Eric Jorge García-Lamberechts1, Francisco Javier Martín-Sánchez1, Agustín Julián-Jiménez2, Ferran Llopis3, Mikel Martínez-Ortiz de Zarate4, María Jesús Arranz-Nieto5, Félix González-Martínez6, Pascual Piñera Salmerón7, Carmen Navarro-Bustos8, Juan González-Del Castillo1. 1. Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España. 2. Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España. 3. Servicio de Urgencias, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España. 4. Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, España. 5. Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España. 6. Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, España. 7. Servicio de urgencias, Hospital Universitario Reina Sofía, Murcia, España. 8. Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, España.
Abstract
OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. RESULTS: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). CONCLUSION: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.
OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality. RESULTS: Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model). CONCLUSION: The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.
Entities:
Keywords:
Anciano; Elderly; Emergency department; Escala pronóstica; Infección; Infection; MEDS; Mortality in Emergency Department Sepsis (MEDS) score; Risk score; Sepsis; Systemic inflammatory response syndrome; Síndrome de respuesta inflamatoria sistémica; Urgencias
Authors: Juan González Del Castillo; Agustín Julián-Jiménez; Julio Javier Gamazo-Del Rio; Eric Jorge García-Lamberechts; Ferrán Llopis-Roca; Josep María Guardiola Tey; Mikel Martínez-Ortiz de Zarate; Carmen Navarro Bustos; Pascual Piñera Salmerón; Jesús Álvarez-Manzanares; María Del Mar Ortega Romero; Martin Ruiz Grinspan; Susana García Gutiérrez; Francisco Javier Martín-Sánchez; Francisco Javier Candel González Journal: Eur J Clin Microbiol Infect Dis Date: 2019-11-13 Impact factor: 3.267
Authors: J Villanueva; L Montes-Andujar; O V Baez-Pravia; E J García-Lamberechts; J González Del Castillo; A Ruiz; C Zurdo; J Barberán; J Menéndez; P Cardinal-Fernández Journal: Rev Esp Quimioter Date: 2020-08-05 Impact factor: 1.553
Authors: E Orviz; P Jerez-Fernández; M Suarez-Robles; C Ramos-Rey; I Armenteros; M Fernández-Revaldería; J González Del Castillo Journal: Rev Esp Quimioter Date: 2020-01-14 Impact factor: 1.553