The Impact of Duration of Organ Dysfunction on the Outcome of Patients with Severe Sepsis and Septic Shock

OBJECTIVES: This study aimed to assess the impact of the duration of organ dysfunction on the outcome of patients with severe sepsis or septic shock. METHODS: Clinical data were collected from hospital charts of patients with severe sepsis and septic shock admitted to a mixed intensive care unit from November 2003 to February 2004. The duration of organ dysfunction prior to diagnosis was correlated with mortality. Results were considered significant if p<0.05. RESULTS: Fifty-six patients were enrolled. Mean age was 55.6 ± 20.7 years, mean APACHE II score was 20.6 ± 6.9, and mean SOFA score was 7.9 ± 3.7. Thirty-six patients (64.3%) had septic shock. The mean duration of organ dysfunction was 1.9 ± 1.9 days. Within the univariate analysis, the variables correlated with hospital mortality were: age (p=0.015), APACHE II (p=0.008), onset outside the intensive care unit (p=0.05), blood glucose control (p=0.05) and duration of organ dysfunction (p=0.0004). In the multivariate analysis, only a duration of organ dysfunction persisting longer than 48 hours correlated with mortality (p=0.004, OR: 8.73 (2.37-32.14)), whereas the APACHE II score remained only a slightly significant factor (p=0.049, OR: 1.11 (1.00-1.23)). Patients who received therapeutic interventions within the first 48 hours after the onset of organ dysfunction exhibited lower mortality (32.1% vs. 82.1%, p=0.0001). CONCLUSIONS: These findings suggest that the diagnosis of organ dysfunction is not being made in a timely manner. The time elapsed between the onset of organ dysfunction and initiation of therapeutic intervention can be quite long, and this represents an important determinant of survival in cases of severe sepsis and septic shock

The Amazon Epiphyte Network: A First Glimpse Into Continental-Scale Patterns of Amazonian Vascular Epiphyte Assemblages

Epiphytes are still an understudied plant group in Amazonia. The aim of this study was to identify distributional patterns and conservation priorities for vascular epiphyte assemblages (VEA) across Amazonia. We compiled the largest Amazonian epiphyte plot database to date, through a multinational collaborative effort of 22 researchers and 32 field sites located across four Amazonian countries – the Amazonian Epiphyte Network (AEN). We addressed the following continental-scale questions by utilizing the AEN database comprising 96,448 epiphyte individuals, belonging to 518 vascular taxa, and growing on 10,907 tree individuals (phorophytes). Our objectives here are, first, to present a qualitative evaluation of the geographic distribution of the study sites and highlight regional lacunae as priorities for future quantitative inventories. Second, to present the floristic patterns for Amazonia-wide VEA and third, to combine multivariate analyses and rank abundance curves, controlled by major Amazonian habitat types, to determine how VEA vary geographically and ecologically based on major Amazonian habitat types. Three of the most striking patterns found are that: (1) VEA are spatially structured as floristic similarity decays with geographic distance; (2) a core group of 22 oligarchic taxa account for more than a half of all individuals; and (3) extensive floristic sampling gaps still exist, mainly across the highly threatened southern Amazonian deforestation belt. This work represents a first step toward unveiling distributional pattern of Amazonian VEA, which is important to guide future questions on ecology and species distribution ranges of VEA once the collaborative database grows allowing a clearer view of patterns