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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Using age, arterial lactate level and sequential organ failure assessment score in risk stratification of sepsis syndromes

Abstract

Introduction: In low income countries, ICU places are limited and not all sepsis patients will benefit from ICU admission. Stratification is an important step to identify patients who require ICU treatment from patients who can be treated on general ward setting. Improper stratification results in increased length of stay, costs, morbidity and mortality.
Objective: The aim of this study was to stratify the risk of mortality in patients with sepsis syndrome using age, arterial lactate level and SOFA score.
Methods: In this prospective observational study, 250 patients with sepsis were enrolled and followed up until discharge. They were categorized into 2 groups according to 7-days mortality.
Results: SOFA score (≥5) was the only good tool (AUC=0.722) while age (≥65 years) (AUC=0.650) and arterial lactate (≥3.25 mmol/L) (0.690) were fair tools to predict 7-days mortality. A new score “ALSOFA score” (≥10) was an excellent tool for prediction (AUC =0.912, 95%CI: 0.851 to 0.940, p<0.0001). It showed an excellent sensitivity (90.9%) and specificity (85.1%).
Conclusion: In critically ill patients with sepsis syndromes, age, arterial lactate and SOFA score are fair tools of stratification. No single marker/score can be used alone to stratify such patients.

Keywords; Emergency, Critical, Sepsis, SOFA, Arterial Lactate, Stratification

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Effect of transported hospital resources on neurologic outcome after out-of-hospital cardiac arrest

Abstract

Objective. Appropriate regional transport protocol for out-of-hospital cardiac arrest (OHCA) patients is important for achieving favorable outcomes in a certain community. This study aimed to investigate the effect of transported hospital resources on the neurologic outcome after OHCA.

Methods. We categorized cardiac receiving centers (CRC) in our community into two levels (primary [P-CRC] and definite CRC [D-CRC]) according to the hospital resources that were identified by the Hospital Assessment Survey in 2015. OHCA patients with presumed cardiac etiology resuscitated by emergency medical service providers between 2012 and 2014, were enrolled in the study. The main exposure was the level of CRC. The primary endpoint was discharge with good neurologic outcomes. We compared outcomes between CRCs after adjusting for potential confounders.

Results. Among the 9,912 patients, 5,876 were transported to P-CRC and 4,036 to D-CRC from 2012 to 2014. Patients admitted to D-CRC showed better neurologic outcome than those admitted to P-CRC (6.2% vs 1.5%, p<0.001). With regard to patients who survived to admission, the neurologic outcome of patients in D-CRC was better than those in P-CRC (11.3% vs 3.3%, p<0.001). In the multivariable logistic model, the adjusted odds ratio for all OHCA patients was 2.10 (95% confidence interval, 1.51–2.95).

Conclusion. Transportation of OHCA patients to the D-CRC resulted in significantly good neurologic outcome than those transported to P-CRC. Further research is needed to establish a regional OHCA transport protocol.

Key words: cardiac arrest, outcome, regionalization

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Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma

Abstract

Objectives. Major injury is a time-dependent illness in which the quantification of the life prognosis is fundamental for professionals. The objective of this study is to evaluate the capacity of prehospital lactic acid to predict mortality (2, 7 and 30 days) and the admission to the Intensive Care Unit (ICU) from the index event.

Methods. This is a longitudinal, prospective observational study, which included patients who were treated by an Advanced Life Support Unit and transferred to the Emergency Department between April 1 and September 30, 2018. We calculated sensitivity, specificity, and likelihood ratios. The main outcome variable was mortality from any cause (2, 7 and 30 days) and admission to ICU.

Results. 109 patients were included in our study. Eleven patients (10%) experienced early mortality before the first 48 hours after the index event, with an ICU admission rate of 28%. The sensitivity and specificity of the test to determine mortality in less than two days was 63.6% (95% CI, 35.4-84.8%) and 87.8% (95% CI, 79.8-92.9%).

Conclusions. Prehospital lactic acid has an excellent capacity to predict the mortality and the admission of patients with major injury to the ICU, and it is a cheap, easy-to-obtain and reliable diagnostic tool that can help in clinical decision-making.

Key words: Critical care, emergency department, outcome, survival, intensive care

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Role of Redcell Distribution Weight in Predicting Disease Severity, Mortality and Complication in Patients With Acute Pancreatitis

Abstract

The goal of the present study was to investigate the significance of the Red Cell Distribution Width (RDW) in identifying the severity, mortality and complications of the disease at an early stage in patients with acute pancreatitis (AP).

343 patients with AP presented to the emergency department during one year were included in this retrospective study. Demographic, laboratory and imaging results were recorded. Bedside Index for Severity in AP (BISAP) score was calculated. The patients who developed pancreatitis-related mortality were recorded.

The diagnostic powers of RDW values in the diagnosis of BISAP Score (≥3), exitus, severe pancreatitis and pancreatitis with complication were analysed by means of Receiver Operating Characteristic Curve (ROC) analysis. p<0,05 was considered statistically significant.

The mean age of the subjects was 59,7 ± 18,0 years. Area under curve (AUC) in ROC analysis conducted for RDW in patients with BISAP score≥ 3 was 0,649 (95% Cl 0,576-0,722) and p <0,001. For developed complications, AUC for RDW was 0,558 (95% Cl 0,454-0,662) and p was 0,243. For RDW<14,4 cut-off value; the sensitivity was 66,25%, specificity was 71,48% in the prediction of BISAP≥ 3, sensitivity was 87,5%, specificity was 65,14% in the prediction of mortality, sensitivity was 72,73%, specificity was 71,12% in the prediction of severe AP.

RDW is as significant as the BISAP score in predicting the severity and mortality of pancreatitis in the patients with acute pancreatitis in the emergency department(ED). But it cannot predict the complications in AP.

Keywords: Emergency, acute pancreatitis, mortality, severity, complications, redcell distribution weight.

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Short- and long-term outcome of patients aged 65 and over after cardiac surgery

Abstract

To analyze the short and long-term outcome of patients aged 65 years and over, after cardiac surgery. Over a 12-year period we analyzed 1750 patients with a mean age of 70.09 3.94 years. They were classified into three age groups: between 65 and 69 (n = 709), between 70 and 74 (n = 695) and 75 years and above (n = 346). Follow-up information was obtained by telephone conversation after a 6-month and 3-year period of discharge from the hospital. Included in the follow-up were 1235 patients and an interview was conducted with 501 (40.6%) patients or their next of kin.

Even though the in-hospital morbidity was highest in the oldest age group, there were no significant differences between groups (p = 0.051). There was no significant difference between groups in the length of hospital stay. The greatest in-hospital mortality was noted in the oldest age group (p = 0.046) compared to patients in the age groups between 65 and 69 and between 70 and 74 years old (p = 0.023 and p = 0.036). In the follow-up study, there was a significantly smaller telephone feedback response in the oldest age group compared to the youngest group (p = 0.003). There were no differences between the groups with respect to mortality and cardiac death after the 6-month and 3-year periods of discharge from hospital.

Our data showed that despite a poor short – and long-term outcome in patients aged 75 and over, all patients had an acceptable operative risk.

Key Words: elderly; outcome; cardiac surgery

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