Prehospital troponin as a predictor of early clinical deterioration

Producción CientíficaAntecedentes y objetivos Los valores elevados de la troponina T (cTnT) se asocian a comorbilidades y a mortalidad temprana, en enfermedades cardiovasculares y noncardiovascular. El objetivo de este estudio es evaluar la exactitud pronóstica de la utilización única de la troponina cardíaca T del punto de atención prehospital para identificar el riesgo de deterioro prehospital del hospital, incluyendo mortalidad en el plazo de 28 días. Métodos Se realizó un estudio prospectivo, multicéntrico, controlado, basado en ambulancias, observacional en adultos con enfermedades agudas transferidos con alta prioridad en ambulancia a los departamentos de emergencia, entre el 1 de enero y el 30 de septiembre de 2020. Excluyeron a los pacientes con diagnosis del hospital del síndrome coronario agudo. El poder discriminativo de la cTnT predictiva fue evaluado a través de un modelo de discriminación entrenado utilizando una cohorte de derivación y evaluado por el área bajo la curva de la característica operativa del receptor en una cohorte de validación. Resultados Un total de 848 pacientes fueron incluidos en nuestro estudio. La edad media era de 68 años (percentiles 25º-75º: 50-81 años), y 385 (45,4%) eran mujeres. La tasa de mortalidad en 28 días fue del 12,4% (156 casos). La capacidad predictiva de la cTnT para predecir la mortalidad presentó un área por debajo de la curva de 0,903 (IC95%: 0,85-0,954; P < .001). Se realizó estratificación del riesgo, resultando en tres categorías con los siguientes puntos de corte óptimos de cTnT: alto riesgo mayor o igual a 100, riesgo intermedio 40-100 y bajo riesgo menor a 40 ng/L. En el grupo de alto riesgo, la tasa de mortalidad fue de 61,7%, y por el contrario, el grupo de bajo riesgo presentó una mortalidad de 2,3%. Conclusiones La implementación de una determinación rutinaria de cTnT en la ambulancia en pacientes transferidos con alta prioridad al servicio de urgencias puede ayudar a estratificar el riesgo de estos pacientes y a detectar un deterioro clínico temprano desconocido.Background and Objectives: Elevated troponin T (cTnT) values are associated with comorbidities and early mortality, in both cardiovascular and noncardiovascular diseases. The objective of this study is to evaluate the prognostic accuracy of the sole utilization of prehospital point-of-care cardiac troponin T to identify the risk of early in-hospital deterioration, including mortality within 28 days. Methods: We conducted a prospective, multicentric, controlled, ambulance-based, observational study in adults with acute diseases transferred with high priority by ambulance to emergency departments, between 1 January and 30 September 2020. Patients with hospital diagnosis of acute coronary syndrome were excluded. The discriminative power of the predictive cTnT was assessed through a discrimination model trained using a derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on a validation cohort. Results: A total of 848 patients were included in our study. The median age was 68 years (25th-75th percentiles: 50-81 years), and 385 (45.4%) were women. The mortality rate within 28 days was 12.4% (156 cases). The predictive ability of cTnT to predict mortality presented an area under the curve of 0.903 (95% CI: 0.85-0.954; P < .001). Risk stratification was performed, resulting in three categories with the following optimal cTnT cut-off points: high risk greater than or equal to 100, interme diate risk 40-100 and low risk less than 40 ng/L. In the high-risk group, the mortality rate was 61.7%, and on the contrary, the low-risk group presented a mortality of 2.3%. Conclusions: The implementation of a routine determination of cTnT on the am bulance in patients transferred with high priority to the emergency department can help to stratify the risk of these patients and to detect unknown early clinical deterioration.Gerencia Regional de Salud de Castilla y León (España), Grant Number [GRS 1678/A/18] and Grant Number [GRS 1903/A/19

Blood Biomarkers for Assessing Headaches in Healthcare Workers after Wearing Biological Personal Protective Equipment in a COVID-19 Field Hospital

The coronavirus disease 2019 (COVID-19) has led to a pandemic, which among other things, has highlighted biosafety as a key cornerstone in the management of disease transmission. The aim of this work was to analyze the role played by different blood biomarkers in predicting the appearance of headaches in healthcare workers wearing personal protective equipment (PPE) in a COVID-19 treatment unit. A prospective cohort study of 38 healthcare workers was performed during April 2020. Blood analysis, performed just before the start of a 4 hour shift, was carried out on all volunteers equipped with PPE. At the end of their shifts and after decontamination, they were asked if they had suffered from headache in order to obtain a binary outcome. The baseline creatinine value reflected a specific odds ratio of 241.36 (95% CI: 2.50&ndash;23,295.43; p = 0.019) and an area under the curve (AUC) value of 0.737 (95%CI: 0.57&ndash;0.90; p &lt; 0.01). Blood creatinine is a good candidate for predicting the appearance of a de novo headache in healthcare workers after wearing PPE for four hours in a COVID-19 unit

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Background: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. Materials and methods: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). Results: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. Conclusions: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.Fil: Martín Rodríguez, Francisco. Universidad de Valladolid; España. Paseo Hospital Militar; EspañaFil: López Izquierdo, Raúl. Universidad de Valladolid; España. Hospital Universitario Rio Hortega; EspañaFil: Medina Lozano, Elena. Universidad de Valladolid; EspañaFil: Ortega, Guillermo José. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Autonoma de Madrid. Hospital Universitario de la Princesa; EspañaFil: del Pozo Vegas, Carlos. Hospital Clínico Universitario; EspañaFil: Carbajosa Rodríguez, Virginia. Hospital Universitario Rio Hortega; EspañaFil: Castro Villamor, Miguel Ángel. Universidad de Valladolid; EspañaFil: Sánchez Soberon, Irene. Paseo Hospital Militar; EspañaFil: Sanz García, Ancor. Universidad Autonoma de Madrid. Hospital Universitario de la Princesa; Españ

Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments