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García-Lamberechts EJ, Fuentes Ferrer M, Fernández-Alonso C, Burillo-Putze G, Aguiló S, Alquezar-Arbé A, Montero-Pérez FJ, Jacob J, Piñera Salmerón P, Salido Mota M, Marchena MJ, Martínez Alonso A, Chacón García A, Güemes de la Iglesia C, Troiano Ungerer OJ, Eiroa-Hernández P, Parra-Esquivel P, Lázaro Aragüés P, Gantes Nieto P, Cuerpo Cardeñosa S, Chacón García C, Serrano Lázaro L, Caballero Martínez M, Guillen L, Muñoz Martos R, González Del Castillo J, Miró Ò. Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00008-X. [PMID: 38296669 DOI: 10.1016/j.eimce.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
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Affiliation(s)
| | - Manuel Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | - Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Norte Tenerife, Icod de los Vinos, Santa Cruz de Tenerife, Spain
| | - Paula Lázaro Aragüés
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | | | | | | | - Lara Guillen
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío Muñoz Martos
- Servicio de Urgencias, Hospital de la Axarquía, Velez-Málaga, Málaga, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Artajona L, García-Martínez A, Aguiló S, Burillo-Putze G, Alquézar-Arbé A, Fernández C, Fernández-Simón A, Fernández Cardona M, Maza Vera MT, Iglesias Vela M, Trenc Español P, Salido Mota M, García García Á, Lucena Aguilera C, Llopis F, Herrero P, Doi Grande AL, Serrano Lázaro L, Chacon García A, Noceda Bermejo JJ, Ibisate Cubillas A, Hernández Martínez MJ, Alemany González FX, Sánchez Ramón S, Espinosa Fernández B, González Del Castillo J, Miró Ò. Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study. Emergencias 2023; 35:423-431. [PMID: 38116966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments. MATERIAL AND METHODS Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions. RESULTS Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667). CONCLUSION The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.
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Affiliation(s)
- Lourdes Artajona
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Ana García-Martínez
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
| | | | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Cesáreo Fernández
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | | | | | | | | | | | - Manuel Salido Mota
- Servicio de Urgencias, Hospital Regional Universitario de Málaga, España
| | | | | | - Ferran Llopis
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central Asturias, Oviedo, España
| | | | | | | | | | | | | | | | | | | | | | - Òscar Miró
- Área de Urgencias, Hospital Clínico, IDIBAPS, Universidad de Barcelona, Barcelona, España
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Burillo-Putze G, Parra-Esquivel P, Aguiló S, Jiménez S, Jacob J, Piñera Salmerón P, Llorens P, García-Lamberechts EJ, Montero-Pérez FJ, Muñoz-Triano E, Gil-Rodrigo A, Fernández-Alonso C, Alquezar-Arbé A, Salido Mota M, Gil Hernández RJ, Pedraza García J, Cobos Requena A, Gargallo Garcia E, de Diego Arnaiz M, Iglesias Vela M, Pérez-Costa RA, Pérez Peñalva SDM, Valle Borrego B, Quero Motto E, Morales Franco B, Adroher Muñoz M, González Del Castillo J, Miró Ò. Study EDEN-12: Analysis of access to intensive care units of patients older than 65 years requiring emergency hospitalization. Med Intensiva 2023:S2173-5727(23)00068-1. [PMID: 37391317 DOI: 10.1016/j.medine.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To investigate the relationship between the age of an urgently hospitalized patient and his or her probability of admission to an intensive care unit (ICU). DESIGN Observational, retrospective, multicenter study. SETTING 42 Emergency Departments from Spain. TIME-PERIOD April 1-7, 2019. PATIENTS Patients aged ≥65 years hospitalized from Spanish emergency departments. INTERVENTIONS None. MAIN VARIABLES OF INTEREST ICU admission, age sex, comorbidity, functional dependence and cognitive impairment. RESULTS 6120 patients were analyzed (median age: 76 years; males: 52%. 309 (5%) were admitted to ICU (186 from ED, 123 from hospitalization). Patients admitted to the ICU were younger, male, and with less comorbidity, dependence and cognitive impairment, but there were no differences between those admitted from the ED and from hospitalization. The OR for ICU-admission adjusted by sex, comorbidity, dependence and dementia reached statistical significance >83 years (OR: 0.67; 95%CI: 0.45-0.49). In patients admitted to the ICU from ED, the OR did not begin to decrease until 79 years, and was significant >85 years (OR: 0.56, 95%CI: 0.34-0.92); while in those admitted to ICU from hospitalization, the decrease began 65 years of age, and were significant from 85 years (OR: 0.55, 95%CI: 0.30-0.99). Sex, comorbidity, dependency and cognitive deterioration of the patient did not modify the association between age and ICU-admission (overall, from the ED or hospitalization). CONCLUSIONS After taking into account other factors that influence admission to the ICU (comorbidity, dependence, dementia), the chances of admission to the ICU of older patients hospitalized on an emergency basis begin to decrease significantly after 83 years of age. There may be differences in the probability of admission to the ICU from the ED or from hospitalization according to age.
