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This study aimed to analyze the prognostic value of the SOFA, APACHE II, and MPI (Mannheim Peritonitis Index) scores in the indication for Damage Control Surgery (DCS) in non-trauma. Retrospective analysis of patients undergoing DCS between 2014 and 2019. SOFA and APACHE II scores were calculated using parameters preceding DCS, while MPI was based on surgical descriptions. Statistical analysis: Qualitative variables were compared using the Chi-square test or Fisher's exact test, and quantitative variables using Pearson's correlation coefficient. The Student's T test was employed for mean comparisons. The sample comprised 104 patients (59 males), with a median age of 63.5 years, of whom 52 (50%) were ASA IV. Operative findings leading to DCS included peritonitis (54; 51.9%), intestinal ischemia (39; 37.5%), inability to close the abdomen (8; 7.6%), and bleeding (3; 2.9%). The mortality rate was 75% (78/104). Thirty patients (28.8%) died after DCS; the remainder underwent one (35; 33.6%), two (21; 20.2%); three (8; 7.7%), and four or more (10;9.7%) revision procedures. The median lengths of ICU and hospital stays were 12.5 and 20.5 days, respectively. The median score values were as follows: SOFA: 12 (0-38), APACHE II: 25 (2-47), and MPI: 26 (8-43). Besides ASA classification (p = 0.03), mortality risk was influenced by: age (≤ 65 years vs. > 65 years; p = 0.04), SOFA (≤ 10 vs. > 10; p = 0.03), APACHE II (≤ 25 vs. > 25; p = 0.04), and MPI (≤ 25 vs. > 25; p = 0.003). The SOFA, APACHE II, and MPI scores proved to be valuable tools in the prognostic assessment of patients undergoing DCS in non-traumatic abdominal emergencies.

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BACKGROUND: This study aimed to develop prognostic models for predicting the need for invasive mechanical ventilation (IMV) in intensive care unit (ICU) patients with COVID-19 and compare their performance with the Respiratory rate-OXygenation (ROX) index. METHODS: A retrospective cohort study was conducted using data collected between March 2020 and August 2021 at three hospitals in Rio de Janeiro, Brazil. ICU patients aged 18 years and older with a diagnosis of COVID-19 were screened. The exclusion criteria were patients who received IMV within the first 24 h of ICU admission, pregnancy, clinical decision for minimal end-of-life care and missing primary outcome data. Clinical and laboratory variables were collected. Multiple logistic regression analysis was performed to select predictor variables. Models were based on the lowest Akaike Information Criteria (AIC) and lowest AIC with significant p values. Assessment of predictive performance was done for discrimination and calibration. Areas under the curves (AUC)s were compared using DeLong's algorithm. Models were validated externally using an international database. RESULTS: Of 656 patients screened, 346 patients were included; 155 required IMV (44.8%), 191 did not (55.2%), and 207 patients were male (59.8%). According to the lowest AIC, arterial hypertension, diabetes mellitus, obesity, Sequential Organ Failure Assessment (SOFA) score, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), temperature, respiratory effort signals, and leukocytes were identified as predictors of IMV at hospital admission. According to AIC with significant p values, SOFA score, SpO2, and respiratory effort signals were the best predictors of IMV; odds ratios (95% confidence interval): 1.46 (1.07-2.05), 0.81 (0.72-0.90), 9.13 (3.29-28.67), respectively. The ROX index at admission was lower in the IMV group than in the non-IMV group (7.3 [5.2-9.8] versus 9.6 [6.8-12.9], p < 0.001, respectively). In the external validation population, the area under the curve (AUC) of the ROX index was 0.683 (accuracy 63%), the AIC model showed an AUC of 0.703 (accuracy 69%), and the lowest AIC model with significant p values had an AUC of 0.725 (accuracy 79%). CONCLUSIONS: In the development population of ICU patients with COVID-19, SOFA score, SpO2, and respiratory effort signals predicted the need for IMV better than the ROX index. In the external validation population, although the AUCs did not differ significantly, the accuracy was higher when using SOFA score, SpO2, and respiratory effort signals compared to the ROX index. This suggests that these variables may be more useful in predicting the need for IMV in ICU patients with COVID-19. GOV IDENTIFIER: NCT05663528.

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BACKGROUND: Trauma and emergency surgery are major causes of morbidity and mortality. The objective of this study was to determine whether serum levels of epinephrine and norepinephrine are associated with aging and mortality. METHODS: This was a prospective observational cohort study conducted in a surgical critical care unit. We included 90 patients who were admitted for postoperative care, because of major trauma, or both. We collected demographic and clinical variables, as well as serum levels of epinephrine and norepinephrine. RESULTS: For patients in the > 60-year age group, the use of vasoactive drugs was found to be associated with an undetectable epinephrine level (OR [95% CI] = 6.36 [1.12, 36.08]), p = 0.05). For the patients with undetectable epinephrine levels, the in-hospital mortality was higher among those with a norepinephrine level ≥ 2006.5 pg/mL (OR [95% CI] = 4.00 [1.27, 12.58]), p = 0.03). CONCLUSIONS: There is an association between age and mortality. Undetectable serum epinephrine, which is more common in older patients, could contribute to poor outcomes. The use of epinephrine might improve the clinical prognosis in older surgical patients with shock.

