Poder pronóstico de mortalidad a corto plazo de los biomarcadores en los ancianos atendidos en Urgencias por infección / Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections

Objetivos: Analizar y comparar el poder predictivo de mortalidad a 30 días de varios biomarcadores (proteína C reactiva, procalcitonina, lactato, suPAR y proadrenomedulina) en los pacientes ancianos que acuden al servicio de Urgencias (SU) por un episodio de infección. Y, secundariamente, comprobar si estos mejoran la capacidad pronóstica de los criterios de sepsis (síndrome de respuesta inflamatoria sistémica y quick Sepsis-related Organ Failure Assessment [qSOFA]). Métodos: Estudio observacional, prospectivo, multicéntrico y analítico. Se incluyó consecutivamente a pacientes de 75 o más años atendidos en 8 SU por un proceso infeccioso. Se analizaron 25 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Resultados: Se incluyó a 136 pacientes, de los que 13 (9,5%) habían fallecido a los 30 días tras su consulta en el SU. La MRproADM es el biomarcador que consigue la mayor área bajo la curva ROC para predecir mortalidad a los 30 días (0,864; IC 95% 0,775-0,997; p < 0,001), con un punto de corte de mayor capacidad predictiva de 2,07 nmol/l, que ofrece una sensibilidad del 77% y una especificidad del 96%. La escala qSOFA ≥ 2 consigue un área bajo la curva ROC de 0,763 (IC 95% 0,623-0,903; p = 0,002), con una sensibilidad del 76% y una especificidad del 75%. El modelo combinado (MRproADM con qSOFA ≥2 ) mejora el área bajo la curva ROC a 0,878 (IC 95% 0,749-1; p < 0,001) y ofrece el mejor rendimiento pronóstico, con una sensibilidad del 69% y una especificidad del 97%. Conclusiones: En los pacientes ancianos que acuden al SU por un episodio de infección, la MRproADM presenta una capacidad pronóstica de mortalidad a los 30 días superior al resto de los biomarcadores, la qSOFA obtiene mayor rendimiento que los criterios de síndrome de respuesta inflamatoria sistémica, y el modelo combinado qSOFA ≥ 2 con MRproADM > 2,07nmol/l mejora el poder predictivo de qSOFA

Objectives: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]). Methods: A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days). Results: The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P <.001) with a prognostic cut-off > 2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score ≥ 2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA ≥ 2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P < .001) with the best prognostic performance with sensitivity of 69% and specificity of 97%. Conclusions: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA ≥ 2 plus MR-proADM > 2.07nmol/l) increased the predictive power of qSOFA

Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections. / Poder pronóstico de mortalidad a corto plazo de los biomarcadores en los ancianos atendidos en Urgencias por infección.

OBJECTIVES: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]). METHODS: A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days). RESULTS: The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P<.001) with a prognostic cut-off>2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score≥2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA≥2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P<.001) with the best prognostic performance with sensitivity of 69% and specificity of 97% CONCLUSIONS: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA≥2 plus MR-proADM>2.07nmol/l) increased the predictive power of qSOFA.

Modelo de riesgo a 30 días en los pacientes ancianos con infección y síndrome de respuesta inflamatoria sistémica atendidos en los servicios de urgencias / Infection and systemic inflammatory response syndrome in older patients in the emergency department: a 30-day risk model

Objetivo: Diseñar un modelo de riesgo para predecir la mortalidad a los 30 días, y compararlo con la escala MEDS (Mortality in Emergency Department), en pacientes >= 75 años atendidos por infección con síndrome de respuesta inflamatoria sistémica (SIRS) en los servicios de urgencias (SU). Método: Estudio analítico de cohortes prospectivo que incluyó por oportunidad a pacientes >= 75 años atendidos por infección con SIRS en 13 SU españoles durante el año 2013. Se recogieron variables demográficas, comorbilidad, factores de riesgo de mala evolución, situación funcional basal, modelo de infección, y parámetros hemodinámicos, clínicos y analíticos en el momento de la primera atención. La variable de resultado principal fue mortalidad por cualquier causa a los 30 días. Resultados: Se incluyeron 379 pacientes con edad media de 84 (DE 5,8) años, 186 (49,1%) fueron mujeres, 150 (39,6%) tenían alto grado de comorbilidad y 113 (34,2%) dependencia funcional grave. Setenta y nueve pacientes (20,8%) fallecieron a los 30 días. El modelo INFURG-OLDER incluyó la presencia de tumor sólido con metástasis (OR=5,4; IC95% 1,618,2; p=0,006), la insuficiencia respiratoria (OR=3,02; IC95% 1,5-6,0; p=0,002), la insuficiencia renal (OR=2,4; IC95% 1,0-5,5; p=0,045), la hipotensión arterial (OR=2,4; IC95% 1,2-5,0; p=0,015) y la disminución del nivel de consciencia (OR=2,9; IC95% 1,4-5,8; p=0,003). El área bajo la curva (ABC) del modelo INFURG-OLDER fue de 0,78 (IC95% 0,720,84; p<0,001) y el ABC de la escala MEDS fue de 0,72 (IC95% 0,64-0,80; p<0,001). Conclusiones: El modelo INFURG-OLDER tiene buena capacidad para predecir la mortalidad a los 30 días en los pacientes >= 75 años atendidos por infección con SIRS en los SU

Objectives: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. Material and methods: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. Results: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). Conclusion: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS

Infection and systemic inflammatory response syndrome in older patients in the emergency department: a 30-day risk model. / Modelo de riesgo a 30 días en los pacientes ancianos con infección y síndrome de respuesta inflamatoria sistémica atendidos en los servicios de urgencias.

OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. RESULTS: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). CONCLUSION: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.

OBJETIVO: . Diseñar un modelo de riesgo para predecir la mortalidad a los 30 días, y compararlo con la escala MEDS (Mortality in Emergency Department), en pacientes 75 años atendidos por infección con síndrome de respuesta inflamatoria sistémica (SIRS) en los servicios de urgencias (SU). METODO: Estudio analítico de cohortes prospectivo que incluyó por oportunidad a pacientes 75 años atendidos por infección con SIRS en 13 SU españoles durante el año 2013. Se recogieron variables demográficas, comorbilidad, factores de riesgo de mala evolución, situación funcional basal, modelo de infección, y parámetros hemodinámicos, clínicos y analíticos en el momento de la primera atención. La variable de resultado principal fue mortalidad por cualquier causa a los 30 días. RESULTADOS: Se incluyeron 379 pacientes con edad media de 84 (DE 5,8) años, 186 (49,1%) fueron mujeres, 150 (39,6%) tenían alto grado de comorbilidad y 113 (34,2%) dependencia funcional grave. Setenta y nueve pacientes (20,8%) fallecieron a los 30 días. El modelo INFURG-OLDER incluyó la presencia de tumor sólido con metástasis (OR = 5,4; IC95% 1,6- 18,2; p = 0,006), la insuficiencia respiratoria (OR = 3,02; IC95% 1,5-6,0; p = 0,002), la insuficiencia renal (OR = 2,4; IC95% 1,0-5,5; p = 0,045), la hipotensión arterial (OR = 2,4; IC95% 1,2-5,0; p = 0,015) y la disminución del nivel de consciencia (OR = 2,9; IC95% 1,4-5,8; p = 0,003). El área bajo la curva (ABC) del modelo INFURG-OLDER fue de 0,78 (IC95% 0,72- 0,84; p < 0,001) y el ABC de la escala MEDS fue de 0,72 (IC95% 0,64-0,80; p < 0,001). CONCLUSIONES: El modelo INFURG-OLDER tiene buena capacidad para predecir la mortalidad a los 30 días en los pacientes 75 años atendidos por infección con SIRS en los SU.

Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por infección / Short-term prognostic factors in the elderly patients seen in emergency departments due to infections

OBJETIVOS: Analizar los factores asociados a la mortalidad a corto plazo en los pacientes ancianos que acuden al servicio de urgencias (SU) por un episodio de infección. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo, multicéntrico y analítico. Se incluyó consecutivamente a pacientes de 75 o más años atendidos en 8 servicios de SU por un proceso infeccioso. Se analizaron 26 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Se realizó un estudio multivariable mediante regresión logística. RESULTADOS: Se incluyó a 488 pacientes, de los que 92 (18,9%) habían fallecido a los 30 días tras su consulta en el SU. Tres variables se asociaron de forma significativa con la mortalidad: la dependencia funcional basal grave con índice de Barthel ≤60 (odds ratio [OR] 8,92; intervalo de confianza [IC] del 95%: 4,98-15,98, p = 0,003), la existencia de una presión arterial sistólica (PAS)<90mmHg (OR 7,34; IC95%: 4,39-12,26, p = 0,005) y lactato sérico >4mmol/l (OR 21,14; IC95%: 8,94-49,97, p = 0,001). El área bajo la curva-ROC del modelo fue 0,971 (IC95%: 0,951-0,991; p < 0,001). CONCLUSIONES: Existen varios factores disponibles tras una primera atención en el SU -entre ellos la valoración funcional, la PAS y, el más importante, el lactato sérico- que determinan un mal pronóstico a corto plazo del paciente anciano que consulta por un proceso infeccioso

OBJECTIVES: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS: A prospective, observational, multicentre, analytical study was carried out on patients aged 75 years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30 days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease

Short-term prognostic factors in the elderly patients seen in emergency departments due to infections. / Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por infección.

OBJECTIVES: To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease. MATERIALS AND METHODS: A prospective, observational, multicentre, analytical study was carried out on patients aged 75years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed. RESULTS: The study included 488 consecutive patients, 92 (18.9%) of whom died within 30days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index ≤60 [odds ratio (OR) 8,92; 95% confidence interval (CI): 4.98-15.98, P=.003], systolic blood pressure <90mmHg [OR 7.34; 95%CI: 4.39-12.26, P=.005] and serum lactate >4mmol/l [OR 21.14; 95%CI: 8.94-49.97, P=.001]. The area under the curve for the model was 0.971 (95%CI: 0.951-0.991; P<.001). CONCLUSIONS: Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.