RESUMO
Se estudiaron dos pacientes ingresados en sala de cuidados intensivos polivalente, los cuales presentaron necrolisis tóxica epidémica (NTE), complicación poco frecuente que tiene una incidencia de 1 a 4 casos por millón de habitantes. La causa de la enfermedad en estos pacientes fue medicamentosa y los principales medicamentos implicados fueron anfotericin B y ciprofloxacino. Una de las cuestiones que hace interesante el reporte de estas reacciones adversas es que se trata del primer caso de NTE relacionada con el uso de Anfotericin B Liposomal que se reporta en Cuba y en el resto de la comunidad científica. El diagnóstico se confirmó por biopsia de piel, ambos pacientes presentaron un riesgo de muerte, según índice de Scorten, mayor al 50 por ciento. Por lo infrecuente que es el tratamiento de esta afección en una sala de cuidados intensivos polivalentes, por lo raro que es ver esta enfermedad en relación a estos antibióticos antes mencionados, por lo dramático del cuadro clínico y por la evolución tórpida de los pacientes, se realizó esta investigación con el objetivo de transmitir la experiencia y el conocimiento a la comunidad médica y científica en general y a los profesionales que laboran en las salas de terapia intensiva polivalente en particular(AU)
Two patients admitted to a multipurpose intensive care ward were studied. They showed epidemic toxic necrolysis (NTE), a rare complication that has an incidence of 1 to 4 cases per million inhabitants. Drugs were the cause of the disease in these patients and the main drugs involved were amphotericin B and ciprofloxacin. This is the first case of NTE related to the use of Liposomal Amphotericin B reported in Cuba and in the rest of the scientific community, which makes it interesting. The diagnosis was confirmed by skin biopsy, both patients had risk of death, according to the Scorten index, higher than 50 percent. This research was carried out with the aim of communicating the experience and knowledge to the medical and scientific community in general and to the professionals who work in multipurpose intensive care rooms in particular, since this condition is rare in a multipurpose intensive care room, it is rare in relation to the aforementioned antibiotics, its dramatic clinical status and the torpid evolution of patients(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome de Stevens-Johnson/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Unidades de Terapia Intensiva , CubaRESUMO
Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.
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Introducción: Se desconoce qué marcadores de riesgo nutricional estratifican mejor el riesgo en pacientes críticos. Objetivo: Evaluar el riesgo nutricional en pacientes críticos mediante dos escalas. Material y métodos: Estudio descriptivo, prospectivo, transversal, con 222 pacientes ingresados en la Terapia 8B del Hospital "Hermanos Ameijeiras" (septiembre 2017 / mayo 2018). Se utilizaron el Control Nutricional (CONUT) y el Nutrition Risk in the Critically ill modificado (mNutric). Resultados: Según CONUT el 96,4 por ciento estaba desnutrido; según mNutric el 27,5 por ciento eran pacientes en alto riesgo nutricional. Hubo asociación entre las escalas (Kappa = 0,102). El 78.3 por ciento de los sobrevivientes eran bajo riesgo por mNutric (p=0,013). Hubo asociación entre la sepsis y la desnutrición por mNutric (p=0,013), no así entre la ventilación mecánica artificial (VMA) y la desnutrición estimada por dicha escala (p=0,116). No se encontraron diferencias entre la sepsis y la desnutrición según CONUT (p=0,126). Hubo diferencias entre la VMA en relación con la desnutrición según CONUT (p=0,027). La frecuencia de fallecidos se incrementó paralelo al grado de desnutrición según CONUT (p=0,004). La variable que más influyó sobre la mortalidad fue la VMA (OR= 8,5). Conclusiones: Según el CONUT, la mayoría de los pacientes estaban desnutridos, y según el mNutric, predominaron los pacientes en bajo riesgo nutricional. Se demostró el valor predictivo de muerte de la presencia de VMA. La desnutrición ligera y moderada y la variable no desnutrido de la escala CONUT, se consideraron categorías de menor riesgo de muerte con respecto a la desnutrición grave(AU)
