RESUMO
OBJECTIVE: To determine mortality risk factors for critically ill postoperative patients. PATIENTS: Two hundred eleven patients undergoing any type of surgery admitted to the intensive care unit (ICU) over a period of one year were enrolled. METHOD: We performed a cross-sectional study that was retrospective for pre- and intraoperative observations and prospective for ICU observations. A univariate analysis was performed and relative risk (95% CI) was calculated. Multivariate analysis was also performed and the adjusted odds ratio calculated (95% CI). The end point of measurement was death in the ICU. RESULTS: The independent risk factors for mortality were age 60 years (OR: 2.8; 95% CI 1.36-5.09), physical status ASA-V (OR: 9.66; 95% CI 5.62-14.31), intracranial surgery to treat severe head injury (OR: 5.33; 95% CI 3.08-9.47), hemorrhagic shock during surgery (OR: 5.20; 95% CI 4.16-8.29), arterial hypotension during surgery (OR: 4.0; 95% CI 2.78-11.65), APACHE III score upon admission to the ICU (OR: 9.29; 95% CI 3.62-21.38), multiple organ dysfunction syndrome (OR: 7.96; 95% CI 3.73-13.92), and cardiopulmonary arrest in the ICU (OR: 5.85; 95% CI 2.21-10.43). The APACHE III score demonstrated high sensitivity (87%) and positive predictive value (96%). CONCLUSIONS: Surgical patients in critical condition continue to account for a large number of admissions to and death in the ICU. The variables analyzed were sufficient to explain patient outcome, such that risk factors for mortality in surgical patients admitted to the ICU could be determined.
Assuntos
Estado Terminal/mortalidade , Procedimentos Cirúrgicos Operatórios/mortalidade , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoAssuntos
Encéfalo/diagnóstico por imagem , Empiema Subdural/diagnóstico , Adulto , Encéfalo/cirurgia , Infecções Bacterianas do Sistema Nervoso Central/complicações , Eletroencefalografia , Empiema Subdural/microbiologia , Empiema Subdural/cirurgia , Epilepsia Generalizada/diagnóstico , Humanos , Masculino , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To determine the significance of the selected risk markers in the development of high blood pressure in a relatively short period of time. DESIGN: Longitudinal or cohort study of a sample of a population from the municipality of Cienfuegos, as a second measurement of the Cienfuegos Global Project. CONTEXT: Community. Municipality of Cienfuegos; geographic area of the subject-object intervention-investigation of the Cienfuegos Global Project. SUBJECT: 1,369 adults aged 15 years of more (619 men and 750 women; 1,294 alive and 75 dead) were followed from January 1992 to February 1994, which constitutes an alleatory, stratified, equiprobabilistic sample by age and sex. Persons diagnosed as hypertensive in the initial evaluation of Cienfuegos Global Project were excluded, so that the new series for hypertensive patients was constituted by 731 individuals with 125 new patients when the risk markers age, sex, color of skin, family history of high blood pressure, salt consumption, sedentarism, alcoholism and tobaccoism were studied. The association of the risk markers hypercholesterolemia or risky cholesterolemia and obesity was studied with another series formed by a second sample of 417 individuals, this sample introduced 74 new cases of high blood pressure. MAIN OUTCOME: It was intended to estimate the odds ratio for high blood pressure for the different risk markers studied, in those patients exposed or not to them. RESULTS: The odds ratio for each of the risk markers was determined. The odds related to age increased from 1.37, to 1.86 in males and decreased to 0.64 in white individuals. These 3 results were statistically significant as risk markers for high blood pressure. The odds ratio for the remaining risk markers had no statistical significance. CONCLUSION: The age, male sex, and black race, in the comparatively short term--slightly over two years--are the main risk markers that will markedly favor the appearance of high blood pressure.
Assuntos
Hipertensão/epidemiologia , Adolescente , Adulto , Biomarcadores , Estudos de Coortes , Cuba/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de RiscoRESUMO
OBJECTIVE AND DEVELOPMENT: We present a synopsis of some of the main achievements of the Cuban Public Health Service in the past 39 years. We emphasize the importance of cerebrovascular disease as a cause of mortality, both in Cuba and in certain selected provinces, together with its relationship with some parameters such as age group. In the second part, we show the main results of a longitudinal or cohort study carried out in the town of Cienfuegos in Cuba. In this the importance of age as a statistically significant risk marker for the development of cerebrovascular disease is clearly seen. We also present the rate of incidence depending on exposure to risk markers, and the estimated number of new cases annually of cerebrovascular disease according to age group and gender in the town of Cienfuegos. We emphasize the need for our Public Health System to continue to deal with this disorder in an integrated manner.
Assuntos
Transtornos Cerebrovasculares/epidemiologia , Cuba/epidemiologia , HumanosRESUMO
OBJECTIVE: To find the value of different risk markers (RM) used for the development of cerebrovascular disease (CVD) in the relatively short term. MATERIAL AND METHODS: We carried out a longitudinal or cohort study in a sample of the population of Cienfuegos as part of the second series of measurements of the Global Project of Cienfuegos (GPC). We followed up 1,369 adults aged 15 years and over (619 men and 750 women: 1,294 alive and 75 posthumously) between January 1992 and February 1994. They formed an equiprobable randomized sample, stratified in groups of age and sex. Persons diagnosed as having CVD in the initial evaluation of the GPC were excluded. Thus the series of CVD for the study of RM was made up of 1,330 individuals requiring a medical interview and 14 new cases. The Odds Ratio (OR) of having CVD was estimated for the different RM studied: Age, sex, colour of skin, smoking, alcoholism, sedentary life, arterial hypertension and the combination of smoking and arterial hypertension. RESULTS: The OR corresponding to age rose to 2.89, which is statistically significant as RM for CVD. The OR of the other RM markers was not found to be statistically significant. CONCLUSIONS: Age, in the comparatively short term--slightly over two years--is the main RM markedly predisposing to the appearance of CVD.