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BACKGROUND: Sepsis remains a worldwide major cause of hospitalization, mortality, and morbidity. To enhance the identification of patients with suspected sepsis at high risk of mortality and adverse outcomes in the emergency department (ED), the use of mortality predictors is relevant. This study aims to establish whether quick sofa (qSOFA) and the severity criteria applied in patients with suspicion of sepsis in a monitored ED are in fact predictors of mortality. METHODS: We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study. RESULTS: The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality. CONCLUSIONS: Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED's initial care.

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Objetivo: Relacionar las complicaciones y el riesgo de muerte en pacientes neurocríticos admitidos en la unidad de cuidados intensivos (UCI) del Hospital Universitario de Caracas durante un período de 5 meses. Métodos: investigación observacional, prospectiva, descriptiva. La muestra estuvo conformada por 65 pacientes neurocríticos, ≥ 18 años, con patologías médicas o quirúrgicas, ingresados en la UCI. El análisis estadístico incluyó la determinación de frecuencias, promedios, porcentajes y medias para descripción de variables y el T de Student. Resultados: La edad promedio fue 50,98 ± 16,66 años; la población masculinarepresentó el 50,76%. Entre las complicaciones, la mayor incidencia correspondió a las no infecciosas (70,77 %) y los trastornos ácido-básicos de tipo metabólico, la anemia y las alteraciones electrolíticas fueron las más frecuentes; el 29,23% de los pacientes presentaron complicaciones infecciosas, y la neumonía asociada a ventilación mecánica fue la más frecuente (73,91 %). La comorbilidad con mayor incidencia fue hipertensión arterial sistémica (53,84%). El 90.70% requirió ventilación mecánica y el tiempo en VM fue 4.29 ± 6.43 días. La estancia en UCI fue 5.96 ± 7.72 días. El 29,23% presentó un puntaje en la escala APACHE II entre 5-9; el SAPS II presentó mayor incidencia entre los 6-21 y 22-37 puntos con (66,70%); el SOFA al ingreso se reportó < 15 puntos en 98,46% y > 15 en 1,53%. La mortalidad del grupo fue 23,08 % (n=15). Conclusiones: Las complicaciones no infecciosas predominaron sobre las infecciosas las primeras íntimamente relacionadas con la mortalida(AU)

Objective: To relate complications and the risk of death in neurocritical patients admitted to the intensive care unit (ICU) of the University Hospital of Caracas during a period of 5 months. Methods: observational, prospective, descriptive research. The sample was made up of 65 neurocritical patients, ≥ 18 years old, with medical or surgical pathologies, admitted to the ICU.The statistical analysis included the determination of frequencies, averages, percentages and meansfor description of variables and Student's T.Results: The average age was 50.98 ± 16.66 years; the male population represented 50.76%. Among the complications, the highest incidence corresponded to non-infectious complications (70.77%) and metabolic acid-base disorders, anemia and electrolyte alterations were the most frequent; 29.23% of patients presented infectious complications, and pneumonia associated with mechanical ventilation was the most frequent (73.91%). The comorbidity with the highest incidence was systemic arterial hypertension (53.84%), 90.70% required mechanical ventilation and the time on MV was 4.29 ± 6.43 days. The ICU stay was 5.96 ± 7.72 days. 29.23% had a score on the APACHE II scale between 5-9; SAPS II presented the highest incidence between 6-21 and 22-37 points with (66.70%); The SOFA upon admission was reported to be < 15 points in 98.46% and > 15 in 1.53%. The mortality of the group was 23.08% (n=15). Conclusions: Non-infectious complications predominated over infectious complications, the former being closely related to mortalit(AU)

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BACKGROUND: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. METHODS: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as "possible" or "definite" endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. RESULTS: The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522-0.681) and SOFA score 0.679 (CI95% 0.602-0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA ≥ 2 showed ROC curves of 0.627 (CI95% 0.563-0.690) and 0.775 (CI95% 0.594-0.956), respectively. CONCLUSIONS: qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient's death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.

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Introducción: Se ha reconocido mundialmente el choque séptico como causa de una alta incidencia en la mortalidad. La incorporación de nuevos biomarcadores posibilita la obtención de un diagnóstico rápido y preciso. Objetivo: Evaluar la utilidad del índice leucocitos/eosinófilos como marcador pronóstico del choque séptico. Métodos: Se realizó una investigación en dos etapas: la primera descriptiva en la cual se detallaron las características clínicas, epidemiológicas y las variaciones de los estudios de laboratorio y la segunda explicativa de cohorte para estimar el valor predictivo del biomarcador leucocitos/eosinopenia en el choque séptico. Se realizó el recuento de eosinófilos y se obtuvo la media aritmética. Se consideró eosinopenia relativa con valores por debajo de la media de eosinófilos. Resultados: En el estudio se demostró que la leucocitosis fue de (27,4 células*mm3), la disminución del hematocrito (32,2 por ciento) y el descenso del número plaquetario (125,6 célula*mm3) prevalecen en el choque séptico. Además se refleja el descenso de los eosinófilos (18,5 células/mcl), aumento del índice leucocitos/eosinófilos (148,1) y empeoramiento del SOFA (2,8). El aumento del índice leucocitos/eosinófilos se correlaciona con el aumento de la proteína C reactiva y la procalcitonina. Conclusiones: La correlación de la leucocitosis y la eosinopenia mostró la utilidad del índice leucocitos/eosinopenia como factor de predicción del choque séptico(AU)

