Publications by authors named "Fabián Jaimes"

62 Publications

Validation of VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) Scores to Determine the Priority of Echocardiography in Patients With Staphylococcus aureus Bacteremia.

Clin Infect Dis 2021 09;73(5):e1151-e1157

Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Background: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography.

Methods: Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated.

Results: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT.

Conclusions: In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
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http://dx.doi.org/10.1093/cid/ciaa1844DOI Listing
September 2021

Biomarkers as a Prognostic Factor in COPD Exacerbation: A Cohort Study.

COPD 2021 06 10;18(3):325-332. Epub 2021 May 10.

Internal Medicine Department, Medical School, University of Antioquia, Medellín, Colombia.

The acute exacerbations of COPD (AECOPD) are one of the main causes of hospitalization and morbimortality in the adult population. There are not many tools available to predict the clinical course of these patients during exacerbations. Our goal was to estimate the clinical utility of C Reactive Protein (CRP), Mean Platelet Volume (MPV), eosinophil count and neutrophil/lymphocyte ratio (NLR) as in-hospital prognostic factors in patients with AECOPD. A prospective cohort study was conducted in patients who consulted three reference hospitals in the city of Medellín for AECOPD and who required hospitalization between 2017 and 2020. A multivariate analysis was performed to estimate the effect of biomarkers in the two primary outcomes: the composite outcome of in-hospital death and/or admission to the ICU and hospital length-of-stay. A total of 610 patients with a median age of 74 years were included; 15% were admitted to the ICU and 3.9% died in the hospital. In the multivariate analysis adjusted for confounding variables, the only marker significantly associated with the risk of dying or being admitted to the ICU was the NLR > 5 (OR: 3; CI95%: 1.5; 6). Similarly, the NLR > 5 was also associated to a lower probability of being discharged alive from the institution (SHR: 0.73; CI95%: 0.57; 0.94) and, therefore, a longer hospital stay. It was found that a neutrophil/lymphocyte ratio greater than 5 is a strong predictor of mortality or ICU admissions and a longer hospital stay in patients hospitalized with AECOPD.
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http://dx.doi.org/10.1080/15412555.2021.1922370DOI Listing
June 2021

Cytomegalovirus Disease, Short-Term Cardiovascular Events and Graft Survival in a Cohort of Kidney Transplant Recipients With High CMV IgG Seroprevalence.

Prog Transplant 2021 06 19;31(2):126-132. Epub 2021 Mar 19.

Department of Internal Medicine, School of Medicine, 27983Universidad de Antioquia Medellin, Medellin, Colombia.

Introduction: Both cytomegalovirus (CMV) infection and CMV disease have been linked with several long-term indirect effects in kidney transplant recipients. Research questions: We conducted a retrospective study to assess the association between cytomegalovirus disease and risks of death, shortterm cardiovascular events and graft loss in a cohort of renal transplant recipients.

Design: The associations between CMV disease and death and cardiovascular events were determined using Cox regression models, while the association between viral disease and graft loss risk was analyzed through a competing risks regression according to the Fine and Gray method. Death with a functioning graft was considered as a competing risk event.

Results: A total of 865 consecutive renal transplant recipients were included. The prevalence of seropositive donor/seronegative recipient (D+/R-) group was 89.9% with the remaining patients classified as seropositive recipient (R+). After median follow-up time of 24.4 months, CMV disease was not a risk factor for all-causes mortality (HR = 1.75; 95% CI 0.94-3.25), early cardiovascular events (HR = 0.54; 95% CI 0.16-1.82) or graft loss (subhazard ratio [the HR adjusted for competing risk of death with functioning graft] = 0.99; 95% CI 0.53-1.84).

Conclusions: In this cohort with high prevalence of CMV IgG antibodies, we found no association between cytomegalovirus disease and risk of death or graft loss. The relationship between CMV and cardiovascular disease remains to be unraveled and probably corresponds to a multifactorial phenomenon involving individual risk factors and the immune response to infection rather than the virus effect itself.
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http://dx.doi.org/10.1177/15269248211002792DOI Listing
June 2021

Validation of VIRSTA and PREDICT scores to determine the priority of echocardiography in patients with Staphylococcus aureus bacteremia.

Clin Infect Dis 2021 Feb 4. Epub 2021 Feb 4.

Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.

Introduction: Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and PREDICT scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography.

