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1.
Cureus ; 16(8): e67137, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39290917

RESUMEN

Sepsis is characterized by life-threatening organ dysfunction due to dysregulated host response to infection. It can progress to cause circulatory and cellular/metabolic abnormalities, resulting in septic shock that may significantly increase mortality. The pathophysiology of sepsis involves a complex interplay of invading pathogens and the body's immune defense, causing alteration in normal homeostasis, eventually leading to derangements in the cellular, humoral, circulatory, and metabolic functions. Several scoring systems have been developed to rapidly predict or suspect sepsis, such as Sequential Organ Failure Assessment (SOFA), modified SOFA (mSOFA), quick SOFA (qSOFA), shock index (SI), and modified SI (mSI). Each of these scores has been utilized for triaging patients with sepsis, and as per medical advancements these scoring systems have been modified to include or exclude certain criteria to improve their clinical utility. This review aims to compare the individual scores and their usage for sepsis that may be used for laying the foundation for early recognition and prediction of sepsis and for formulating more precise definitions in the future.

2.
Ann Med ; 56(1): 2397090, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-39221748

RESUMEN

BACKGROUND: The quick sequential [sepsis-related] organ failure assessment (qSOFA) acts as a prompt to consider possible sepsis. The contributions of individual qSOFA elements to assessment of severity and for prediction of mortality remain unknown. METHODS: A total of 3974 patients with community-acquired pneumonia were recruited to an observational prospective cohort study. The area under the receiver operating characteristic curve (AUROC), odds ratio, relative risk and Youden's index were employed to assess discrimination. RESULTS: Respiratory rate ≥22/min demonstrated the most superior diagnostic value, indicated by largest odds ratio, relative risk and AUROC, and maximum Youden's index for mortality. However, the indices for altered mentation and systolic blood pressure (SBP) ≤100 mm Hg decreased notably in turn. The predictive validities of respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg were good, adequate and poor for mortality, indicated by AUROC (0.837, 0.734 and 0.671, respectively). Respiratory rate ≥22/min showed the strongest associations with SOFA scores, pneumonia severity index, hospital length of stay and costs. However, SBP ≤100 mm Hg was most weakly correlated with the indices. CONCLUSIONS: Respiratory rate ≥22/min made the greatest contribution to parsimonious qSOFA to assess severity and predict mortality. However, the contributions of altered mentation and SBP ≤100 mm Hg decreased strikingly in turn. It is the first known prospective evidence of the contributions of individual qSOFA elements to assessment of severity and for prediction of mortality, which might have implications for more accurate clinical triage decisions.


Respiratory rate ≥22/min demonstrated the most superior diagnostic value.Respiratory rate ≥22/min showed the strongest association with severity.Respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg predicted mortality well, adequately and poorly, respectively.


Asunto(s)
Puntuaciones en la Disfunción de Órganos , Curva ROC , Humanos , Masculino , Femenino , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Neumonía/mortalidad , Neumonía/diagnóstico , Índice de Severidad de la Enfermedad , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/diagnóstico , Sepsis/mortalidad , Sepsis/diagnóstico , Frecuencia Respiratoria , Anciano de 80 o más Años , Presión Sanguínea , Valor Predictivo de las Pruebas , Pronóstico
3.
J Surg Res ; 301: 647-655, 2024 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-39116831

RESUMEN

INTRODUCTION: The quick Sequential Organ Failure Assessment (qSOFA) score identifies patients with suspected infection at high risk for adverse outcomes. The qSOFA score is the sum of three variables (respiratory rate, systolic blood pressure, and Glasgow Coma Score) with binary thresholds. The role of qSOFA in predicting hospitalization outcomes in nonpenetrating trauma patients was determined at a level 1 and a level 2 trauma center. METHODS: The trauma registries at the two institutions were queried for adult (18+ y) and pediatric (0-17 y) nonpenetrating trauma hospitalizations between January 1, 2019 and September 30, 2021. RESULTS: At institution A, there were 3720 adult hospitalizations (qSOFA = 0: 2906 patients, qSOFA = 1: 677, qSOFA = 2: 124, qSOFA = 3: 13) and 418 pediatric hospitalizations (qSOFA = 0: 238 patients, qSOFA = 1: 159, qSOFA = 2: 20, qSOFA = 3: 1). At institution B, there were 3579 adult hospitalizations (qSOFA = 0: 2638 patients, qSOFA = 1: 816, qSOFA = 2: 121, qSOFA = 3: 4) and 429 pediatric hospitalizations (qSOFA = 0: 273 patients, qSOFA = 1: 149, qSOFA = 2: 6, qSOFA = 3: 1). In adults at both institutions, increased qSOFA was significantly associated with higher mortality rates. Intensive care unit (ICU) admission increased at institution A and increased at institution B to qSOFA = 2. In multivariable analyses, qSOFA predicted ICU admission and mortality. Pediatric patients had low injury severity, morbidity, and mortality. Excluding the one early qSOFA = 3 mortality, higher qSOFA scores were associated with increased ICU admission in pediatric patients. CONCLUSIONS: Elevated qSOFA scores are associated with ICU admission and mortality in adult nonpenetrating trauma patients. Further investigation on qSOFA for resource allocation is indicated.

