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Enlace permanente de la investigaciónImpact of COVID-19 infection on patients with cancer: experience in a Latin American country: the ACHOCC-19 study / Alicia Quiroga Echeverri
Título : Impact of COVID-19 infection on patients with cancer: experience in a Latin American country: the ACHOCC-19 study Tipo de documento : documento electrónico Autores : Alicia Quiroga Echeverri, Fecha de publicación : 2021 Títulos uniformes : The Oncologist Idioma : Inglés (eng) Palabras clave : Cancer Covid-19 Latin America mortality survival Resumen : Introduction: The ACHOCC-19 study was performed to characterize COVID-19 infection in our oncological population. Methodology: Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression. Results: 742 patients were included. 72% > 51 years. The most prevalent neoplasms were breast (132 [17,77%]), colorectal (92 12,34%), and prostate (81 [10,9%]). 220 (29,6%) patients were asymptomatic and 96 (26,3%) died. In the bivariate descriptive analysis, higher mortality in patients > 70 years, lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute phase reactants. In the logistic regression analysis, higher mortality with ECOG 3 OR 28,67 (8,2-99,6), ECOG 4 OR 20,89 (3,36-129,7), two complications from COVID-19 OR 5,3 (1,50-18,1), and cancer in progression OR 02,08 (1,01-4,27). In the Cox regression analysis, the statistically significant HRs were metastatic disease HR 1,58 (1,16 - 2,16), cancer in progression HR 1,08 (1,24 - 2,61) vs partial response HR 0,31 (0,11 - 0,88), use of steroids HR 1,44 (1,01 - 2,06) and antibiotics HR 2,11 (1,47 - 2,95). Interpretations: In our study, cancer patients have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG status >2 and low socioeconomic status. Implications for practice: Our findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired ECOG to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment. Mención de responsabilidad : Aylen Vanessa Ospina, Ricardo Bruges, William Mantilla, Iván Triana, Pedro Ramos, Sandra Aruachan, Alicia Quiroga, Isabel Munevar, Juan Ortiz, Néstor Llinás, Paola Pinilla, Henry Vargas, Henry Idrobo, Andrea Russi, Ray Manneh Kopp, Giovanna Rivas, Héctor González, Daniel Santa, Jesús Insuasty, Laura Bernal, Jorge Otero, Carlos Vargas, Javier Pacheco, Carmen Alcalá, Paola Jiménez, Milton Lombana, Fernando Contreras, Javier Segovia, Luis Pino, José Lobatón, Manuel González, Javier Cuello, Juliana Bogoya, Angela Barrero, Gilberto de Lima Lopes Jr Referencia : Oncologist. 2021 Oct;26(10):e1761-e1773. DOI (Digital Object Identifier) : 10.1002/onco.13861 PMID : 34132449 En línea : https://theoncologist.onlinelibrary.wiley.com/doi/10.1002/onco.13861 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Impact of COVID-19 infection on patients with cancer: experience in a Latin American country: the ACHOCC-19 study [documento electrónico] / Alicia Quiroga Echeverri, . - 2021.
Obra : The Oncologist
Idioma : Inglés (eng)
Palabras clave : Cancer Covid-19 Latin America mortality survival Resumen : Introduction: The ACHOCC-19 study was performed to characterize COVID-19 infection in our oncological population. Methodology: Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression. Results: 742 patients were included. 72% > 51 years. The most prevalent neoplasms were breast (132 [17,77%]), colorectal (92 12,34%), and prostate (81 [10,9%]). 220 (29,6%) patients were asymptomatic and 96 (26,3%) died. In the bivariate descriptive analysis, higher mortality in patients > 70 years, lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute phase reactants. In the logistic regression analysis, higher mortality with ECOG 3 OR 28,67 (8,2-99,6), ECOG 4 OR 20,89 (3,36-129,7), two complications from COVID-19 OR 5,3 (1,50-18,1), and cancer in progression OR 02,08 (1,01-4,27). In the Cox regression analysis, the statistically significant HRs were metastatic disease HR 1,58 (1,16 - 2,16), cancer in progression HR 1,08 (1,24 - 2,61) vs partial response HR 0,31 (0,11 - 0,88), use of steroids HR 1,44 (1,01 - 2,06) and antibiotics HR 2,11 (1,47 - 2,95). Interpretations: In our study, cancer patients have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG status >2 and low socioeconomic status. Implications for practice: Our findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired ECOG to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment. Mención de responsabilidad : Aylen Vanessa Ospina, Ricardo Bruges, William Mantilla, Iván Triana, Pedro Ramos, Sandra Aruachan, Alicia Quiroga, Isabel Munevar, Juan Ortiz, Néstor Llinás, Paola Pinilla, Henry Vargas, Henry Idrobo, Andrea Russi, Ray Manneh Kopp, Giovanna Rivas, Héctor González, Daniel Santa, Jesús Insuasty, Laura Bernal, Jorge Otero, Carlos Vargas, Javier Pacheco, Carmen Alcalá, Paola Jiménez, Milton Lombana, Fernando Contreras, Javier Segovia, Luis Pino, José Lobatón, Manuel González, Javier Cuello, Juliana Bogoya, Angela Barrero, Gilberto de Lima Lopes Jr Referencia : Oncologist. 