[Lactate levels with regards to the pulse pressure in patients with shock]

BACKGROUND

Lactate is one of the most useful biomarkers to screen patients with shock; therefore, the aim of this study was to establish the levels of lactate regarding the pulse pressure in that sort of patients.

METHODS

Observational, retrospective, cross-sectional and descriptive study of patients over 18 years diagnosed with shock from an emergency room of a tertiary care hospital. Lactate levels and pulse pressure were used as biomarkers. We used descriptive statistics, Student's t test and Pearson correlation coefficient.

RESULTS

We obtained 46 patients. The average age was 39.52 (SD 15.22), media initial lactate level was 5.88 mmol/L (SD 3.89) and media final lactate level 3.31 mmol/L (SD = 3.12); initial pulse pressure was 19.78 mmHg (SD 7.45) and final pulse pressure 31.52 mmHg (SD 31.52). The relation of secondary diagnosis did show predominance in chest trauma with 13 patients. There was a statistical significance in initial lactate and final lactate of r = 0.83 (p = 0.00), and initial pulse pressure and final pulse pressure: r = 0.57 (p = 0.001). There was not a significant correlation between final lactate and final pulse pressure (r: -0.184, p = 0.222).

CONCLUSION

Even when several studies emphasize the clinical significance of biomarkers in the diagnosis and management of patients with hypovolemic shock, it is necessary to do more studies in order to find the efficacy of the non-invasive screening in this type of pathology.

[Lactate levels as a predictor of mortality in patients with septic shock]

BACKGROUND

The objective was to determine the association between serum lactate levels and mortality in patients with septic shock in the Emergency Room of the Instituto Mexicano del Seguro Social's Centro Médico Nacional Adolfo Ruiz Cortines.

METHODS

We included the patients admitted to the Emergency Room with diagnosis of septic shock who had measure of serum lactate at admission during the period 01-12/2013; it was a case-control study. The cut-off value of serum lactate associated with mortality was performed using the ROC (receiver operating characteristic) curves.

RESULTS

Sixty-seven patients were studied, out of which 56 survived (cases) and 11 died (controls). There was no association with gender, age and comorbidities. The cut-off value for mortality of serum lactate was 4.9 mmol/L. Ten patients out of 40 with lactate levels > 4.9 mmol/L, and only one out of 27 with lactate < 4.9 mmol/L died (p = 0.04); odds ratio was of 8.7. The mortality in patients with septic shock and lactate > 4.9 mmol/ is high and had a sensitivity of 90.9 % and specificity of 46.4 %.

CONCLUSIONS

The levels of serum lactate greater than four are associated to an increased risk of mortality in patients with septic shock.

[Validation of an instrument to measure the clinical aptitude of the pregraduated intern attention of the diabetic patient with chronic complications in home]

OBJECTIVE

To validate an instrument to evaluate the clinic aptitude of the pregraduate intern in the integral attention of the diabetic patient with chronic complications at home.

METHODS

A comparative cross-sectional study; 114 pregraduate interns from five medical units were included to determine the clinic aptitude by an instrument with five real clinical cases of diabetic patients. Seven clinical indicators and 175 statements were used. The instrument was validated with two rounds of experts and the trustworthiness with a pilot group. Nonparametric statistics were used.

RESULTS

The consistency of the instrument was of 0.91. The clinic aptitude of the pregraduate interns was low and very low, except in a medical units that resulted intermediate. When comparing the five medical units, there were significant differences in the global qualification in six of the seven indicators.

CONCLUSIONS

The instrument fulfilled the requirements of validity.