ABSTRACT
Introducción: La health care-associated pneumonia (HCAP, «neumonía asociada a la asistencia sanitaria») es la principal causa de infección hospitalaria y está asociada a una alta tasa de mortalidad. Este estudio tuvo como objetivo evaluar el desempeño de los sistemas Pneumonia Severity Index (PSI, «índice de gravedad de la neumonía») y Confusion, Urea, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65, «confusión, urea, frecuencia respiratoria, presión arterial, edad≥65) en la predicción de la mortalidad a 30 días en pacientes adultos de HCAP. Pacientes y métodos: Se realizó un estudio de tipo transversal y se analizaron los datos de 109 individuos no inmunocomprometidos>18 años. El diagnóstico clínico de HCAP incluyó la presencia de infiltrados radiográficos en pacientes≥48h tras el ingreso hospitalario. Se calcularon las puntuaciones PSI y CURB-65 y se estimaron las medidas de rendimiento. Se utilizaron estadísticas resumidas para describir la muestra del estudio. Las calificaciones PSI y CURB-65 se calcularon sobre la base de 20 y 5 criterios, respectivamente, y se estimaron los indicadores de desempeño de las herramientas de cribado. Resultados: La mortalidad general a los 30 días fue del 59,6%. En cada umbral determinado, la sensibilidad del PSI fue mayor, pero mostró una especificidad más baja que el CURB-65, observándose el índice más alto de Youden (0,392) en el punto de corte V de PSI. El área bajo la curva ROC fue 0,737 (IC del 95%: 0,646-0,827) y 0,698 (IC del 95%: 0,6-0,797) utilizando los sistemas PSI y CURB-65, respectivamente (p=0,323). Conclusión: Nuestros resultados indican que el desempeño de PSI y CURB-65 es razonablemente bueno para predecir la mortalidad a 30 días en pacientes adultos de HCAP, pudiendo recomendarse o utilizarse en los centros de salud (AU)
Introduction: Healthcare-associated pneumonia (HCAP) is the leading cause of infection in a hospital setting and is associated with a high mortality rate. This study aimed to evaluate the performance of the pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age≥65 (CURB-65) systems in predicting 30-day mortality in HCAP in adult patients. Patients and methods: A cross-sectional study took place and data from 109 non-immunocompromised individuals aged>18 years were analyzed. The clinical diagnosis of HCAP included the presence of radiographic infiltrates in patients≥48hours after hospital admission. The PSI and CURB-65 scores were calculated and performance measures were estimated. Summary statistics were used to describe the study sample. The PSI and CURB-65 scores were calculated based on 20 and 5 criteria, respectively, and the performance indicators of the screening tools were estimated. Results: The overall 30-day mortality was 59.6%. At every given threshold, PSI sensitivity was higher, but showed a lower specificity than the CURB-65, and the highest Youden index (0.392) was observed at cut-off V in the PSI. The area under the ROC curve was 0.737 (95% CI: 0.646-0.827) and 0.698 (95% CI: 0.600-0.797) using the PSI and CURB-65 systems, respectively (P=.323). Conclusion: Our findings suggest that the performance of the PSI and CURB-65 is reasonable for predicting 30-day mortality in adult HCAP patients and may be used in healthcare settings (AU)
Subject(s)
Humans , Male , Female , Pneumonia/mortality , Delivery of Health Care , Pneumonia/diagnostic imaging , Cross-Sectional Studies/methods , ROC Curve , Indicators of Morbidity and Mortality , Hospital Mortality , Retrospective Studies , 28599ABSTRACT
INTRODUCTION: Healthcare-associated pneumonia (HCAP) is the leading cause of infection in a hospital setting and is associated with a high mortality rate. This study aimed to evaluate the performance of the pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age≥65 (CURB-65) systems in predicting 30-day mortality in HCAP in adult patients. PATIENTS AND METHODS: A cross-sectional study took place and data from 109 non-immunocompromised individuals aged>18 years were analyzed. The clinical diagnosis of HCAP included the presence of radiographic infiltrates in patients≥48hours after hospital admission. The PSI and CURB-65 scores were calculated and performance measures were estimated. Summary statistics were used to describe the study sample. The PSI and CURB-65 scores were calculated based on 20 and 5 criteria, respectively, and the performance indicators of the screening tools were estimated. RESULTS: The overall 30-day mortality was 59.6%. At every given threshold, PSI sensitivity was higher, but showed a lower specificity than the CURB-65, and the highest Youden index (0.392) was observed at cut-off V in the PSI. The area under the ROC curve was 0.737 (95% CI: 0.646-0.827) and 0.698 (95% CI: 0.600-0.797) using the PSI and CURB-65 systems, respectively (P=.323). CONCLUSION: Our findings suggest that the performance of the PSI and CURB-65 is reasonable for predicting 30-day mortality in adult HCAP patients and may be used in healthcare settings.