Introduction: Septic shock has been recognized worldwide as a cause of high incidence of mortality. The incorporation of new biomarkers makes it possible to obtain a rapid and accurate diagnosis. Objective: To evaluate the usefulness of the leukocyte/eosinophil ratio as a prognostic marker of septic shock. Methods: An investigation was carried out in two stages: in the first (the descriptive phase) the clinical and epidemiological characteristics and variations of the laboratory studies were detailed and in the second (the explanatory cohort phase), the predictive value of the leukocytes/eosinopenia biomarker in septic shock was estimated. The eosinophil count was performed and the arithmetic mean was obtained. Relative eosinopenia was considered with eosinophil values below the average. Results: The study showed that leukocytosis was 27.4 cells*mm3, hematocrit decreased in 32.2percent and decreased platelet number (125.6 cells*mm3) prevail in septic shock. In addition, a decrease in eosinophils (18.5 cells/mcl), an increase in the leukocyte/eosinophil ratio (148.1) and worsening of SOFA (2.8) are reflected. The increase in the leukocyte/eosinophil ratio is correlated with the increase in C-reactive protein and procalcitonin. Conclusions: The correlation of leukocytosis and eosinopenia showed the usefulness of the leukocyte/eosinopenia index as a predictor of septic shock(AU)

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BACKGROUND: Sepsis is a condition characterized by organic dysfunction, leading to hemodynamic instability and high morbidity and mortality rates in humans and animals. Early identification of perfusion changes and appropriate management of sepsis are crucial for improving patient prognosis. Currently, the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely studied for sepsis identification and evaluation of organ dysfunction. However, these scores do not assess gastrointestinal involvement, which is common in this condition. Contrast-enhanced ultrasound (CEUS) and Doppler have been considered promising diagnostic techniques for detecting changes in vascularization and microcirculation in a non-invasive and safe manner, particularly in the gastrointestinal system. This study aimed to evaluate duodenal perfusion using CEUS, as well as abdominal aortic and cranial mesenteric artery blood flow using Doppler ultrasound, and systolic arterial pressure (SAP) in 17 bitches with pyometra and in 10 healthy animals. RESULTS: The variables were compared between the pyometra and control groups, as well between patients with and without sepsis determined by the SOFA or SIRS scores. Pyometra was found to cause a reduction in abdominal aortic blood flow volume, aortic peak systolic velocity, and resistivity index as evaluated by Doppler ultrasound. Patients with sepsis according to the SOFA criteria only presented lower SAP. In contrast, sepsis animals identified by the SIRS score exhibited lower SAP, aortic peak systolic velocity, aortic blood flow volume, and aortic resistivity index and additionally, higher peak intensity of contrast in the duodenal wall. CONCLUSIONS: Pyometra causes a reduction in abdominal aortic blood flow, which is more pronounced in animals with sepsis identified by the SIRS criteria. These animals also exhibited a decrease in systolic blood pressure and an increase in duodenal perfusion, as evident by CEUS. However, these changes were not observed in patients with sepsis identified by the SOFA criteria. The alterations in intestinal perfusion observed in animals with sepsis indicate the presence of inflammation or dysfunction. In this regard, CEUS proves to be a valuable technique for detecting subtle changes in tissue hemodynamics that may not be apparent in conventional exams.

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La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

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Resumen: Se ha propuesto el uso de la escala nutritional risk in the critically ill (NUTRIC) como una herramienta para la valoración nutricional en el paciente crítico. Una de las principales desventajas es que dicha escala no considera variables críticas en la determinación de desnutrición como el desgaste muscular. El objetivo del presente estudio es evaluar la importancia del músculo valorado por ultrasonido del recto femoral y vasto intermedio, en conjunto con el riesgo nutricional por la escala NUTRIC en los resultados clínicos de pacientes críticamente enfermos. Se realizó ultrasonido muscular dentro de las primeras 48 horas de ingreso a pacientes adultos. A su vez se calculó el riesgo nutricional con la escala NUTRIC, y se dio seguimiento detectando mortalidad hospitalaria. Se incluyeron 43 pacientes, 21 presentaron riesgo nutricional (48.8%) sin mostrar diferencia en el grosor muscular. En el modelo de regresión ajustado por la escala NUTRIC, ventilación mecánica mayor de 48 horas, índice de masa corporal y grosor muscular, este último se mostró como un factor protector de mortalidad (OR: 0.21, IC 95%: 0.03-0.83). El presente estudio resalta la necesidad de una valoración integral considerando la masa muscular como variable cardinal en la detección de desnutrición en pacientes críticamente enfermos.

