ABSTRACT
Objective: To evaluate procalcitonin clearance as a prognostic biomarker in septic shock. Design: Prospective, observational pilot study. Setting: Intensive care unit. Patients: Patients admitted to the ICU due to septic shock and multiorgan dysfunction. Interventions: Serum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. Data collected: Demographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). Results: Procalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4-83.8]% vs 22.7 [-331-58.4], p<0.05) and 48h (81.6 [71.6-91.3]% vs -7.29 [-108.2-82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54-0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69-1.0, p<0.05) at 48h. Conclusions: ICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker (AU)
Objetivo: Evaluar el aclaramiento de procalcitonina como biomarcador pronóstico del shock séptico. Diseño: Estudio piloto, observacional y prospectivo. Ámbito: Servicio de Medicina Intensiva. Pacientes: Enfermos ingresados en el Servicio de Medicina Intensiva por shock séptico y disfunción multiorgánica. Intervenciones: Determinación de las concentraciones séricas de procalcitonina en las primeras 12h de evolución del shock séptico (coincidiendo con el ingreso en el Servicio de Medicina Intensiva) y posteriormente a las 24 horas, 48 horas y a las 72 horas en los pacientes supervivientes. Variables recogidas: datos demográficos, score Acute Physiology and Chronic Health Evaluation II, score Sequential Organ Failure Assessment, datos relativos al foco de sepsis y al resultado del paciente (mortalidad en el Servicio de Medicina Intensiva). Resultados: El aclaramiento de procalcitonina fue mayor en los pacientes supervivientes respecto a los no supervivientes, con diferencias significativas a las 24 horas (73,9 [56,4-83,8]% vs 22,7 [-331-58,4], p<0,05) y las 48 horas (81,6 [71,6-91,3]% vs -7,29 [-108,2-82,3], p<0,05). El área por debajo de la curva ROC fue 0,74 (IC del 95%, 0,54 a 0,95, p<0,05) para el aclaramiento de procalcitonina a las 24 horas y 0,86 (IC del 95%, 0,69 a 1,0, p<0,05) para el aclaramiento de procalcitonina a las 48 horas. Conclusiones: La persistencia de concentraciones elevadas de procalcitonina se asoció a una mayor mortalidad. El aclaramiento de procalcitonina realizado a las 48h puede ser de utilidad como biomarcador pronóstico (AU)
Subject(s)
Humans , Receptors, Calcitonin/isolation & purification , Shock, Septic/physiopathology , Multiple Organ Failure/physiopathology , Prospective Studies , Biomarkers/analysis , PrognosisABSTRACT
OBJECTIVE: To evaluate procalcitonin clearance as a prognostic biomarker in septic shock. DESIGN: Prospective, observational pilot study. SETTING: Intensive care unit. PATIENTS: Patients admitted to the ICU due to septic shock and multiorgan dysfunction. INTERVENTIONS: Serum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. DATA COLLECTED: Demographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). RESULTS: Procalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4-83.8]% vs 22.7 [-331-58.4], p<0.05) and 48h (81.6 [71.6-91.3]% vs -7.29 [-108.2-82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54-0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69-1.0, p<0.05) at 48h. CONCLUSIONS: ICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker.
Subject(s)
Calcitonin/blood , Multiple Organ Failure/blood , Multiple Organ Failure/mortality , Protein Precursors/blood , Shock, Septic/blood , Shock, Septic/mortality , Aged , Biomarkers/blood , Calcitonin Gene-Related Peptide , Female , Humans , Male , Pilot Projects , Prognosis , Prospective StudiesABSTRACT
OBJECTIVE: To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables. DESIGN: Cross-sectional study.Setting. Les Planes (Sant Joan Despí, Barcelona). Urban Health District. PATIENTS: 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study. MEASUREMENTS AND RESULTS: The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p < 0.01), receiving social assistance 46% (p < 0.001), being a widow/widower 21% (p < 0.01), not having had paid employment 20% (p < 0.04) and having a rotating residence 28% (p < 0.003). On application of multivariate analysis, being a woman (OR 4.99) and receiving social assistance (OR 7.55) maintained their significance. The presumed perpetrators were son/daughter (57%), spouse (8%), son/daughter-in-law (23%). 19% of these were drug-dependent and 15% suffered psychiatric disorders. CONCLUSIONS: The high prevalence of ITE is clear. These results should alert doctors to a previously under-rated health problem.
Subject(s)
Elder Abuse/statistics & numerical data , Aged , Cross-Sectional Studies , Female , Humans , Male , Prevalence , Spain/epidemiology , Surveys and QuestionnairesABSTRACT
Objetivo. Determinar la prevalencia de sospecha de malos tratos a ancianos (SMA) en población atendida en una área básica de salud (ABS) y analizar las variables asociadas. Diseño. Estudio transversal. Emplazamiento. Les Planes (Sant Joan Despí, Barcelona). ABS urbana. Pacientes. Un total de 307 pacientes 70 años, visitados en el ABS. Las pérdidas fueron 39, las exclusiones por trastorno cognitivo 31 y por imposibilidad para la entrevista 18; 219 acabaron el estudio. Mediciones y resultados. Mediante entrevista se administró el test de Pfeiffer, se recogieron variables sociodemográficas, se pasó un cuestionario sobre malos tratos (una respuesta positiva se consideraba como SMA) y se valoró la dependencia física (índice de Katz). La prevalencia de SMA fue del 11,9 por ciento (IC del 95 por ciento, 7,6-16,2), 26 personas, distribuyéndose en 6 de tipo físico, 20 psicológico, uno sexual, 3 negligencia y 3 abandono. Nueve personas presentaban más de un tipo de maltrato. Las variables asociadas significativamente fueron: sexo femenino, 18 por ciento (p < 0,01); percibir ayudas sociales, 46 por ciento (p < 0,001); ser viudo/a, 21 por ciento (p < 0,01); no haber tenido un trabajo remunerado, 20 por ciento (p < 0,04), y tener residencia rotatoria, 28 por ciento (p < 0,003). Al aplicar el análisis multivariante, mantuvieron la significación ser mujer (OR 4,99) y percibir ayudas sociales (OR 7,55). Los presuntos perpetradores fueron en un 57 por ciento, hijo/a; 8 por ciento, cónyuge; 23 por ciento, yerno/nuera. El 19 por ciento presentaba toxicomanías y un 15 por ciento trastornos psiquiátricos. Conclusión. Es manifiesta la elevada prevalencia de SMA. Estos resultados deben alertar a los médicos de familia sobre un problema de salud hasta ahora infravalorado (AU)
Subject(s)
Aged , Male , Female , Humans , Spain , Prevalence , Surveys and Questionnaires , Cross-Sectional Studies , Elder AbuseABSTRACT
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