RESUMO
Fourier Transform-Infrared (FT-IR) absorption spectroscopy has been used to investigate pathophysiological changes caused by sepsis. Sepsis has been defined as a potentially fatal organic dysfunction caused by a dysregulated host response to infection and can lead a patient to risk of death. This study used samples consisting of the blood plasma of mice which were induced to sepsis state, compared to a healthy group using FT-IR associated with attenuated total reflectance (ATR) spectroscopy. For statistical analysis, principal components analysis (PCA) and linear discriminant analysis (LDA) were applied, independently, to the second derivative spectra of both the fingerprint (900-1800 cm-1) and the high wavenumber (2800-3100 cm-1) regions. The technique efficiently differentiated the blood plasma of the two groups, sepsis and healthy mice, the analysis indicating that fatty acids and lipids in the blood samples could be an important biomarker of sepsis.
Assuntos
Fotoquimioterapia , Sepse , Animais , Atenção à Saúde , Humanos , Camundongos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
RESUMO Objetivo: Avaliar a razão neutrófilo-linfócito na predição de sepse e mortalidade em pacientes admitidos em uma unidade de terapia intensiva. Métodos: Estudo de caso-controle de pacientes adultos admitidos em terapia intensiva. Foram incluídos como casos pacientes que tiveram sepse como razão de admissão e possuíam exame laboratorial de hemograma prévio. As análises estatísticas realizadas foram curva ROC, regressão logística binária, Mann Whitney e qui-quadrado de Pearson. Foi considerado significativo valor de p < 0,05. Resultados: Os valores de curva ROC foram 0,62 para razão neutrófilo-linfócito, 0,98 para neutrófilos bastonados e 0,51 para leucócitos totais. A presença de razão neutrófilo-linfócito superior a 5,0, o número de leucócitos acima de 12.000mm3/mL e número de neutrófilos bastonados acima 10% foram fatores de risco para sepse, entretanto somente os escores SAPS 3 e SOFA estavam relacionados a mortalidade dos pacientes. Conclusão: A razão neutrófilo-linfócito e os neutrófilos bastonados em combinação com outros parâmetros podem ser marcadores na detecção precoce de sepse em terapia intensiva.
ABSTRACT Objective: To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit. Methods: Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant. Results: The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm3/mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality. Conclusion: The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.
Assuntos
Humanos , Masculino , Feminino , Idoso , Linfócitos/metabolismo , Sepse/diagnóstico , Unidades de Terapia Intensiva , Neutrófilos/metabolismo , Biomarcadores/sangue , Estudos de Casos e Controles , Modelos Logísticos , Fatores de Risco , Sepse/sangue , Diagnóstico Precoce , Contagem de Leucócitos , Pessoa de Meia-IdadeRESUMO
ABSTRACT Objective To describe the clinical and epidemiological features of patients with and without sepsis at critical care units of a public hospital. Methods A cross-sectional study was carried out from May 2012 to April 2013. Clinical and laboratory data of patients with and without sepsis in the intensive care units were reviewed of medical records. Results We evaluated 466 patients, 58% were men, median age was 40 years, and 146 (31%) of them were diagnosed with sepsis. The overall mortality was 20% being significantly higher for patients with sepsis (39%). The factors associated with intensive care unit mortality were the presence of sepsis (OR: 6.1, 95%CI: 3.7-10.5), age (OR: 3.6, 95%CI: 1.4-7.2), and length of hospital stay (OR: 0.96, 95%CI: 0.94-0.98). Pulmonary (49%) and intra-abdominal (20%) infections were most commonly identified sites, and coagulase-negative staphylococci and enteric Gram negative bacilli the most frequent (66%) pathogens isolated. Conclusion Although the impact of sepsis on mortality is related to patients' clinical and epidemiological characteristics, a critical evaluation of these data is important since they will allow the direct implementation of local policies for managing this serious public health problem.