Abstract: Nutritional Risk in the critically ill score, it has been used like tool to asses nutritional state in critically ill patient. A mayor limitation of this score is that not include important variables in the assessment of malnutrition, like muscular wasting. The main goal of this study is to evaluate the relevance of the muscle, by measuring the femoral quadriceps, along with NUTRIC score of critically ill patients results. An ultrasound in the first 48 hours of admission to ICU was made plus NUTRIC score and a follow up detecting in-hospital mortality. We included 43 patients, with 21 with nutritional risk (48.8%) showing no difference in muscular thickness. The NUTRIC score adjusted regression model, mechanical ventilation longer than 48 hours, body weight index and muscular thickness. The muscular thickness shows as mortality protector factor (OR: 0.21, 95% CI: 0.03-0.83). This study remarks the need for integral assessment considering muscular mass as a main variable in the malnutrition detection in critically ill patients.

Resumo: A utilização da escala de Nutritional Risk in the Critically Ill tem sido proposta como uma ferramenta para avaliação nutricional em pacientes em estado crítico. Uma das principais desvantagens é que esta escala não considera variáveis críticas na determinação da desnutrição, como a perda de massa muscular. O objetivo do presente estudo é avaliar a importância do músculo, avaliado por ultrassom do reto femoral e vasto intermediário, em conjunto com o risco nutricional por NUTRIC score nos resultados clínicos de pacientes em estado crítico. O ultrassom muscular foi realizado nas primeiras 48 horas de internação em pacientes adultos. Paralelamente, calculou-se o risco nutricional pelo NUTRIC, bem como o seguimento detectando a mortalidade hospitalar. Incluíram-se 43 pacientes, 21 apresentando risco nutricional (48.8%) sem diferença na espessura muscular. No modelo de regressão ajustado pelo NUTRIC, ventilação mecânica maior a 48 horas, índice de massa corporal e espessura muscular, esta última se mostrou fator protetor para mortalidade (OR: 0.21, IC 95%: 0.03-0.83). Este estudo destaca a necessidade de uma avaliação abrangente considerando a massa muscular como uma variável cardinal na detecção de desnutrição em pacientes em estado crítico.

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BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) colonisation at liver transplantation (LT) increases the risk of CRE infection after LT, which impacts on recipients' survival. Colonization status usually becomes evident only near LT. Thus, predictive models can be useful to guide antibiotic prophylaxis in endemic centres. AIMS: This study aimed to identify risk factors for CRE colonisation at LT in order to build a predictive model. METHODS: Retrospective multicentre study including consecutive adult patients who underwent LT, from 2010 to 2019, at two large teaching hospitals. We excluded patients who had CRE infections within 90 days before LT. CRE screening was performed in all patients on the day of LT. Exposure variables were considered within 90 days before LT and included cirrhosis complications, underlying disease, time on the waiting list, MELD and CLIF-SOFA scores, antibiotic use, intensive care unit and hospital stay, and infections. A machine learning model was trained to detect the probability of a patient being colonized with CRE at LT. RESULTS: A total of 1544 patients were analyzed, 116 (7.5%) patients were colonized by CRE at LT. The median time from CRE isolation to LT was 5 days. Use of antibiotics, hepato-renal syndrome, worst CLIF sofa score, and use of beta-lactam/beta-lactamase inhibitor increased the probability of a patient having pre-LT CRE. The proposed algorithm had a sensitivity of 66% and a specificity of 83% with a negative predictive value of 97%. CONCLUSIONS: We created a model able to predict CRE colonization at LT based on easy-to-obtain features that could guide antibiotic prophylaxis.

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Objetivo: Evaluar el polimorfismo TLR2 Arg753Gln como posible marcador de riesgo para el desarrollo de sepsis Materiales y métodos: Estudio de asociación, el cual incluyó 183 individuos venezolanos no relacionados, agrupados en individuos sépticos (n=50), hospitalizados en el área de emergencia del Hospital Central del Instituto Venezolano de los Seguros Sociales -Dr. Miguel Pérez Carreño-, e individuos aparentemente sanos (n=133). El polimorfismo TLR2 Arg753Gln se determinó utilizando la técnica reacción en cadena de la polimerasa con iniciadores de secuencias específicas. Resultados: Se observó en el grupo de pacientes con escala SOFA en el rango entre 6-9 una mayor frecuencia de fallecimientos con respecto al grupo de pacientes con escala SOFA en el rango entre 0-5 (OR: 8.5; IC 95%: 2.33-30.90, p= 0,000357). El polimorfismo Arg753Gln del gen TLR2 está ausente en los pacientes con diagnóstico de sepsis. Conclusión: Se verificó que la escala SOFA es un sistema que permite predecir la mortalidad. La ausencia del polimorfismo Arg753Gln del gen TLR2 en el grupo de pacientes sépticos y una baja frecuencia del mismo en los individuos aparentemente sanos, sugiere la rareza de este polimorfismo en la población venezolana. Consecuentemente, se requiere incrementar el tamaño de la muestra para poder comprobar si es un marcador de riesgo para el desarrollo de sepsis en nuestra población.

