Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad
Infection is one of the most frequent reasons for admission to the ICU and mortality secondary to septic shock is high. In the last years, there is a high interest to get diagnostic tools to predict sepsis and mortality and to optimize healthcare resources. Objective: To carry out a descriptive stu...
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Universidad de La Rioja (España)
2021
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Infection is one of the most frequent reasons for admission to the ICU and mortality secondary to septic shock is high. In the last years, there is a high interest to get diagnostic tools to predict sepsis and mortality and to optimize healthcare resources.
Objective:
To carry out a descriptive study of the epidemiological characteristics of patients admitted to the Intensive Care Unit (ICU) at the San Pedro Hospital ( Logroño, Spain) with a diagnosis of infection over a year, and to evaluate the
prognostic performance of sepsis and mortality on the qSOFA and SOFA severity scales. In addition, to develop a new scale, called qSOFA PLUS, to provide improved results.
Material and Methods:
A descriptive, observational and retrospective cohort study. All patients admitted to the ICU during 2013 with a diagnosis of infection were included. A value ≥ 2 points was considered positive for the SOFA and qSOFA scales. For the elaboration of the qSOFA PLUS scale, the cut-off value for procalcitonine (PCT) > 2ng/ml and for lactate > 2 mmol/L was used. A cut-off value for lactate > 4 mmol/L was also considered, as it is a threshold value of extreme severity.
Results:
151 patients were identified, of which 107 (9% of the total admissions that year) presented sepsis and 41 died (27.15%). A clear dominant sex was not observed. The overall mean age was 67 years. The 65 years and over age group was the most prevalent and showed the highest rate of mortality. The most frequent septic focus was respiratory (40%). 58.27% of the patients presented one or two risk factors. A total of 8 risk factors were detected that could negatively influence the prognosis. Incidence according to prevalence of these factors were: cardiovascular disease, immunosuppression and diabetes mellitus. Only 4.87% of the patients presented obesity. Cardiovascular disease was the one with the highest rate of mortality (51.21%), followed by immunodeficiency and diabetes mellitus.
For the diagnosis of sepsis, the positive predictive value (PPV) of the qSOFA was 92.7% compared to 73.8% in the case of the SOFA scale. To predict mortality, the PPV for qSOFA was 36.5% versus 29.1% for SOFA. 73% of the deceased had serum lactate levels > 2 mmol/L and almost half of them (48.78%) had serum levels > 4 mmol/L.
There are no statistically significant differences that justify the inclusion of lactate, in any of its values, in the multivariate qSOFA PLUS model.
There are statistically significant differences in the proportion of sepsis in each classification group (chi-square p <0.001) that would justify the use of PCT in the multivariate qSOFA PLUS model. The qSOFA PLUS model, based on the original qSOFA scale and the qualitative PCT value, has an Area under the curve (AUC) value of 0.879 (p <0.001) and a PPV of 92%.
The diagnostic accuracy of the qSOFA PLUS scale is 87.8% compared to 83.2% of the qSOFA scale, with a sensitivity rate of 92% and 83%, respectively.
Conclusion:
1. The best performing scale for predicting sepsis and mortality outside the ICU was qSOFA.
2. The lactate biomarker was useful as a prognosis of death. However, it was not used in the qSOFA PLUS model, since no statistically significant differences were found to justify its inclusion.
