[Age as predictive factor of mortality in an intensive and intermediate care unit]. / La edad biológica como factor predictor de mortalidad en una unidad de cuidados críticos e intermedios.

INTRODUCTION: Age by itself is not a criterion of biological prognosis. Scores for physiological variables on admission and multiorgan failure are better predictors of mortality. PATIENTS AND METHODS: We performed a retrospective/ prospective observational study from September, 2005 to May, 2007. The following variables were analyzed: age, sex, Acute Physiology and Chronic Health Classification System (APACHE) II, modified APACHE II score (without the variable of age), Sequential Organ Failure Assessment (SOFA) score, length of hospital stay, type of disease and mortality, limitation of therapeutic effort (LTE), Katz index on admission, intensive and intermediate care unit (IICU) mortality and in-hospital mortality. Student's t-test was used to analyze continuous variables. RESULTS: Of the 572 patients admitted to the IICU, we excluded 75 due to transfer to other hospitals, 142 due to direct admission to intermediate care, and 89 due to acute coronary syndrome. Of the 266 remaining patients with medical disease, mortality was higher when the APACHE II score was > 20 (OR = 9.4) and/or the SOFA score was >4 (OR = 15.41) but not when age was 3 76 years (OR = 2.04). Multivariate analysis of these parameters revealed higher mortality in the IICU (P=.01) in patients with a SOFA score > 4 and modified APACHE II score >16, independently of age or the Katz index. In addition to the SOFA and the APACHE II scores, in-hospital mortality was significantly influenced by the Katz index (P=.05). LTE was significantly greater in patients with a Katz index E-G. CONCLUSIONS: Higher SOFA and APACHE II scores predicted higher IICU mortality, regardless of age. LTE was more frequent in patients with a greater degree of dependence.

La edad biológica como factor predictor de mortalidad en una unidad de cuidados críticos e intermedios / Age as predictive factor of mortality in an intensive and intermediate care unit

Introducción: la edad no es por sí misma un criterio de pronóstico biológico. Puntuaciones asociadas a variables fisiológicas al ingreso y al fallo multiorgánico predicen mejor la mortalidad.Pacientes y métodos: estudio observacional, retrospectivo/ prospectivo, desde septiembre de 2005 a mayo/2007. Se analizaron la edad, el sexo, el APACHE II (Acute Physiology and Chronic Health Evaluation), el APACHE II modificado (sin el parámetro de la edad), SOFA (Sequential Organ Failure Assesment), estancia, tipo de afección y mortalidad por patologías, limitacióndel esfuerzo terapéutico (LET), índice de Katz basal, mortalidad en la unidad de cuidados críticos e intermedios (UCCI) e intrahospitalaria. Se realizó la prueba de la t de Student para variables continuas.Resultados: ingresamos a 572 pacientes en la UCCI, de los que excluimos a 75 por traslado a otros hospitales, 142 fueron ingresados directamente en cuidados intermedios y 89 con síndrome coronario agudo. De los 266 pacientes restantes con afección médica, encontramos mayor mortalidad cuando presentaban una puntuación en le APACHE II > 20 (odds ratio [OR] = 9,4) y SOFA > 4 (OR = 15,41), pero no cuando la edad era ≥ 76 años(OR = 2,04). Si realizamos un análisis multivariante de estos parámetros, encontramos mayor mortalidad en la UCCI (p ≤ 0,01) en pacientes con SOFA > 4 y APACHE II modificado > 16, independientemente de la edad o del índice de Katz. Mientras que en la mortalidad intrahospitalaria, además del SOFA y el APACHE II,influía significativamente también el índice de Katz (p < 0,05). La LET fue significativamente mayor en pacientes con índices de Katz E-G.Conclusiones: la mortalidad en la UCCI fue significa-tivamente mayor conforme aumentaban el SOFA y el APACHE II, independientemente de la edad. Encontramos mayor LET en pacientes con mayor grado de dependencia

Introduction: age by itself is not a criterion of biological prognosis. Scores for physiological variables on admission and multiorgan failure are better predictors of mortality.Patients and methods: We performed a retrospective/ prospective observational study from September, 2005 to May, 2007. The following variables were analyzed: age, sex, Acute Physiology and Chronic Health Classification System (APACHE) II, modified APACHE II score (without the variable of age), Sequential Organ Failure Assessment (SOFA) score, length of hospital stay, type ofdisease and mortality, limitation of therapeutic effort (LTE), Katz index on admission, intensive and intermediate care unit (IICU) mortality and in-hospital mortality. Student’s t-test was used to analyze continuous variables.Results: of the 572 patients admitted to the IICU, we excluded 75 due to transfer to other hospitals, 142 due to direct admission to intermediate care, and 89 due to acute coronary syndrome. Of the 266 remaining patients with medical disease, mortality was higher when the APACHE II score was > 20 (OR = 9.4) and/or theSOFA score was >4 (OR = 15.41) but not when age was ≥ 76years (OR = 2.04). Multivariate analysis of these parameters revealed higher mortality in the IICU (P=.01) in patients with a SOFA score > 4 and modified APACHE II score >16, independently of age or the Katz index. In addition to the SOFA and the APACHE II scores, in-hospital mortality was significantly influenced by theKatz index (P=.05). LTE was significantly greater in patients with a Katz index E-G.Conclusions: higher SOFA and APACHE II scores predictedhigher IICU mortality, regardless of age. LTE was more frequent in patients with a greater degree of dependence (AU)

Síndrome de Guillain-Barré como manifestación inicial de una leucemia mielomonocítica crónica / Chronic myelomonocytic leukemia presenting as Guillain-Barré syndrome

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