2021 Oct;26(10):e1761-e1773. DOI (Digital Object Identifier) : 10.1002/onco.13861 PMID : 34132449 En línea : https://theoncologist.onlinelibrary.wiley.com/doi/10.1002/onco.13861 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001722 AC-2021-041 Archivo digital Producción Científica Artículos científicos Disponible
Título : Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study) Tipo de documento : documento electrónico Autores : Laura Fernanda Niño Serna, ; Carolina Giraldo Alzate, Fecha de publicación : 2021 Títulos uniformes : BMC Pediatrics Idioma : Inglés (eng) Palabras clave : Sepsis SARS-CoV2 PIMS-TS infammatory mortality Resumen : Background: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children. Mención de responsabilidad : Lorena Acevedo, Byron Enrique Piñeres-Olave, Laura Fernanda Niño-Serna, Liliana Mazzillo Vega, Ivan Jose Ardila Gomez, Shayl Chacón, Juan Camilo Jaramillo-Bustamante, Hernando Mulett-Hoyos, Otto González-Pardo, Eliana Zemanate, Ledys Izquierdo, Jaime Piracoca Mejìa, Jose Luis Junco González, Beatriz Giraldo Duran, Carolina Bonilla Gonzalez, Helen Preciado, Rafael Orozco Marun, Martha I Alvarez-Olmos, Carolina Giraldo Alzate, Jorge Rojas, Juan Carlos Salazar-Uribe, Juan-Manuel Anaya & Jaime Fernández-Sarmiento Referencia : BMC Pediatr. 2021 Nov 18;21(1):516. DOI (Digital Object Identifier) : 10.1186/s12887-021-02974-9 PMID : 34794410 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02974-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Mortality and clinical characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with covid-19 in critically ill patients: an observational multicenter study (MISCO study) [documento electrónico] / Laura Fernanda Niño Serna, ; Carolina Giraldo Alzate, . - 2021.
Obra : BMC Pediatrics
Idioma : Inglés (eng)
Palabras clave : Sepsis SARS-CoV2 PIMS-TS infammatory mortality Resumen : Background: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children. Mención de responsabilidad : Lorena Acevedo, Byron Enrique Piñeres-Olave, Laura Fernanda Niño-Serna, Liliana Mazzillo Vega, Ivan Jose Ardila Gomez, Shayl Chacón, Juan Camilo Jaramillo-Bustamante, Hernando Mulett-Hoyos, Otto González-Pardo, Eliana Zemanate, Ledys Izquierdo, Jaime Piracoca Mejìa, Jose Luis Junco González, Beatriz Giraldo Duran, Carolina Bonilla Gonzalez, Helen Preciado, Rafael Orozco Marun, Martha I Alvarez-Olmos, Carolina Giraldo Alzate, Jorge Rojas, Juan Carlos Salazar-Uribe, Juan-Manuel Anaya & Jaime Fernández-Sarmiento Referencia : BMC Pediatr. 2021 Nov 18;21(1):516. DOI (Digital Object Identifier) : 10.1186/s12887-021-02974-9 PMID : 34794410 Derechos de uso : CC BY En línea : https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02974-9 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001773 AC-2021-089 Archivo digital Producción Científica Artículos científicos Disponible
Título : Outcomes and complications of hospitalised patients with HIV-TB co-infection Tipo de documento : documento electrónico Autores : Alicia Inés Hidrón Botero, Fecha de publicación : 2021 Títulos uniformes : Tropical Medicine & International Health Idioma : Inglés (eng) Palabras clave : co-infection HIV/TB drug toxicity latent tuberculosis mortality readmission Resumen : Background: Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. Methods: Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. Results: Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. Conclusions: Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities. Mención de responsabilidad : Carlos Andrés Agudelo, María Fernanda Álvarez, Alicia Hidrón Juan Pablo Villa, Lina María Echeverri‐Toro, Adriana Ocampo Glenys Patricia Porras, Iván Mauricio Trompa, Laura Restrepo, Alejandro Eusse, Carlos Andrés Restrepo Referencia : Trop Med Int Health. 2021 Jan;26(1):82-88. DOI (Digital Object Identifier) : 10.1111/tmi.13509 PMID : 33155342 En línea : https://onlinelibrary.wiley.com/doi/10.1111/tmi.13509 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Outcomes and complications of hospitalised patients with HIV-TB co-infection [documento electrónico] / Alicia Inés Hidrón Botero, . - 2021.
