Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa / Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity

Objetivo Comparar la validez pronóstica del APACHE II-M y O-SOFA versus el APACHE II y SOFA para predecir mortalidad en pacientes con morbilidad materna severa. Diseño Estudio de cohorte, retrospectivo, longitudinal y analítico. Ámbito Unidad de cuidados intensivos (UCI) médico-quirúrgica de un hospital de tercer nivel. Pacientes Pacientes embarazadas o puérperas de cualquier edad ingresadas en la UCI. Intervenciones Cálculo de scores pronósticos al ingreso. Variables de interés APACHE II, SOFA, APACHE II-M, O-SOFA y mortalidad materna. Resultados Se incluyeron 141 pacientes. Noventa y nueve (70,2%) fueron puérperas. El diagnóstico más frecuente fue la enfermedad hipertensiva del embarazo (50 casos). La discriminación de cada modelo pronóstico se estimó con el área bajo la curva ROC (ABC-ROC). La calibración se estimó utilizando la razón de mortalidad y el estadístico de Hosmer-Lemeshow. Las 4 escalas discriminaron entre supervivientes y no supervivientes con áreas bajo la curva >0,85. El modelo APACHE II-M fue el modelo pronóstico con mayor discriminación y calibración. En la regresión de Hosmer-Lemeshow la predicción de mortalidad de APACHE II y O-SOFA fue significativamente diferente a las muertes observadas. Conclusiones el APACHE II-M tuvo la mayor validez pronóstica para predecir muerte materna. Esta diferencia está dada por su mejoría en la calibración. (AU)

Objective To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity. Design A retrospective, longitudinal and analytical cohort study was carried out. Setting Medical-surgical intensive care unit (ICU) of a tertiary hospital. Patients Pregnant or puerperal patients of any age admitted to the ICU. Interventions Calculation of prognostic scores upon admission. Variables of interest APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality. Results A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality. Conclusions The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration. (AU)

Comparison of four prognostic scales for predicting mortality in patients with severe maternal morbidity. / Comparación de 4 escalas pronósticas para predecir mortalidad en pacientes con morbilidad materna severa.

OBJECTIVE: To compare the prognostic validity of the APACHE II-M and O-SOFA scales versus the APACHE II and SOFA to predict mortality in patients with severe maternal morbidity. DESIGN: A retrospective, longitudinal and analytical cohort study was carried out. SETTING: Medical-surgical intensive care unit (ICU) of a tertiary hospital. PATIENTS: Pregnant or puerperal patients of any age admitted to the ICU. INTERVENTIONS: Calculation of prognostic scores upon admission. VARIABLES OF INTEREST: APACHE II, SOFA, APACHE II-M and O-SOFA scores and maternal mortality. RESULTS: A total of 141 patients were included. The majority (70.2%) were puerperal. The most frequent diagnosis was gestational hypertensive disease (50 cases). The discrimination of each prognostic model was estimated with the area under the ROC curve (AUC-ROC). The calibration was estimated using the mortality ratio and the Hosmer-Lemeshow statistic. The four scales discriminated between survivors and non-survivors with areas under the curve >0.85. The APACHE II-M model was the predictive model with the highest discrimination and calibration. In the Hosmer-Lemeshow regression analysis, mortality as predicted by the APACHE II and O-SOFA was significantly different from the observed mortality. CONCLUSIONS: The APACHE II-M exhibited the greatest prognostic validity in predicting maternal mortality. This difference was given by its improvement in calibration.

A blood micro-culture system for the diagnosis of bacteremia in pediatric patients.

The aim of this study was to evaluate the utility of a volume-modified blood culture system to diagnose bacteremia in newborns and infants. A total of 793 paired blood cultures, obtained from 464 patients (173 newborns and 291 infants), were analyzed. Vacutainer tubes containing 18 ml supplemented peptone broth sodium-polyanethol-sulfonate were used as the gold standard, in comparison with a blood micro-culture system containing 1.8 ml of the broth. Prior to antibiotic treatment, 2.2 ml of blood was obtained from each patient; 0.2 ml was inoculated in a blood micro-culture tube and 2 ml in a routine tube. Sensitivity, specificity and predictive values were calculated. Microorganisms were isolated in 153 standard blood culture tubes and 151 blood micro-culture tubes. The sensitivity of the blood micro-culture system was 95%, specificity 99% and positive and negative predictive values 96% and 99% respectively. The sensitivity and specificity of blood micro-culture in neonates and infants is high. We recommend that this system be used for the diagnosis of bacteremia in newborns and infants in laboratories where manual systems are still in use.

[AIDS in children. Experience at the National Institute of Pediatrics]. / Síndrome de inmunodeficiencia adquirida en niños. Experiencia en el Instituto Nacional de Pediatría.

We describe retrospectively the experience with 44 cases of AIDS from January 1987 to October 1991 at the Instituto Nacional de Pediatria, a tertiary care children hospital in Mexico City. All patients with 2 ELISA and a positive Western Blot test were included. Thirty three patients were infected perinatally (75%) and 11 through blood transfusion (25%). Fourty one patients belonged to the P2 classification of the Centers for Disease Control. Chronic diarrhea (77%), lymphadenopathy (75%), hepatomegaly/splenomegaly (70%) and oral candidiasis (61%) were the most common clinical findings. Twenty patients died (45.4%). No statistical relation were found between survival rate and the way of transmission and age at onset. Autopsy was performed in 14 patients and revealed a sharp decrease of lymphoid tissue at all levels with severe thymic atrophy.