Charlson's weighted index of comorbidities is useful in assessing the risk of death in septic patients

Oltean, Simona; Țățulescu, D.; Bondor, Cosmina Ioana; Slavcovici, Adriana; Cismaru, Cosmin Andrei; Lupşe, Mihaela; Muntean, Monica; Jianu, Cristian; Marcu, Cristian; Oltean, Mihai

doi:10.1016/j.jcrc.2011.08.021

Cited by 38 publications

(32 citation statements)

References 34 publications

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“…9 The SOFA, however, takes no account of age and comorbidity, known to be independent drivers of sepsis mortality. 12,13 While our data confirm that organ failure is important in predicting worse outcome, it is unsurprising that the PIRO, which takes into account age, comorbidity, and the source of infection, outperformed the SOFA for 30-day mortality prediction. We found the PIRO and MEDS scores to perform similarly overall, although the PIRO model may have better sensitivity for mortality.…”

Section: Discussionmentioning

confidence: 64%

“…[8][9][10][11] The SOFA score uses only physiologic and laboratory variables but does not consider host factors such as age, ethnicity, and comorbid disease burden, which are important drivers of mortality in sepsis. 12,13 The MEDS score requires a subjective assessment of likelihood of short-term mortality and may perform less accurately at higher illness severity. 14 Another issue relates to virulence of the infecting pathogen.…”

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confidence: 99%

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Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

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Objectives: The Predisposition Insult Response and Organ failure (PIRO) scoring system has been developed for use in the emergency department (ED) to risk stratify sepsis cases, but has not been well studied among high-risk patients with severe sepsis and septic shock. The PIRO score was compared with the Sequential Organ Failure Assessment (SOFA) and Mortality in ED Sepsis (MEDS) scores to predict mortality in ED patients with features suggesting severe sepsis or septic shock in the ED. Methods:This was an analysis of sepsis patients enrolled in a prospective observational ED study of patients presenting with evidence of shock, hypoxemia, or other organ failure. PIRO, MEDS, and SOFA scores were calculated from ED data. Analysis compared areas under the receiver operator characteristic (ROC) curves for 30-day mortality.Results: Of 240 enrolled patients, final diagnoses were septic shock in 128 (53%), severe sepsis without shock in 70 (29%), and infection with no organ dysfunction in 42 (18%). Forty-eight (20%) patients died within 30 days of presentation. Area under the ROC curve (AUC) for mortality was 0.86 (95% confidence interval [CI] = 0.80 to 0.92) for PIRO, 0.81 (95% CI = 0.74 to 0.88) for MEDS, and 0.78 (95% CI = 0.71 to 0.87) for SOFA scores. Pairwise comparisons of the AUC were as follows: PIRO versus SOFA, p = 0.01; PIRO versus MEDS, p = 0.064; and MEDS versus SOFA; p = 0.37. Mortality increased with increasing PIRO scores: PIRO < 5, 0%; PIRO 5 to 9, 5%; PIRO 10 to 14, 5%; PIRO 15 to 19, 37%; and PIRO ≥ 20, 80% (p < 0.001). The MEDS score also showed increasing mortality with higher scores: MEDS < 5, 0%; MEDS 5 to 7, 12%; MEDS 8 to 11, 15%; MEDS 12 to 14, 48%; and MEDS > 15, 65% (p < 0.001).Conclusions: The PIRO model, taking into account comorbidities and septic source as well as physiologic status, performed better than the SOFA score and similarly to the MEDS score for predicting mortality in ED patients with severe sepsis and septic shock. These findings have implications for identifying and managing high-risk patients and for the design of clinical trials in sepsis.

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

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“…Biz komor- bidite indeksi olarak yine hastane yatışında anamnez bilgilerine dayalı Charlson Comorbidity Index kullandık [15]. Yapılan çalışmalarla bu komorbidite indeksinin yoğun bakım hastaları için prognostik değeri standart indekslerle karşılaştırılmış ve alternatif metot olarak kullanılabilirliği gösterilmiştir [20,21]. Genç-yaşlı (65-79 yaş) ve çok-yaşlı (80 yaş üstü) yoğun bakım hastalarının karşılaştırıldığı bir çalış-mada hastaların komorbiditelerini değerlendirmek için CCI ve SAPS-II kullanılmıştır [4].…”

Section: Discussionunclassified

Comparison of clinical characteristics of the elderly and very elderly patients in the medical intensive care unit