4.
Yonago Acta Med ; 67(3): 225-232, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39193134

RESUMEN

Background: Recent studies have analyzed the qSOFA (quick sequential organ failure assessment) score as a prognostic indicator in many diseases, particularly sepsis. However, the effect of qSOFA score on prognosis and mortality in critical care patients has not been sufficiently analyzed. There is not enough data, especially regarding its use as critical care mortality and prognosis scoring. In this study, we aimed to analyze the effect of qSOFA score on mortality and prognosis in critical care unit (CCU) patients. Methods: This study was conducted retrospectively using the chart review method. The APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores of patients admitted to our CCU were compared with the qSOFA score. In addition, the need for intubation and mechanical ventilation, short- and long term mortality rates, the relationship between blood gas lactate values and qSOFA score were analyzed. Results: A total of 1816 patients were included in the study. During critical care follow-up, 374 (20.6%) of our patients died, and at the end of 6 months, 796 (43.8%) of our patients died. A statistically significant association was found between in-hospital mortality and qSOFA, SOFA scores and lactate levels (P = 0.001, P = 0.001, P = 0.01 respectively). A statistically significant association was found between 6-month mortality and SOFA score only. (P = 0.001) The SOFA score appeared to be the most successful predictor of mortality. The cut-off for mortality using the ROC curve was ≥ 7 [sensitivity 78.1%; specificity 85.9%; AUC 0.91; 95% confidence interval (CI), 0.89 to 0.92; P = 0.001]. qSOFA scoring also performed well. The cut-off value for mortality using the ROC curve was ≥ 2 (sensitivity 42.5%; specificity 93.9%; AUC 0.83;95% CI, 0.80-0.85; P = 0.001). Conclusion: We believe that the qSOFA score can be used as a marker for in-hospital mortality and prognosis in critical care patients. Especially in cases where the qSOFA score is ≥ 2, it provides valuable information regarding mortality and prognosis.

5.
Indian J Anaesth ; 68(8): 718-724, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39176117

RESUMEN

Background and Aims: Early diagnosis of sepsis is crucial. The primary objective of this study was to explore the role of uncoupling protein 2 (UCP2) in diagnosing sepsis and septic shock. Methods: This prospective observational study was conducted over 19 months. All adult patients aged more than 18 years with a diagnosis of sepsis or septic shock based on quick sequential organ failure assessment (qSOFA) score were enroled. Blood was drawn for procalcitonin (PCT) and UCP2 on days 0, 3, 7 and 28. Blood samples from 50 healthy volunteers were used as controls. An electrochemiluminescence test was done for PCT. A quantitative enzyme-linked immune sorbent assay was used for UCP2. The Chi-square test was used for qualitative variables and the independent t-test for quantitative variables. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of UCP2. Results: A total of 128 subjects were included in the study. Out of these, 78 patients (qSOFA score ≥2) were subcategorised into the infection group, sepsis or septic shock group based on the PCT levels. The UCP2 levels in the infection, sepsis or septic shock group were significantly higher than in the control group (P > 0.001). The UCP2 levels correlated with PCT on admission, day 3 and day 7. Conclusion: The UCP2 levels were significantly higher in sepsis and septic shock groups compared to controls and hence could be a potential diagnostic biomarker of sepsis.