3. The qSOFA PLUS model improved the prognostic performance of the qSOFA scale, but not significantly. However, it could be of practical relevance as a screening method. |
| author2 |
Torres Manrique, Carmen (Universidad de La Rioja) |
| author_facet |
Torres Manrique, Carmen (Universidad de La Rioja) Ruiz de la Cuesta López, Mirian |
| format |
text (thesis) |
| author |
Ruiz de la Cuesta López, Mirian |
| spellingShingle |
Ruiz de la Cuesta López, Mirian Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| author_sort |
Ruiz de la Cuesta López, Mirian |
| title |
Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| title_short |
Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| title_full |
Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| title_fullStr |
Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| title_full_unstemmed |
Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidad |
| title_sort |
estudio de las escalas pronósticas de gravedad al ingreso en uci y su impacto en la sepsis y la mortalidad |
| publisher |
Universidad de La Rioja (España) |
| publishDate |
2021 |
| url |
https://dialnet.unirioja.es/servlet/oaites?codigo=289410 |
| work_keys_str_mv |
AT ruizdelacuestalopezmirian estudiodelasescalaspronosticasdegravedadalingresoenuciysuimpactoenlasepsisylamortalidad |
| _version_ |
1718346696291778560 |
| spelling |
oai-TES00000230002021-07-17Estudio de las escalas pronósticas de gravedad al ingreso en UCI y su impacto en la sepsis y la mortalidadRuiz de la Cuesta López, MirianInfection is one of the most frequent reasons for admission to the ICU and mortality secondary to septic shock is high. In the last years, there is a high interest to get diagnostic tools to predict sepsis and mortality and to optimize healthcare resources. Objective: To carry out a descriptive study of the epidemiological characteristics of patients admitted to the Intensive Care Unit (ICU) at the San Pedro Hospital ( Logroño, Spain) with a diagnosis of infection over a year, and to evaluate the prognostic performance of sepsis and mortality on the qSOFA and SOFA severity scales. In addition, to develop a new scale, called qSOFA PLUS, to provide improved results. Material and Methods: A descriptive, observational and retrospective cohort study. All patients admitted to the ICU during 2013 with a diagnosis of infection were included. A value ≥ 2 points was considered positive for the SOFA and qSOFA scales. For the elaboration of the qSOFA PLUS scale, the cut-off value for procalcitonine (PCT) > 2ng/ml and for lactate > 2 mmol/L was used. A cut-off value for lactate > 4 mmol/L was also considered, as it is a threshold value of extreme severity. Results: 151 patients were identified, of which 107 (9% of the total admissions that year) presented sepsis and 41 died (27.15%). A clear dominant sex was not observed. The overall mean age was 67 years. The 65 years and over age group was the most prevalent and showed the highest rate of mortality. The most frequent septic focus was respiratory (40%). 58.27% of the patients presented one or two risk factors. A total of 8 risk factors were detected that could negatively influence the prognosis. Incidence according to prevalence of these factors were: cardiovascular disease, immunosuppression and diabetes mellitus. Only 4.87% of the patients presented obesity. Cardiovascular disease was the one with the highest rate of mortality (51.21%), followed by immunodeficiency and diabetes mellitus. For the diagnosis of sepsis, the positive predictive value (PPV) of the qSOFA was 92.7% compared to 73.8% in the case of the SOFA scale. To predict mortality, the PPV for qSOFA was 36.5% versus 29.1% for SOFA. 73% of the deceased had serum lactate levels > 2 mmol/L and almost half of them (48.78%) had serum levels > 4 mmol/L. There are no statistically significant differences that justify the inclusion of lactate, in any of its values, in the multivariate qSOFA PLUS model. There are statistically significant differences in the proportion of sepsis in each classification group (chi-square p <0.001) that would justify the use of PCT in the multivariate qSOFA PLUS model. The qSOFA PLUS model, based on the original qSOFA scale and the qualitative PCT value, has an Area under the curve (AUC) value of 0.879 (p <0.001) and a PPV of 92%. The diagnostic accuracy of the qSOFA PLUS scale is 87.8% compared to 83.2% of the qSOFA scale, with a sensitivity rate of 92% and 83%, respectively. Conclusion: 1. The best performing scale for predicting sepsis and mortality outside the ICU was qSOFA. 2. The lactate biomarker was useful as a prognosis of death. However, it was not used in the qSOFA PLUS model, since no statistically significant differences were found to justify its inclusion. 