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      Factores asociados a la mortalidad en pacientes con sepsis y choque séptico de la unidad de cuidados intensivos de adultos de un hospital de Paraguay Translated title: Factors associated with mortality in patients with sepsis and septic shock in the adult intensive care unit of a hospital in Paraguay

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          Abstract

          RESUMEN Introducción: la sepsis representa un problema de salud pública debido a su elevada mortalidad y la incidencia que va en aumento, en la cual se estima en 9% al año. Objetivo: analizar los factores asociados a la mortalidad en pacientes con sepsis y choque séptico del Servicio de cuidados intensivos adultos del Hospital Nacional, Itauguá, Paraguay, de enero 2019 a noviembre 2020. Sujetos y Métodos: estudio de casos y controles donde se incluyó a 57 pacientes (19 casos y 38 controles) con diagnóstico de sepsis y choque séptico. Resultados: se hallaron los siguientes factores de riesgo: edad mayor a 60 años (OR= 3,98; p≤0,05), patología de base (OR= 18; p≤0,05), internación mayor a 20 días (OR= 5,52; p≤0,05), choque séptico (OR= 6,42; p≤0,05), uso previo de antibióticos (OR= 0,45; p≥0,05), retraso en el inicio de la antibioticoterapia (OR= 2,80; p≥0,05), falla multiorgánica (OR= 9,44; p≤0,05), lactato elevado (OR= 1,54; p≥0,05), procalcitonina elevada (OR= 4,42; p≤0,05), PCR elevado (OR= 5,58; p≥0,05) y ventilación mecánica (OR= 6,42; p≥0,05). Conclusión: se asociaron de manera significativa a la mortalidad la edad mayor a 60 años, ser portador de patología de base, internación en terapia intensiva mayor a 20 días, ingresar con choque séptico y con falla multiorgánica.

          Translated abstract

          ABSTRACT Introduction: Sepsis represents a public health problem due to its high mortality and increasing incidence, with an increase of 9% estimated per year. Objective: To analyze the factors associated with mortality in sepsis and septic shock patients in the adult intensive care unit of the National Hospital of Itauguá from January 2019 to November 2020. Subjects and Methods: Observational, analytical study of cases and controls that included 57 patients (19 cases and 38 controls) diagnosed with sepsis and septic shock. Results: The following risk factors were found: Age over 60 years (OR = 3.98; p≤0.05), underlying pathology (OR = 18; p≤0.05), hospitalization greater than 20 days (OR = 5.52; p≤0.05), septic shock (OR = 6.42; p≤0.05), previous use of antibiotics (OR = 0.45; p≥0.05), delay in initiation of antibiotic therapy (OR = 2.80; p≥0.05), multiple organ failure (OR = 9.44; p≤0.05), elevated lactate (OR = 1.54; p≥0.05), elevated procalcitonin (OR = 4.42; p≤0.05), elevated CRP (OR = 5.58; p≥0.05) and mechanical ventilation (OR = 6.42; p≥0.05). Conclusion: Age over 60 years, being a carrier of an underlying pathology, hospitalization in intensive care for more than 20 days, entering septic shock, and admission with multiorgan failure were significantly associated with mortality.

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          Most cited references 33

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          The immunopathogenesis of sepsis in elderly patients.

          Prominent among the numerous events that contribute to the enhanced susceptibility of elderly patients to infection is the decline of immune function that accompanies aging. Elderly patients experience a marked decline in cell-mediated immune function and reduced humoral immune function. Age-dependent defects in T and B cell function are readily demonstrable in elderly patients, yet the essential elements of innate immunity are remarkably well preserved. The cytokine and chemokine signaling networks are altered in elderly patients and tends to favor a type 2 cytokine response over type 1 cytokine responses. The induction of proinflammatory cytokines after septic stimuli is not adequately controlled by anti-inflammatory mechanisms in elderly persons. This immune dysregulation is accompanied by a more pronounced procoagulant state in older patients. These molecular events function in concert to render elderly patients at excess risk for mortality from severe sepsis and septic shock.
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            Características y evolución de los pacientes que ingresan a una Unidad de Cuidados Intensivos de un hospital público

            The epidemiology of critical patients in Chile could differ from that reported in international studies.
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              Quality of Life of Severe Sepsis Survivors After Hospital Discharge

              AIMS: to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD: This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS: The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS: After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.
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                Author and article information

                Journal
                spmi
                Revista Virtual de la Sociedad Paraguaya de Medicina Interna
                Rev. virtual Soc. Parag. Med. Int.
                Sociedad Paraguaya de Medicina Interna (Asunción, , Paraguay )
                2312-3893
                September 2021
                : 8
                : 2
                : 44-56
                Affiliations
                Encarnación Itapúa orgnameUniversidad Nacional de Itapúa Paraguay
                Article
                S2312-38932021000200044 S2312-3893(21)00800200044
                10.18004/rvspmi/2312-3893/2021.08.02.44
                d09226bd-390d-4b28-9d65-2f7bf92202a4

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 13
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