RESUMO Objetivo Descrever as características clínicas e epidemiológicas de pacientes com sepse e sem sepse em unidades de cuidados intensivos de um hospital público. Métodos Estudo transversal realizado de maio de 2012 a abril de 2013. Os dados clínicos e laboratoriais de pacientes com sepse e sem sepse das unidades de terapia intensiva foram revisados a partir dos prontuários médicos. Resultados Avaliamos 466 pacientes, 58% homens, mediana de idade 40 anos; sendo 146 (31%) diagnosticados com sepse. A mortalidade global foi 20%, e significativamente maior para pacientes com sepse (39%). Os fatores associados à mortalidade em unidade de terapia intensiva foram a presença de sepse (OR: 6,1, IC95%: 3,7-10,5), idade (OR: 3,6, IC95%: 1,4-7,2) e tempo de internação (OR: 0,96, IC95%: 0,94-0,98). As infecções pulmonares (49%) e intra-abdominais (20%) foram os focos mais comumente identificados, e os estafilococos coagulase-negativa e bacilos entéricos Gram-negativos foram os patógenos isolados mais frequentes (66%). Conclusão Embora o impacto da sepse sobre a mortalidade esteja relacionado às características clínicas e epidemiológicas dos pacientes, uma avaliação crítica desses dados é importante, pois permitirá a implementação direta de políticas locais para gerenciar este grave problema de saúde pública.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Sepse/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Fatores de Tempo , Brasil/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Mortalidade Hospitalar , Sepse/microbiologia , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricosRESUMO
RESUMO Objetivo: Descrever os efeitos de melhorias sucessivas nos sistemas de alerta precoce para identificação de pacientes com sepse, no que se refere ao tempo até o diagnóstico, à administração de antibióticos e à mortalidade. Métodos: Trata-se de um estudo observacional de coorte, que descreve as sucessivas melhorias implantadas em um período de 10 anos no sistema de alerta precoce para detecção de sepse, incluindo vigilância ativa manual sistemática, alertas eletrônicos via telefonista, e alertas enviados diretamente a dispositivos móveis da enfermagem. Para todos os períodos, após o desencadeamento do alerta, o tratamento foi realizado segundo as diretrizes institucionais para sepse. Resultados: Durante estes anos, detectaram-se 637 pacientes com sepse. O tempo mediano entre a triagem e o diagnóstico foi reduzido de 19:20 (9:10 - 38:15) horas para 12:40 (2:50 - 23:45) horas quando se utilizou o método manual de vigilância (p = 0,14), para 2:10 (1:25 - 2:20) horas quando o alerta foi enviado automaticamente ao serviço telefônico do hospital (p = 0,014) e para 1:00 (0:30 - 1:10) horas quando o alerta foi enviado diretamente ao telefone celular da enfermagem (p = 0,02), com manutenção de valores similares nos anos que se seguiram. Não houve diferença no tempo até o tratamento em relação aos pacientes sobreviventes e não sobreviventes. Conclusão: Sistemas eletrônicos auxiliam na redução do tempo entre a triagem e o diagnóstico e entre o diagnóstico e o início da antibioticoterapia em pacientes com sepse.
ABSTRACT Objective: To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. Methods: This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. Results: In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. Conclusion: Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.
Assuntos
Humanos , Masculino , Feminino , Idoso , Telefone , Triagem/métodos , Sepse/diagnóstico , Antibacterianos/administração & dosagem , Fatores de Tempo , Estudos de Coortes , Guias de Prática Clínica como Assunto , Sepse/mortalidade , Sepse/tratamento farmacológicoRESUMO
BACKGROUND: Several studies were published to validate the quick Sepsis-related Organ Failure Assessment (qSOFA), namely in comparison with the systemic inflammatory response syndrome (SIRS) criteria. We performed a systematic review and meta-analysis with the aim of comparing the qSOFA and SIRS in patients outside the ICU. METHODS: We searched MEDLINE, CINAHL, and the Web of Science database from February 23, 2016 until June 30, 2017 to identify full-text English-language studies published after the Sepsis-3 publication comparing the qSOFA and SIRS and their sensitivity or specificity in diagnosing sepsis, as well as hospital and ICU length of stay and hospital mortality. Data extraction from the selected studies followed the recommendations of the Meta-analyses of Observational Studies in Epidemiology group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: From 4,022 citations, 10 studies met the inclusion criteria. Pooling all the studies, a total of 229,480 patients were evaluated. The meta-analysis of sensitivity for the diagnosis of sepsis comparing the qSOFA and SIRS was in favor of SIRS (risk ratio [RR], 1.32; 95% CI, 0.40-2.24; P < .0001; I2 = 100%). One study described the specificity for the diagnosis of infection comparing SIRS (84.4%; 95% CI, 76.2-90.6) with the qSOFA (97.3%; 95% CI < 92.1-99.4); the qSOFA demonstrated better specificity. The meta-analysis of the area under the receiver operating characteristic curve of six studies comparing the qSOFA and SIRS favored the qSOFA (RR, 0.03; 95% CI, 0.01-0.05; P = .002; I2 = 48%) as a predictor of inhospital mortality. CONCLUSIONS: The SIRS was significantly superior to the qSOFA for sepsis diagnosis, and the qSOFA was slightly better than the SIRS in predicting hospital mortality. The association of both criteria could provide a better model to initiate or escalate therapy in patients with sepsis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017067645.
Assuntos
Escores de Disfunção Orgânica , Sepse/diagnóstico , Sepse/mortalidade , Mortalidade Hospitalar , Humanos , Valor Preditivo dos Testes , Síndrome de Resposta Inflamatória SistêmicaRESUMO
Objective To test and validate a multiplex real-time polymerase chain reaction method for bloodstream infections, as well as to compare the results with conventional blood culture. Methods A total of 114 consecutive patients with clinical evidence of sepsis were submitted to blood culture and LightCycler™ SeptiFast tests. Results More positive specimens (23; 20.2%) were detected using the LightCycler™ SeptiFast than the blood culture (17; 14.9%), with an agreement of 86.8%. Discordant results were seen in four patients positive only to blood culture, ten positive only to LightCycler™ SeptiFast and one to different pathogens found by each test. Infections with microorganisms detected only using blood culture reassured the need to perform both tests. The mean time to results for blood culture was 5 days for negative and 3.5 days for positive results. LightCycler™ SeptiFast results were achieved in less than 8 hours. Conclusion LightCycler™ SeptiFast showed a high potential as a test to be carried out concomitantly with blood culture for sepsis diagnosis in severely ill patients. This test allowed a faster diagnosis of bacterial and fungal infections that helped to reduce hospital stay and to control the use of antibiotics. LightCycler™ SeptiFast can also eventually detect microorganism and infections that are hardly detected by blood culture, especially Candida non-albicans infections. .