6.
J Family Med Prim Care ; 13(6): 2455-2461, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-39027859

RESUMEN

Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P < 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P < 0.01). The difference in mortality rates between patients with and without co-morbidity (P < 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

7.
Ther Clin Risk Manag ; 20: 437-447, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39040852

RESUMEN

Background: Listeriosis is caused by the facultative anaerobic bacterium Listeria monocytogenes. Infection from Listeria-contaminated food or water is the main etiology. If Listeria travels outside the intestines, it can cause invasive listeriosis, such as sepsis, meningitis, and meningoencephalitis. Invasive illness is especially dangerous for pregnant women and their newborns, elderly people, and people with compromised immune systems or medical conditions such as end-stage kidney disease (ESKD) patients receiving long-term dialysis. Purpose: Describe the manifestations and hospital outcomes of invasive listeriosis and identify the risk factors for in-hospital and one-year mortality in ESKD patients receiving long-term dialysis. Patients and Methods: This retrospective observational study examined hospitalized patient records at a Taiwanese tertiary medical center from August 1, 2000, to August 31, 2021. ESKD patients on chronic dialysis were identified with invasive listeriosis by blood culture and discharge diagnosis. Over 21 years, we accurately recorded 26 cases. Results: ESKD patients on chronic dialysis with invasive listeriosis have a poor prognosis. Only 53.8% of chronic dialysis patients with invasive listeriosis survived their first hospital episode. 42.3% of hospitalized ESKD patients with invasive listeriosis survived one year later. In univariate analysis, shock, tachypnea (RR ≥ 22), respiratory failure, qSOFA score ≥ 2, and lower initial platelet count were linked to greater in-hospital mortality rates. Conclusion: ESKD patients with invasive listeriosis have a grave prognosis. Our research reveals that an early blood sample for a bacterial culture may identify invasive listeriosis in chronic dialysis patients with fever, nausea or vomiting, confusion, and respiratory distress. This study is the first to identify a lower platelet count and qSOFA score ≥ 2 as markers of high-risk invasive listeriosis in ESKD patients.

9.
BMC Urol ; 24(1): 116, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849783

RESUMEN

BACKGROUND: There are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia. METHODS: Patients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators. RESULTS: Among the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS, qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows: qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969). CONCLUSIONS: IL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.


Asunto(s)
Interleucina-6 , Nefrolitotomía Percutánea , Complicaciones Posoperatorias , Polipéptido alfa Relacionado con Calcitonina , Choque Séptico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Interleucina-6/sangre , Nefrolitotomía Percutánea/efectos adversos , Puntuaciones en la Disfunción de Órganos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/sangre , Valor Predictivo de las Pruebas , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Retrospectivos , Choque Séptico/etiología , Choque Séptico/sangre
10.
Gac Med Mex ; 160(1): 62-67, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38753542

RESUMEN

BACKGROUND: The quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) is a score that has been proposed to quickly identify patients at higher risk of death. OBJECTIVE: To describe the usefulness of the qSOFA score to predict in-hospital mortality in cancer patients. MATERIAL AND METHODS: Cross-sectional study carried out between January 2021 and December 2022. Hospital mortality was the dependent variable. The area under the ROC curve (AUC) was calculated to determine the discriminative ability of qSOFA to predict in-hospital mortality. RESULTS: A total of 587 cancer patients were included. A qSOFA score higher than 1 obtained a sensitivity of 57.2%, specificity of 78.5%, a positive predictive value of 55.4% and negative predictive value of 79.7%. The AUC of qSOFA for predicting in-hospital mortality was 0.70. In-hospital mortality of patients with qSOFA scores of 2 and 3 points was 52.7 and 64.4%, respectively. In-hospital mortality was 31.9% (187/587). CONCLUSION: qSOFA showed acceptable discriminative ability for predicting in-hospital mortality in cancer patients.


