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Review Article08-08-2022
Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
- Arnaldo Dubin
, - Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande , [ ... ],
- Ariel Bardach
Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views48See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
Views48
Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views48See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
- Arnaldo Dubin
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Original Article08-08-2022
Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study
- Carla Daniele Nascimento Pontes ,
- Juliane Lúcia Gomes da Rocha ,
- Janaina Maria Rodrigues Medeiros ,
- Bruno Fernando Barros dos Santos ,
- Paulo Henrique Monteiro da Silva , [ ... ],
- Rosana Maria Feio Libonati
Abstract
Original ArticleLow T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study
Revista Brasileira de Terapia Intensiva. 2022;34(2):262-271
DOI 10.5935/0103-507X.20220024-en
- Carla Daniele Nascimento Pontes ,
- Juliane Lúcia Gomes da Rocha ,
- Janaina Maria Rodrigues Medeiros ,
- Bruno Fernando Barros dos Santos ,
- Paulo Henrique Monteiro da Silva ,
- Janine Maria Rodrigues Medeiros ,
- Gabriela Góes Costa ,
- Isabella Mesquita Sfair Silva ,
- Daniel Libonati Gomes ,
- Flávia Marques Santos ,
- Rosana Maria Feio Libonati
Views44ABSTRACT
Objective:
To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.
Methods:
This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.
Results:
Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).
Conclusion:
The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.
Keywords:critical careEuthyroid sick syndromeintensive care unitsmortalityprognosisTriiodothyronineTriiodothyronine, reverseSee moreViews44Abstract
Original ArticleLow T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study
Revista Brasileira de Terapia Intensiva. 2022;34(2):262-271
DOI 10.5935/0103-507X.20220024-en
- Carla Daniele Nascimento Pontes ,
- Juliane Lúcia Gomes da Rocha ,
- Janaina Maria Rodrigues Medeiros ,
- Bruno Fernando Barros dos Santos ,
- Paulo Henrique Monteiro da Silva ,
- Janine Maria Rodrigues Medeiros ,
- Gabriela Góes Costa ,
- Isabella Mesquita Sfair Silva ,
- Daniel Libonati Gomes ,
- Flávia Marques Santos ,
- Rosana Maria Feio Libonati
Views44ABSTRACT
Objective:
To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.
Methods:
This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.
Results:
Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).
Conclusion:
The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.
Keywords:critical careEuthyroid sick syndromeintensive care unitsmortalityprognosisTriiodothyronineTriiodothyronine, reverseSee more
- Carla Daniele Nascimento Pontes
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Original Article08-08-2022
Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
- Bárbara Vieira Carneiro ,
- Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Abstract
Original ArticleComparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Revista Brasileira de Terapia Intensiva. 2022;34(2):220-226
DOI 10.5935/0103-507X.20220019-en
- Bárbara Vieira Carneiro ,
- Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Views41ABSTRACT
Objective:
To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.
Methods:
We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing.
Results:
We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.
Conclusion:
Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
Keywords:critical illnessDecision MakingDelivery of health careHospitalizationintensive care unitsInternship and residencymortalityprognosisSee moreViews41Abstract
Original ArticleComparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Revista Brasileira de Terapia Intensiva. 2022;34(2):220-226
DOI 10.5935/0103-507X.20220019-en
- Bárbara Vieira Carneiro ,
- Lucas Lonardoni Crozatti ,
- Pedro Vitale Mendes ,
- Antonio Paulo Nassar Júnior ,
- Leandro Utino Taniguchi
Views41ABSTRACT
Objective:
To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.
Methods:
We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing.
Results:
We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.
Conclusion:
Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
Keywords:critical illnessDecision MakingDelivery of health careHospitalizationintensive care unitsInternship and residencymortalityprognosisSee more
- Bárbara Vieira Carneiro
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Original Article06-24-2022
High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study
- John Sprockel ,
- Anggie Murcia ,
- Juan Rincon ,
- Katherine Berrio ,
- Marisol Bejarano , [ ... ],
- Jhon Parra
Abstract
Original ArticleHigh-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study
Revista Brasileira de Terapia Intensiva. 2022;34(1):124-130
DOI 10.5935/0103-507X.20220006-en
- John Sprockel ,
- Anggie Murcia ,
- Juan Rincon ,
- Katherine Berrio ,
- Marisol Bejarano ,
- Zulima Santofimio ,
- Hellen Cárdenas ,
- Diego Hernández ,
- Jhon Parra
Views43ABSTRACT
Objective:
The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care.
Methods:
A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality.
Results:
A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12.
Conclusion:
Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.
Keywords:Coronavirus infectionsCOVID-19critical caremortalityReverse transcriptase polymerase chain reactionTroponinSee moreViews43Abstract
Original ArticleHigh-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study
Revista Brasileira de Terapia Intensiva. 2022;34(1):124-130
DOI 10.5935/0103-507X.20220006-en
- John Sprockel ,
- Anggie Murcia ,
- Juan Rincon ,
- Katherine Berrio ,
- Marisol Bejarano ,
- Zulima Santofimio ,
- Hellen Cárdenas ,
- Diego Hernández ,
- Jhon Parra
Views43ABSTRACT
Objective:
The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care.