Objetivo Testar e validar um método molecular multiplex para detecção de infecções sanguíneas, além de comparar os resultados com os obtidos pela hemocultura convencional. Métodos Os testes de hemocultura e o LightCycler® SeptiFast foram realizados em 114 pacientes consecutivos com evidência clínica de sepse. Resultados Mais amostras positivas (23; 20,2%) foram detectadas pelo LightCycler® SeptiFast do que pela hemocultura (17; 14,9%), mostrando concordância de 86,8%. Os resultados discordantes foram de quatro pacientes positivos apenas para hemocultura, dez positivos apenas para LightCycler® SeptiFast e um com patógenos diferentes encontrados em cada método. Infecções por micro-organismos não reconhecidos pelo LightCycler® SeptiFast e detectados apelas pela hemocultura confirmam a necessidade da realização dos dois métodos. O tempo médio para os resultados da hemocultura foi de 5 dias para amostras negativas e de 3,5 dias para as positivas. Os resultados pelo LightCycler® SeptiFast foram obtidos em menos de 8 horas. Conclusão O LightCycler® SeptiFast mostrou ser um teste de grande potencial para ser realizado simultaneamente à hemocultura para diagnóstico de sepse em doentes graves, permitindo um diagnóstico mais rápido de infecções por bactérias e fungos e, dessa forma, auxiliando a redução do tempo de hospitalização e racionalização do uso de antibióticos. Eventualmente, o LightCycler® SeptiFast pode detectar inclusive infecções por micro-organismos dificilmente detectáveis via hemocultura, especialmente aquelas causadas por Candida não albicans. .
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bacteriemia/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Brasil , Bacteriemia/microbiologia , Estado Terminal , DNA Bacteriano , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e EspecificidadeRESUMO
O objetivo do presente artigo é oferecer uma atualização dos principais aspectos da sepse, complicação infecciosa extremamente importante do ponto de vista da clínica e da saúde pública. Algumas hipóteses têm sido propostas para explicar sua gênese, as quais encerram aspectos referentes a interação microrganismo/sistema imune inato, a inflamação/mediação imunológica e o sistema de coagulação. As manifestações clínicas são variadas e dependem do local primário da infecção. A identificação precoce dos sinais e sintomas é de crucial importância para a instituição de medidas terapêuticas que se baseiam, fundamentalmente, em reposição volêmica, antibioticoterapia, emprego de costicosteróides, tratamento anticoagulante, medidas de manutenção da viabilidade biológica e suporte nutricional.
This paper aims to provide an update on the main aspects of sepsis, a very relevant health care issue. A number of hypotheses have been proposed to explain its origin, involving interactions between microorganisms and the innate immune system, inflammation/immune mediation and the coagulation system. The clinical features of sepsis are variable and depend on the primary site of infection. The identification of early signs and symptoms is crucial for starting therapeutic measures fundamentally based on volume resuscitation, antibiotic therapy, use of steroids, anticoagulant therapy, biologic viability maintenance interventions and nutritional support.
RESUMO
OBJECTIVES: This study aimed to assess the impact of the duration of organ dysfunction on the outcome of patients with severe sepsis or septic shock. METHODS: Clinical data were collected from hospital charts of patients with severe sepsis and septic shock admitted to a mixed intensive care unit from November 2003 to February 2004. The duration of organ dysfunction prior to diagnosis was correlated with mortality. Results were considered significant if p<0.05. RESULTS: Fifty-six patients were enrolled. Mean age was 55.6 ± 20.7 years, mean APACHE II score was 20.6 ± 6.9, and mean SOFA score was 7.9 ± 3.7. Thirty-six patients (64.3 percent) had septic shock. The mean duration of organ dysfunction was 1.9 ± 1.9 days. Within the univariate analysis, the variables correlated with hospital mortality were: age (p=0.015), APACHE II (p=0.008), onset outside the intensive care unit (p=0.05), blood glucose control (p=0.05) and duration of organ dysfunction (p=0.0004). In the multivariate analysis, only a duration of organ dysfunction persisting longer than 48 hours correlated with mortality (p=0.004, OR: 8.73 (2.37-32.14)), whereas the APACHE II score remained only a slightly significant factor (p=0.049, OR: 1.11 (1.00-1.23)). Patients who received therapeutic interventions within the first 48 hours after the onset of organ dysfunction exhibited lower mortality (32.1 percent vs. 82.1 percent, p=0.0001). CONCLUSIONS: These findings suggest that the diagnosis of organ dysfunction is not being made in a timely manner. The time elapsed between the onset of organ dysfunction and initiation of therapeutic intervention can be quite long, and this represents an important determinant of survival in cases of severe sepsis and septic shock.