3. The qSOFA PLUS model improved the prognostic performance of the qSOFA scale, but not significantly. However, it could be of practical relevance as a screening method.La infección es uno de los motivos más frecuentes de ingreso en la UCI y la mortalidad secundaria del shock séptico es muy elevada. En los últimos años, existe un gran interés en disponer de las herramientas diagnósticas adecuadas para predecir sepsis y mortalidad y para conseguir optimizar los recursos sanitarios. Objetivos: Realizar un estudio descriptivo de las características epidemiológicas de los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) del Hospital San Pedro de Logroño con diagnóstico de infección, durante un año, y evaluar el rendimiento pronóstico de sepsis y mortalidad de las escalas de gravedad qSOFA y SOFA. Además, elaborar una nueva escala, llamada qSOFA PLUS, con el fin de mejorar los resultados pronósticos. Material y métodos: Estudio de cohortes descriptivo, observacional y retrospectivo. Se incluyeron todos los pacientes ingresados en la UCI durante el año 2013 con diagnóstico de infección. Se consideró como positivo un valor superior a 2 puntos para la escala SOFA y qSOFA. Para la elaboración de la escala qSOFA PLUS, se utilizó como valor de corte para procalcitonina (PCT) > 2ng/ml y para lactato > 2 mmol/L. También se consideró un valor de corte para el lactato >4 mmol/L, por ser un valor umbral de extrema gravedad. Resultados: Se obtuvieron 151 pacientes de los cuales 107 (9% del total de ingresos ese año) presentaron sepsis y 41 fallecieron (27,15%). No se observó un claro sexo dominante. La edad media global fue de 67 años. El grupo de edad mayor de 65 años fue el más prevalente y con mayor impacto en la mortalidad. El foco séptico más frecuente fue el respiratorio (40%). El 58,27% de los pacientes presentó uno o dos factores de riesgo. Se detectaron un total de 8 factores de riesgo que podrían influir negativamente en el pronóstico. Los factores más frecuentes fueron: patología cardiovascular, inmunosupresión y diabetes mellitus. Solamente un 4,87% de los pacientes presentó obesidad. La patología cardiovascular fue la que presentó mayor impacto en la mortalidad (51,21%), seguido también por la inmunodeficiencia y diabetes mellitus. Para el diagnóstico de sepsis, el valor predictivo positivo (VPP) del qSOFA fue del 92,7% frente a un 73,8% en el caso de la escala SOFA. Para predecir mortalidad, el VPP de qSOFA fue de un 36,5% frente a un 29,1 % del SOFA. Un 73% de los fallecidos presentó unos niveles séricos de lactato > 2 mmol/L y casi la mitad (48,78%), niveles séricos > 4 mmol/L. No se detectaron diferencias estadísticamente significativas que justifiquen la inclusión del lactato, en cualquiera de sus valores, en el modelo multivariante qSOFA PLUS. Existen diferencias estadísticamente significativas en la proporción de sepsis de cada grupo de clasificación (chi-cuadrado p<0,001) que justificaría el empleo de la PCT en el modelo multivariante qSOFA PLUS. El modelo qSOFA PLUS, basado en la escala qSOFA original y el valor cualitativo de PCT, tiene un valor del área bajo la curva (AUC) de 0,879 (p<0,001) y VPP del 92%. La precisión diagnóstica de la escala qSOFA PLUS es del 87,8% frente al 83,2% de la escala qSOFA, con una sensibilidad del 92% y 83% respectivamente. Conclusión: 1. La escala con mejor rendimiento para predecir sepsis y mortalidad fuera de la UCI fue qSOFA. 2. El biomarcador lactato fue útil como pronóstico de muerte. Sin embargo, no se empleó en el modelo qSOFA PLUS, puesto que no se encontraron diferencias estadísticamente significativas que justificasen su inclusión. 3. El modelo qSOFA PLUS mejoró el rendimiento pronóstico de la escala qSOFA, pero no de forma significativa. Sin embargo, podría tener relevancia práctica como método de cribado.Universidad de La Rioja (España)Torres Manrique, Carmen (Universidad de La Rioja)Antoñanzas Villar, Fernando Jesús (Universidad de La Rioja)2021text (thesis)application/pdfhttps://dialnet.unirioja.es/servlet/oaites?codigo=289410spaLICENCIA DE USO: Los documentos a texto completo incluidos en Dialnet son de acceso libre y propiedad de sus autores y/o editores. Por tanto, cualquier acto de reproducción, distribución, comunicación pública y/o transformación total o parcial requiere el consentimiento expreso y escrito de aquéllos. Cualquier enlace al texto completo de estos documentos deberá hacerse a través de la URL oficial de éstos en Dialnet. Más información: https://dialnet.unirioja.es/info/derechosOAI | INTELLECTUAL PROPERTY RIGHTS STATEMENT: Full text documents hosted by Dialnet are protected by copyright and/or related rights. 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