.t.) pretreatment once with pertussis toxin (PTX; 0.1 microg/5 ml) for 6 days caused a reduction of D-glucose-induced protection of mortality and hyperglycemia. Furthermore, once the hypoglycemic state is continued up to 6 h after sepsis initiated, sepsis-induced mortality could not be reversed by D-glucose fed orally. Based on these findings, it is assumed that the hypoglycemic duration between 3 and 6 h after the sepsis induction may be a critical time of period for the survival. D-glucose-induced protective effect against sepsis-induced mortality appears to be mediated via activating PTX-sensitive G-proteins in the spinal cord. Finally, the production of hyperglycemic state may be critical for the survival against the sepsis-induced mortality.

Infecciones intrahospitalarias en los servicios clínicos / Intrahospital infections at clinical services

Fundamento: La gravedad de las infecciones intrahospitalarias es cada vez más frecuente y difícil de tratar, constituye una importante causa de morbilidad y mortalidad. Objetivo: Caracterizar la infección intrahospitalaria en servicios clínicos. Método: Se realizó un estudio descriptivo transversal en los servicios clínicos de Nefrología, Unidad de Cuidados Intermedios, Unidad de Cuidados Intensivos, Cardiocentro y Medicina Interna del Hospital Provincial Docente Clínico Quirúrgico «Manuel Ascunce Domenech¼ de Camagüey durante un período de tres años (enero de 2004 a diciembre de 2006). La muestra estuvo constituida por 751 pacientes ingresados en estos servicios y en cuyas historias clínicas existían datos inequívocos de infección intrahospitalaria desde el punto de vista clínico y de laboratorio microbiológico. Resultados: No se encontraron diferencias significativas en cuanto al sexo. Los procederes invasivos terapéuticos con el 94 % fueron los principales factores de riesgo identificados, dentro de los cuales el empleo de sondaje vesical, catéter venoso central y ventilación mecánica artificial fueron los más importantes. El mayor número de pacientes le correspondió a Unidad de Cuidados Intermedios y al servicio de Medicina Interna en los que predominaron la infección por Enterobacterias y Estafilococo sp. Aunque no resultó significativo, se aisló en las salas de terapia el Acinetobacter sp. multirresistente. Los sitios más frecuentes de infección fueron el sistema respiratorio y urinario. Conclusiones: La mayoría de los pacientes egresaron vivos y un tercio tuvo una estadía de 23 días y más. El 12.2 % de los pacientes fallecieron a causa de la sepsis nosocomial.

Background: The gravity of intrahospital infections is more frequent and difficult to treat, constitutes an important cause of morbidity and mortality. Objective: To characterize the intrahospital infection at clinical services. Method: A cross-sectional descriptive study was carried out at Nephrology, Intermediate Care Unit, Intensive Care Unit, Cardiology Center and Internal Medicine clinical services of the Surgical Clinical Educational Provincial Hospital «Manuel Ascunce Domenech¼ of Camagüey during a period of three years (January 2004 to December 2006). The sample was constituted by 751 patients admitted in these services and in whose medical histories unmistakable data of intrahospital infection existed since the clinical point of view and microbiological laboratory. Results: It were not found significant differences about sex. The therapeutic invasive procedures with the 94% were the main risk factors identified, within the employment of vesical catheterization, central venous catheter and artificial mechanical ventilation were the most important. The major number of patients corresponded to Intermediate Care Unit and to Internal Medicine service in which the infection by Enterobacteria and Staphylococci sp dominated. Although did not turn out to be significant, the Acinetobacter sp. multirresistant was isolated in the therapy rooms. The most frequent sites of infection were the urinary and respiratory system. Conclusions: The majority of patients discharged alive and a one third had a stopover of 23 days and more. The 12.2% of patients died because of nosocomial sepsis.