Nível de agudização, gravidade e intensidade do cuidado de adultos e idosos na admissão em Unidade de Terapia Intensiva

Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults

Evaluation of score performance for prognostic evaluation in patients diagnosed with cirrhosis and sepsis in a tertiary hospital

Objetivo: comparar os escores em termo de desempenho para os desfechos de óbito, reinternação hospitalar, internação em unidade de terapia intensiva e desenvolvimento de disfunção orgânica. Descrever a frequência de necessidade de intubação, uso de drogas vasoativas, terapias substitutivas nas primeiras 24 horas de identificação da sepse em pacientes com cirrose hepática e sepse. Avaliar a adequação da abertura de protocolo de sepse nesse grupo de pacientes. Métodos: estudo realizado em hospital terciário no estado de São Paulo especializado em transplantes, trata-se de um estudo transversal, observacional e retrospectivo de portadores de cirrose hepática que receberam diagnóstico de sepse no período de janeiro de 2016 a dezembro de 2019. Foram avaliados os desempenhos dos escores MEWS, SOFA, CLIF-SOFA, ACLF e MELD para a identificação dos desfechos primários e secundários do estudo. Resultados: no período estudado foram identificados 191 casos de sepse em portadores de cirrose hepática, sendo 144 pacientes elegíveis para este estudo. Predominou o sexo masculino com idade mediana de 60 anos de idade. As etiologias relacionadas ao uso de álcool e hepatite C foram as mais encontradas nessa população (39,6% e 25%). O total de óbito ocorreu em 95 pacientes (66%). O instrumento MEWS não demonstrou desempenho significativa para este desfecho (0,042), embora SOFA, CLIF-SOFA, ACLF e MELD possuíram desempenho estatisticamente significativa (< 0,005). Na predição de reinternação, os instrumentos SOFA, CLIF-SOFA, ACLF e MELD apresentaram diferença estatística. A identificação da necessidade de assistência em terapia intensiva foi prevista pelos instrumentos SOFA, CLIF-SOFA e MELD. O uso de assistências avançadas foi presente em mais da metade da amostra, sendo cateter venosa central 40,3%, intubação 31,9% e terapia renal substitutiva 13,9%. Nesta amostra 83,7% dos pacientes que morreram, não tiveram seus protocolos abertos adequadamente. Conclusão: o instrumento MEWS de detecção precoce para deterioração clinica não apresentou bom desempenho para desfechos de óbito e necessidade de terapia intensiva neste grupo. Os instrumentos com melhor desempenho foram os que avaliam especificamente aspectos de doenças graves do fígado o que corrobora com a necessidade de novos estudos para validação de instrumentos específicos para a vigilância de deterioração clínica por sepse esta população. O estudo reforçou a baixa adequação de abertura de protocolo sepse nessa população, sugerindo urgentes medidas educacionais.Objective: to compare performance scores for the outcomes of death, hospital readmission, intensive care unit admission and development of organ dysfunction. To describe the frequency of need for intubation, use of vasoactive drugs, substitutive therapies in the first 24 hours of sepsis identification in patients with liver cirrhosis and sepsis. To assess the adequacy of opening a sepsis protocol in this group of patients. Methods: a study carried out in a tertiary hospital in the state of São Paulo specialized in transplants, this is a cross-sectional, observational and retrospective study of patients with liver cirrhosis who were diagnosed with sepsis from January 2016 to December 2019. the performances of the MEWS, SOFA, CLIF-SOFA, CLIF C ACLF and MELD scores for the identification of primary and secondary study outcomes. Results: in the period studied, 191 cases of sepsis were identified in patients with liver cirrhosis, with 144 patients being eligible for this study. There was a predominance of males with a median age of 60 years old. Etiologies related to alcohol use and hepatitis C were the most common in this population (39.6% and 25%). The total number of deaths occurred in 95 patients (66%). The MEWS instrument showed no significant performance for this outcome (0.042), although SOFA, CLIF-SOFA, CLIF C ACLF and MELD had statistically significant performance (< 0.005). In the prediction of rehospitalization, the SOFA, CLIF-SOFA, CLIF C ACLF and MELD instruments showed statistical difference. The identification of the need for assistance in intensive care was predicted by the SOFA, CLIF-SOFA and MELD instruments. The use of advanced assistance was present in more than half of the sample, with central venous catheter 40.3%, intubation 31.9% and renal replacement therapy 13.9%. In this sample, 83.7% of patients who died did not have their protocols properly opened. Conclusion: the MEWS tool for early detection of clinical deterioration did not perform well for the outcomes of death and need for intensive care in this group. The instruments with the best performance were those that specifically assess aspects of severe liver disease, which corroborates the need for further studies to validate specific instruments for monitoring clinical deterioration due to sepsis in this population. The study reinforced the low adequacy of opening a sepsis protocol in this population, suggesting urgent educational measures.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Level of acuity, severity and intensity of care of adults and older adults admitted to the Intensive Care Unit

ABSTRACT Objective: To characterize the level of acuity, severity and intensity of care of adults and older adults admitted to Intensive Care Units and to identify the predictors of severity with their respective predictive capacity according to the age group. Method: A retrospective cohort based on the analysis of medical records of individuals admitted to eight adult intensive care units in the city of São Paulo. The clinical characteristics at admission in relation to severity profile and intensity of care were analyzed through association and correlation tests. The predictors were identified by linear regression and the predictive capacity through the ROC curve. Results: Of the 781 cases (41.1% from older adults), 56.2% were males with a mean age of 54.1 ± 17.3 years. The burden of the disease, the organic dysfunction and the number of devices were the predictors associated with greater severity among adults and older adults, in which the organic dysfunction had the highest predictive capacity (80%) in both groups. Conclusion: Adults and older adults presented a similar profile of severity and intensity of care in admission to the Intensive Care Unit. Organic dysfunction was the factor with the best ability to predict severity in adults and older adults