Subject(s)
Healthcare-Associated Pneumonia/mortality , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Healthcare-Associated Pneumonia/diagnosis , Humans , Male , Mexico/epidemiology , Middle Aged , Retrospective StudiesABSTRACT
ABSTRACT Objective To evaluate the association of several clinical markers with acute laboratory-positive Dengue Virus infection. Methods A hospital-based case-control study was conducted in the state of Colima, Mexico, by using information from the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica [SINAVE]) for Dengue. Data from 2 732 cases and 2 775 frequency-matched controls were analyzed. Odds Ratio (OR) and the 95 % Confidence Interval (CI), estimated by means of logistic regression models, were used. Results The presence of skin rash (OR=1,7; 95 % CI 1,5-2,1), persisting vomiting (OR=1,8; 95 % CI 1,5-2,3) and increased capillary fragility (petechiae, ecchymosis, hematoma or positive tourniquet test; OR=1,8; 95 % CI 1,2-2,6) were associated with laboratory-positive infection. Conclusions Three clinical markers were significantly associated with an increased risk of acute laboratory-confirmed dengue infection. These findings would support accurate and timely diagnosis of dengue in laboratory-limited settings.(AU)
RESUMEN Objetivo Evaluar la asociación de distintos marcadores clínicos con la infección por virus de Dengue, confirmada por laboratorio. Métodos Se condujo un estudio hospitalario de casos y controles, en el estado de Colima, México, usando información del Sistema Nacional de Vigilancia Epidemiológica (SINAVE) para dengue. Se analizó la información de 2 732 casos y 2 775 controles de frecuencia compatible/pareada. Se utilizó la Razón de Momios (RM) y el Intervalo de Confianza de 95 % (IC), estimado con modelos de regresión logística. Resultados La presencia de exantema (OR=1,7; 95 % CI 1,5-2,1), vómito persistente (OR=1,8; 95 % CI 1,5-2,3) y fragilidad capilar aumentada (petequias, equimosis, hematomas o prueba del torniquete positiva; OR=1,8; 95 % CI 1,2-2,6) se asociaron con la infección por dengue confirmada por laboratorio. Conclusiones Tres marcadores clínicos se asociaron significante con un riesgo incrementado de la infección aguda por dengue confirmada por laboratorio. Estos hallazgos pueden apoyar al preciso y oportuno diagnóstico de la infección en sitios con acceso limitado a laboratorios.(AU)
Subject(s)
Humans , Biomarkers/analysis , Population Surveillance/methods , Dengue/epidemiology , Enzyme-Linked Immunosorbent Assay/instrumentation , Communicable Diseases/epidemiology , Data Interpretation, StatisticalABSTRACT
BACKGROUND: Road traffic injuries (RTIs) are a leading cause of premature mortality, mainly in low- and middle-income countries Objective: To estimate the 2014 burden of RTIs in Mexico calculating years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to evaluate sex, age, and region-related differences in premature mortality. METHODS: Mortality data were obtained from the National Institute of Statistics and Geography and 14,637 deaths of individuals 15 years of age and older were analyzed. The YLL and ASYLL were computed. RESULTS: The overall burden of RTIs was 332,922 YLL and 82.4% of the deaths occurred in males. Males from 25 to 34 years of age and females from 15 to 24 years of age showed the highest age-adjusted YLL rates (933 and 158 YLL per 100,000 inhabitants, respectively). The national ASYLL rate was 416 per 100,000 inhabitants and the highest state-stratified mortality rates were observed in Tabasco (851), Sinaloa (709), Durango (656), Zacatecas (642), and Baja California Sur (570). CONCLUSIONS: RTIs contributed to the premature mortality rate in the study population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life.
Subject(s)
Accidents, Traffic , Life Expectancy , Mortality, Premature/trends , Wounds and Injuries/epidemiology , Accidents, Traffic/statistics & numerical data , Adolescent , Adult , Aged , Female , Geography , Health Policy , Humans , Male , Mexico/epidemiology , Middle Aged , Pregnancy , Young AdultABSTRACT
OBJECTIVE: To evaluate the association of several clinical markers with acute laboratory-positive Dengue Virus infection. METHODS: A hospital-based case-control study was conducted in the state of Colima, Mexico, by using information from the National System of Epidemiological Surveillance (Sistema Nacional de Vigilancia Epidemiológica [SINAVE]) for Dengue. Data from 2 732 cases and 2 775 frequency-matched controls were analyzed. Odds Ratio (OR) and the 95 % Confidence Interval (CI), estimated by means of logistic regression models, were used. RESULTS: The presence of skin rash (OR=1,7; 95 % CI 1,5-2,1), persisting vomiting (OR=1,8; 95 % CI 1,5-2,3) and increased capillary fragility (petechiae, ecchymosis, hematoma or positive tourniquet test; OR=1,8; 95 % CI 1,2-2,6) were associated with laboratory-positive infection. CONCLUSIONS: Three clinical markers were significantly associated with an increased risk of acute laboratory-confirmed dengue infection. These findings would support accurate and timely diagnosis of dengue in laboratory-limited settings.
