Comparison of different strategies for short-term death prediction in the infected older patient
Por:
Yanez, M, Mota, M, Ferrer, M, Julian-Jimenez, A, Pinera, P, Llopis, F, del Rio, J, de Zarate, M, Estella, A, Martin-Sanchez, F, del Castillo, J, Puente, P, Diaz, R, Olmeda, D, Izquierdo, R, Nicolas, J, Hurtado, A, Vegas, C, Bautista, J, Candel, F, Echebarria, B, Roman, F, Llorens, P, Perales, R, Onate, J, Ordonez, B, Fragero, E, Ortega, M, Burillo, G, Hernandez, C, Arranz, M, Juarez, R, Amez, J, Muro, E, Ordono, L, Criado, J, von Wernitz, A, del Arco, C, Yglesias, P, Ruiz, F, Castrillo, L, Alonso, H, Salido, M, Miranda, B, Grinspan, M, Tey, J, Mateo, S, Roca, M, Ezponda, F, Diez, E, Garcia, F, Huarte, I, Martin, S, Moreno, M, de Sosa, S, de la Chica, A, Losa, C, Navarro, R, Vela, M, Gilmartin, L, Martinez, C, Rodriguez, V, Rodriguez, M, Marti, A, Beliz, O, Quesada, S, Ungerer, O, Rodriguez, T, Irigoyen, L, Andonegui, C, Cortes, N, Gamito, G, Borrego, B, Betegon, M, Moreno, A, Borras, M, Gamaury, A, Quevedo, J, Munoz, V, Tejada, C, Menchaca, B, Deltell, J, Lopez, A, Lecinera, M, Moreto, S, Mendez, C, Fernandez, S, Rodriguez, R, Aljama, M, Rivas, M, Amador, L, Munoz, J, Carrasco, E, Salazar, D, Orantos, M, Adrada, E and Grp Infecciones Soc Espanola Med
Publicada:
1 abr 2019
Resumen:
Objective. The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED).
Methods. We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.
Results. We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS >= 2 and 0.698 (IC 95% 0.635- 0.761; p<0,001) for qSOFA >= 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573).
Conclusions. Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index.
Filiaciones:
Yanez, M:
Hosp Univ Infanta Leonor, Serv Urgencias, Madrid, Spain
Mota, M:
Hosp Reg Univ Malaga, Serv Urgencias, Malaga, Spain
Ferrer, M:
Univ Alfonso X El Sabio, Serv Med Prevent, Hosp Clin San Carlos, Fac Ciencias Salud, Madrid, Spain
Hosp San Carlos, Inst Invest Sanitaria, Madrid, Spain
Julian-Jimenez, A:
Complejo Hosp Toledo, Serv Urgencias, Toledo, Spain
Pinera, P:
Hosp Univ Reina Sofia, Serv Urgencias, Murcia, Spain
Llopis, F:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
del Rio, J:
Hosp Univ Galdakao, Serv Urgencias, Galdakao, Spain
de Zarate, M:
Hosp Univ Basurto, Serv Urgencias, Bilbao, Spain
Estella, A:
Hosp Jerez, Serv Urgencias, Jerez de la Frontera, Spain
Hosp Jerez, Jerez de la Frontera, Spain
Martin-Sanchez, F:
Hosp San Carlos, Inst Invest Sanitaria, Madrid, Spain
Hosp Clin San Carlos, Serv Urgencias, Calle Profesor Martin Lagos S-N, Madrid 28040, Spain
del Castillo, J:
Hosp San Carlos, Inst Invest Sanitaria, Madrid, Spain
Hosp Clin San Carlos, Serv Urgencias, Calle Profesor Martin Lagos S-N, Madrid 28040, Spain
Puente, P:
Hosp Univ Cent Asturias, Oviedo, Spain
Diaz, R:
Complejo Hosp Toledo, Toledo, Spain
Olmeda, D:
Hosp Virgen de La Luz, Cuenca, Spain
Izquierdo, R:
Hosp Rio Hortega, Valladolid, Spain
Nicolas, J:
Hosp Univ Reina Sofia, Murcia, Spain
Hurtado, A:
Hosp Clin Valladolid, Valladolid, Spain
Vegas, C:
Hosp Clin Valladolid, Valladolid, Spain
Bautista, J:
Hosp Univ Virgen de la Macarena, Seville, Spain
Candel, F:
Hosp Univ Clin San Carlos, Madrid, Spain
Echebarria, B:
Hosp Univ Basurto, Bilbao, Spain
:
Hosp Univ Gen Alicante, Alicante, Spain
:
Hosp Univ Gen Alicante, Alicante, Spain
Perales, R:
Hosp Gen Albacete, Albacete, Spain
Onate, J:
Hosp Cruces, Baracaldo, Spain
Ordonez, B:
Hosp Virgen de la Victoria, Malaga, Spain
Fragero, E:
Hosp Virgen de la Victoria, Malaga, Spain
Ortega, M:
Hosp Clin Barcelona, Barcelona, Spain
Burillo, G:
Hosp Univ Canarias, Tenerife, Spain
Hernandez, C:
Hosp Univ Canarias, Tenerife, Spain
Arranz, M:
Hosp Nuestra Senora Prado, Talavera, Spain
Juarez, R:
Hosp Nuestra Senora Prado, Talavera, Spain
Amez, J:
Hosp Royo Villanova, Zaragoza, Spain
Muro, E:
Hosp Univ 12 Octubre, Madrid, Spain
Ordono, L:
Hosp Univ 12 Octubre, Madrid, Spain
Criado, J:
Hosp Univ, Salamanca, Spain
von Wernitz, A:
Hosp Univ La Princesa, Madrid, Spain
del Arco, C:
Hosp Univ La Princesa, Madrid, Spain
Yglesias, P:
Parc Sanitari St Joan Deu Hosp Gen, Barcelona, Spain
Hosp Moises Broggi St Joan Despi, Barcelona, Spain
Ruiz, F:
Hosp Clin Univ, Zaragoza, Spain
Castrillo, L:
Hosp Valdecilla, Santander, Spain
Alonso, H:
Hosp Valdecilla, Santander, Spain
Salido, M:
Hospl Carlos Haya, Malaga, Spain
Miranda, B:
Hosp Rey Juan Carlos, Madrid, Spain
Grinspan, M:
Hosp Henares, Madrid, Spain
Tey, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Mateo, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Roca, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Ezponda, F:
Hosp Zumarraga, Zumarraga, Spain
Diez, E:
Hosp San Juan, Alicante, Spain
Garcia, F:
Hosp Reina Sofia, Cordoba, Spain
Huarte, I:
Hosp Donosti, San Sebastian, Spain
Martin, S:
Hosp Escorial, San Lorenzo Del Escorial, Spain
Moreno, M:
Hosp Univ Burgos, Burgos, Spain
de Sosa, S:
Hosp Univ Burgos, Burgos, Spain
de la Chica, A:
Hosp Sol, Marbella, Spain
Losa, C:
Hosp Univ Bellvitge, Hosp Llobregat, Lhospitalet De Llobregat, Spain
Navarro, R:
Hosp Univ Torrevieja, Torrevieja, Spain
Vela, M:
Hosp Leon, Leon, Spain
Gilmartin, L:
Hosp Leon, Leon, Spain
Martinez, C:
Hosp Segovia, Segovia, Spain
Rodriguez, V:
Hosp Univ Getafe, Getafe, Spain
Rodriguez, M:
Hosp San Eloy, Baracaldo, Spain
Marti, A:
Hosp Son Espases, Palma De Mallorca, Spain
Beliz, O:
Hosp Univ Fdn Alcorcon, Alcorcon, Spain
Quesada, S:
Hosp St Pau & Santa Tecla, Tarragona, Spain
Ungerer, O:
Hosp St Pau & Santa Tecla, Tarragona, Spain
Rodriguez, T:
Hosp Santiago Apostol, Burgos, Spain
Irigoyen, L:
Hosp Soria, Soria, Spain
Andonegui, C:
Hosp Mendaro, Mendaro, Spain
Cortes, N:
Hosp Alto Deba, Arrasate Mondragon, Spain
Gamito, G:
Hosp Univ Mutua Terrassa, Terrassa, Spain
Borrego, B:
Hosp Severo Ochoa, Leganes, Spain
Betegon, M:
Hosp Viladecans, Viladecans, Spain
Moreno, A:
Hosp Viladecans, Viladecans, Spain
Borras, M:
Hosp Verge de la Cinta Tortosa, Tortosa, Spain
Gamaury, A:
Hosp Zamora, Zamora, Spain
Quevedo, J:
Hosp Gen Univ Santa Lucia, Cartagena, Spain
Munoz, V:
Hosp Juan Ramon Jimenez, Huelva, Spain
Tejada, C:
Hosp Nuestra Senora Valme, Seville, Spain
Menchaca, B:
Hosp Bidasoa, Hondarribia, Spain
Deltell, J:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Lopez, A:
Hosp Avila, Avila, Spain
Lecinera, M:
Hosp Can Misess, Ibiza, Spain
Moreto, S:
Hosp Vendrell, El Vendrell, Spain
Mendez, C:
Hosp Axarquia, Malaga, Spain
Fernandez, S:
Hosp Axarquia, Malaga, Spain
Rodriguez, R:
Hosp Univ Ciudad Real, Ciudad Real, Spain
Aljama, M:
Hosp Univ Ciudad Real, Ciudad Real, Spain
Rivas, M:
Hosp Bierzo, Ponferrada, Spain
Amador, L:
Hosp Vigo, Vigo, Spain
Munoz, J:
Complejo Hosp Jaen, Jaen, Spain
Carrasco, E:
Virgen de Alta Gracia, Manzanares, Spain
Salazar, D:
Hosp Comarcal Amposta, Amposta, Spain
Orantos, M:
Hosp Clin San Carlos, Madrid, Spain
Adrada, E:
Hosp Univ Rey Juan Carlos, Inst Invest Sanitaria, Madrid, Spain
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