Valor pronóstico del aclaramiento de procalcitonina, PCR y leucocitos en el shock séptico / Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock

Objetivos: El presente estudio evalúa la utilidad pronóstica que la determinación seriada de diferentes biomarcadores (procalcitonina [PCT], proteína C reactiva [PCR] y leucocitos) podría tener en los enfermos en shock séptico. Diseño: Estudio prospectivo observacional. Ámbito: La unidad de cuidados intensivos (UCI) de nuestro centro, un Hospital Universitario de tercer nivel. Pacientes: Ochenta y ocho pacientes en shock séptico según criterios de la Conferencia de Consenso SCCM/ESICM/ACCP/ATS/SIS de 2001. Se llevó a cabo la determinación de PCT, PCR y leucocitos al ingreso en la UCI y a las 72 horas del mismo. Intervenciones: Ninguna. Resultados: Los pacientes con incremento en los valores de PCT presentaron una mayor mortalidad hospitalaria en comparación con los que presentaron un descenso de los mismos (58,8 frente al 15,4%, p<0,01). Este efecto no se observó en las determinaciones de PCR ni los leucocitos. El mejor área bajo la curva ROC para el pronóstico correspondió al aclaramiento de PCT (0,79). El aclaramiento del 70% en los valores de PCT permitió discriminar la supervivencia hospitalaria con una sensibilidad del 94,7% y una especificidad del 53%. Conclusiones: La determinación seriada de los valores de PCT predice mejor que la determinación única el pronóstico de los pacientes en shock séptico. Su fiabilidad pronóstica es superior a la de la PCR y los leucocitos. El uso de las determinaciones seriadas de PCT podría ayudar a identificar a aquellos pacientes sépticos con mayor riesgo de muerte permitiendo optimizar su tratamiento (AU)

Objetives: This study evaluates the potential prognostic value of serial measurements of different biomarkers (procalcitonin [PCT], C-reactive protein and leukocytes [CRP]) in septic shock patients. Design: Prospective observational study. Setting: Intensive care unit of a third-level University Hospital. Patients: The study comprised a total of 88 septic shock patients defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria. The PCT, CRP and leukocytes were recorded on admission to the ICU and again 72hours after admission. Interventions: None. Results: Those patients with increasing procalcitonin levels showed higher hospital mortality than those with a decreasing levels (58.8% vs. 15.4%, P<0.01). No such effect was observed in relation to C-reactive protein or leukocytes. The best area under the curve for prognosis was for procalcitonin clearance (0.79). A procalcitonin clearance of 70% or higher offered a sensitivity and specificity of 94.7% and 53%, respectively. Conclusions: Serial procalcitonin measurements are more predictive of the prognosis of septic shock patients than single measurements of this parameter. The prognostic reliability of the latter is also better than in the case of C-reactive protein and leukocytes. The application of serial procalcitonin measurements may allow the identification of those septic patients at increased mortality risk, and help improve their treatment (AU)

[Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock]. / Valor pronóstico del aclaramiento de procalcitonina, PCR y leucocitos en el shock séptico.

OBJECTIVES: This study evaluates the potential prognostic value of serial measurements of different biomarkers (procalcitonin [PCT], C-reactive protein and leukocytes [CRP]) in septic shock patients. DESIGN: Prospective observational study. SETTING: Intensive care unit of a third-level University Hospital. PATIENTS: The study comprised a total of 88 septic shock patients defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria. The PCT, CRP and leukocytes were recorded on admission to the ICU and again 72 hours after admission. INTERVENTIONS: None. RESULTS: Those patients with increasing procalcitonin levels showed higher hospital mortality than those with a decreasing levels (58.8% vs. 15.4%, P<0.01). No such effect was observed in relation to C-reactive protein or leukocytes. The best area under the curve for prognosis was for procalcitonin clearance (0.79). A procalcitonin clearance of 70% or higher offered a sensitivity and specificity of 94.7% and 53%, respectively. CONCLUSIONS: Serial procalcitonin measurements are more predictive of the prognosis of septic shock patients than single measurements of this parameter. The prognostic reliability of the latter is also better than in the case of C-reactive protein and leukocytes. The application of serial procalcitonin measurements may allow the identification of those septic patients at increased mortality risk, and help improve their treatment.

Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation / External validation of the Risk Quantification of Early Outcome After Lung Transplantation scale

Objetivo: Validar la escala Risk Quantification of Early Outcome After Lung Transplantation (RQLT) en una cohorte de enfermos trasplantados de pulmón. Diseño: Prospectivamente se recogieron los parámetros incluidos en la escala RQLT. Pacientes: Se analizaron 74 enfermos trasplantados de pulmón en el Hospital Universitario Marqués de Valdecilla (Santander) entre septiembre de 2004 y marzo de 2008. Variables de interés principales: Asociación de la puntuación de la escala RQLT con la mortalidad a 30 días y la estancia en unidad de cuidados intensivos prolongada. Ajuste de la escala mediante modelo de regresión logística teniendo como variable dependiente la mortalidad a 30 días. Valoración de la eficacia diagnóstica mediante curva receiver operating characteristics, y calibración del sistema sobre la muestra mediante el test de bondad del ajuste de Hosmer y Lemeshow. Resultados: La mortalidad a 30 días en los enfermos trasplantados de pulmón es significativamente mayor conforme aumenta el valor del RQLT, y muestra una odds ratio de 2,20 (1,24-3,93) por cada punto de más en la escala. El área bajo la curva receiver operating characteristics, con respecto a la mortalidad a 30 días, fue de 0,79 (0,68-0,88); p=0,01. El test de bondad de ajuste de Hosmer y Lemeshow describió un valor p=0,58. Conclusiones: La escala RQLT es una herramienta útil como indicador de mortalidad a 30 días en los pacientes trasplantados (AU)

Objective: To validate the «Risk Quantification of Early Outcome After Lung Transplantation» (RQLT) scale in a cohort of lung transplantation patients. Design: The parameters included in the RQLT scale were recorded prospectively. Patient: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. Main variables of interest: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. Results: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. Conclusions: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients (AU)

[External validation of the Risk Quantification of Early Outcome after Lung Transplantation scale]. / Validación externa de la escala Risk Quantification of Early Outcome After Lung Transplantation.

OBJECTIVE: To validate the "Risk Quantification of Early Outcome After Lung Transplantation" (RQLT) scale in a cohort of lung transplantation patients. DESIGN: The parameters included in the RQLT scale were recorded prospectively. PATIENT: A total of 74 lung transplant patients in the University Hospital Marquis of Valdecilla (Santander) were analyzed between September 2004 and March 2008. MAIN VARIABLES OF INTEREST: This was the association of the score on the RQLT scale with mortality at 30 days and prolonged ICU stay. The dependent variable of mortality at 30 days was adjustment of scale using the logistic regression model. Diagnostic efficacy was evaluated using the ROC curve and calibration of the system on the sample with the Hosmer and Lemeshow goodness of fit test. RESULTS: The 30-day mortality in lung transplant patients increases significantly as the RQLT score increases, with an odds ratio (OR) of 2.20 (1.24-3.93) for each point increase on the RQLT scale. The area under the ROC curve for 30-day mortality was 0.79 (0.68-0.88; P=0.01). The Hosmer and Lemeshow goodness of fit test described a value p=0.58. CONCLUSIONS: The RQLT scale is a useful tool as an indicator of 30-day mortality in transplant patients.

Discrepancias entre el diagnóstico clínico y el diagnóstico anatomopatológico en la mortalidad temprana del trasplante pulmonar / Discrepancies between the clinical and pathological diagnosis in lung transplant early mortality

Objetivo: Analizar la frecuencia y el espectro de las enfermedades más relevantes encontradas en las autopsias de los enfermos a los que se les realizó un trasplante pulmonar y en las autopsias de los fallecidos en el primer mes postrasplante. Valorar la concordancia de los diagnósticos pre mórtem y post mórtem, y compararlos mediante la escala de Goldman et al modificada por Battle et al. Material y método: Análisis retrospectivo y longitudinal de las historias clínicas y de los registros de autopsias de los enfermos trasplantados de pulmón en nuestro centro (Hospital Universitario Marqués de Valdecilla) desde 1997 hasta 2007 que fallecieron en el período postoperatorio temprano (primer mes postrasplante). La discordancia entre el diagnóstico clínico y el diagnóstico anatomopatológico se clasificó de acuerdo a la clasificación de Goldman et al (N Engl JMed: 1983) y Battle et al (JAMA: 1987). En la comparación de los grupos se utilizó el test de la t de Student para las variables cuantitativas y la prueba de la Chi cuadrado para las variables cualitativas. Resultados: Los 5 errores de clase I se circunscriben a enfermedades respiratorias: 2 rechazos agudos no diagnosticados, una tromboembolia pulmonar bilateral, una embolia grasa y un infarto hemorrágico del pulmón injertado. Encontramos una diferencia significativa (p=0,05) entre los días de supervivencia de los enfermos del grupo con errores de clase I (6±4,52 días) y los enfermos del grupo sin discrepancia (15,42±8,99). Conclusiones: El breve período de tiempo existente entre el trasplante y el fallecimiento del enfermo hace que se reduzca la posibilidad de llegar a un diagnóstico correcto. Este dato debe hacer extremar las posibilidades diagnósticas en las enfermedades potencialmente mortales en este período, de este modo la tasa de estudios necrópsicos en este período debería ser del 100% (AU)

Objective: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. Material and methods: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. Results: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6±4.52 days) and patients from the group with no discrepancy (15.42±8.99). Conclusion: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100% (AU)

[Discrepancies between the clinical and pathological diagnosis in lung transplant early mortality]. / Discrepancias entre el diagnóstico clínico y el diagnóstico anatomopatológico en la mortalidad temprana del trasplante pulmonar.

OBJECTIVE: To analyze the prevalence and frequency spectrum of the most relevant diseases found in the autopsies of patients who underwent a lung transplant and died in the first month after transplantation. To evaluate the consistency of the pre-and post-mortem diagnoses, comparing them with the Goldman et al. scale modified by Battle et al. MATERIAL AND METHODS: Retrospective and longitudinal analysis, comparison of the medical records and records of autopsies of patients who received a lung transplant in our center (University Hospital Marques de Valdecilla) from 1997 to 2007, who died in the early postoperative period (first month post-transplant). The discordance between clinical and pathological diagnosis was classified according to the classification of Goldman et al. and Battle et al. The Student t test for quantitative variables and chi-square for qualitative variables were used for the comparison of the groups. RESULTS: The five class I errors are limited to respiratory diseases: 2 undiagnosed acute rejection, 1 bilateral pulmonary thromboembolism, 1 fat embolism and 1 hemorrhagic infarction of the lung graft. We found a significant difference (p=0.05) between days of survival of patients with group Class I errors (6+/-4.52 days) and patients from the group with no discrepancy (15.42+/-8.99). CONCLUSION: The short time between transplant and death of the patient reduces the possibility of reaching a correct diagnosis. Because of this information, diagnostic possibilities must be maximized in life-threatening diseases during this period. Therefore, the rate of autopsy studies in this period should be 100%.

Utilidad de la procalcitonina en el diagnóstico de la infección del paciente trasplantado pulmonar / Usefulness of procalcitonin in the diagnosis of infection in lung transplant patients

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