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Affiliation(s)
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | - Marta Iglesias Vela
- Servicio de Urgencias, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | - Eva Quero Motto
- Servicio de Urgencias, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - Belén Morales Franco
- Servicio de Urgencias, Hospital Universitario Lorenzo Guirao, Cieza, Murcia, Spain
| | - Maria Adroher Muñoz
- Servicio de Urgencias, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Miró Ò, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Jiménez S, Burillo-Putze G, Montero-Pérez FJ, Aguiló S, Gil-Rodrigo A, Fernández Alonso C, Alquézar-Arbé A, Parra-Esquivel P, Fortuny Bayarri MJ, González Tejera M, Millán Soria J, Cirera I, Adroher M, Martín Mojarro E, Gargallo García E, Valle B, Díaz Salado Á, Ruiz Grispán M, López Díez MP, Beddar Chaib F, Salido Mota M, Pedraza García J, Sánchez Sindín G, Juárez González R, Pérez Costa RA, Escudero Sánchez C, Prieto Zapico A, González Del Castillo J. Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort. Emergencias 2022; 34:418-427. [PMID: 36625691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe the sociodemographic characteristics of and the health care resources used to treat patients aged 65 years or older who come to hospital emergency departments (EDs) in Spain, according to age groups. MATERIAL AND METHODS We studied the phase-1 data for the EDEN cohort (Emergency Department and Elder Needs). Forty Spanish EDs collected data on all patients aged 65 years or older who were treated on the first 7 days in April 2019. We registered information on 6 sociodemographic and 5 function variables for all patients. For health resource use we used 6 diagnostic, 13 therapeutic, and 5 physical structural variables, for a total of 24 variables. Differences were analyzed according to age in blocks of 5 years. RESULTS A total of 18 374 patients with a median age of 78 years were included; 55% were women. Twenty-seven percent arrived by ambulance, 71% had not previously been seen by a physician, and 13% lived alone without assistance. Ten percent had a high level of functional dependence, and 14% had serious comorbidity. Resources used most often were blood analysis (in 60%) and radiology (59%), analgesics (25%), intravenous fluids (21%), antibiotics (14%), oxygen (13%), and bronchodilators (11%). Twenty-six percent were kept under observation in the ED, 26% were admitted to wards, and 2% were admitted to intensive care units (ICUs). The median stay in the ED was 3.5 hours, and the median hospital stay was 7 days. Sociodemographic characteristics changed according to age. Functional dependence worsened with age, and resource requirements increased in general. However, benzodiazepine use was unaffected, while the use of nonsteroidal anti-inflammatory drugs and ICU admission decreased. CONCLUSION The functional dependence of older patients coming to EDs increases with age and is associated with a high level of health care resource use, which also increases with age. Planners should take into consideration the characteristics of the older patients and the proportion of the caseload they represent when arranging physical spaces and designing processes for a specific ED.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Sònia Jiménez
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | | | | | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Adriana Gil-Rodrigo
- Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | - Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, España
| | - Aitor Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | | | - Javier Millán Soria
- Servicio de Urgencias, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Isabel Cirera
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - María Adroher
- Servicio de Urgencias, Hospital Doctor Josep Trueta, Girona, España
| | | | | | - Beatriz Valle
- Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Ángel Díaz Salado
- Servicio de Urgencias, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | | | | | | | - Manuel Salido Mota
- Servicio de Urgencias, Hospital Regional Universitario de Málaga, Málaga, España
| | - Jorge Pedraza García
- Servicio de Urgencias, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España
| | | | - Ricardo Juárez González
- Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
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García‐Lamberechts EJ, Miró Ò, Fragiel M, Llorens P, Jiménez S, Piñera P, Burillo‐Putze G, Martín A, Martín‐Sánchez FJ, Jacob J, Alquézar‐Arbé A, Ejarque Martínez L, Rodríguez Miranda B, Ruiz Grinspan M, Domínguez MJ, Teigell Muñoz FJ, Gayoso Martín S, García García Á, Iglesias Vela M, Carbajosa V, Salido Mota M, Marchena González MJ, Agüera Urbano C, Porta‐Etessam J, Calvo E, González del Castillo J. A case-control analysis of stroke in COVID-19 patients: Results of unusual manifestations of COVID-19-study 11. Acad Emerg Med 2021; 28:1236-1250. [PMID: 34490961 PMCID: PMC8653054 DOI: 10.1111/acem.14389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization. METHODS We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls. RESULTS We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively). CONCLUSIONS The incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.
