MEDS score and vitamin D status are independent predictors of mortality in a cohort of Internal Medicine patients with microbiological identified sepsis

OBJECTIVE

Sepsis is a life-threatening disease resulting from the interaction between pathogen and host response; its dysregulation causes organ dysfunction, high morbidity, and mortality. Despite the increase of septic patients admitted to Internal Medicine wards, data about clinical predictors of mortality in this setting are still lacking. The aim of this study was to evaluate the role of MEDS score and vitamin D as predictors of mortality (28-day and 90-day) in septic patients admitted to the Internal Medicine department.

PATIENT S AND METHODS

Prospectively collected clinical data, lab tests including vitamin D, and clinical scores (SIRS, MEDS, SCS, REMS, SOFA, qSOFA) were retrospectively analyzed. Eighty-eight microbiologically identified septic patients (median age 75 years old, IQR 65-82 years old; range 37-94 years old) were evaluated.

RESULTS

Twenty-three patients (26.1%) died at 28 days, 33 (37.5%) died at 90 days. The logistic regression showed a positive effect of MEDS score (p=0.006; OR 1.24, 95% CI 1.08-1.49), and a negative effect of low vitamin D levels (p=0.008, OR 0.83, 95% CI 0.72-0.94) on mortality. Moreover, the cut-off of 7 points for MEDS score and of 7 ng/ml for vitamin D levels significantly predicted poor prognosis at 28 and 90 days.

CONCLUSIONS

MEDS score and vitamin D levels represent independent predictors of mortality in a cohort of Internal Medicine septic patients. Further studies on larger samples are needed to confirm our results and to clarify the pathophysiological mechanisms at the basis of vitamin D deficiency as a predictor of mortality in septic patients.

Networking consumers' participation in a community mental health service: mutual support groups, 'citizenship' and coping strategies

Consumers' and family members' involvement was indispensable to create social support networks promoted by the comprehensive mental health services resulting from the closure and subsequent complete reconversion of the mental hospital in Trieste. Despite long term consumers' disabilities and the families' heavy burden the individuals' positive skills and resources can be, and indeed are, 'valorized'. Mutual help groups, social clubs and solidarity initiatives in the community were the outcome of the individual consumer's active daily involvement in the service therapeutic programmes and of stimulation of social and communication skills. The service considers these forms of supported self-organisation of consumers and family members as new instruments for further deinstitutionalisation and demedicalisation of therapeutic and rehabilitative practices, for the overcoming of social isolation and learning of coping strategies from the mutual experience.