Objective: To evaluate the TLR2 Arg753Gln polymorphism as a possible risk marker for sepsis development. Materials and Methods: Association study which included 183 unrelated Venezuelan individuals, divided into two groups: patients with sepsis (n = 50), hospitalized in the emergency area of the Central Hospital of the Venezuelan Institute of Social Security "Dr. Miguel Pérez Carreño", and apparently healthy individuals (n = 133). The TLR2 Arg753Gln polymorphism was determined using the polymerase chain reaction technique with specific sequence primers. Results: A higher death rate was observed among the group of patients with the SOFA scale range between 6-9, compared to the group of patients with the SOFA scale range between 0-5 (OR: 8.5; 95% CI: 2.33-30.90, p = 0.000357). The Arg753Gln polymorphism of the TLR2 gene is absent in patients diagnosed with sepsis. Conclusion: It was verified that the SOFA scale is a useful system to predict the mortality rate associated with sepsis. The absence of the Arg753Gln polymorphism of the TLR2 gene among the group of patients with sepsis diagnosis and its low frequency in apparently healthy individuals suggests the rarity of this polymorphism in the Venezuelan population. Consequently, it is necessary to increase the size of the sample to be able to evaluate whether it can be considered as a risk marker for sepsis development in our population.

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Resumen Introducción: Son escasas las publicaciones sobre aplicación de escalas pronósticas para predecir el uso de ventilación mecánica invasiva (VMI) en neumonía por SARS-CoV-2. El objetivo del estudio fue evaluar el desempeño de las escalas PSI/PORT y SOFA para predecir el uso de VMI en pacientes con neumonía por SARS-CoV-2. Material y métodos: Estudio retrospectivo que incluyó pacientes hospitalizados con neumonía por SARS-CoV-2 del 01 de abril al 31 de mayo de 2020. Se realizó análisis de curvas ROC, calculando el área bajo la curva de las escalas PSI/PORT y SOFA, así como sensibilidad, especificidad y valores predictivos. Resultados: Se incluyó a 151 pacientes, con edad de 52 años (IQR 45-64); 69.5% eran hombres. Del total, 102 pacientes necesitaron VMI (67.5%). Las áreas bajo las curvas ROC para predecir VMI fueron: SOFA 0.71 (IC 95% 0.64-0.78) y PSI/PORT 0.78 (IC 95% 0.71-0.85). Al compararlas, no hubo significancia estadística (p = 0.08). Conclusiones: Las escalas SOFA y PSI/PORT pueden infraestimar la necesidad de VMI en la neumonía por SARS-CoV-2. En nuestro estudio, SOFA y PSI/PORT no tuvieron un buen desempeño para predecir el uso de VMI en pacientes hospitalizados con neumonía por SARS-CoV-2.

Abstract Introduction: There are few publications on the application of prognostic scales to predict the use of invasive mechanical ventilation (IMV) in SARS-CoV-2 pneumonia. Therefore, the study's objective was to evaluate the performance of PSI/PORT and SOFA in predicting the use of IMV in patients with SARS-CoV-2 pneumonia. Material and methods: A retrospective study that included hospitalized patients with SARS-CoV-2 pneumonia from April 01, 2020, to May 31, 2020. Analysis of ROC curves was performed, calculating the area under the curve for PSI/PORT and SOFA scores, as well as sensitivity, specificity, and predictive values. Results: 151 patients were included, aged 52 years (IQR 45-64); 69.5% were men. Of the total, 102 patients required IMV (67.5%). Area under the curve to predict IMV were: SOFA 0.71 (95% CI 0.64-0.78) and PSI/PORT 0.78 (95% CI 0.71-0.85). When comparing them, there was no statistical significance (p = 0.08). Conclusions: In patients with SARS-CoV-2 infection, SOFA and PSI/PORT may underestimate the need for IMV. In our study, SOFA and PSI/PORT score performed fair in predicting IMV use in hospitalized patients with SARS-CoV-2 pneumonia.

Resumo Introdução: Existem poucas publicações sobre a aplicação de escalas prognósticas para prever o uso de ventilação mecânica invasiva (VMI) na pneumonia por SARS-CoV-2. O objetivo do estudo foi avaliar o desempenho do PSI/PORT e SOFA para prever o uso de IMV em pacientes com pneumonia por SARS-CoV-2. Material e métodos: Estudo retrospectivo que incluiu pacientes internados com pneumonia por SARS-CoV-2 entre 1o de abril de 2020 e 31 de maio de 2020. Foi realizada análise da curva ROC, calculando a área sob a curva PSI/PORT e SOFA, bem como a sensibilidade, especificidade e valores preditivos. Resultados: Foram incluídos 151 pacientes, com idade de 52 anos (IQR 45-64); 69.5% eram homens. Do total, 102 pacientes necessitaram de VMI (67.5%). As áreas sob as curvas ROC para predizer VMI foram: SOFA 0.71 (IC 95% 0.64-0.78) e PSI/PORT 0.78 (IC 95% 0.71-0.85). Ao compará-los, não houve significância estatística (p = 0.08). Conclusões: SOFA e PSI/PORT podem subestimar a necessidade de VMI na pneumonia por SARS-CoV-2. Em nosso estudo, SOFA e PSI/PORT não tiveram bom desempenho na previsão do uso de VMI em pacientes hospitalizados com pneumonia por SARS-CoV-2.

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BACKGROUND: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. AIMS: This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). METHODS: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. RESULTS: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. CONCLUSIONS: The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

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Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed. Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.