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Affiliation(s)
| | - Òscar Miró
- Emergency Department Hospital ClínicIDIBAPSUniversity of Barcelona Barcelona Catalonia Spain
| | - Marcos Fragiel
- Emergency Department Hospital Clínico San CarlosIDISSCUnivesidad Complutense Madrid Spain
| | - Pere Llorens
- Emergency Department Hospital General de AlicanteUniversity Miguel Hernández Elche Alicante Spain
| | - Sònia Jiménez
- Emergency Department Hospital ClínicIDIBAPSUniversity of Barcelona Barcelona Catalonia Spain
| | | | | | - Alfonso Martín
- Emergency Department Hospital Universitario de Móstoles Móstoles, Madrid Spain
| | | | - Javier Jacob
- Emergency Department Hospital Universitari de Bellvitge Barcelona Catalonia Spain
| | - Aitor Alquézar‐Arbé
- Emergency Department Hospital de la Santa Creu i Sant Pau Barcelona Catalonia Spain
| | | | | | | | | | | | | | - Ángel García García
- Emergency Department Complejo Asistencial Universitario de Salamanca Salamanca Spain
| | | | - Virginia Carbajosa
- Emergency Department Hospital Universitario Rio Hortega Valladolid Spain
| | - Manuel Salido Mota
- Emergency Department Hospital Universitario Regional de Málaga Málaga Spain
| | | | | | - Jesus Porta‐Etessam
- Neurology Department Hospital Clínico San CarlosIDISSCUniversidad Complutense Madrid Spain
| | - Elpidio Calvo
- Internal Medicine Department Hospital Clínico San CarlosIDISSCUniversidad Complutense Madrid Spain
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Yañez MC, Mota MS, Ferrer MF, Julián-Jiménez A, Piñera P, Llopis F, Gamazo del Rio J, Martínez Ortiz de Zarate M, Estella Á, Martín-Sánchez FJ, González del Castillo J. [Comparison of different strategies for short-term death prediction in the infected older patient]. Rev Esp Quimioter 2019; 32:156-164. [PMID: 30808154 PMCID: PMC6441984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). METHODS We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed. RESULTS We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0.001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). CONCLUSIONS Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index.
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Affiliation(s)
| | - Manuel Salido Mota
- Servicio de Urgencias. Hospital Regional Universitario de Málaga. Málaga
| | - Manuel Fuentes Ferrer
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos. Facultad de Ciencias de la Salud, Universidad Alfonso X el Sabio, Madrid,Instituto de Investigación Sanitaria del Hospital San Carlos. Madrid, España
| | | | - Pascual Piñera
- Servicio de Urgencias. Hospital Universitario Reina Sofía. Murcia
| | - Ferrán Llopis
- Servicio de Urgencias. Hospital Universitario de Bellvitge. Barcelona
| | | | | | | | - Francisco Javier Martín-Sánchez
- Instituto de Investigación Sanitaria del Hospital San Carlos. Madrid, España,Servicio de Urgencias. Hospital Clínico San Carlos. Madrid
| | - Juan González del Castillo
- Instituto de Investigación Sanitaria del Hospital San Carlos. Madrid, España,Servicio de Urgencias. Hospital Clínico San Carlos. Madrid
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