Hernández OM, Pérez AA, Torres CV

Language: Spanish
References: 20
Page: 1-8
PDF size: 703.21 Kb.

ABSTRACT

Introduction: Sepsis represents an indisputable and serious global health threat, with high mortality in intensive care units.
Objective: To identify risk factors related to death in patients admitted to the intensive care unit with sepsis.
Material and Methods: An observational, analytical and prospective study was conducted in patients admitted to the Intensive Care Unit at "Aleida Fernandez Chardiet" Teaching Clinical Surgical Hospital from 2018 to 2019. The study group consisted of a total of 224 patients.
Results: In the bivariate analysis it was observed that patients with serum lactate˃ 2 mmol/L, PaO2/FiO2 ratio< 200, DA-aO2˃ 200, serum creatinine˃ 160 mmol/L, and total cholesterol levels< 3,9 mmol/L were at a higher risk of death (p< 0,001). According to the multivariate logistic regression model, the variables significantly associated with death were invasive mechanical ventilation (OR= 3,8; 95 % CI, 1,7-8,6; p= 0,001), serum lactate levels˃ 2 mmol/L (OR= 3,9; 95 % CI, 1,9-8,2; p˂ 0,001), PaO2/FiO2 ratio< 200 (OR= 2,6; 95 % CI, 1,2-2,7; p= 0,012), serum creatinine levels˃160 mmol/L (OR= 3,4; 95 % CI, 1,4-8,1: p= 0,005), age≥ 60 years (OR= 3,1; 95 % CI, 1,4-6,8; p= 0,003), and white blood cell count˃ 12x109 (OR= 2,2; 95 % CI, 1,1-4,5; p= 0,031). Hosmer-Lemeshow test indicated an excellent calibration of the model (p= 0,471) with an area under the curve value of 0,864 (95 % CI, 0,817-0,912, p< 0,001).
Conclusions: In these patients, the factors related to death were invasive mechanical ventilation, serum lactate˃ 2 mmol/L, PaO2/FiO2 ratio< 200, serum creatinine˃ 160 mmol/L, age≥ 60 years, and white blood cell count˃ 12x109.

REFERENCES

1. World Health Organization. Global report on the epidemiology and burden of sepsis current evidence, identifying gaps and future directions [Internet]. Geneva: WHO; 2020 [Citado 25/03/2021]. Disponible en: Disponible en: https://apps.who.int/iris/handle/10665/334216 1.

2. Singer M, Deutschman CS, Seymour CW, Shankar Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA [Internet]. 2016 [Citado 12/12/2019];315(8):[Aprox. 10p.]. Disponible en: Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2492881 2.

3. Mendieta Pedroso M, Sotolongo López JC. El pronóstico y su importancia en la práctica clínica. Rev Cubana de Med [Internet]. 2019 [Citado 25/03/2021]; 58(3):[Aprox. 9p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S0034-752320190003000063.

4. Hernández López GD, Amezcua Gutiérrez MA, Geroldo Delsol LA, Cruz montesinos S, Zamora Gómez SE, Lima Lucero IM, et al. Sepsis en el paciente anciano críticamente enfermo. Rev Hosp Jua Mex [Internet]. 2018 [Citado 25/03/2021];85(4):222-27. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=840334.

5. Vargas Belizario CH. Incidencia y características clínicas epidemiológicas relacionadas a mortalidad en sepsis y shock séptico en el servicio de UCI del Hospital III Goyeneche en los años 2015 al 2017 [Tesis de Especialidad]. Perú: Universidad Nacional de San Agustín de Arequipa; 2018 [Citado 25/03/2021]. Disponible en: Disponible en: http://repositorio.unsa.edu.pe/handle/UNSA/5631 5.

6. Zhiqiang L, Zibo M, Yongfeng L, Jingyuan Z, Shihong W, Shanmiao G, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine [Internet]. 2019 [Citado 25/03/2021]; 27(51):[Aprox. 10p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64923726. /

7. Wang J, Sun Y, Teng S, Li K. Prediction of sepsis mortality using metabolite biomarkers in the blood: ameta-analysis of death-related pathways and prospective validation. BMC Medicine [Internet]. 2020 [Citado 25/03/2021];18(83):[Aprox. 15p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32290837/7.