Obra : Tropical Medicine & International Health
Idioma : Inglés (eng)
Palabras clave : co-infection HIV/TB drug toxicity latent tuberculosis mortality readmission Resumen : Background: Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. Methods: Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. Results: Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. Conclusions: Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities. Mención de responsabilidad : Carlos Andrés Agudelo, María Fernanda Álvarez, Alicia Hidrón Juan Pablo Villa, Lina María Echeverri‐Toro, Adriana Ocampo Glenys Patricia Porras, Iván Mauricio Trompa, Laura Restrepo, Alejandro Eusse, Carlos Andrés Restrepo Referencia : Trop Med Int Health. 2021 Jan;26(1):82-88. DOI (Digital Object Identifier) : 10.1111/tmi.13509 PMID : 33155342 En línea : https://onlinelibrary.wiley.com/doi/10.1111/tmi.13509 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001649 AC-2021-005 Archivo digital Producción Científica Artículos científicos Disponible
Título : Positive culture and prognosis in patients with sepsis: a prospective cohort study Tipo de documento : documento electrónico Autores : Fabián Alberto Jaimes Barragán, Fecha de publicación : 2020 Títulos uniformes : Journal of Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : Blood culture epidemiology microbiological culture mortality sepsis Resumen : Purpose: To analyze the prognostic role of positive cultures in patients with sepsis. Methods: A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. Results: Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). Conclusion: Positive cultures are not associated with prognosis in patients with sepsis. Mención de responsabilidad : Fernando Molina, Pablo Castaño, Maribel Plaza, Carolina Hincapié, Wilmar Maya, Juan Carlos Cataño, Javier González, Alba León, Fabián Jaimes Referencia : J Intensive Care Med. 2020 Aug;35(8):755-762. DOI (Digital Object Identifier) : 10.1177/0885066618783656 PMID : 29925284 En línea : https://journals.sagepub.com/doi/abs/10.1177/0885066618783656?journalCode=jica Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Positive culture and prognosis in patients with sepsis: a prospective cohort study [documento electrónico] / Fabián Alberto Jaimes Barragán, . - 2020.
Obra : Journal of Intensive Care Medicine
Idioma : Inglés (eng)
Palabras clave : Blood culture epidemiology microbiological culture mortality sepsis Resumen : Purpose: To analyze the prognostic role of positive cultures in patients with sepsis. Methods: A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. Results: Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). Conclusion: Positive cultures are not associated with prognosis in patients with sepsis. Mención de responsabilidad : Fernando Molina, Pablo Castaño, Maribel Plaza, Carolina Hincapié, Wilmar Maya, Juan Carlos Cataño, Javier González, Alba León, Fabián Jaimes Referencia : J Intensive Care Med. 2020 Aug;35(8):755-762. DOI (Digital Object Identifier) : 10.1177/0885066618783656 PMID : 29925284 En línea : https://journals.sagepub.com/doi/abs/10.1177/0885066618783656?journalCode=jica Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001170 AC-2018-109 Archivo digital Producción Científica Artículos científicos Disponible 
Título : Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study Tipo de documento : documento electrónico Autores : Byron Enrique Piñeres Olave, Fecha de publicación : 2020 Títulos uniformes : Critical Care Medicine Idioma : Inglés (eng) Palabras clave : mortality pediatric acute respiratory distress syndrome prediction risk stratification ventilator-free days Resumen : Objectives: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome. Design: Leveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Separate models were built for the entire Version 1 cohort, for the cohort excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths. Models were externally validated in a cohort of intubated pediatric acute respiratory distress syndrome patients from the Children's Hospital of Philadelphia. Setting: The derivation cohort represented 100 centers worldwide; the validation cohort was from Children's Hospital of Philadelphia. Patients: There were 624 and 640 subjects in the derivation and validation cohorts, respectively. Interventions: None. Measurements and main results: The model for the full cohort included immunocompromised status, Pediatric Logistic Organ Dysfunction 2 score, day 0 vasopressor-inotrope score and fluid balance, and PaO2/FIO2 6 hours after pediatric acute respiratory distress syndrome onset. This model had good discrimination (area under the receiver operating characteristic curve 0.82), calibration, and internal validation. Models excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths also demonstrated good discrimination (all area under the receiver operating characteristic curve ≥ 0.84) and calibration. In the validation cohort, models for intubated pediatric acute respiratory distress syndrome (including and excluding neurologic deaths) had excellent discrimination (both area under the receiver operating characteristic curve ≥ 0.85), but poor