ABSTRACT
OBJECTIVE: To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU). DESIGN: A multicenter, observational descriptive study was carried out. PARTICIPANTS: Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM's) was assessed using a Fagan test. RESULTS: A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (nâ¯=â¯605) at discharge from the ICU. The variables showing statistical significance (Pâ¯<â¯.001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM's yielded a mean of 0.0257 (95%CI: 0.0245-0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533-0.2886) in those who died (Pâ¯<â¯.001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907-0.930). Based on the Fagan test, the ARIAM's showed the mortality risk to be 19% (95%CI: 18%-20%) when positive and 0.9% (95%CI: 0.8%-1.01%) when negative. CONCLUSIONS: A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.
Subject(s)
Acute Coronary Syndrome , Humans , Hospital Mortality , Intensive Care Units , Hospitalization , Patient DischargeABSTRACT
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Subject(s)
Humans , Cardiopulmonary Resuscitation/statistics & numerical data , Heart Arrest/epidemiology , Tissue and Organ Procurement/ethics , Hospice Care/ethics , Hospital Statistics , Donor Selection/ethicsABSTRACT
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Subject(s)
Humans , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Advanced Cardiac Life Support/ethics , Practice Patterns, Physicians' , Life Support CareSubject(s)
Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Cardiopulmonary Resuscitation/adverse effects , Cardiopulmonary Resuscitation/ethics , Cardiopulmonary Resuscitation/standards , Cardiovascular Agents/therapeutic use , Combined Modality Therapy , Contraindications, Procedure , Fluid Therapy , Hospitalization , Humans , Practice Guidelines as Topic , Terminal Care/ethics , Terminal Care/methods , Terminal Care/standards , Withholding Treatment/ethics , Withholding Treatment/standardsABSTRACT
Fundamento y objetivo: Ver la influencia de la interleucina 6 (IL-6) como mediador inflamatorio en pacientes con criterios de systemic inflammatory response syndrome (SIRS, «síndrome de respuesta inflamatoria sistémica») y sepsis valorando si su determinación plasmática durante el ingreso en la unidad de cuidados intensivos (UCI) sirve como marcador precoz de mortalidad. Material y métodos: Estudio observacional prospectivo de cohortes con 203 pacientes ingresados en UCI de un Hospital de tercer nivel. Se efectuó análisis descriptivo comparando las variables cualitativas con el test X2, las cuantitativas con la T-Student. También análisis multivariante tipo regresión logística al ingreso, tercer y séptimo día con variable dependiente mortalidad e independientes edad, sexo, niveles plasmáticos de IL-6, lactato, proteína C reactiva, scores APACHE II y SOFA. La exactitud pronóstica de los biomarcadores se efectuó mediante curvas ROC con su sensibilidad y especificidad. Por último, se llevó a cabo curva de supervivencia a los 28 días. Resultados: De 203 pacientes fallecieron 52 (26%) y sobrevivieron 151 (74%). Noventa y ocho (48,3%) presentaron SIRS de etiología infecciosa (sepsis). No hubo diferencias significativas entre edad, sexo y mortalidad. Más pacientes fallecidos en el grupo sepsis. La persistencia de cifras elevadas de IL-6 se relacionó con la mortalidad. Al tercer día, la IL-6 fue la variable con mayor significación en relación con la mortalidad, con sensibilidad del 75% y especificidad del 86%. Los pacientes que al 3tercer día mantuvieron una cifra de IL-6 mayor de 124,14pg/ml tuvieron 6,1 veces mayor probabilidad de fallecer que los de niveles inferiores. Conclusiones: Los pacientes con SIRS-sepsis que fallecieron presentaron cifras de IL-6 más elevadas que los que sobrevivieron. La IL-6 fue un marcador pronóstico precoz de mortalidad intra-UCI (AU)
Background and objective: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker. Material and methods: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X2 test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days. Results: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels. Conclusions: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality (AU)