8. Marin Marin D, Soto A. Comparación de sistemas de puntaje pronóstico en la predicción de mortalidad y complicaciones en sepsis. Rev Peru Med Exp Salud Pública [Internet]. 2016 [Citado 25/03/2021];33(1):51-7. Disponible en: http://revistas.urp.edu.pe/index.php/RFMH/article/view/964/8728.

9. Torres V, Ramos N, Lizazo D, Monteagudo F, Noda A. Statistical model for measuring the impact of innovation or technology transfer in agriculture Cuban. Journal of Agricultural Science [Internet]. 2008 [Citado 25/03/2021];42(2):13. Disponible en: http://www.ciencia-animal.org/cuban-journal-of-agricultural-science/articles/V42-N2-Y2008-P131-V-Torres.pdf9.

10. Aguayo Canela M, Lora Monge E, eds. Como hacer una regresión logística binaria (II): análisis multivariante [Internet]. Sevilla: Fundación andaluza Beturia para la investigación en salud; 2013 [Citado 25/03/2021]. Disponible en: http://metodos-avanzados.sociales.uba.ar/wp-content/uploads/sites/216/2014/03/Regres_log_AGUAYO-otros.pdf10.

11. Fuentes Smith LE. Metodología para la elección de punto de corte óptimo para dicotomizar covariables continúas. Rev Cubana Genet Comunit [Internet]. 2013 [Citado 25/03/2021];7(3):36-42. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=5368911.

12. Gao J, Zhong L, Wu M, Ji J, Liu Z, Wang C, et al. Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study. BMC Infect Dis [Internet]. 2021[Citado 25/03/2021];21(1):[Aprox. 8p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223178/12.

13. Rangel Vera JA, Laguado Nieto MA, Amaris Vergara AA,Vargas Ordóñez JE, García León SJ, Centeno Hurtado KT. Actualización en sepsis y choque séptico en adultos. Med UNAB [Internet]. 2019 [Citado 25/03/2021];22(2):213-27. Disponible en: https://revistas.unab.edu.co/index.php/medunab/article/view/334513.

14. Vucelic V, Klobucar I, Ðuras Cuculic B, Gveric Grginic A, Prohaska Potocnik C, Jajic I, et al. Sepsis and septic shock - an observational study of the incidence, management, and mortality predictors in a medical intensive care unit. Croat Med J [Internet]. 2020 [Citado 25/03/2021];61:429-39. Disponible en: https://doi.org/10.3325/cmj.2020.61.429

15. Javed A, Guirgis FW, Sterling SA, Puskarich MA, Bowman J, Robinson T, et al. Clinical Predictors of Early Death from Sepsis. J Crit Care [Internet]. 2017 [Citado 25/03/2021];42:30-4. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(17)30062-X15.

16. Nava RHJ, Zamudio CP, Quiroz CY, Martínez RI, Espinosa PA, García CA, et al. La disfunción mitocondrial como posible causa de la falla orgánica múltiple asociada a la sepsis severa. Rev Inst Nal Enf Resp Mex [Internet]. 2009 [Citado 25/03/2022];22(1):37-47. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=2179216.

17. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ [Internet]. 2019 [Citado 25/03/2021];364:k4891. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890472/17.

18. Lombardi R, Ferreiro A, Claure Del Granado R, Burdmann EA, Rosa Diez G, Yu L, et al. EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America. PLoS ONE [Internet]. 2019 [Citado 25/03/2021];14(11):[Aprox. 14p.]. Disponible en: https://doi.org/10.1371/journal.pone.0224655

19. Quintano Neira RA, Hamacher S, Miguel Japiassu AA. Epidemiology of sepsis in Brazil: Incidence,lethality, costs, and other indicators for Brazilian Unified Health System hospitalizations from 2006 to 2015. PLoS ONE [Internet]. 2018;13(4):15

20. López Pérez AB. La Sepsis en una Unidad de Cuidados Intensivos. Caracteristicas epidemiológicas y factores de riesgo asociados a la mortalidad [Tesis de Especialidad]. España: Universidad de Salamanca; 2019 [Citado 25/03/2021]. Disponible en: Disponible en: https://gredos.usal.es/handle/10366/140448 20.