ANTECEDENTES: El quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) es una puntuación propuesta para identificar de forma rápida a pacientes con mayor probabilidad de morir. OBJETIVO: Describir la utilidad de la puntuación qSOFA para predecir mortalidad hospitalaria en pacientes con cáncer. MATERIAL Y MÉTODOS: Estudio transversal realizado entre enero de 2021 y diciembre de 2022. La mortalidad hospitalaria fue la variable dependiente. Se calculó el área bajo la curva ROC (ABC) para determinar la capacidad discriminativa de qSOFA para predecir mortalidad hospitalaria. RESULTADOS: Se incluyeron 587 pacientes con cáncer. La puntuación qSOFA < 1 obtuvo una sensibilidad de 57.2 %, una especificidad de 78.5 %, un valor predictivo positivo de 55.4 % y un valor predictivo negativo de 79.7 %. El ABC de qSOFA para predecir mortalidad hospitalaria fue de 0.70. La mortalidad hospitalaria de los pacientes con qSOFA de 2 y 3 puntos fue de 52.7 y 64.4 %, respectivamente. La mortalidad hospitalaria fue de 31.9 % (187/587). CONCLUSIÓN: qSOFA mostró capacidad discriminativa aceptable para predecir mortalidad hospitalaria en pacientes con cáncer.


Asunto(s)
Mortalidad Hospitalaria , Neoplasias , Puntuaciones en la Disfunción de Órganos , Humanos , Neoplasias/mortalidad , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Anciano , Sensibilidad y Especificidad , Curva ROC , Sepsis/mortalidad , Sepsis/diagnóstico , Valor Predictivo de las Pruebas , Área Bajo la Curva , Adulto , Anciano de 80 o más Años
12.
Infection ; 2024 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-38607592

RESUMEN

PURPOSE: Sepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown. METHODS: This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality. RESULTS: 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality. CONCLUSION: In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.

13.
Clin Mol Hepatol ; 30(3): 388-405, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38600873

RESUMEN

BACKGROUND/AIMS: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF). METHODS: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. RESULTS: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353-5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484- 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). CONCLUSION: Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.


Asunto(s)
Insuficiencia Hepática Crónica Agudizada , Puntuaciones en la Disfunción de Órganos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Insuficiencia Hepática Crónica Agudizada/diagnóstico , Insuficiencia Hepática Crónica Agudizada/mortalidad , Insuficiencia Hepática Crónica Agudizada/complicaciones , Adulto , Anciano , Pronóstico , Curva ROC , Escala de Coma de Glasgow , Modelos de Riesgos Proporcionales , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/complicaciones , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/complicaciones
14.
Rev Recent Clin Trials ; 19(3): 196-203, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38644718

RESUMEN

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The qSOFA and procalcitonin are currently used for both diagnostic as well as prognostic purposes. OBJECTIVE: To explore the combined use of day one procalcitonin level and qSOFA scores for prognostication of sepsis-related mortality. DESIGN: This was a prospective observational study. PARTICIPANTS: All patients who fulfilled the inclusion criteria for sepsis with an age of more than 16 years were enrolled in the study. RESULTS: In this study of 211 patients, 15 patients died (7.1%) during hospital stay. Among the 15 patients who died, the highest mortality of 29.4% was seen in patients with qSOFA of "3", qSOFA of "2" had a mortality of 12.8%, qSOFA of "1" had a mortality of 1% and qSOFA of "0" had zero mortality. In this study, procalcitonin had a statistically significant positive correlation/association with both qSOFA and mortality. CONCLUSION: The qSOFA and procalcitonin at presentation to the emergency department in septic patients have a significant correlation with mortality in patients hospitalized with sepsis. Obtaining these two parameters at presentation will help in managing aggressively these patients who at presentation have higher qSOFA and procalcitonin levels.


Asunto(s)
Biomarcadores , Puntuaciones en la Disfunción de Órganos , Polipéptido alfa Relacionado con Calcitonina , Sepsis , Humanos , Sepsis/sangre , Sepsis/mortalidad , Sepsis/diagnóstico , Polipéptido alfa Relacionado con Calcitonina/sangre , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Biomarcadores/sangre , Anciano , Pronóstico , Mortalidad Hospitalaria , Adulto , Anciano de 80 o más Años
15.
Ann Med ; 56(1): 2337714, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38590177

