30). A média do escore Acute Physiologic Chronic Heatlh Evaluation II (APACHE II) foi de 15,0 ± 8,1. A mortalidade na unidade de terapia intensiva foi de 39,7%. Os principais fatores associados a essa mortalidade foram exame positivo no teste RT-PCR, níveis baixos de relação PaO2/FiO2 inicial, níveis elevados de uréia e desidrogenase lática iniciais, nível de pressão expiratória final positiva necessária, necessidade de posição prona e de drogas vasopressoras. CONCLUSÕES: Pacientes admitidos em unidades de terapia intensiva com infecção por vírus A(H1N1) apresentaram alto risco de óbito, particularmente devidos ao comprometimento respiratório. O exame RT-PCR positivo, níveis de uréia e de desidrogenase láctica, além baixa PaO2/FiO2 e necessidades de PEEP alta, foram relacionados com uma maior mortalidade.]]>
Accurate detection of Alzheimer's disease (AD) is of considerable clinical importance. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) is the current research standard for evaluating the quality of studies that validate diagnostic tests; however, its own construct validity has not yet been evaluated empirically. Our aim was to evaluate how well the proposed QUADAS-2 items and its domains converge to indicate the study quality criteria. This study applies confirmatory factor analysis to determine whether a measurement model would be consistent with meta-analytic data. Cochrane meta-analyses assessing the accuracy of AD diagnostic tests were identified. The seven ordinal QUADAS-2 items, intended to inform study quality based on risk of bias and applicability concerns, were extracted for each of the included studies. The QUADAS-2 pre-specified factor structure (i.e., four domains assessed in terms of risk of bias and applicability concerns) was not testable. An alternative model based on two correlated factors (i.e., risk of bias and applicability concerns) returned a poor fit model. Poor factor loadings were obtained, indicating that we cannot provide evidence that the indicators convergent validity markers in the context of AD diagnostic accuracy metanalyses, where normally the sample size is low (around 60 primary included studies). A Monte Carlo simulation suggested that such a model would require at least 90 primary studies to estimate these parameters with 80% power. The reliability of the QUADAS-2 items to inform a measurement model for study quality remains unconfirmed. Considerations for conceptualizing such a tool are discussed.
Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.
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