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Middle Aged , Interleukin-6/blood , Sepsis/mortality , Sepsis/blood , Sepsis/diagnosis , Prospective Studies , Longitudinal Studies , Biomarkers/blood , Logistic Models , Prognosis , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
BACKGROUND AND OBJECTIVE: To see the influence of interlukin-6 (IL-6) as an inflammatory mediator in patients with systemic inflammatory response syndrome (SIRS) and sepsis, assessing whether their serum levels during their stay in intensive care unit (ICU) serve as an early mortality prognostic marker MATERIAL AND METHODS: A prospective observational cohort study with 203 ICU patients from a third level hospital. A descriptive analysis was made, X(2) test used to compare qualitative variables, T-Student test to compare quantitative ones. We made a logistic regression multivariant analysis on admission, third and seventh day of stay with dependent variable mortality and independent variables age, gender and IL-6, lactate and C-reactive protein plasma levels as well as APACHE II and SOFA scores. The biomarkers' prognostic accuracy was established through ROC curves with their sensitivity and specificity. Finally, a survival curve was performed at 28 days RESULTS: Of 203 patients, 52 (26%) died and 151 (74%) survived. Ninety-eight (48,3%) had SIRS of infectious aetiology (sepsis). There were no significant differences between age, gender and mortality. More patients died in the sepsis group. The persistence of high IL-6 plasma levels was associated with mortality. On the third day of stay, IL-6 was the most significant variable in relation to mortality with 75% sensitivity and 86% specificity. Patients with IL-6 plasma levels greater than 124.14pg/ml on the 3th day were 6.1 times more likely to die than those with lower levels CONCLUSIONS: Patients with SIRS-sepsis who died had higher IL-6 plasma levels than those who survived. IL-6 was an early marker of intra-ICU mortality.
Subject(s)
Interleukin-6/blood , Sepsis/mortality , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Female , Humans , Logistic Models , Longitudinal Studies , Male , Middle Aged , Prognosis , Prospective Studies , Sensitivity and Specificity , Sepsis/blood , Sepsis/diagnosis , Severity of Illness IndexABSTRACT
No disponible
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Humans , Resuscitation/methods , Death, Sudden, Cardiac , Cardiopulmonary Resuscitation/methods , Hospital StatisticsABSTRACT
No disponible
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Humans , Cardiopulmonary Resuscitation/methods , Advanced Cardiac Life Support/methods , Heart Arrest/therapy , Electric Countershock , Brain Damage, Chronic/epidemiologySubject(s)
Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Respiratory Insufficiency/therapy , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/therapy , Clinical Protocols , Electric Countershock , Heart Arrest/mortality , Hospital Mortality , Hospitals , Humans , Practice Guidelines as Topic , Respiratory Insufficiency/mortalityABSTRACT
La endocarditis infecciosa es una enfermedad grave que puede conllevar un pronóstico ominoso en caso de no tratarse adecuadamente. En otras ocasiones, el cuadro clínico evoluciona desfavorablemente a pesar de un tratamiento médico óptimo, y los antibióticos no llegan a esterilizar la sangre; la cirugía en estos pacientes tiene un papel importante para extraer el foco de infección o realizar un recambio valvular. La sorprendente evolución de los pacientes intervenidos en circunstancias desesperadas ha llevado a un análisis del papel de la cirugía precoz. Nosotros, como clínicos, debemos conocer el riesgo de estos pacientes y ser conscientes de la importancia de establecer unas indicaciones quirúrgicas adecuadas (AU)
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients risks and to establish the adequate surgical indications (AU)
Subject(s)
Humans , Endocarditis, Bacterial/surgery , Heart Valve Prosthesis/microbiology , Heart Failure/complications , Prosthesis-Related Infections , Sepsis/complications , Pacemaker, Artificial/microbiology , Aneurysm, Infected , Abdominal Abscess , Anticoagulants/therapeutic useABSTRACT
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients' risks and to establish the adequate surgical indications.
Subject(s)
Endocarditis/microbiology , Endocarditis/surgery , HumansABSTRACT
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