Köş

Titiz²,

Öneç³

et al. 2015

J Clin Exp Invest

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Objective: The increase in the mean age of the general population is reflected in the patient populations who are in need of intensive care. Increasing number of comorbidities with age is also an important issue to be considered in the management of these patients. We evaluated clinical and laboratory features of the elderly (65-79 years) and very elderly (≥80 years) patients in our medical intensive care unit (ICU). Methods:The clinical and laboratory data of intensive care patients aged 65 and over were retrospectively analyzed. Comorbidities were commented with 19 diseaseweighted Charlson Comorbidity Index (CCI).Results: 231 elderly and 216 very elderly patients were included in this study. Pulmonary diseases were the most prevalent primary cause of admission to ICU in both groups. The most common comorbidities were hypertension and heart failure in both groups. Number of patients whose CCI scores>3 were higher in very elderly patients group than in elderly patients group. While there was no difference in terms of median ICU-survival between two groups in general, when 30 days and longer intensive care follow-ups were evaluated, it was found 81.0 (95% CI: 48.8-113.2) days and 41.0 (95% CI: 36.6-45.4) days in the elderly and very elderly patients respectively (p = 0.009). Conclusion:We concluded that, age is not the main factor affecting the ICU-survival in patient over 65 years old in intensive care unit. However, increasing age may be associated with short survival at prolonged hospitalizations in ICU. J Clin Exp Invest 2015; 6 (2): 144-149Key words: İntensive care unit, aged, survival ÖZET Amaç: Genel nüfustaki yaş ortalamalarındaki artış yoğun bakıma ihtiyaç duyan hasta popülasyonuna da yansımaktadır. Yaşla birlikte eşlik eden hastalıkların artması bu hastaların takibinde ayrıca dikkat edilmesi gereken bir konudur. Biz de medikal yoğun bakım (YB) ünitemizde takip edilen yaşlı (65-79 yaş) ve çok yaşlı (80 yaş üstü) gruptaki hastalarımızın klinik ve laboratuvar özelliklerini karşılaştırdık.Yöntemler: 65 yaş ve üstü YB hastalarının klinik ve laboratuvar verileri retrospektif olarak tarandı. Hastaların komorbiditeleri 19 hastalık ağırlıklı Charlson Comorbidity Index (CCI) ile değerlendirildi. Bulgular: Çalışmaya 231 yaşlı ve 216 çok yaşlı hasta alındı. Her iki hasta grubunda da pulmoner hastalıklar YB'ye en sık primer alınış sebebiydi. Yine her iki grupta da hipertansiyon ve kalp yetmezliği en sık komorbid hastalıklardı. Çok yaşlı hasta grubunda CCI skoru >3 olanların sayısı daha fazla idi. Takip süresince gruplar arasında medyan YB-sağkalım açısından fark saptanmazken 30 gün ve üzerindeki YB takiplerinde ise median YB-sağka-lım yaşlı hastalarda 81 gün (%95 CI: 48,8-113,2) iken çok yaşlı hastalarda 41 gün (%95 CI: 36,6-45,4) idi (p=0,009).Sonuç: 65 yaşın üzerindeki hastalarda artan yaşın YBsağ kalımlarında primer faktör olmadığını saptadık. Ancak yoğun bakımda uzun süreli yatışlarda artan yaş kısa sağ kalımla ilişkili olabilir.Anahtar kelimeler: Yoğun bakım, yaşlı, sağkalım

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“…La mortalidad de los pacientes dependerá también de otros factores como la comorbilidad, la polifarmacia, las interacciones medicamentosas y los factores sociales 10 . Desde hace años se ha utilizado el índice de comorbilidad de Charlson como una escala con validez pronóstica para la valoración de la comorbilidad, considerán-dose un índice mayor de 2 como un factor de riesgo de mortalidad 42 . En un estudio reciente realizado en pacientes ancianos que acudían al servicio de Urgencias por un proceso infeccioso se obtuvieron tres variables predictoras de mortalidad que incluían la alteración del nivel de conciencia, la taquipnea y la comorbilidad grave (índi-ce de Charlson >2 puntos) como factores independientes de mal pronóstico 43 .…”

Section: Perfil Clínico Del Pacienteunclassified

Factors predicting failure in empirical antibiotic treatment

García-Lamberechts

Castillo

Hormigo-Sánchez

et al. 2017

An Sist Sanit Navar

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resuMenLas infecciones constituyen uno de las principales causas de morbimortalidad en la población. La elección del tratamiento empírico es una de las decisiones más habituales para cualquier médico responsable de su atención. Además, esta primera decisión puede tener consecuencias en cuanto al pronóstico del paciente o provocar un incremento de los costes asociados al proceso. Esta revisión intenta resumir cuáles son los aspectos que pueden provocar el fracaso al tratamiento antibiótico considerando aspectos microbiológicos, farmacológicos, del perfil del paciente y del control del foco infeccioso. Además, se establecen una serie de recomendaciones para minimizar este riesgo, desde el punto de vista de la precisión diagnóstica del foco y de la etiología, la estratificación adecuada de la gravedad del paciente, el conocimiento de los aspectos farmacocinéticos y farmacodinámicos de los antibióticos y el control, quirúrgico o mediante radiología intervencionista, del foco infeccioso.Palabras clave: Antibiótico. Adecuación. Tratamiento inapropiado. Infección. Urgencias. AbstrACtInfections are one of the main causes of morbidity and mortality in the population. The choice of empirical treatment is one of the most common decisions facing the physician. This first decision has consequences in the prognosis of the patient and the costs associated with the process. This review attempts to summarize the aspects that can lead to failure of antibiotic treatment by considering microbiological and pharmacological aspects, patient profile and infectious focus control. In addition, a series of recommendations are established to minimize this risk, from the point of view of diagnostic accuracy, adequate severity stratification of the patient, knowledge of the pharmacokinetic and pharmacodynamic aspects of antibiotics and control of the infectious focus.

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Charlson's weighted index of comorbidities is useful in assessing the risk of death in septic patients

Cited by 38 publications

References 34 publications

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Comparison of clinical characteristics of the elderly and very elderly patients in the medical intensive care unit

Factors predicting failure in empirical antibiotic treatment

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