calibration. After revision, the model for all intubated subjects remained miscalibrated, whereas the model excluding neurologic deaths showed perfect calibration. Mortality models also stratified ventilator-free days at 28 days in both derivation and validation cohorts. Conclusions: We describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials. Mención de responsabilidad : Nadir Yehya, Michael O Harhay, Margaret J Klein, Steven L Shein, Byron E Piñeres-Olave, Ledys Izquierdo, Anil Sapru, Guillaume Emeriaud, Philip C Spinella, Heidi R Flori, Mary K Dahmer, Aline B Maddux, Yolanda M Lopez-Fernandez, Bereketeab Haileselassie, Deyin Doreen Hsing, Ranjit S Chima, Amanda B Hassinger, Stacey L Valentine, Courtney M Rowan, Martin C J Kneyber, Lincoln S Smith, Robinder G Khemani, Neal J Thomas, on behalf of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V1 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Crit Care Med. 2020 Jun;48(6):e514-e522. DOI (Digital Object Identifier) : 10.1097/CCM.0000000000004345 PMID : 32271186 Derechos de uso : CC BY-NC-ND En línea : https://journals.lww.com/ccmjournal/FullText/2020/06000/Predicting_Mortality_in_ [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Predicting Mortality in Children With Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study [documento electrónico] / Byron Enrique Piñeres Olave, . - 2020.
Obra : Critical Care Medicine
Idioma : Inglés (eng)
Palabras clave : mortality pediatric acute respiratory distress syndrome prediction risk stratification ventilator-free days Resumen : Objectives: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist with trial design. We aimed to develop and validate mortality prediction models for patients with pediatric acute respiratory distress syndrome. Design: Leveraging additional data collection from a preplanned ancillary study (Version 1) of the multinational Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology study, we identified predictors of mortality. Separate models were built for the entire Version 1 cohort, for the cohort excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths. Models were externally validated in a cohort of intubated pediatric acute respiratory distress syndrome patients from the Children's Hospital of Philadelphia. Setting: The derivation cohort represented 100 centers worldwide; the validation cohort was from Children's Hospital of Philadelphia. Patients: There were 624 and 640 subjects in the derivation and validation cohorts, respectively. Interventions: None. Measurements and main results: The model for the full cohort included immunocompromised status, Pediatric Logistic Organ Dysfunction 2 score, day 0 vasopressor-inotrope score and fluid balance, and PaO2/FIO2 6 hours after pediatric acute respiratory distress syndrome onset. This model had good discrimination (area under the receiver operating characteristic curve 0.82), calibration, and internal validation. Models excluding neurologic deaths, for intubated subjects, and for intubated subjects excluding neurologic deaths also demonstrated good discrimination (all area under the receiver operating characteristic curve ≥ 0.84) and calibration. In the validation cohort, models for intubated pediatric acute respiratory distress syndrome (including and excluding neurologic deaths) had excellent discrimination (both area under the receiver operating characteristic curve ≥ 0.85), but poor calibration. After revision, the model for all intubated subjects remained miscalibrated, whereas the model excluding neurologic deaths showed perfect calibration. Mortality models also stratified ventilator-free days at 28 days in both derivation and validation cohorts. Conclusions: We describe predictive models for mortality in pediatric acute respiratory distress syndrome using readily available variables from day 0 of pediatric acute respiratory distress syndrome which outperform severity of illness scores and which demonstrate utility for composite outcomes such as ventilator-free days. Models can assist with risk stratification for clinical trials. Mención de responsabilidad : Nadir Yehya, Michael O Harhay, Margaret J Klein, Steven L Shein, Byron E Piñeres-Olave, Ledys Izquierdo, Anil Sapru, Guillaume Emeriaud, Philip C Spinella, Heidi R Flori, Mary K Dahmer, Aline B Maddux, Yolanda M Lopez-Fernandez, Bereketeab Haileselassie, Deyin Doreen Hsing, Ranjit S Chima, Amanda B Hassinger, Stacey L Valentine, Courtney M Rowan, Martin C J Kneyber, Lincoln S Smith, Robinder G Khemani, Neal J Thomas, on behalf of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V1 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Crit Care Med. 2020 Jun;48(6):e514-e522. DOI (Digital Object Identifier) : 10.1097/CCM.0000000000004345 PMID : 32271186 Derechos de uso : CC BY-NC-ND En línea : https://journals.lww.com/ccmjournal/FullText/2020/06000/Predicting_Mortality_in_ [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_dis Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD001344 AC-2020-048 Archivo digital Producción Científica Artículos científicos Disponible Documentos electrónicos
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