Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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Factor de impacto 2021
5.345
1er cuartil (5 de 32)
Emergency Medicine
Resumen
< VolverInfection and systemic inflammatory response syndrome in older patients in the emergency department: a 30-day risk model
García-Lamberechts EJ, Martín-Sánchez FJ, Julián Jiménez A, Llopis F, Martínez Ortiz de Zárate M, Arranz Nieto MJ, González Martínez F, Piñera Salmerón P, Navarro Bustos C, González Del Castillo J
Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, Spain. Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain. Servicio de Urgencias, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, Spain. Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain. Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, Spain. Servicio de urgencias, Hospital Universitario Reina Sofía, Murcia, Spain. Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, Spain.
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.
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.
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