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RESUMEN Introducción: La intensidad de la ventilación mecánica está reflejada por la presión de conducción dinámica y el poder mecánico. Es un predictor de lesión pulmonar inducida por el ventilador y está asociada a la mortalidad. Objetivo: Determinar si existe relación entre intensidad de la ventilación mecánica y el ΔSOFA>0 (agravamiento) en los pacientes con la COVID-19 a las 72 horas después de la intubación. Material y Métodos: Grupo de estudio conformado por 35 pacientes diagnosticados con la COVID-19 que estuvieron ventilados por más de 72 horas. Se empleó la prueba de Chi cuadrado (X 2 ) o test exacto de Fisher para comparar variables cualitativas; para las cuantitativas se empleó la prueba t de Student o U de Mann-Whitney. Se realizó una Regresión Logística Binaria Simple para encontrar relación de las variables con ΔSOFA dicotomizada para ΔSOFA≤0 y ΔSOFA>0. La capacidad discriminativa de los modelos se evaluó mediante la Curva ROC. Resultados: Presentaron SOFA>0 21 pacientes (60 %). No se encontraron diferencias significativas de la Presión de Conducción entre ambos grupos (15 vs. 18, U=94.00, z= -1,795, p=0,77). Fueron buenas predictoras de ΔSOFA>0 el Poder Mecánico (OR 3,421 [95 % IC1,510 a 7,750, p=0,003]) y el Volumen Tidal (OR 1,03 [95 % IC 1,012 a 1,068], p=0,005). El Modelo Predictivo de ΔSOFA>0 en función del Poder Mecánico (AUC 0,888 [95 % IC 0,775 a 1], p<0,001) mostró una buena capacidad discriminatoria. Conclusiones: El Poder Mecánico está relacionado con el agravamiento de la disfunción multiorgánica en pacientes sometidos a ventilación mecánica por la COVID-19.

ABSTRACT Introduction: The intensity of mechanical ventilation is reflected by driving pressure and mechanical power. It is a predictor of ventilator-induced lung injury and it can be associated with mortality. Objective: To determine if there is a relationship between intensity of mechanical ventilation and ΔSOFA>0 (worsening) in patients with COVID-19 at 72 h after intubation. Material and Methods: Study group composed of 35 COVID-19 patients who were ventilated for more than 72 hours. Chi-square test (X 2 ) or Fisher's exact test was used to compare qualitative variables; Student t test or Mann-Whitney U test was employed for quantitative ones. A Simple Binary Logistic Regression Model was performed in order to find the relationship between variables and dichotomized ΔSOFA for ΔSOFA≤0 and ΔSOFA>0. The discriminatory capacity of the models was tested by using ROC Curve. Results: A total of 21 patients (60 %) presented ΔSOFA>0 (worsening). No significant differences related to Driving Pressure were found between the two groups (15 vs. 18, U=94,00, z= -1,795, p=0,77). Mechanical Power (OR 3,421 [95 % CI 1,510 a 7,750, p=0,003]) and Tidal Volume (OR 1,03 [95 % CI 1,012 a 1,068], p=0,005) were good predictors of ΔSOFA>0. The Predictive Model of ΔSOFA>0 depending on Mechanical Power (AUC 0,888 [95 % CI 0,775 a 1], p<0,001) showed a good discriminatory capacity. Conclusions: Mechanical Power is related to multi-organ dysfunction worsening in mechanically ventilated patients with COVID-19.

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OBJECTIVE: To examine the effects of infant sofa-sleeping, recent use by caregivers of alcohol, cannabis, and/or other drugs, and bed type and pillows, on the risk of sudden unexpected death in infancy (SUDI) in New Zealand. STUDY DESIGN: A nationwide prospective case-control study was implemented between March 2012 and February 2015. Data were collected during interviews with parents/caregivers. "Hazards" were defined as infant exposure to 1 or more of sofa-sleeping and recent use by caregivers of alcohol, cannabis, and other drugs. The interaction of hazards with tobacco smoking in pregnancy and bed sharing, including for very young infants, and the difference in risk for Maori and non-Maori infants, also were assessed. RESULTS: The study enrolled 132 cases and 258 controls. SUDI risk increased with infant sofa-sleeping (imputed aOR [IaOR] 24.22, 95% CI 1.65-356.40) and with hazards (IaOR 3.35, 95% CI 1.40-8.01). The SUDI risk from the combination of tobacco smoking in pregnancy and bed sharing (IaOR 29.0, 95% CI 10.10-83.33) increased with the addition of 1 or more hazards (IaOR 148.24, 95% CI 15.72-1398), and infants younger than 3 months appeared to be at greater risk (IaOR 450.61, 95% CI 26.84-7593.14). CONCLUSIONS: Tobacco smoking in pregnancy and bed sharing remain the greatest SUDI risks for infants and risk increases further in the presence of sofa-sleeping or recent caregiver use of alcohol and/or cannabis and other drugs. Continued implementation of effective, appropriate programs for smoking cessation, safe sleep, and supplying safe sleep beds is required to reduce New Zealand SUDI rates and SUDI disparity among Maori.

