Importancia de la predicción de bacteriemia en los servicios de urgencias: seis años después

Díaz, Rafael Rubio; Rojas, Isabel Nieto; Julián-Jiménez, Agustín

doi:10.1016/j.eimc.2020.04.006

Cited by 11 publications

(31 citation statements)

References 4 publications

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“…Los resultados del presente estudio nos permiten confirmar la gran capacidad predictiva de riesgo de mortalidad que ofrecen algunos BM para los pacientes atendidos en los SUH por procesos infecciosos [2,3,[12][13][14][15]. En concreto, suPAR [16][17][18][19][20][21][22][23][24][25], que se presenta como el BM que obtiene el mejor rendimiento pronóstico de mortalidad a corto plazo (30 días) de forma individual.…”

Section: Discussionunclassified

“…La procalcitonina (PCT) se sintetiza en situaciones de infección bacteriana y sepsis y sus concentraciones tienen relación con la carga bacteriana y/o la concentración de endotoxina, la existencia de bacteriemia y el pronóstico de mortalidad [12][13][14][15]. El lactato es considerado el mejor marcador de hipoperfusión e hipoxia tisular y sus valores >2 mmol/l constituyen un poderoso factor independiente de mortalidad [12,16].…”

Section: Métodos Estudio Observacional Prospectivo Y Analíticounclassified

“…(y trombopenia <150.000/mm 3 ) y determinaciones de los BM incluidos (PCR en mg/L, PCT en ng/ml, lactato sérico en mmol/L y suPAR en ng/ml) y distintas dicotomizaciones de los mismos (Tabla 1) utilizadas y seleccionadas según las publicaciones previas del grupo INFURG-SEMES (grupo de estudio de infecciones de la Sociedad Española de Medicina de Urgencias y Emergencias) [2,3,10,13,15]. Definiciones, técnicas y métodos establecidos para las muestras.…”

Section: Introductionunclassified

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Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

Díaz¹,

González²,

Torres³

et al. 2021

Rev Esp Quimioter

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Objectives. To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). Methods. A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Results. The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P <.001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. Conclusions. suPAR showed better performance for 30-day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA.

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Section: Discussionunclassified

Section: Métodos Estudio Observacional Prospectivo Y Analíticounclassified

Section: Introductionunclassified

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Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

Díaz¹,

González²,

Torres³

et al. 2021

Rev Esp Quimioter

Self Cite

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“…Por otro lado, los HC con aislamiento significativo en pacientes dados de alta desde urgencias (BPAU) pueden representar un 3-5% [8] y los HC contaminados hasta el 20-40% de los aislamientos [9]. Estos hechos representan verdaderos problemas, al conllevar un incremento de las pruebas diagnósticas, estancia hospitalaria, costes y la administración de tratamientos antibióticos innecesarios o, en su caso, altas improcedentes en los casos de BPAU [7,10].…”

Section: Introductionunclassified

“…La sospecha y confirmación de BV tiene un relevante significado diagnóstico, pronóstico y obliga a cambiar algunas de las decisiones a tomar en el SUH (indicar el alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz) [10]. Distintos factores predictivos de BV se han publicado en los últimos años, pero son pocos los evaluados específicamente en pacientes con NAC [11][12][13][14].…”

Section: Introductionunclassified

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department

Julián-Jiménez

Castillo²,

García-Lamberechts³

et al. 2021

Rev Esp Quimioter

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Objective. To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. Patients and methods. Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. Results. A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. Conclusion. The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

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A bacteraemia risk prediction model: development and validation in an emergency medicine population

et al. 2021

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Importancia de la predicción de bacteriemia en los servicios de urgencias: seis años después

Cited by 11 publications

References 4 publications

Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department

A bacteraemia risk prediction model: development and validation in an emergency medicine population

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