BackgroundProgression from nonsevere sepsis—i.e., sepsis without organ failure or shock—to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality. Early recognition in the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes. We sought to identify clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic shock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis.MethodsThis is a retrospective cohort of patients presenting to a single urban academic ED from November 2008 to October 2010. Patients aged 18 years or older who met criteria for sepsis and had a lactate level measured in the ED were included. Patients were excluded if they had any combination of the following: a systolic blood pressure <90 mmHg upon triage, an initial whole blood lactate level ≥4 mmol/L, or one or more of a set of predefined signs of organ dysfunction upon initial assessment. Disease progression was defined as the development of any combination of the aforementioned conditions, initiation of vasopressors, or death within 96 h of ED presentation. Data on predefined potential predictors of disease progression and outcome measures of disease progression were collected by a query of the electronic medical record and via chart review. Logistic regression was used to assess associations of potential predictor variables with a composite outcome measure of sepsis progression to organ failure, hypotension, or death.ResultsIn this cohort of 582 ED patients with nonsevere sepsis, 108 (18.6 %) experienced disease progression. Initial serum albumin <3.5 mg/dL (OR 4.82; 95 % CI 2.40–9.69; p < 0.01) and a diastolic blood pressure <52 mmHg at ED triage (OR 4.59; 95 % CI 1.57–13.39; p < 0.01) were independently associated with disease progression to severe sepsis or shock within 96 h of ED presentation. There were no deaths within 96 h of ED presentation.ConclusionsIn our patient cohort, serum albumin <3.5 g/dL and an ED triage diastolic blood pressure <52 mmHg independently predict early progression to severe sepsis or shock among ED patients with presumed sepsis.
Background: Preventive health care measures among immigrants and minority groups are generally underutilized. While there is data available regarding healthcare utilization among several ethnic minorities in the USA, little is known regarding health behavior among Albania American communities. Objectives:To assess the rate of preventive health screening measures among Albanian American immigrants.Methods: Cross sectional analysis of data obtained through anonymous surveys offered to Albanian-American adults over eighteen years of age. Results:Of the 175 participants, 52% were females in the age range of 18-80 years. Body Mass Index (BMI) measured as Kg/ m2 was 29.0 ± 0.62 (± SEM) versus 26.3±0.73 for men and women respectively, P < 0.01. Of the above participants of 50 years of age and older, 62% had screening colonoscopy and 49% had hepatitis C screening test irrespective of their gender. Out of the eligible female participants, 68% had a pap smear and 71% had a mammogram.
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