Introduction: Nutritional status markers that better stratify risk in critically ill patients have yet to be established. Objective: To assess nutritional risk in critically ill patients through the use of two assessment scales. Material and Methods: A prospective descriptive cross-sectional study was conducted in 222 patients admitted to the Intensive Care Unit (8B) at the "Hermanos Ameijeiras" Hospital from September, 2017 to May, 2018. The Controlling Nutritional Status (CONUT) and the modified Nutrition Risk in the Critically ill (mNutric) were used. Results: According to CONUT, 96.4 percent of patients were alnourished; according to mNutric, 27.5 percent of patients were categorized as high nutritional risk. There was an association between the scales (Kappa = 0.102). Among survivors, 78.3 percent of patients were at low risk according to mNutric score (p=0,013). There was an association between sepsis and malnutrition due to mNutric (p = 0.013) versus artificial mechanical ventilation (AMV) and malnutrition estimated by this scale (p = 0.116). No differences were found between sepsis and malnutrition according to CONUT (p = 0.126). There were differences between the AMV in relation to malnutrition according to CONUT score (p = 0.027). The frequency of deaths increased in parallel to the degree of malnutrition according to CONUT (p = 0.004). AMV was the variable that most influenced mortality (OR = 8,5). Conclusions: According to CONUT, most of the patients were malnourished; according to mNutric, patients at low nutritional risk predominated. The predictive value of death in patients receiving AMV was demonstrated. The light and moderate malnutrition and the variable related with the not malnourished group (CONUT scale) were considered as categories associated with lower risk of death with regard to severe malnutrition(AU)
Assuntos
Humanos , Avaliação Nutricional , Programas de Rastreamento/métodos , Cuidados Críticos , Distúrbios Nutricionais/diagnóstico , Epidemiologia Descritiva , Estudos Transversais , Estudos Prospectivos , Estado TerminalRESUMO
OBJECTIVE: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. METHODS: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. RESULTS: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. CONCLUSION: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.
Assuntos
Unidades de Terapia Intensiva , Suporte Ventilatório Interativo/métodos , Respiração Artificial/métodos , Idoso , Estado Terminal , Feminino , Humanos , Inalação/fisiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
RESUMO Objetivo: Identificar la relación de la asincronía paciente-ventilador con el nivel de sedación y evaluar la asociación con los resultados hemogasométricos y clínicos. Métodos: Estudio prospectivo de 122 pacientes admitidos en la unidad de cuidados intensivos con > 24 horas de ventilación mecánica invasiva y esfuerzo inspiratorio. En los primeros 7 días de ventilación, diariamente se evaluó la asincronía paciente-ventilador durante 30 minutos. La asincronía paciente-ventilador severa se definió con un índice de asincronía > 10%. Resultados: Se evaluaron 339.652 ciclos respiratorios en 504 observaciones. La media del índice de asincronía fue 37,8% (desviación estándar 14,1% - 61,5%). La prevalencia de asincronía paciente-ventilador severa fue 46,6%. Las asincronías paciente-ventilador más frecuentes fueron: trigger ineficaz (13,3%), auto-trigger (15,3%), flujo insuficiente (13,5%) y ciclado demorado (13,7%). La asincronía paciente-ventilador severa se relacionó con el nivel de sedación (trigger ineficaz: p = 0,020; flujo insuficiente: p = 0,016; ciclado precoz: p = 0,023) y el uso de midazolam (p = 0,020). La asincronía paciente-ventilador severa se asoció con las alteraciones hemogasométricas. La persistencia de la asincronía paciente-ventilador severa fue un factor de riesgo independiente para fracaso en la prueba de ventilación espontánea, tiempo de ventilación, neumonía asociada al ventilador, disfunción de órganos, mortalidad en la unidad de cuidados intensivos y estadía en la unidad de cuidados intensivos. Conclusión: La asincronía paciente-ventilador es un trastorno frecuente en los pacientes críticos con esfuerzo inspiratorio. La interacción del paciente con el ventilador debe optimizarse para mejorar los parámetros hemogasométricos y los resultados clínicos. Se requieren otros estudios que confirmen estos resultados.
