Outcome of patients with autoimmune diseases in the intensive care unit: a mixed cluster analysis.

OBJECTIVES: The interest on autoimmune diseases (ADs) and their outcome at the intensive care unit (ICU) has increased due to the clinical challenge for diagnosis and management as well as for prognosis. The current work presents a-year experience on these topics in a tertiary hospital. METHODS: The mixed-cluster methodology based on multivariate descriptive methods such as principal component analysis and multiple correspondence analyses was performed to summarize sets of related variables with strong associations and common clinical context. RESULTS: Fifty adult patients with ADs with a mean age of 46.7±17.55 years were assessed. The two most common diagnoses were systemic lupus erythematosus and systemic sclerosis, registered in 45% and 20% of patients, respectively. The main causes of admission to ICU were infection and AD flare up, observed in 36% and 24%, respectively. Mortality during ICU stay was 24%. The length of hospital stay before ICU admission, shock, vasopressors, mechanical ventilation, abdominal sepsis, Glasgow score and plasmapheresis were all factors associated with mortality. Two new clinical clusters variables (NCVs) were defined: Time ICU and ICU Support Profile, which were associated with survivor and no survivor variables. CONCLUSIONS: Identification of single factors and groups of factors from NCVs will allow implementation of early and aggressive therapies in patients with ADs at the ICU in order to avoid fatal outcomes.

Prevención no farmacológica de la neumonía asociada a ventilación mecánica / Non-Pharmacological Prevention of Ventilator Associated Pneumonia

La neumonía asociada a ventilación mecánica es la primera causa de mortalidad por infecciones nosocomiales en la unidad de cuidados intensivos. Su incidencia oscila entre el 9 y el 67% de los pacientes que requieren ventilación mecánica. Hay múltiples factores de riesgo asociados y aumenta significativamente la estancia en la unidad de cuidados intensivos y en el hospital. El coste adicional por cada neumonía asociada a ventilación mecánica oscila entre 9.000 y 31.000 €.Por tanto, su prevención debe considerarse una prioridad. Ésta podría disminuir tanto la morbimortalidad asociada como el coste de la atención, y mejorar la seguridad del paciente(AU)

Ventilator-associated pneumonia (VAP) is the first cause of mortality due to nosocomial infections in the intensive care unit. Its incidence ranges from 9% to 67% of patients on mechanical ventilation. Risk factors are multiple and are associated with prolonged stays in hospital and intensive care units. Additional costs for each episode of VAP range from 9,000 € to 31,000 €.Thus, its prevention should be considered as a priority. This prevention could decrease associated morbidity, mortality, costs, and increase patient safety(AU)

[Non-pharmacological prevention of ventilator-associated pneumonia]. / Prevención no farmacológica de la neumonía asociada a ventilación mecánica.

Ventilator-associated pneumonia (VAP) is the first cause of mortality due to nosocomial infections in the intensive care unit. Its incidence ranges from 9% to 67% of patients on mechanical ventilation. Risk factors are multiple and are associated with prolonged stays in hospital and intensive care units. Additional costs for each episode of VAP range from 9,000 euro to 31,000 euro. Thus, its prevention should be considered as a priority. This prevention could decrease associated morbidity, mortality, costs, and increase patient safety.

Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients.

To analyze the different clinical and histologic types of cutaneous vasculitis in patients with primary Sjögren syndrome (SS), we investigated the clinical and immunologic characteristics of 558 consecutive patients with primary SS from our units and selected those with clinical evidence of cutaneous lesions, excluding drug reactions and xeroderma. All patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. A total of 89 (16%) patients presented with cutaneous involvement (88 female patients and 1 male; mean age, 51.8 yr). The main cutaneous involvement was cutaneous vasculitis, present in 52 (58%) patients. There were 51 (98%) female patients and 1 (2%) male, with a mean age at diagnosis of cutaneous vasculitis of 51 years (range, 20-80 yr). Fourteen presented with cryoglobulinemic vasculitis, 11 with urticarial vasculitis, and the remaining 26, with cutaneous purpura not associated with cryoglobulins. A skin biopsy specimen was obtained in 38 patients (73%). Involvement of small-sized vessels was observed in 36 (95%) patients (leukocytoclastic vasculitis), while the remaining 2 (5%) presented with medium-sized vessel vasculitis (necrotizing vasculitis). Patients with cutaneous vasculitis had a higher prevalence of articular involvement (50% vs 29%, p = 0.044), peripheral neuropathy (31% vs 4%, p < 0.001), Raynaud phenomenon (40% vs 15%, p = 0.008), renal involvement (10% vs 0%, p = 0.028), antinuclear antibodies (88% vs 60%, p = 0.002), rheumatoid factor (78% vs 48%, p = 0.004), anti-Ro/SS-A antibodies (70% vs 43%, p = 0.011), and hospitalization (25% vs 4%, p = 0.005) compared with SS patients without vasculitis. Six (12%) patients died, all of whom had multisystemic cryoglobulinemia.In conclusion, cutaneous involvement was detected in 16% of patients with primary SS, with cutaneous vasculitis being the most frequent process. The main characteristics of SS-associated cutaneous vasculitis were the overwhelming predominance of small versus medium vessel vasculitis and leukocytoclastic versus mononuclear vasculitis, with a higher prevalence of extraglandular and immunologic SS features. Small vessel vasculitis manifested as palpable purpura, urticarial lesions, or erythematosus maculopapules, with systemic involvement in 44% of patients in association with cryoglobulins in 30%. Life-threatening vasculitis was closely related to cryoglobulinemia.

Strongiloidiasis diseminada posterior a tratamiento de meningitis bacteriana / Posterior disseminated strongyloidiasis in the treatment of bacterial meningitis

Informamos el caso de una paciente de 31 años de edad con strongyloidiasis diseminada posterior a tratamiento con esteroides y antibióticos para una meningitis bacteriana. El diagnóstico se realizó a los 21 días de su hospitalización por presencia de síntomas gastrointestinales y deterioro del estado general después de establecerse la erradicación del foco infeccioso en el SNC.