RESUMEN

The purpose was to investigate how well age-adjusted modified quick Sequential Organ Failure Assessment (qSOFA) scores paired with blood glucose and lactate levels predict the outcomes of septicemic children in the pediatric intensive care unit (PICU). One hundred children who were diagnosed with sepsis and septic shock in the PICU of Henan Children's Hospital were eligible, and other 20 patients in the same hospital at different times were selected as a validation set. Respiratory rate (RR), heart rate (HR), capillary refill time (CRT), and Alert, Voice, Pain, Unresponsive (AVPU) scale were included in the age-adjusted modified qSOFA scoring criteria for scoring. The primary outcome was 28-day all-cause mortality. The predictive values were evaluated by the ROC curve. In the sepsis group, 50 patients were male, and 50 patients were female. The 28-day all-cause mortality rate was 52%. Fifty-one patients with age-adjusted modified qSOFA scores >1. The serum lactate level was 2.4 mmol/L, and the blood glucose level was 9.3 mmol/L. The AUCs for the age-adjusted modified qSOFA score, serum lactate and blood glucose levels for the prediction of 28-day all-cause mortality in children with sepsis were 0.719, 0.719 and 0.737, respectively. The cut-off values were one point, 3.8 mmol/L and 10 mmol/L, respectively. The AUC of the age-adjusted modified qSOFA score for the validation set of was 0.925. When the three indices were combined, the AUC was 0.817, the Hosmer-Lemeshow goodness-of-fit test showed χ2 = 2.428 and p = .965. When children with sepsis are admitted to the ICU, we recommend performing rapid scoring and rapid bedside lactate and glucose testing to determine the early prognosis.


Asunto(s)
Puntuaciones en la Disfunción de Órganos , Sepsis , Niño , Humanos , Masculino , Femenino , Ácido Láctico , Glucosa , Glucemia , Estudios Retrospectivos , Pronóstico , Unidades de Cuidado Intensivo Pediátrico , Curva ROC , Sepsis/diagnóstico , Mortalidad Hospitalaria
16.
Cureus ; 16(2): e54030, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38481909

RESUMEN

This comprehensive review navigates the intricate landscape of sepsis scoring systems, aiming to provide healthcare professionals and researchers with a nuanced understanding of their role in contemporary sepsis management. Beginning with a succinct overview of sepsis, the review emphasizes the significance of scoring systems in standardizing assessments and guiding clinical decision-making. Through a detailed analysis of prominent systems such as SOFA, APACHE, and qSOFA, the review delineates their unique attributes, strengths, and limitations. The implications for sepsis management and patient outcomes are discussed, highlighting the potential for these tools to enhance early detection and intervention. The review concludes with a compelling call to action, urging healthcare professionals to integrate scoring systems into routine practice and researchers to explore novel approaches. By synthesizing current knowledge and addressing future directions, this review serves as a valuable resource for those seeking clarity and guidance in the dynamic landscape of sepsis management.

17.
Animals (Basel) ; 14(6)2024 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-38539990

RESUMEN

The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer's lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4-2 mcg/kg/min) than the DEX group (0.12, 0-0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs.

18.
Ir J Med Sci ; 193(4): 2051-2059, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38483773

RESUMEN

BACKGROUND: Triage refers to classifying and prioritizing patients based on the severity of their injuries or illnesses in the health care setting. The increasing number of elderly patients seeking care in emergency departments (EDs) highlights the need for special attention to the unique needs of this patient population. AIM: We aimed to compare the qSOFA, Emergency Severity Index (ESI), National Early Warning Score (NEWS), and Manchester Triage System (MTS) scores to assist ED physicians in assessing the severity of elderly patients' clinical conditions and triaging them appropriately. METHODS: This cross-sectional study included 1066 patients aged 65 and over who presented to our ED as outpatients or by ambulance between September 1, 2022, and August 30, 2023. Scoring systems at the time of admission to the ED were recorded separately for outpatients and arriving by ambulance. RESULTS: According to the qSOFA, patients with a score of 0 were 0.976 times less likely to arrive by ambulance compared to those scoring 1 and above (OR = 0.976, p = .934). According to the NEWS, patients in the moderate-risk category were 0.447 times less likely to arrive by ambulance (OR = 0.447, p = .054). According to the ESI score, patients requiring high resource use with normal vital signs were 146.758 times more likely to arrive by ambulance (OR = 146.758, p = .001). CONCLUSION: Significant differences in patients' methods of presentation to the ED were observed based on the MTS, qSOFA, NEWS, and ESI scores.


