1
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Pereira RA, Sousa M, Cidade JP, Melo L, Lopes D, Ventura S, Aragão I, Lima Neto RMDF, Molinos E, Marques A, Cardoso N, Marino F, Monteiro FB, Oliveira AP, Silva RC, Real AMN, Banheiro BS, Reis R, Adão-Serrano M, Cracium A, Valadas A, Ribeiro JM, Póvoa P, Tapadinhas C, Mendes V, Coelho L, Maia R, Freitas PT, Ferreira IA, Ramires T, Val-Flores LS, Cascão M, Alves R, Rodeia SC, Barrigoto C, Cardiga R, da Silva MJF, Vale B, Fonseca T, Rios AL, Camões J, Pérez D, Cabral S, Ribeiro MI, Mendes JJ, Gouveia J, Fernandes SM. What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care. Rev Bras Ter Intensiva 2022; 34:433-442. [PMID: 36888823 PMCID: PMC9987006 DOI: 10.5935/0103-507x.20210037-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/27/2022] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. METHODS This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. RESULTS Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. CONCLUSION There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
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Affiliation(s)
- Rui Antunes Pereira
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Marta Sousa
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - José Pedro Cidade
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Melo
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Diogo Lopes
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Sara Ventura
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Irene Aragão
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | | | - Elena Molinos
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Ana Marques
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - Flávio Marino
- Hospital de Vila Franca de Xira - Vila Franca de Xira, Portugal
| | - Filipa Brás Monteiro
- Hospital de Egas Moniz, Centro Hospitalar Universitário
Lisboa Oriental - Lisboa, Portugal
| | | | - Rogério C Silva
- Hospital de Santa Luzia, Unidade Local de Saúde Alto Minho
- Viana do Castelo, Portugal
| | | | | | - Renato Reis
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Maria Adão-Serrano
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Cracium
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Ana Valadas
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - João Miguel Ribeiro
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Camila Tapadinhas
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Vítor Mendes
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Coelho
- Hospital São Francisco Xavier, Centro Hospitalar
Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Raquel Maia
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | | | | | - Tiago Ramires
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Luís Silva Val-Flores
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Mariana Cascão
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Rita Alves
- Hospital de Curry Cabral, Centro Hospitalar Universitário
Lisboa Central - Lisboa, Portugal
| | - Simão C Rodeia
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Cleide Barrigoto
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | - Rosa Cardiga
- Hospital de São José, Centro Hospitalar
Universitário Lisboa Central - Lisboa, Portugal
| | | | - Bruno Vale
- Hospital de Santo António, Centro Hospitalar do Porto -
Porto, Portugal
| | - Tatiana Fonseca
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - João Camões
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Danay Pérez
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos
- Matosinhos, Portugal
| | - Susana Cabral
- Centro Hospitalar Universitário de Coimbra - Coimbra,
Portugal
| | | | - João João Mendes
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
| | - João Gouveia
- Hospital de Santa Maria, Centro Hospitalar Universitário
Lisboa Norte - Lisboa, Portugal
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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2
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Pereira RA, Sousa M, Cidade JP, Melo L, Lopes D, Ventura S, Aragão I, Lima Neto RMDF, Molinos E, Marques A, Cardoso N, Marino F, Monteiro FB, Oliveira AP, Silva RC, Real AMN, Banheiro BS, Reis R, Adão-Serrano M, Cracium A, Valadas A, Ribeiro JM, Póvoa P, Tapadinhas C, Mendes V, Coelho L, Maia R, Freitas PT, Ferreira IA, Ramires T, Val-Flores LS, Cascão M, Alves R, Rodeia SC, Barrigoto C, Cardiga R, Silva MJFD, Vale B, Fonseca T, Rios AL, Camões J, Pérez D, Cabral S, Ribeiro MI, Mendes JJ, Gouveia J, Fernandes SM. What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care. Rev Bras Ter Intensiva 2022; 34:433-442. [PMID: 36888823 PMCID: PMC9987006 DOI: 10.5935/0103-507x.20210037-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. METHODS This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. RESULTS Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. CONCLUSION There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.
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Affiliation(s)
- Rui Antunes Pereira
- Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Marta Sousa
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - José Pedro Cidade
- Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Melo
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Diogo Lopes
- Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Sara Ventura
- Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Irene Aragão
- Hospital de Santo António, Centro Hospitalar do Porto - Porto, Portugal
| | | | - Elena Molinos
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal
| | - Ana Marques
- Centro Hospitalar Universitário de Coimbra - Coimbra, Portugal
| | | | - Flávio Marino
- Hospital de Vila Franca de Xira - Vila Franca de Xira, Portugal
| | - Filipa Brás Monteiro
- Hospital de Egas Moniz, Centro Hospitalar Universitário Lisboa Oriental - Lisboa, Portugal
| | | | - Rogério C Silva
- Hospital de Santa Luzia, Unidade Local de Saúde Alto Minho - Viana do Castelo, Portugal
| | | | | | - Renato Reis
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Maria Adão-Serrano
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Ana Cracium
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Ana Valadas
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - João Miguel Ribeiro
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal
| | - Pedro Póvoa
- Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Camila Tapadinhas
- Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Vítor Mendes
- Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Luís Coelho
- Hospital São Francisco Xavier, Centro Hospitalar Universitário Lisboa Ocidental - Lisboa, Portugal
| | - Raquel Maia
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | | | | | - Tiago Ramires
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal
| | - Luís Silva Val-Flores
- Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Mariana Cascão
- Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Rita Alves
- Hospital de Curry Cabral, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Simão C Rodeia
- Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Cleide Barrigoto
- Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | - Rosa Cardiga
- Hospital de São José, Centro Hospitalar Universitário Lisboa Central - Lisboa, Portugal
| | | | - Bruno Vale
- Hospital de Santo António, Centro Hospitalar do Porto - Porto, Portugal
| | - Tatiana Fonseca
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - Ana Lúcia Rios
- Hospital Vila Nova de Gaia-Espinho - Vila Nova de Gaia, Portugal
| | - João Camões
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal
| | - Danay Pérez
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos - Matosinhos, Portugal
| | - Susana Cabral
- Centro Hospitalar Universitário de Coimbra - Coimbra, Portugal
| | | | - João João Mendes
- Hospital Professor Doutor Fernando Fonseca - Amadora, Portugal.,Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
| | - João Gouveia
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte - Lisboa, Portugal.,Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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3
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Carvalho JA, Boavida L, Amorim Ferreira I, Grima B, Delgado Alves J. Native Valve Aspergillus Endocarditis in a Non-Neutropenic Immunocompromised Patient on Anti-TNF α Blockers Therapy. Cureus 2021; 13:e20629. [PMID: 35106197 PMCID: PMC8786574 DOI: 10.7759/cureus.20629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/05/2022] Open
Abstract
Invasive aspergillosis is a rare opportunistic infection mainly occurring in patients with a well-established risk such as neutropenia or conditions that lead to chronically impaired cellular immune responses. Systemic corticosteroids are a well-known risk factor for fungal infections. Recently, reports of invasive aspergillosis in patients treated with monoclonal biologic agents, such as tumor necrosis factor-alpha inhibitors, have been increasing. We present the case of a 47-year-old female patient with seronegative spondyloarthropathy treated with infliximab and corticosteroids. The patient presented classical symptoms of an acute lower respiratory infection, and she was treated with a β-lactam antibiotic. Infliximab administration was deferred until nine days after clinical recovery. Fourteen days after drug administration, she was admitted with a symptomatic subcortical hematoma in the left parietal region. There was a rapid neurological recovery, and there were no risk factors for haemorrhagic stroke detected. The chest X-ray revealed an oval mass with an air crescent sign, and the CT scan was suggestive of aspergilloma. Bronchoalveolar lavage cytology identified Aspergillus spp. Voriconazole was initiated and, after one month of treatment, the patient was readmitted with a left facial palsy associated with hemiparesis and dysarthria. Laboratory evaluation showed leukocytosis and elevated C-reactive protein. A severe right middle cerebral artery stroke was present on the brain CT scan. Transesophageal echocardiogram revealed large mitral valve vegetation, and the diagnosis of Aspergillus endocarditis with cerebral embolization was made. Fungal infections are challenging due to the diagnosis infrequency and paucisymptomatic natural history. Despite being crucial in the treatment of autoimmune diseases, immunosuppressive drugs increase the risk of fungal infection. It is extremely important to consider Aspergillus infection in immunosuppressed patients, and the need for prophylaxis in non-neutropenic patients with risk factors should be clarified.
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4
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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Seguro Paula F, Ferreira IA, Amaral MC, Delgado Alves J. Systemic sclerosis-related changes on nailfold videocapillaroscopy in genetic and metabolic myopathies. Rheumatology (Oxford) 2016; 55:1911-2. [PMID: 27313276 DOI: 10.1093/rheumatology/kew249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Filipe Seguro Paula
- Fernando Fonseca Hospital, Systemic Immune-mediated Diseases Unit, Amadora Immune Response and Vascular Disease Unit, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Isabel Amorim Ferreira
- Fernando Fonseca Hospital, Systemic Immune-mediated Diseases Unit, Amadora Immune Response and Vascular Disease Unit, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Marta Carapeto Amaral
- Fernando Fonseca Hospital, Systemic Immune-mediated Diseases Unit, Amadora Immune Response and Vascular Disease Unit, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - José Delgado Alves
- Fernando Fonseca Hospital, Systemic Immune-mediated Diseases Unit, Amadora Immune Response and Vascular Disease Unit, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
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Akkerman JWN, Gerrits AJ, Ferreira IA, Heemskerk JWM. Insulin inhibition of platelet-endothelial interaction is mediated by insulin effects on endothelial cells without direct effects on platelets: a rebuttal. J Thromb Haemost 2009; 7:369-71; author reply 371-3. [PMID: 19036062 DOI: 10.1111/j.1538-7836.2008.03239.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ferreira IA, Bertollo LAC, Martins C. Comparative chromosome mapping of 5S rDNA and 5S HindIII repetitive sequences in Erythrinidae fishes (Characiformes) with emphasis on the Hoplias malabaricus ‘species complex’. Cytogenet Genome Res 2007; 118:78-83. [PMID: 17901704 DOI: 10.1159/000106445] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 02/27/2007] [Indexed: 11/19/2022] Open
Abstract
Chromosomal localization of 5S rDNA and 5SHindIII repetitive sequences was carried out in several representatives of the Erythrinidae family, namely in karyomorphs A, D, and F of Hoplias malabaricus, and in H. lacerdae, Hoplerythrinusunitaeniatus and Erythrinus erythrinus. The 5S rDNA mapped interstitially in two chromosome pairs in karyomorph A and in one chromosome pair in karyomorphs D and F and in H. lacerdae. The 5SHindIII repetitive DNA mapped to the centromeric region of several chromosomes (18 to 22 chromosomes) with variations related to the different karyomorphs of H. malabaricus. On the other hand, no signal was detected in the chromosomes of H. lacerdae, H. unitaeniatus and E. erythrinus, suggesting that the 5SHindIII-DNA sequences have originated or were lost after the divergence of H. malabaricus from the other erythrinid species. The chromosome distribution of 5S rDNA and 5SHindIII-DNA sequences contributes to a better understanding of the mechanisms of karyotype differentiation among the Erythrinidae members.
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Affiliation(s)
- I A Ferreira
- UNESP-Universidade Estadual Paulista, Instituto de Biociências, Departamento de Morfologia, Botucatu, SP, Brazil
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