Red blood cell distribution width as prognostic factor in sepsis: A new use for a classical parameter.

PURPOSE: To evaluate Red blood cell distribution width (RDW) as a sepsis prognostic biomarker. METHODS: 203 septic patients admitted to the ICU. Analysis of RDW dynamics, hospital mortality discrimination ability and the added value when incorporated to the SOFA, LODS, SAPS-II and APACHE-II scores using the AUC-ROC. RESULTS: Non-survivors presented higher RDW values during the first week after ICU admission (p = 0.048). Only SOFA and RDW were independently associated with mortality when adjusted by Charlson, immunosuppression, nosocomial infection, NEWS2, SAPS-II, septic shock and haemoglobin (p < 0.05). After adjustment, AUC-ROC was 0.827, 0.822, 0.824, 0.834 and 0.812 for each model including admission, 24, 48 and 72-h and 7-days RDW, respectively. When added to the scores, 24-h RDW and admission RDW improved their discrimination ability (SOFA AUC-ROC = 0.772 vs 0.812 SOFA + admission RDW, p = 0.041; LODS AUC-ROC = 0.687 vs 0.710, p = 0.002; SAPS-II AUC-ROC = 0.734 vs 0.785, p = 0.021; APACHE-II AUC-ROC = 0.672 vs 0.755, p = 0.003). Admission RDW with SOFA presented the better discrimination ability for mortality. CONCLUSION: RDW is an independent prognostic marker of death in septic patients admitted in the ICU that improves SOFA, LODS, APACHE-II and SAPS-II discrimination ability. This parameter could be incorporated to the prognostic scores as a marker of systemic dysfunction and dysregulated inflammatory response.

Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems / Características y evolución de los pacientes con tumores sólidos que requieren ingreso en la unidad de cuidados intensivos. Utilidad de 3 escalas de gravedad

Background and objective: To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores. Material and methods: Descriptive study including 132 patients with solid tumour admitted to the ICU (2010-2016). Demographics and cancer-related data, organ failures, life-supporting therapies and severity scores: APACHE II, SOFA and ICU Cancer Mortality Model (ICMM) were collected. Results: There were 58 patients admitted for medical reasons and 74 for scheduled surgery. The ICU and hospital mortality rate were 12.9% and 19.7%, respectively. The medical reason for admission, the number of organ failures, and the need of life-supporting therapies were significantly associated with a higher mortality (p<0.05). In the logistic regression analysis, the three severity scores: SOFA (OR 1.18, 95% IC 1.14-1.48), APACHE II (OR 1.11, 95% CI 1.09-1.27), and ICMM (OR 1.03, 95% CI 1.02-1.07) were independently associated with a higher mortality (p<0.05). To evaluate the discrimination, the area under the receiver operating characteristics curves (AUROC) were calculated: APACHE II (0.795, 95% CI 0.69-0.9), SOFA (0.77, 95% CI 0.69-0.864) and ICMM (0.794, 95% CI 0.697-0.891). The comparison of AUC ROC after DeLong's test showed no difference between them. Conclusion: Hospital mortality was associated with the type and severity of acute illness. The three severity scores were useful to assess outcome and accurate in the discrimination, but we did not find a significant difference between them

Introducción y objetivo: Describir las características generales y la evolución de los pacientes con tumores sólidos ingresados en una unidad de cuidados intensivos (UCI), identificar los factores asociados a la mortalidad y evaluar el valor pronóstico de 3 escalas de gravedad. Material y métodos: Estudio descriptivo de 132 pacientes con diagnóstico de tumour sólido admitidos en la UCI (2010-2016). Se analizaron los datos demográficos relacionados con el tumour, la disfunción orgánica y las terapias de soporte vital, así como las escalas de gravedad APACHE II, SOFA e ICMM. Resultados: Ingresaron 58 pacientes por causa médica y 74 tras cirugía programada. La tasa de mortalidad en la UCI y hospitalaria fue del 12,9% y 19,7%, respectivamente. La causa médica de ingreso, el número de fallos orgánicos y la necesidad de terapias de soporte vital se asociaron significativamente con mayor mortalidad (p<0,05). En el análisis por regresión logística las 3 escalas evaluadas: SOFA (OR: 1,18; IC 95%: 1,14-1,48), APACHE II (OR: 1,11; IC 95%: 1,09-1,27) e ICMM (OR: 1,03; IC 95%: 1,02-1,07) se asociaron de forma independiente con una mayor mortalidad (p<0,05). Para evaluar la discriminación, se calcularon las AUROC: APACHE II (0,795; CI 95%: 0,69-0,9), SOFA (0,77; CI 95%: 0,69-0,864) e ICMM (0,794; CI 95%: 0,697-0,891). La comparación de las mismas por el test DeLong no mostró diferencias entre los sistemas de puntuación. Conclusiones: La mortalidad hospitalaria se asoció con el tipo y la gravedad de la enfermedad aguda. Las e escalas de gravedad evaluadas fueron igualmente útiles para evaluar el pronóstico, sin mostrar diferencias entre ellas

Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems.

BACKGROUND AND OBJECTIVE: To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores. MATERIAL AND METHODS: Descriptive study including 132 patients with solid tumour admitted to the ICU (2010-2016). Demographics and cancer-related data, organ failures, life-supporting therapies and severity scores: APACHE II, SOFA and ICU Cancer Mortality Model (ICMM) were collected. RESULTS: There were 58 patients admitted for medical reasons and 74 for scheduled surgery. The ICU and hospital mortality rate were 12.9% and 19.7%, respectively. The medical reason for admission, the number of organ failures, and the need of life-supporting therapies were significantly associated with a higher mortality (p<0.05). In the logistic regression analysis, the three severity scores: SOFA (OR 1.18, 95% IC 1.14-1.48), APACHE II (OR 1.11, 95% CI 1.09-1.27), and ICMM (OR 1.03, 95% CI 1.02-1.07) were independently associated with a higher mortality (p<0.05). To evaluate the discrimination, the area under the receiver operating characteristics curves (AUROC) were calculated: APACHE II (0.795, 95% CI 0.69-0.9), SOFA (0.77, 95% CI 0.69-0.864) and ICMM (0.794, 95% CI 0.697-0.891). The comparison of AUC ROC after DeLong's test showed no difference between them. CONCLUSION: Hospital mortality was associated with the type and severity of acute illness. The three severity scores were useful to assess outcome and accurate in the discrimination, but we did not find a significant difference between them.