Methods:
A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality.
Results:
A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12.
Conclusion:
Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.
Keywords:Coronavirus infectionsCOVID-19critical caremortalityReverse transcriptase polymerase chain reactionTroponinSee more
- John Sprockel
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Original Article01-24-2021
Correlation between syndecan-1 level and PELOD-2 score and mortality in pediatric sepsis
Revista Brasileira de Terapia Intensiva. 2021;33(4):549-556
Abstract
Original ArticleCorrelation between syndecan-1 level and PELOD-2 score and mortality in pediatric sepsis
Revista Brasileira de Terapia Intensiva. 2021;33(4):549-556
DOI 10.5935/0103-507X.20210083
Views73See moreABSTRACT
Objective:
To analyze the correlation between glycocalyx disruption measured via the serum syndecan-1 level and organ dysfunctions assessed by the PELOD-2 score and to evaluate its association with mortality in pediatric sepsis.
Methods:
We performed a prospective observational study in a tertiary public hospital. Sixty-eight pediatric patients diagnosed with sepsis according to International Pediatric Sepsis Consensus Conference criteria were consecutively recruited. We performed measurements of day 1 and day 5 serum syndecan-1 levels and PELOD-2 score components. Patients were followed up to 28 days following sepsis diagnosis.
Results:
Overall, the syndecan-1 level was increased in all subjects, with a significantly higher level among septic shock patients (p = 0.01). The day 1 syndecan-1 level was positively correlated with the day 1 PELOD-2 score with a correlation coefficient of 0.35 (p = 0.003). Changes in syndecan-1 were positively correlated with changes in the PELOD-2 score, with a correlation coefficient of 0.499 (p < 0.001) during the first five days. Using the cutoff point of day 1 syndecan-1 ≥ 430ng/mL, organ dysfunction (PELOD-2 score of ≥ 8) could be predicted with an AUC of 74.3%, sensitivity of 78.6%, and specificity of 68.5% (p = 0.001).
Conclusion:
The day 1 syndecan-1 level was correlated with the day 1 PELOD-2 score but not 28-day mortality. Organ dysfunction (PELOD-2 ≥ 8) could be predicted by the syndecan-1 level in the first 24 hours of sepsis, suggesting its significant pathophysiological involvement in sepsis-associated organ dysfunction.
Views73Abstract
Original ArticleCorrelation between syndecan-1 level and PELOD-2 score and mortality in pediatric sepsis
Revista Brasileira de Terapia Intensiva. 2021;33(4):549-556
DOI 10.5935/0103-507X.20210083
Views73See moreABSTRACT
Objective:
To analyze the correlation between glycocalyx disruption measured via the serum syndecan-1 level and organ dysfunctions assessed by the PELOD-2 score and to evaluate its association with mortality in pediatric sepsis.
Methods:
We performed a prospective observational study in a tertiary public hospital. Sixty-eight pediatric patients diagnosed with sepsis according to International Pediatric Sepsis Consensus Conference criteria were consecutively recruited. We performed measurements of day 1 and day 5 serum syndecan-1 levels and PELOD-2 score components. Patients were followed up to 28 days following sepsis diagnosis.
Results:
Overall, the syndecan-1 level was increased in all subjects, with a significantly higher level among septic shock patients (p = 0.01). The day 1 syndecan-1 level was positively correlated with the day 1 PELOD-2 score with a correlation coefficient of 0.35 (p = 0.003). Changes in syndecan-1 were positively correlated with changes in the PELOD-2 score, with a correlation coefficient of 0.499 (p < 0.001) during the first five days. Using the cutoff point of day 1 syndecan-1 ≥ 430ng/mL, organ dysfunction (PELOD-2 score of ≥ 8) could be predicted with an AUC of 74.3%, sensitivity of 78.6%, and specificity of 68.5% (p = 0.001).
Conclusion:
The day 1 syndecan-1 level was correlated with the day 1 PELOD-2 score but not 28-day mortality. Organ dysfunction (PELOD-2 ≥ 8) could be predicted by the syndecan-1 level in the first 24 hours of sepsis, suggesting its significant pathophysiological involvement in sepsis-associated organ dysfunction.
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Original Article10-25-2021
SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker
- Valeska Fernandes Pasinato ,
- Oellen Stuani Franzosi ,
- Sérgio Henrique Loss ,
- Diego Silva Leite Nunes,
- Kelly Carraro Foletto, [ ... ],
- Silvia Regina Rios Vieira
Abstract
Original ArticleSAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker
Revista Brasileira de Terapia Intensiva. 2021;33(3):394-400
DOI 10.5935/0103-507X.20210064
- Valeska Fernandes Pasinato ,
- Oellen Stuani Franzosi ,
- Sérgio Henrique Loss ,
- Diego Silva Leite Nunes,
- Kelly Carraro Foletto,
- Gabriela Soranço Salazar,
- Silvia Regina Rios Vieira
Views82ABSTRACT
Objective:
To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction.
Methods:
This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss’ Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve.
Results:
The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001).
Conclusion:
The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.