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Introduction: The acute physiology and chronic health evaluation (APACHE), sepsis-related organ failure assessment (SOFA), score for pneumonia severity (CURB-65) scales, a low phase angle (PA) and low muscle strength (MS) have demonstrated their prognostic risk for mortality in hospitalized adults. However, no study has compared the prognostic risk between these scales and changes in body composition in a single study in adults with SARS-CoV-2 pneumonia. The great inflammation and complications that this disease presents promotes immobility and altered nutritional status, therefore a low PA and low MS could have a higher prognostic risk for mortality than the scales. The aim of the present study was to evaluate the prognostic risk for mortality of PA, MS, APACHE, SOFA, and CURB-65 in adults hospitalized with SARS-CoV-2 pneumonia. Methodology: This was a longitudinal study that included n = 104 SARS-CoV-2-positive adults hospitalized at General Hospital Penjamo, Guanajuato, Mexico, the PA was assessed using bioelectrical impedance and MS was measured with manual dynamometry. The following disease severity scales were applied as well: CURB-65, APACHE, and SOFA. Other variables analyzed were: sex, age, CO-RADS index, fat mass index, body mass index (BMI), and appendicular muscle mass index. A descriptive analysis of the study variables and a comparison between the group that did not survive and survived were performed, as well as a Cox regression to assess the predictive risk to mortality. Results: Mean age was 62.79 ± 15.02 years (31-96). Comparative results showed a mean PA of 5.43 ± 1.53 in the group that survived vs. 4.81 ± 1.72 in the group that died, p = 0.030. The mean MS was 16.61 ± 10.39 kg vs. 9.33 ± 9.82 in the group that died, p = 0.001. The cut-off points for low PA was determined at 3.66° and ≤ 5.0 kg/force for low grip strength. In the Cox multiple regression, a low PA [heart rate (HR) = 2.571 0.726, 95% CI = 1.217-5.430] and a low MS (HR = 4.519, 95% CI = 1.992-10.252) were associated with mortality. Conclusion: Phase angle and MS were higher risk predictors of mortality than APACHE, SOFA, and CURB-65 in patients hospitalized for COVID-19. It is important to include the assessment of these indicators in patients positive for SARS-CoV-2 and to be able to implement interventions to improve them.

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BACKGROUND: Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay. METHODS: Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality. RESULTS: 73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU. CONCLUSIONS: High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%.

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Resumen: Introducción: La infección por SARS-CoV-2 en Wuhan, China, ocasionó una pandemia de tal magnitud que ha provocado la muerte por neumonía a causa de enfermedad infecciosa por coronavirus 19 (COVID-19) de millones de personas. Nos dimos a la tarea de recolectar todas las características de los pacientes que estuvieron hospitalizados por esta enfermedad en nuestra UCI adultos. Material y métodos: Se realizó un estudio de tipo analítico, descriptivo, observacional y retrospectivo en pacientes con diagnóstico de COVID-19 ingresados en la Unidad de Cuidados Intensivos (UCI) del Hospital Ángeles Clínica Londres en la Ciudad de México, evaluados en el periodo del 23 de marzo de 2020 al 10 de mayo de 2020. Se revisaron los expedientes y se tomaron los datos de los mismos, se describieron variables de tipo demográfico, factores de riesgo, signos y síntomas, tratamiento médico y atención respiratoria. Se revisaron escalas de mortalidad SAPS III, APACHE II, SOFA y CALL-score. Se formaron dos grupos con y sin mortalidad realizándose análisis bivariado y multivariado de las variables significativas. El análisis estadístico se efectuó con el programa SPSS 25. Resultados: En el periodo considerado, 25 expedientes cumplieron con los criterios de inclusión, de ellos la demografía y factores de riesgo, 18 (72%) correspondieron a hombres y siete (38%) a mujeres con una mortalidad de 10 (40%). Los factores de riesgo más frecuentes fueron diabetes mellitus (DM) en siete (38%) pacientes, hipertensión arterial (HAS) en seis (24%), obesidad en cuatro (16%), enfermedad pulmonar obstructiva crónica (EPOC) en uno (4%), tabaquismo en 11 (44%) y alcoholismo en siete (28%). Se encontraron diferencias estadísticamente significativas en los grupos sin mortalidad y con mortalidad, 15 y 10 pacientes, respectivamente, observando las siguientes significancias: glucosa 105 mg/dL (percentil [PE 88]) versus 171 mg/dL (PE 125) p = 0.012, urea 33 mg/dL (PE 22) versus 95 mg/dL (PE 57) p = 0.03, BUN 15.3 mg/dL (PE 11) versus 44.2 mg/dL (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 U/L (PE 260) p = 0.003, triglicéridos 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritina 446 mg/L (PE 238) versus 1,030 mg/L (PE 665) p = 0.007. Se realizó un análisis bivariado con regresión logística binaria, con la variable mortalidad dicotómica, no resultando significativa con esta prueba. Conclusiones: Se entiende que ninguna variable es predominantemente importante para explicar la mortalidad y que se recurre a muchos factores que se conjugan para explicar este desenlace, uno de éstos es la severidad misma del problema respiratorio en que se encuentre el paciente.

