RESUMO
BACKGROUND: Following the SEPSIS-3 consensus, detection of organ failure as assessed by the SOFA (Sequential Organ Failure Assessment) score, is mandatory to detect sepsis. Calculating SOFA outside of the Intensive Care Unit (ICU) is challenging. The alternative in this scenario, the quick SOFA, is very specific but less sensible. Biomarkers could help to detect the presence of organ failure secondary to infection either in ICU and non-ICU settings. MATERIALS AND METHODS: We evaluated the ability of four biomarkers (C-Reactive protein (CRP), lactate, mid-regional proadrenomedullin (MR-proADM) and procalcitonin (PCT)) to detect each kind of organ failure considered in the SOFA in 213 patients with infection, sepsis or septic shock, by using multivariate regression analysis and calculation of the area under the receiver operating curve (AUROC). RESULTS: In the multivariate analysis, MR-proADM was an independent predictor of five different failures (respiratory, coagulation, cardiovascular, neurological and renal). In turn, lactate predicted three (coagulation, cardiovascular and neurological) and PCT two (cardiovascular and renal). CRP did not predict any of the individual components of SOFA. The highest AUROCs were those of MR-proADM and PCT to detect cardiovascular (AUROC, CI95%): MR-proADM (0.82 [0.76-0.88]), PCT (0.81 [0.75-0.87] (P < .05) and renal failure: MR-proADM (0.87 [0.82-0.92]), PCT (0.81 [0.75-0.86]), (P < .05). None of the biomarkers tested was able to detect hepatic failure. CONCLUSIONS: In patients with infection, MR-proADM was the biomarker detecting the largest number of SOFA score components, with the exception of hepatic failure.
Assuntos
Adrenomedulina/sangue , Proteína C-Reativa/metabolismo , Infecções/sangue , Ácido Láctico/sangue , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Precursores de Proteínas/sangue , Sepse/sangue , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/diagnóstico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Unidades de Terapia Intensiva , Falência Hepática/sangue , Falência Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/diagnóstico , Escores de Disfunção Orgânica , Curva ROC , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Respiratória/sangue , Insuficiência Respiratória/diagnóstico , Sepse/diagnóstico , Choque Séptico/sangue , Choque Séptico/diagnósticoRESUMO
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RESUMO
Early recognition of sepsis is a key factor to improve survival to this disease in surgical patients, since it allows prompt control of the infectious source. Combining pro-inflammatory and immunosupression biomarkers could represent a good strategy to improve sepsis detection. Here we evaluated the combination of procalcitonin (PCT) with gene expression levels of HLA-DRA to detect sepsis in a cohort of 154 surgical patients (101 with sepsis and 53 with no infection). HLA-DRA expression was quantified using droplet digital PCR, a next-generation PCR technology. Area under the receiver operating curve analysis (AUROC) showed that the PCT/HLA-DRA ratio outperformed PCT to detect sepsis (AUROC [CI95%], p): PCT: 0.80 [0.73-0.88], <0.001; PCT/HLA-DRA: 0.85 [0.78-0.91], <0.001. In the multivariate analysis, the ratio showed a superior ability to predict sepsis compared to that of PCT (OR [CI 95%], p): PCT/HLA-DRA: 7.66 [1.82-32.29], 0.006; PCT: 4.21 [1.15-15.43] 0.030. Multivariate analysis was confirmed using a new surgical cohort with 74 sepsis patients and 21 controls: PCT/HLA-DRA: 34.86 [1.22-995.08], 0.038; PCT: 5.52 [0.40-75.78], 0.201. In conclusion, the combination of PCT with HLA-DRA is a promising strategy for improving sepsis detection in surgical patients.
RESUMO
Malignant disease is present in the pericardium of 1.5% to 20.6% of patients dying of malignant diseases as was examined postmortem. We present a case of a 57-year-old man with a history of Hodgkin's disease and a sarcoma of gluteus who presented with tachypnea, generalized weakness, and anasarca for 7 days. The echocardiogram revealed the presence of a significant pericardial thickening and localized pericardial effusion resulting from a tricuspid stenosis. A right anterior thoracotomy was performed, and a pericardiectomy (4 x 4 cm) was done. The histologic examination of the pericardium revealed the presence of a metastatic dissemination from a sarcoma. The cause for the clinical presentation and the treatment of malignant pericardial disease are discussed.
Assuntos
Neoplasias Cardíacas/secundário , Neoplasias Musculares/patologia , Derrame Pericárdico/cirurgia , Sarcoma/secundário , Estenose da Valva Tricúspide/etiologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Técnicas de Janela Pericárdica , Pericárdio/patologia , Sarcoma/complicações , Sarcoma/cirurgia , Estenose da Valva Tricúspide/cirurgiaAssuntos
Bartonella henselae/isolamento & purificação , Doença da Arranhadura de Gato/complicações , Endocardite Bacteriana/etiologia , Idoso , Ampicilina/uso terapêutico , Animais , Valva Aórtica/cirurgia , Azitromicina/uso terapêutico , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/microbiologia , Gatos , Quimioterapia Combinada/uso terapêutico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Gentamicinas/uso terapêutico , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/microbiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/cirurgia , UltrassonografiaRESUMO
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Animais , Gatos , Adolescente , Idoso , Masculino , Humanos , Bartonella henselae , Azitromicina , Valva Mitral , Prolapso da Valva Mitral , Encefalite por Varicela Zoster , Implante de Prótese de Valva Cardíaca , Fotofobia , Antivirais , Valva Aórtica , Diagnóstico Diferencial , Aciclovir , Ampicilina , Herpes Zoster , Endocardite Bacteriana , Eletroencefalografia , Gentamicinas , Febre , Cefaleia , Vômito , Quimioterapia Combinada , Transtornos de Enxaqueca , Doença da Arranhadura de GatoRESUMO
A 27-year-old asymptomatic woman was investigated for an abnormal finding in the cardiac contour on routine chest radiography. Echocardiography revealed a heterogeneous mass in the anterolateral left ventricular wall. Excision of the tumor disclosed an absence of communication between the residual cavity and the left ventricular endocardium. Histological features of the tumor indicated an intramural myxoma.
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Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adulto , Ecocardiografia , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Imageamento por Ressonância Magnética , Mixoma/cirurgia , RadiografiaRESUMO
La enfermedad de Moyamoya es una angiopatía poco frecuente que afecta a las arterias de la base del cráaaneo y presenta importantes implicaciones obstétricas, cuyo manejo aún es controvertida, fundamentalmente por la escasez de casos reportados en la literatura(AU)
Assuntos
Humanos , Feminino , Gravidez , Doença de Moyamoya , Cesárea , GravidezRESUMO
La enfermedad de Moyamoya es una angiopatía poco frecuente que afecta a las arterias de la base del cráaaneo y presenta importantes implicaciones obstétricas, cuyo manejo aún es controvertida, fundamentalmente por la escasez de casos reportados en la literatura