Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients

Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.Fundacao de Amparo a Pesquisa do Estado de Sao PauloFederal University of São Paulo Department of Anesthesiology Pain and Critical CareLatin American Sepsis InstituteFederal University of São Paulo Department of Infectious DiseasesSírio Libanês Hospital Intensive Care UnitHospital Israelita Albert Einstein Intensive Care UnitUNIFESP, Department of Anesthesiology Pain and Critical CareUNIFESP, Department of Infectious DiseasesSciEL

Brazilian Sepsis Epidemiological Study (BASES study)

INTRODUCTION: Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome METHODS: This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used. RESULTS: For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract. CONCLUSION: Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate

Analogs of Asp f 1 (mitogillin, alfa-sarcin and restrictocin) on the diagnosis and stage assessment of Allergic Bronchopulmonary Aspergillosis

A Aspergilose Broncopulmonar alérgica (ABPA) é uma doença complexa,desencadeada por uma reação de hipersensibilidade ao Aspergillus fumigatus, que apresenta vários estágios, sendo que no estágio mais grave, os pacientes apresentam bronquiectasias. O diagnóstico da doença é difícil e o maior problema é a falta de antígenos padronizados necessários para a determinação de anticorpos específicos. O objetivo do presente estudo é avaliar se os testes cutâneos com os análogos de Asp f 1 podem auxiliar no diagnóstico e no estadiamento da ABPA. Três grupos de pacientes classificados por testes sorológicos foram obtidos a saber 20 ABPA (16BQ+; 4BQ-), 25 possíveis -ABPA (14BQ+;11BQ-) e 24 asmáticos sem ABPA (11BQ+;13BQ-). Fizeram parte do estudo 10 pessoas sem asma . Todos foram submetidos a testes intradérmicos com três antígenos a-sarcina, mitogilina e estrictocina.Houve uma intensa reação a todos os antígenos e as reações produzidas foram semelhantes para os três antígenos. As reações de leitura tardia positivas à mitogilina foram biopsiadas. As biopsias de 2 (12,5%) dos pacientes BQ+ do grupo ABPA e 5 do grupo ABPA possível com BQ+ (35,6%) mostraram vasculite por depósito de imunocomplexos. 11 pacientes do terceiro grupo não apresentaram vasculite. O quarto grupo não apresentou reação tardia. Todos os pacientes com reação positiva apresentaram BQ+. alfa-sarcina, a mitogilina e a restrictocina diferenciaram pacientes com ABPA por testes intradérmicos e podem ser aplicados no diagnóstico da doença. A maior incidência de bronquiectasias foi encontrada no primeiro grupo (80%) e no segundo (56%). No terceiro grupo nenhum caso foi encontrado em 23 pacientes com asma e teste ID positivo ao aspergillus fumigatus todos os pacientes com vasculite tinham bronquiectasia. Há possibilidade de que as lesões produzidas nos pulmões sejam produzidas por vasculite.Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex disease, triggered by a hypersensitivity reaction to Aspergillus fumigatus. The disease diagnosis is difficult, and a major problem is the lack of standardized allergens for the determination of specific antibodies. The aim of the present study is to evaluate if intradermal (ID) tests with analogs of Asp f 1 can aid in the diagnosis and stage assessment of abpa. Three groups of patients classified by serological tests were obtained. 20 ABPA (16BQ+; 4BQ-), 25 possible-ABPA (14BQ+; 11BQ-), 24 asthmatic-ABPAfree (11BQ+; 13BQ-) and 10 asthma-free people were submitted to id tests with three antigens: mitogillin, a-sarcin and restrictocin. There was intense reaction to all three antigens and the response was similar. The positive reactions to mitogillin were biopsied. The skin biopsies of two (12,5%) bq+ patients of the first group and 5 BQ+ (35,6%) patients of the second one showed vasculitis by immune complexes (IC) deposition. 11 patients of the third group had negative biopsies. The fourth group didn\'t have late-reaction. All patients with positive reaction were BQ+. By ID test, alfa-sarcin, mitogillin and restrictocin could differentiate patients with abpa and can be applicable in disease diagnosis. The higher incidence of bronchiectasis was found in the first (80%) and second (56%) groups. In the third group, IC wasn\'t found in 23 asthma patients and id test was positive to A. fumigatus. All patients with vasculitis by IC had bronchiectasis. Therefore, the results indicate that this kind of pulmonary lesion is caused by vasculitis