Abstract Objective: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. Methods: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. Results: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. Conclusion: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Respiração Artificial/métodos , Suporte Ventilatório Interativo/métodos , Unidades de Terapia Intensiva , Fatores de Tempo , Inalação/fisiologia , Estudos Prospectivos , Fatores de Risco , Estado Terminal , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Tempo de InternaçãoRESUMO
BACKGROUND: The aim of the study was to evaluate the performance of "Acute Physiology and Chronic Health Evaluation II" (APACHE-II), "Simplified Acute Physiology Score 3" (SAPS-3), and "APACHE-II Score for Critically Ill Patients with a Solid Tumor" (APACHE-IICCP) models in cancer patients admitted to ICU. METHODS: Prospective cohort study of 414 patients with an active solid tumor. Discrimination was assessed by area under receiver operating characteristic (AROC) curves and calibration by Hosmer-Lemeshow goodness-of-fit C test (H-L). RESULTS: The hospital mortality rate was 32.6%. In the total cohort, discrimination for prognostic models were: APACHE-IICCP (AROC 0.98), APACHE-II (AROC 0.96), SAPS-3 for Central and South American countries (SAPS-3CSA) (AROC 0.95), and SAPS-3 (AROC 0.91). Calibration was good (p value of H-L test > 0.05) using APACHE-IICCP, APACHE-II and SAPS-3CSA models. Estimation of the probability of death was more precise with APACHE-IICCP (standardized mortality ratio, SMR = 1.03) and SAPS-3 (SMR = 1.08) models. Further analysis showed that discrimination was high with all prognostic model whether for patients with planned ICU admission (AROC APACHE-IICCP 0.97, APACHE-II 0.96, SAPS-3 0.95, SAPS-3CSA 0.95) or for patients with unplanned ICU admission (AROC APACHE-IICCP 0.97, APACHE-II 0.94, SAPS-3 0.86, SAPS-3CSA 0.95). Calibration was good for all predictive models in both subgroups (p value of H-L test > 0.05, except for APACHE-II model inpatients with planned ICU admission). CONCLUSIONS: In this prospective study, general predictive models (e.g., APACHE-II, SAPS-3) and cancer-specific models (e.g., APACHE-IICCP) are accurate in predicting hospital mortality. Other studies confirming these results are required.
Assuntos
APACHE , Modelos Estatísticos , Neoplasias/etiologia , Neoplasias/mortalidade , Idoso , Área Sob a Curva , Estado Terminal/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROCRESUMO
Introducción: en los pacientes críticos existe un desequilibrio entre las actividades procoagulantes y las anticoagulantes, por ello las alteraciones de la coagulación o coagulopatías son una complicación frecuente que se asocia con una elevada morbilidad y mortalidad. Objetivos: identificar factores de riesgo asociados con coagulopatías adquiridas en pacientes ingresados y analizar la relación entre coagulopatía y mortalidad. Métodos: se realizó un estudio longitudinal prospectivo, donde se revisaron complementarios e historias clínicas de 29 pacientes ingresados en la unidad de cuidados intensivos del hospital Hermanos Ameijeiras, desde abril hasta junio de 2011. Se identificaron factores de riesgo asociados a las coagulopatías y se analizó su relación con la mortalidad. Resultados: se identificó la presencia de coagulopatías al ingreso en 58,62 por ciento, entre las 48-72 h 44,82 por ciento y en la última evaluación 51,73 por ciento. Predominó la coagulopatía por deficiencia de factores dependientes de vitamina K. Dentro de la unidad, el uso de hemocomponentes y la administración de aminoglucósidos resultaron estadísticamente significativos. Fallecieron 21 de los pacientes y en 13 de ellos se detectó la presencia de coagulopatía representando 44,8 por ciento. Conclusiones: se detectó que es dos veces más probable que a la persona que le administren hemocomponentes desarrolle algún tipo de coagulopatía y 5 veces más probable si se le administran aminoglucósidos. No se encontró relación significativa entre la presencia de coagulopatía y mortalidad, ni relación significativa entre la presencia de sangramiento y mortalidad(AU)
Introduction: There is an imbalance between procoagulant activities and anticoagulants in critical patients, so coagulation disorders or coagulopathies are a frequent complication associated with high morbidity and mortality. Objectives: To identify risk factors associated with acquired coagulopathies in hospitalized patients and to analyze the relationship between coagulopathy and mortality. Methods: A prospective longitudinal study was carried out. Complementary and clinical histories of 29 patients were reviewed. These patients had been admitted to the intensive care unit at Hermanos Ameijeiras hospital from April to June 2011. Risk factors associated with coagulopathies were identified. Mortality relationship was analyzed. Results: The presence of coagulopathies on admission was identified in 58.62 percent, 44.82 percent in 48-72 h and 51.73 percent in last assessment. Coagulopathy was predominant due to deficiency of vitamin K dependent factors. The use of blood components and the administration of aminoglycosides were statistically significant in the unit. Twenty one (21) patients died and thirteen (13) coagulopathy was detected, (44.8 percent). Conclusions: It was detected that it is twice as likely that the person receiving hemocomponents will develop some type of coagulopathy and five times more likely if they are administered aminoglycosides. No significant relationship was found between the presence of coagulopathy and mortality, nor significant relationship between the presence of bleeding and mortality(AU)
Assuntos
Humanos , Masculino , Feminino , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/prevenção & controle , Estudos Prospectivos , Fatores de Risco , Estudos Longitudinais , Cuidados Críticos/métodos , HospitalizaçãoRESUMO
Introducción: las coagulopatías adquiridas constituyen un problema de salud serio y frecuente en pacientes de las Unidades de Cuidados Intensivos, existe falta de evidencia para su tratamiento adecuado y eficaz. Es importante el reconocimiento temprano de estas anormalidades para reducir morbilidad, estadía hospitalaria, costos y mortalidad. Objetivos: describir el comportamiento de las coagulopatías adquiridas y las concentraciones de los factores de la coagulación (I, II, V, VII y X) en pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Clínico Quirúrgico Hermanos Ameijeiras. Métodos: se realizó un estudio longitudinal prospectivo desde abril hasta junio de 2011, en 29 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Clínico Quirúrgico Hermanos Ameijeiras. Se determinaron los parámetros hematológicos al ingreso y cada 48-72 h para detectar coagulopatías adquiridas y déficit de factores de la coagulación. Resultados: presencia de coagulopatías al ingreso 58,62 por ciento, entre las 48-72 h 44,82 por ciento y en la última evaluación 51,73 por ciento. Predominó la coagulopatía por deficiencia de factores dependientes de vitamina K. Se encontró disminución significativa de los factores II, V, VII y X en el momento del ingreso; el II, V y X a las 48-72 h y en el momento final, los factores I y II. Conclusiones: se identificó la presencia de coagulopatías en diferentes momentos de la estadía dentro de la Unidad de Cuidados Intensivos, predominó la coagulopatía tipo 3: por consumo de factores dependientes de vitamina K. Hubo disminución significativa de la concentración de los factores dependientes de vitamina K(AU)
Introduction: Acquired coagulopathies constitute a serious and frequent health problem in patients at intensive care units. There is a lack of evidence for their adequate and effective treatment. Early recognition of these abnormalities is important to reduce morbidity, hospital stay, costs, and mortality. Objectives: To describe the behavior of acquired coagulopathies and the concentrations of coagulation factors (I, II, V, VII and X) in patients admitted to the Intensive Care Unit of Hermanos Ameijeiras Clinical-Surgical Hospital. Methods: A prospective longitudinal study was carried out from April to June 2011 in 29 patients admitted to the Intensive Care Unit of Hermanos Ameijeiras Clinical-Surgical Hospital. Hematological parameters were determined at admission time and every 48-72 hours in order to detect acquired coagulopathies and coagulation factor deficits. Results: Presence of coagulopathies on the admission was 58.62 percent, between 48-72 hours it was 44.82 percent and in the last assessment it was 51.73 percent. Prevalence of coagulopathy due to deficiency of vitamin K-dependent factors. Significant decrease in factors II, V, VII and X was found at the admission time; of the factor II, V and X after 48-72 hours, and of factors I and II in the final moment. Conclusions: The presence of coagulopathies was identified at different times of hospital stay within the intensive care unit, type 3 coagulopathy predominated: consumption of vitamin K-dependent factors. There was a significant decrease in the concentration of vitamin K-dependent factors(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos da Coagulação Sanguínea/epidemiologia , Cuidados Críticos/métodos , Transtornos da Coagulação Sanguínea/prevenção & controle , Estudos Prospectivos , Estudos LongitudinaisRESUMO
OBJECTIVE AND DESIGN: To evaluate the association of pro-inflammatory mediators with organ dysfunction and adverse outcome in intra-abdominal sepsis patients. SUBJECTS: Twenty-one patients admitted to the Intensive Care Unit (ICU) were prospectively included in the study. Only patients with surgical diagnosis of intra-abdominal sepsis were enrolled. RESULTS: Tumor necrosis factor-α (TNFα) and interleukin (IL)-6 produced ex vivo were significantly lower in non-survivors on admission (p = 0.021) and day 2 (p = 0.013), respectively. Nitric oxide (NO(x)) levels were significantly higher in non-survivors from the onset of sepsis and until day 4 after diagnosis (p < 0.05). Circulating lymphocyte counts were lower in non-survivors after admission over time, but there was no association with impaired cytokine production in this group of patients during the entire follow-up. All non-survivors developed nosocomial pneumonia concomitantly with multiple organ dysfunction and septic shock. There was a significant correlation between nitric oxide (NO(x)) concentrations and the sequential organ failure assessment (SOFA) score at day 2 (r = 0.598, p = 0.009), and ICU stay (r = 0.605, p = 0.006). Continuously high NO(x) levels correlated with organ failure. The pro-inflammatory mediators TNFα, IL-6 and NO(x), and also the Simplified Acute Physiology Score II (SAPS-II), discriminate survivors from non-survivors. According to logistic regression models, although these parameters are independently associated with the outcome, they do not improve the predictive power of the SAPS-II score for mortality risk. CONCLUSIONS: Disturbances in inflammatory responses and increase in NO(x) generation seem to characterize early intra-abdominal sepsis, in which immune suppression is associated with an increased susceptibility to nosocomial infections. Sequential NO(x) determinations could be a useful approach for improving the management of patients with intra-abdominal sepsis.
