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      Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia

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          Abstract

          Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

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          Most cited references46

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          The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

          Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
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            Acute respiratory distress syndrome: the Berlin Definition.

            The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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              Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

              To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                02 July 2019
                July 2019
                : 8
                : 7
                : 961
                Affiliations
                [1 ]Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
                [2 ]August Pi i Sunyer Biomedical Research Institute–IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
                [3 ]Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain
                [4 ]Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
                [5 ]Departments of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, 43121 Parma, Italy
                [6 ]Department of Surgical Sciences and Integrated Diagnostic, Policlinico San Martino, University of Genova, 16126 Genova, Italy
                [7 ]Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
                [8 ]Department of Anesthesia and Intensive Care, University of Milan, 20122 Milan, Italy
                [9 ]Infectious Diseases Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
                [10 ]Respiratory Department, Sotiria Chest Diseases Hospital, Mesogion 152, 11527 Athens, Greece
                [11 ]Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Cruciform Building, Gower St, London WC1E 6BT, UK
                Author notes
                [* ]Correspondence: catiacilloniz@ 123456yahoo.com (C.C.); atorres@ 123456clinic.cat (A.T.); Tel.: +34-93-227-5779 (A.T.); Fax: +34-93-227-9813 (A.T.)
                [†]

                These authors contributed equally to this study.

                Author information
                https://orcid.org/0000-0002-4646-9838
                https://orcid.org/0000-0001-8171-6673
                Article
                jcm-08-00961
                10.3390/jcm8070961
                6678833
                31269766
                ae9ee9b4-193d-489d-be13-c52c05bf9b0e
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 14 May 2019
                : 01 July 2019
                Categories
                Article

                sepsis,community-acquired pneumonia,very old,pneumonia
                sepsis, community-acquired pneumonia, very old, pneumonia

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