ABSTRACT
No disponible
Subject(s)
Humans , Nocardia/pathogenicity , Nocardia Infections/diagnosis , Diagnosis, Differential , Abdominal Neoplasms/diagnosisABSTRACT
OBJECTIVES: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. PATIENTS AND METHODS: Prospective study of 204 patients with fever > 38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. RESULTS: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. CONCLUSIONS: Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.
Subject(s)
Bacteremia/mortality , Fever of Unknown Origin/etiology , Sepsis/mortality , Aged , Bacteremia/diagnosis , Female , Fever of Unknown Origin/mortality , Hospitalization , Humans , Infections/diagnosis , Infections/mortality , Male , Prognosis , Prospective Studies , Sepsis/diagnosisABSTRACT
Objetivos: La fiebre en pacientes hospitalizados (FI) es un problema complejo. Se pretenden establecer las características de estos pacientes y parámetros predictívos de infección, sepsis y evolución. Pacientes y métodos: Estudio prospectivo de 204 pacientes con temperatura > 38 ºC ingresados en Medicina Interna. En cada paciente se realizó evaluación clínica, hemograma, sistemático de orina (SO), proteína C reactiva (PCR), radiografía de tórax (RXT), hemocultivos y urocultivo. Resultados: Tuvieron infección 115 pacientes (nosocomial:75.9%, sepsis: 7.4%), causa no infecciosa 35 y no filiada 54. Hemograma y PCR no discriminaron infección, bacteriemia ni sepsis. En SO, la positividad de nitritos + leucocituria + bacteriuria, tiene valor predictívo para urocultivo positivo. La RXT diagnosticó 18,6% de pacientes. Fueron positivos 18% de urocultivos y 13% de hemocultivos. Se administraron antibióticos a 71,6% de pacientes (innecesarios en 18%). Los resultados microbiológicos modificaron 25% de tratamientos iniciales. Evolución: estancia: 17 días, mortalidad: 16,7%. Existieron variables asociadas a infección (enfermedad pulmonar crónica, duración de la fiebre, alteraciones en la deglución y en vías urinarias), bacteriemia (diabetes, obesidad, hepatopatía crónica, inmunodepresión, vía vascular central, duración de la fiebre e infección nosocomial), sepsis (varón, neoplasia, infecciones vascular y nosocomial) y mortalidad (hepatopatía crónica descompensada, infección nosocomial, infección respiratoria de vías bajas y sepsis). Conclusiones: El diagnóstico de sospecha de FI tiene baja fiabilidad. La causa más frecuente es la infección. Tienen utilidad diagnóstica: SO, RXT, hemocultivos y urocultivo. Nuestros modelos predictívos de infección, bacteriemia, sepsis y mortalidad, tuvieron baja sensibilidad y especificidad
Objectives: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome. Patients and methods: Prospective study of 204 patients with fever > 38 ºC admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed. Results: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality. Conclusions: Clinical diagnosis of FHP is inaccurate. Infection is its most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictibles models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low
Subject(s)
Male , Female , Aged , Middle Aged , Aged, 80 and over , Humans , Cross Infection/diagnosis , Cross Infection/etiology , Fever/etiology , Fever/diagnosis , Cross Infection/mortality , Sensitivity and Specificity , Reproducibility of Results , Prospective Studies , Cohort Studies , Predictive Value of TestsSubject(s)
Pyelonephritis, Xanthogranulomatous/diagnosis , Adult , Female , Humans , Tomography, X-Ray ComputedABSTRACT
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Subject(s)
Female , Adult , Humans , Pyelonephritis, Xanthogranulomatous/diagnosis , Tomography, X-Ray ComputedABSTRACT
Metastatic infiltration is most frequent than primary pericardiac tumors. Most frequent tumors are adenocarcinoma and lymphomas. A retrospective analysis of 18 oncological patients with significant pericardiac effusion (SPE) is carried out. The conclusions of the study are: SPE can be the first manifestation of a neoplasm; frequently, pericardiac tamponade (PT) has a neoplastic origin; thorax is the most frequent localization of the primary tumor; pericardiac fluid (PF) cytology analysis has low diagnostic yield; most useful diagnostic tests are thoracocentesis, thorax computerized tomography (CT) and bronchoscopy; SPE in a neoplasm suggest poor short-term prognosis; poor prognosis variables in this series were primary tumor unfavorable histology, advanced tumor disease and (probably) presentation as PT.
Subject(s)
Neoplasms/complications , Pericardial Effusion/etiology , Adult , Aged , Cardiac Surgical Procedures , Cardiac Tamponade/etiology , Cardiac Tamponade/mortality , Cardiac Tamponade/pathology , Female , Humans , Male , Middle Aged , Neoplasm Staging , Neoplasms/mortality , Neoplasms/pathology , Pericardial Effusion/pathology , Pericardial Effusion/therapy , Retrospective Studies , Survival AnalysisABSTRACT
Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.
Subject(s)
Cardiac Tamponade/etiology , Pericardial Effusion/etiology , Pericarditis/complications , Pericardium/pathology , Adolescent , Adult , Aged , Cardiac Surgical Procedures , Cardiac Tamponade/mortality , Cardiac Tamponade/surgery , Cause of Death , Clinical Trials as Topic , Echocardiography , Female , Humans , Male , Middle Aged , Pericardial Effusion/mortality , Pericardial Effusion/therapy , Pericarditis/epidemiology , Pericarditis/therapy , Pericardium/diagnostic imaging , Pericardium/surgery , Retrospective Studies , Spain/epidemiologyABSTRACT
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