ABSTRACT
OBJECTIVE: To study the incidence of sepsis in the Valencian Community (Spain) during a period of 10 years (1995-2004). METHODS: We downloaded data on discharge diagnoses of septicemia in all 26 public hospitals in the Valencian Community during the 10-year study period, as well as the additional discharge diagnoses of each patient. RESULTS: We identified 33,767 cases of sepsis during the study period. The age-standardized incidence rates among men increased from 64.11 (95% confidence interval [CI], 60.37-67.85) cases per 100,000 population in 1995 to 114.02 (95% CI, 109.02-118.50) cases per 100,000 population in 2004 (P < .001), and those among women increased from 45.08 (95% CI, 42.01-48.15) cases per 100,000 population in 1995 to 83.62 (95% CI, 79.85-87.39) cases per 100,000 population in 2004 (P < .001). Gram-negative bacteria were the most frequently involved microorganisms (in 21.4% of cases), and there was a significant increase in the number of sepsis cases caused by these organisms from 1999 onward. The mortality rate was approximately 42.5% among patients hospitalized for sepsis, and mortality was associated with organ failure. In addition, mortality was associated with the microorganism responsible not being known, with infection due to fungi, and with polymicrobial sepsis. CONCLUSIONS: The rates of hospitalization both for sepsis overall and for severe sepsis in the Valencian Community (Spain) are lower than those in other countries but are increasing, by 5% each year. The increase in the number of cases in which gram-negative bacteria are the cause of sepsis is notable.
Subject(s)
Gram-Negative Bacterial Infections , Sepsis/epidemiology , Female , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/mortality , Hospital Mortality , Hospitals, Public/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Sepsis/microbiology , Sepsis/mortality , Spain/epidemiology , Survival RateABSTRACT
INTRODUCTION: In adult human beings, 80-85% of the immune cells are located in the digestive tract mucosa; hence the importance of the Gut Associated Lymphoid Tissue (GALT) in host defence. We studied the influence of the surgical removal of two important parts of the gut associated with lymphoid tissue (tonsillectomy and appendectomy) on immune parameters. METHODS: One hundred and sixty patients were enrolled in this study. They were divided into four groups of forty patients each and matched for gender and age: group 1, appendectomized and tonsillectomized; group 2, only appendectomized; group 3, only tonsillectomized; and group 4, control group, neither tonsillectomized nor appendectomized. We analysed in blood: hemogram, protein electrophoresis, lymphocytic populations (T4 cells, T8 cells, NK cells), IgG, IgM, IgA immunoglobulin, and their fractions IgA1, IgA2, and secretory IgA. RESULTS: Levels of secretory IgA in serum of patients in group 1 were significantly lower than in the other three groups (1.89 mg/dl, group 1; 2.32 mg/dl, group 2; 2.19 mg/dl, group 3 and 4.97 mg/dl, group 4; p<0.0001). Also, the values found in the two groups that had undergone only one of the operations were clearly lower than in control patients (p<0.0001). In this study, the reduction was sustained for a period of between 3 months and 3 years in appendectomized patients, and more than 20 years in tonsillectomized patients. IN SUMMARY: GALTectomy (appendectomy and tonsillectomy) significantly decreases secretory IgA levels in serum. The decrease is more intense when both operations have been done.
Subject(s)
Appendectomy , Immunoglobulin A, Secretory/blood , Tonsillectomy , Adult , Aged , Basophils/cytology , Blood Cell Count , Blood Proteins/analysis , CD4-Positive T-Lymphocytes/cytology , Cell Count , Eosinophils/cytology , Female , Humans , Immunoglobulin A/blood , Immunoglobulins/blood , Lymphoid Tissue/surgery , Male , Middle Aged , Platelet CountABSTRACT
Objetivo: descripción de las características clínicas, funcionales y sociosanitarias de la población anciana con enfermedad crónica y/o terminal (perfil PALET) atendida en la Unidad Médica de Corta Estancia (UMCE) adscrita a un servicio de urgencias, en relación con el resto de pacientes. Material y métodos: estudio descriptivo de todos los pacientes admitidos en la UMCE durante un período de un año. Se recogen edad, sexo, estancia, tipología, situación funcional (índice de Barthel), cognitiva (Pfeiffer), nutricional (Mini Nutritional Assessment), depresión (Yesavage), situación de convivencia y destino de paciente. Se realizó un estudio descriptivo y análisis bivariante (t de Student, χ2), con nivel de significación p < 0,05 (intervalo de confianza [IC] del 95%). Resultados: el número total de pacientes fue de 1.028, (51,0% varones), edad media 71,6 [15-104], mediana 77 años. Perfil PALET 264 (25,7%), pacientes oncológicos 94 (9,1%), otros 770 (65,2%). Estancia media sin diferencias significativas entre grupos. Mortalidad global en UMCE 39 casos (76,9% casos perfil PALET). Los pacientes PALET son mayores, odds ratio [OR] = 8,16 (IC del 95%, 4,18-14,16), p < 0,001; presentan peor situación funcional y mental (p < 0,001) y mayor mortalidad, OR = 10,76 (IC del 95%, 5,03-22,98), p < 0,001, que el resto. Asimismo, necesitan mayor proporción de recursos de tipo domiciliario y de media o larga estancia al alta (p < 0,001). Conclusiones: nuestra UMCE atiende a una proporción importante de ancianos con enfermedad crónica y/o terminal (PALET), cuya situación funcional, mental y nutricional, así como su comorbilidad y elevada tasa de mortalidad, obligan a desarrollar recursos domiciliarios, sociosanitarios y hospitales de apoyo que permitan mejorar la calidad de su atención
Objective: to describe the clinical, functional, health and social characteristics of the elderly population with chronic and/or terminal diseases (PALET profile) in a short-stay medical unit (SSMU) attached to an emergency department in relation to the remaining patients. Material and methods: a descriptive study of all patients admitted to the SSMU during a 1-year period was performed. Data on age, sex, length of hospital stay, patient profile (PALET or oncological), functional status (Barthel index), cognitive status (Pfeiffer), nutritional status (MNA), depression (Yesavage), living arrangements, and destination after discharge were gathered. The statistical analysis consisted of descriptive study and bivariate analysis (Student's t-test, chi-square test) with a significance level of p < 0.05 (95% confidence interval [CI]). Results: there were 1,028 patients (51.0% men), with a mean age of 71.6 years [15-104] (median 77 years). There were 264 PALET patients (25.7%), 94 oncological patients (9.1%), and 770 patients with other diagnoses (65.2%). No significant differences were found between the groups in the mean length of stay. Overall mortality in the SSMU: 39 patients (76.9% PALET patients). PALET patients were older (OR = 8.16 [95% CI: 4.18-14.16], p < 0.001), had poorer functional and mental status (p < 0.001) and showed higher mortality (OR = 10.76 [95% CI: 5.03-22.98], p < 0.001) than the remaining patients. PALET patients required a higher proportion of domiciliary resources and were more likely to be referred to medium- or long-stay facilities at discharge (p < 0.001). Conclusions: our SSMU attends a substantial proportion of elderly patients with chronic and/or terminal diseases (PALET). Because of the functional, mental, and nutritional status of these patients, as well as the presence of comorbidities and the high mortality rate, domiciliary, health and social resources should be developed to improve the quality of care provided to these patients
