Quadruple therapies are superior to standard triple therapy for Helicobacter pylori first-line eradication in Chile. / Terapias cuádruples son superiores a terapia triple estándar en primera línea de erradicación de Helicobacter pylori en Chile.

INTRODUCTION: Helicobacter pylori infection affects approximately 70% of the Chilean population. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. OBJECTIVES: Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. METHODS: A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. RESULTS: 242 patients and 4 main therapies were analyzed: standard triple therapy, dual therapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44-87.63), 88.5% (95% CI 73.13-95.67), 93.7% (95% CI 78.07-98.44) and 97.6% (95% CI 84.81-99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01-1.29; p=.028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09-1.31; p<.001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66-65.92), 35.4% (95% CI 24.6-48.11), 22.9% (95% CI 81-37.14) and 63.4% (95% CI 47.8-76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. CONCLUSIONS: Quadruple therapies are superior to standard triple therapy and should be considered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective.

[Total globulins and lymphocyte count as markers of mortality in sepsis and septic shock]. / Globulinas totales y recuento linfocitario como marcadores de mortalidad en sepsis y shock séptico.

BACKGROUND: There are no studies probing if patients in sepsis or septic shock with lower levels of total plasmatic globulins and/or lymphocyte count have higher mortality. PATIENTS AND METHOD: Prospective cohort study of 103 patients admitted in Intensive Care Unit followed daily at the Dr. Gustavo Fricke Hospital between June and November of 2009, with sepsis or septic shock criteria. RESULTS: There was association between mortality and lymphocytic count measured from the third day of their hospitalization (P < 0.05), but not when compared with the plasmatic globulin measurements (P > 0.05). The area under ROC curve for the mean lymphocyte count at the third day was 0.68 (95% CI 0.53-0.82), with a sensitivity of 75%, specificity of 52%, LR(+) 1.57 and LR(-) 0.48 for a cut-off at 510 lymphocytes/mm³, behaving also as an independent risk factor of mortality (OR 3.67, 95% CI 1.03-13.1). DISCUSSION: Lymphocyte count is early and independently associated with increased mortality in patients with sepsis or septic shock.

Globulinas totales y recuento linfocitario como marcadores de mortalidad en sepsis y shock séptico / Total globulins and lymphocyte count as markers of mortality in sepsis and septic shock

Background: There are no studies probing if patients in sepsis or septic shock with lower levels of total plas-matic globulins and/or lymphocyte count have higher mortality. Patients and Method: Prospective cohort study of 103 patients admitted in Intensive Care Unit followed daily at the Dr. Gustavo Fricke Hospital between June and November of 2009, with sepsis or septic shock criteria. Results: There was association between mortality and lymphocytic count measured from the third day of their hospitalization (P < 0.05), but not when compared with the plasmatic globulin measurements (P > 0.05). The area under ROC curve for the mean lymphocyte count at the third day was 0.68 (95% CI 0.53-0.82), with a sensitivity of 75%, specificity of 52%, LR(+) 1.57 and LR(-) 0.48 for a cut-off at 510 lymphocytes/mm³, behaving also as an independent risk factor of mortality (OR 3.67, 95% CI 1.03-13.1). Discussion: Lymphocyte count is early and independently associated with increased mortality in patients with sepsis or septic shock.

Introducción: No existen estudios que demuestren si pacientes en sepsis o shock séptico que presentan globulinas plasmáticas totales y/o recuento linfocitario plasmático disminuidos, tendrían mayor mortalidad. Pacientes y Método: Estudio de cohorte prospectivo de 103 pacientes ingresados a la Unidad de Cuidados Intensivos, que cumplían criterios de sepsis o shock séptico, seguidos diariamente en el Hospital Dr. Gustavo Fricke entre junio y noviembre de 2009. Resultados: Hubo asociación entre mortalidad y recuento linfocitario medido a partir del tercer día (valor p < 0,05), pero no al comparar mortalidad con mediciones de globulinas plasmáticas (valor p > 0,05). El área bajo la curva ROC del recuento linfocitario medido al tercer día fue 0,68 (IC 95% 0,530,82), con una sensibilidad de 75%, especificidad 52%, LR(+) 1,57 y LR(-) 0,48 para un punto de corte de 510 linfocitos/mm³, comportándose además como factor de riesgo independiente de mortalidad (OR 3,67, IC 95% 1,03-13,1). Discusión: El recuento linfocitario se asocia precozmente y en forma independiente al pronóstico de mayor mortalidad en estos pacientes.