Asunto(s)
Puntuación de Alerta Temprana , Servicio de Urgencia en Hospital , Triaje , Humanos , Triaje/métodos , Triaje/estadística & datos numéricos , Anciano , Estudios Transversales , Femenino , Masculino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anciano de 80 o más Años , Pronóstico , Índice de Severidad de la Enfermedad , Ambulancias/estadística & datos numéricos , Evaluación Geriátrica/métodos , Evaluación Geriátrica/estadística & datos numéricos
19.
Saudi Med J ; 45(3): 230-234, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38438215

RESUMEN

OBJECTIVES: To examine the simplified Fournier Gangrene Severe Index Score (SFGSI) and the number of species in culture findings for predicting death in Fournier Gangrene (FG) patients in terms of their predictive power. METHODS: From January 2017 to July 2022, the medical records of individuals undergoing emergency surgery for FG were obtained. A total of 80 patients were examined for clinical data such as age, gender, laboratory parameters, etiology, isolated bacteria, and mortality rate. RESULTS: We identified a statistically significant mean difference between SFGSI (p<0.0001) and quickSOFA (qSOFA) scores (p=0.002) in determining the survival rate of FG patients. The sensitivity and specificity of the SFGSI score in predicting mortality were 90.1% and 88.3% respectively, whereas the sensitivity and specificity of the qSOFA score were 88.2% and 86.2%. E. Coli comprised 56.2% of the bacteria, followed by S. Haemolyticus, S. Aureus, P. Aeruginosa, and K. Pneumoniae. On the basis of bacterial culture results, P. Aeruginosa had the highest fatality rate (100%) followed by S. Aureus (75%), S. Haemolyticus (30%), and E. Coli (20%), in that order. CONCLUSION: The survival rate of FG patients can be predicted using the sensitivity and specificity of the SFGSI and qSOFA scores together. P. Aeruginosa-infected patients have the greatest mortality rate (100%) compared to the other groups.


Asunto(s)
Gangrena de Fournier , Humanos , Masculino , Tasa de Supervivencia , Gangrena de Fournier/diagnóstico , Escherichia coli , Puntuaciones en la Disfunción de Órganos , Staphylococcus aureus
20.
Gac. méd. Méx ; 160(1): 67-72, ene.-feb. 2024. tab, graf
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1557805

RESUMEN

Resumen Antecedentes: El quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) es una puntuación propuesta para identificar de forma rápida a pacientes con mayor probabilidad de morir. Objetivo: Describir la utilidad de la puntuación qSOFA para predecir mortalidad hospitalaria en pacientes con cáncer. Material y métodos: Estudio transversal realizado entre enero de 2021 y diciembre de 2022. La mortalidad hospitalaria fue la variable dependiente. Se calculó el área bajo la curva ROC (ABC) para determinar la capacidad discriminativa de qSOFA para predecir mortalidad hospitalaria. Resultados: Se incluyeron 587 pacientes con cáncer. La puntuación qSOFA < 1 obtuvo una sensibilidad de 57.2 %, una especificidad de 78.5 %, un valor predictivo positivo de 55.4 % y un valor predictivo negativo de 79.7 %. El ABC de qSOFA para predecir mortalidad hospitalaria fue de 0.70. La mortalidad hospitalaria de los pacientes con qSOFA de 2 y 3 puntos fue de 52.7 y 64.4 %, respectivamente. La mortalidad hospitalaria fue de 31.9 % (187/587). Conclusión: qSOFA mostró capacidad discriminativa aceptable para predecir mortalidad hospitalaria en pacientes con cáncer.


Abstract Background: The quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) is a score that has been proposed to quickly identify patients at higher risk of death. Objective: To describe the usefulness of the qSOFA score to predict in-hospital mortality in cancer patients. Material and methods: Cross-sectional study carried out between January 2021 and December 2022. Hospital mortality was the dependent variable. The area under the ROC curve (AUC) was calculated to determine the discriminative ability of qSOFA to predict in-hospital mortality. Results: A total of 587 cancer patients were included. A qSOFA score higher than 1 obtained a sensitivity of 57.2 %, specificity of 78.5 %, a positive predictive value of 55.4 % and negative predictive value of 79.7 %. The AUC of qSOFA for predicting in-hospital mortality was 0.70. In-hospital mortality of patients with qSOFA scores of 2 and 3 points was 52.7 and 64.4 %, respectively. In-hospital mortality was 31.9 % (187/587). Conclusions: qSOFA showed acceptable discriminative ability for predicting in-hospital mortality in cancer patients.

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