Assuntos
Cavidade Abdominal/microbiologia , Citocinas/sangue , Citocinas/imunologia , Óxido Nítrico/sangue , Sepse/sangue , Sepse/imunologia , Adulto , Idoso , Animais , Biomarcadores/sangue , Estudos de Coortes , Infecção Hospitalar/sangue , Infecção Hospitalar/imunologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Fatores de Risco , Sepse/mortalidade , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/imunologiaRESUMO
La glucemia es factor de riesgo de infección, sin embargo, no existen evidencias suficientes que permitan utilizarla como marcador pronóstico de mortalidad en el paciente séptico crítico. Se realizó un estudio longitudinal y prospectivo, para evaluar la utilidad de la glucemia como factor pronóstico de mortalidad en pacientes sépticos críticos. Se incluyeron 206 pacientes que ingresaron de forma consecutiva en la Terapia Intensiva (piso 8) del Hospital "Hermanos Ameijeiras". La gravedad se evaluó a través de la escala Simplified Acute Physiology Score (SAPS-3). Se midió el valor diario de glucemia en ayunas durante los primeros 6 días de estadía, el valor más alto de los 3 primeros días y la diferencia de valores entre el tercer y el primer día. Se aplicó el coeficiente de correlación de Spearman para variables cuantitativas. Se estudió el valor independiente de la variable mediante varios modelos de regresión logística. Se consideró una significación estadística de p<0,05. Se encontró asociación entre el SAPS-3 y la glucemia del primer día (p=0,01). Los valores de glucemia entre vivos y fallecidos no mostraron diferencias significativas. El valor más alto de glucemia de los 3 primeros días para sobrevivientes fue de 8,41 (±3,25) mmol/L, y 8,72 (±3,04) mmol/L para los fallecidos. No hubo diferencias entre la resta de los valores de glucemia entre el tercer y el primer día entre vivos (-0,17±3,9 mmol/L) y fallecidos (0,07±2,8 mmol/L) (p=0,66). No se demostró utilidad de la glucemia como marcador pronóstico en relación con la mortalidad en pacientes con sepsis, aunque la glucemia del primer día se asoció con la gravedad(AU)
Glycemia is a infection risk factor, however, there are not enough evidences allowing its use as a prognostic marker of mortality in critical septic patients. Study includes 206 patients admitted in a consecutive way in Intensive Therapy Care (eight floor) of the "Hermanos Ameijeiras" Clinical Surgical Hospital. Severity was assessed according to the Simplified Acute Physiology Score scale (SAPS-3). The fasting daily value of glycemia was measured for the first 6 days of stay, the higher value during the 3 first days and the values difference between the third and the first day. The Spearmen's correlation coefficient was applied for quantitative variables. The independent value of the variable was studied using several logistic regression forms. A statistic significance of p<0,05 was considered. There was association between SAPS-3 and the first day glycemia (p=0,01). Glycemia among the living and death persons haven't significant differences. The higher value of glycemia of the first three days for survivors was of 8,41 (±3,25) mmol/L and 8,72 (±3,04) mmol/L for deceased. There weren't differences between the glycemia subtraction between the third and the first day among the leaving persons(-0,17 ±3,9 mmol/L) and those deceased (0,07±2,8 mmol/L) (p=0,66). It was impossible to demonstrate the usefulness of glycemia as a prognostic marker in relation to mortality in patients presenting with sepsis although glycemia of first day was associated with severity(AU)