Abstract: Introduction: The SARS-CoV-2 infection in Wuhan, China caused a pandemic of such magnitude that it has caused the death of millions of people from pneumonia due to infectious disease caused by coronavirus 19 (COVID-19). We took on the task of collecting all the characteristics of the patients who were hospitalized for this disease in our Adult Intensive Care Unit. Material and methods: An analytical, descriptive, observational and retrospective study was carried out in patients with a diagnosis of COVID-19 admitted to the Intensive Care Unit (ICU) of the Hospital Ángeles Clínica Londres in Mexico City, evaluated in the period of March 23 from 2020 to May 10, 2020. The files were reviewed and the data taken from them, demographic variables, risk factors, signs and symptoms, medical treatment and respiratory care were described. SAPS III, APACHE II, SOFA and CALL-score mortality scales were reviewed. Two groups were formed with and without mortality, performing bivariate and multivariate analyzes of the significant variables. Statistical analysis was performed with the SPSS 25 program. Results: In the period considered, 25 files met the inclusion criteria for them: demographics and risk factors were 18 (72%) corresponding to men and seven (38%) to women. With a mortality of 10 (40%). The most frequent risk factors are diabetes mellitus (DM) in seven (38%), arterial hypertension (SAH) six (24%), obesity four (16%), chronic obstructive pulmonary disease (COPD) one (4%), smoking 11 (44%) and alcoholism seven (28%). Statistically significant differences were found in the groups without mortality and with mortality 15 and 10 patients respectively, observing the following significance: glucose 105 mg/dL (percentil [PE] 88) versus 171 mg/dL (PE 125) p = 0.012, urea 33 mg/dL (PE 22) versus 95 mg/dL (PE 57) p = 0.03, BUN 15.3 mg/dL (PE 11) versus 44.2 mg/dL (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 U/L (PE 260) p = 0.003, triglycerides 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritin 446 mg/L (PE 238) versus 1,030 mg/L (PE 665) p = 0.007. A bivariate analysis with binary logistic regression was performed, with the dichotomous mortality variable, not resulting in this significant test. Conclusions: It is understood that no variable is predominantly important to explain mortality and that many factors are involved that are combined to explain this outcome, one of these being the same severity of the respiratory problem in which the patient is.

Resumo: Introdução: A infecção por SARS-CoV-2 em Wuhan China causou uma pandemia de tal magnitude que causou a morte de milhões de pessoas por pneumonia devido a doença infecciosa causada pelo coronavírus 19 (COVID-19). Assumimos a tarefa de coletar todas as características dos pacientes internados por essa doença em nossa unidade de terapia intensiva adulto. Material e métodos: Realizou-se um estudo analítico, descritivo, observacional e retrospectivo em pacientes com diagnóstico de COVID-19 internados na Unidade de Terapia Intensiva (UTI) do Hospital Ángeles Clínica Londres na Cidade do México, validado para o período de 23 de março de 2020 a 10 de maio de 2020. Os prontuários médicos foram revisados e seus dados coletados, as variáveis do tipo demográficas foram descritas, fatores de risco, sinais e sintomas, tratamento médico e cuidados respiratórios. Foram revisadas as escalas de mortalidade SAPS III, APACHE II, SOFA e CALL-score. Dois grupos foram formados com e sem mortalidade, realizando análises bivariadas e multivariadas das variáveis significativas. A análise estatística foi realizada com o programa SPSS 25. Resultados: No período considerado, 25 prontuários atenderam aos critérios de inclusão para os mesmos: dados demográficos e fatores de risco foram 18 (72%) correspondentes a homens e 7 (38%) a mulheres. Com mortalidade de 10 (40%). Os fatores de risco mais frequentes são diabetes mellitus (DM) em 7 (38%), hipertensão arterial (HAS) 6 (24%), obesidade 4 (16%), doença pulmonar obstrutiva crônica (DPOC) 1 (4%), tabagismo 11 (44%) e alcoolismo 7 (28%). Encontrou-se diferenças estatisticamente significativas nos grupos sem mortalidade e com mortalidade de 15 e 10 pacientes respectivamente, observando a seguinte significância: glicose 105 mg/dL (percentil [PE] 88) versus 171 mg/dL (PE 125) p = 0.012, uréia 33 mg/L (PE 22) versus 95 mg/L (PE 57) p = 0.03, BUN 15.3 mg/L (PE 11) versus 44.2 mg/L (PE 26.28) p = 0.04, TGO 32 U/L (PE 24.4) versus 58 U/L (PE 43.8) p = 0.010, DHL 239 U/L (PE 198) 454 (PE 260) p = 0.003, triglicerídeos 148 mg/dL (PE 120) versus 187.5 mg/dL (PE 165) p = 0.002, CPK 70 U/L (PE 35) versus 81 U/L (PE 78.25) p = 0.003, ferritina 446 mg/L (PE 238) versus 1030 mg/L (PE 665) p = 0.007. Realizou-se análise bivariada com regressão logística binária, com a variável mortalidade dicotômica, não resultando em teste significativo. Conclusões: Entende-se que nenhuma variável é predominantemente importante para explicar a mortalidade e que usamos muitos fatores que se conjugam para explicar esse desfecho, sendo um deles a mesma gravidade do problema respiratório em que o paciente se encontra.