Keywords:APACHEcritical caremortalitynutritional assessmentSeverity of illness indexSimplified acute physiology scoreSee moreViews82Abstract
Original ArticleSAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker
Revista Brasileira de Terapia Intensiva. 2021;33(3):394-400
DOI 10.5935/0103-507X.20210064
- Valeska Fernandes Pasinato ,
- Oellen Stuani Franzosi ,
- Sérgio Henrique Loss ,
- Diego Silva Leite Nunes,
- Kelly Carraro Foletto,
- Gabriela Soranço Salazar,
- Silvia Regina Rios Vieira
Views82ABSTRACT
Objective:
To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction.
Methods:
This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss’ Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve.
Results:
The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001).
Conclusion:
The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.
Keywords:APACHEcritical caremortalitynutritional assessmentSeverity of illness indexSimplified acute physiology scoreSee more
- Valeska Fernandes Pasinato
-
Original Article07-05-2021
Association of uteroglobin-related protein 1 with smoke inhalation injury severity
- Sabrina Frighetto Henrich,
- Tatiana Helena Rech ,
- Cristiane Ritter,
- Monique Michels ,
- Felipe Dal-Pizzol , [ ... ],
- Gilberto Friedman
Abstract
Original ArticleAssociation of uteroglobin-related protein 1 with smoke inhalation injury severity
Revista Brasileira de Terapia Intensiva. 2021;33(2):276-281
DOI 10.5935/0103-507X.20210035
- Sabrina Frighetto Henrich,
- Tatiana Helena Rech ,
- Cristiane Ritter,
- Monique Michels ,
- Felipe Dal-Pizzol ,
- Gilberto Friedman
Views67See moreABSTRACT
Objective:
To evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients.
Methods:
Smoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay.
Results:
The mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007).
Conclusion:
Plasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.
Views67Abstract
Original ArticleAssociation of uteroglobin-related protein 1 with smoke inhalation injury severity
Revista Brasileira de Terapia Intensiva. 2021;33(2):276-281
DOI 10.5935/0103-507X.20210035
- Sabrina Frighetto Henrich,
- Tatiana Helena Rech ,
- Cristiane Ritter,
- Monique Michels ,
- Felipe Dal-Pizzol ,
- Gilberto Friedman
Views67See moreABSTRACT
Objective:
To evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients.
Methods:
Smoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay.
Results:
The mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007).
Conclusion:
Plasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.
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Original Article07-05-2021
Driving pressure and mortality in trauma without acute respiratory distress syndrome: a prospective observational study
Revista Brasileira de Terapia Intensiva. 2021;33(2):261-265
Abstract
Original ArticleDriving pressure and mortality in trauma without acute respiratory distress syndrome: a prospective observational study
Revista Brasileira de Terapia Intensiva. 2021;33(2):261-265
DOI 10.5935/0103-507X.20210033
Views72ABSTRACT
Objective:
To identify the possible association between driving pressure and mechanical power values and oxygenation index on the first day of mechanical ventilation with the mortality of trauma patients without a diagnosis of acute respiratory distress syndrome.
Methods:
Patients under pressure-controlled or volume-controlled ventilation were included, with data collection 24 hours after orotracheal intubation. Patient follow-up was performed for 30 days to obtain the clinical outcome. The patients were admitted to two intensive care units of the Hospital de Pronto Socorro de Porto Alegre from June to September 2019.
Results:
A total of 24 patients were evaluated. Driving pressure, mechanical power and oxygenation index were similar among patients who survived and those who died, with no statistically significant difference between groups.
Conclusion:
Driving pressure, mechanical power and oxygenation index values obtained on the first day of mechanical ventilation were not associated with mortality of trauma patients without acute respiratory distress syndrome.
Keywords:critical careintensive care unitsmortalityRespiration, artificialRespiratory distress syndrome, adultrespiratory mechanicstraumaSee moreViews72Abstract
Original ArticleDriving pressure and mortality in trauma without acute respiratory distress syndrome: a prospective observational study
Revista Brasileira de Terapia Intensiva. 2021;33(2):261-265
DOI 10.5935/0103-507X.20210033
Views72ABSTRACT
Objective:
To identify the possible association between driving pressure and mechanical power values and oxygenation index on the first day of mechanical ventilation with the mortality of trauma patients without a diagnosis of acute respiratory distress syndrome.
Methods:
Patients under pressure-controlled or volume-controlled ventilation were included, with data collection 24 hours after orotracheal intubation. Patient follow-up was performed for 30 days to obtain the clinical outcome. The patients were admitted to two intensive care units of the Hospital de Pronto Socorro de Porto Alegre from June to September 2019.
Results:
A total of 24 patients were evaluated. Driving pressure, mechanical power and oxygenation index were similar among patients who survived and those who died, with no statistically significant difference between groups.
Conclusion:
Driving pressure, mechanical power and oxygenation index values obtained on the first day of mechanical ventilation were not associated with mortality of trauma patients without acute respiratory distress syndrome.
Keywords:critical careintensive care unitsmortalityRespiration, artificialRespiratory distress syndrome, adultrespiratory mechanicstraumaSee more
mortality Archives - Critical Care Science (CCS)