Methodology: Cohort of patients hospitalized with SAB in two high complexity institutions in Medellin, Colombia, between 2012-2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated.

Results: The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the ROC curve (AUC), was 0.86 for VIRSTA and 0.64 for PREDICT.

Conclusions: In patients with negative VIRSTA, screening echocardiography may be unnecessary due to the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
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http://dx.doi.org/10.1093/cid/ciaa1844DOI Listing
February 2021

Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review.

Lupus 2021 Mar 6;30(3):421-430. Epub 2021 Jan 6.

Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.

Introduction: Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions.

Objective: To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature.

Methods: A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings' archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model.

Results: We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic.

Conclusions: To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures. PROSPERO CRD42020171638.
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http://dx.doi.org/10.1177/0961203320983462DOI Listing
March 2021

Supervised classification techniques for prediction of mortality in adult patients with sepsis.

Am J Emerg Med 2021 07 12;45:392-397. Epub 2020 Sep 12.

GRAEPIC - Clinical Epidemiology Academic Group (Grupo Académico de Epidemiología Clínica), Universidad de Antioquia, Medellín, Colombia; Department of Internal Medicine; Universidad de Antioquia; Medellín, Colombia; Hospital San Vicente Fundación, Medellín, Colombia. Electronic address:

Background: Sepsis mortality is still unacceptably high and an appropriate prognostic tool may increase the accuracy for clinical decisions.

Objective: To evaluate several supervised techniques of Artificial Intelligence (AI) for classification and prediction of mortality, in adult patients hospitalized by emergency services with sepsis diagnosis.

Methods: Secondary data analysis of a prospective cohort in three university hospitals in Medellín, Colombia. We included patients >18 years hospitalized for suspected or confirmed infection and any organ dysfunction according to the Sepsis-related Organ Failure Assessment. The outcome variable was hospital mortality and the prediction variables were grouped into those related to the initial clinical treatment and care or to the direct measurement of physiological disturbances. Four supervised classification techniques were analyzed: the C4.5 Decision Tree, Random Forest, artificial neural networks (ANN) and support vector machine (SVM) models. Their performance was evaluated by the concordance between the observed and predicted outcomes and by the discrimination according to AUC-ROC.

Results: A total of 2510 patients with a median age of 62 years (IQR = 46-74) and an overall hospital mortality rate of 11.5% (n = 289). The best discrimination was provided by the SVM and ANN using physiological variables, with an AUC-ROC of 0.69 (95%CI: 0.62; 0.76) and AUC-ROC of 0.69 (95%CI: 0.61; 0.76) respectively.

Conclusion: Deep learning and AI are increasingly used as support tools in clinical medicine. Their performance in a syndrome as complex and heterogeneous as sepsis may be a new horizon in clinical research. SVM and ANN seem promising for improving sepsis classification and prognosis.
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http://dx.doi.org/10.1016/j.ajem.2020.09.013DOI Listing
July 2021

A protocol for the development and internal validation of a model to predict clinical response to antihistamines in urticaria patients.

PLoS One 2020 6;15(10):e0239962. Epub 2020 Oct 6.

Internal Medicine Department, "San Vicente" Clinic, University of Antioquia, Medellín, Colombia.

Chronic urticaria causes a significant limitation to quality of life. In the literature, various studies can be found that have reviewed several clinical and laboratory markers, but none of these variables alone is sufficient to predict the patient's prognosis. In this study, we present a protocol to develop a prognostic model that can predict the clinical response of urticaria patients to antihistamines. This is a protocol for a bidirectional cohort study. Urticaria data will be routinely collected from a population of patients over 18 years old. A full multivariable logistic regression model will be fitted, following five steps: 1) Selection of predictive variables for the model; 2) Evaluation of the quality of the collected data and control of lost data; 3) Data statistical management; 4) Strategies to select the variables to include at the end of the model; 5) Evaluation of the performance of the different possible models (predictive accuracy) and selection of the best model. The performance and internal validation of the model will be assessed. Some clinical and paraclinical variables will be measured for further exploration.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239962PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537877PMC
November 2020

Author's response to letter "Antimicrobials administration time in patients with suspected sepsis: faster is better for severe patients".

J Intensive Care 2020 23;8:55. Epub 2020 Jul 23.

GRAEPIC-Clinical Epidemiology Academic Group (Grupo Académico de Epidemiología Clínica), The University of Antioquia, Medellín, Colombia.

We are appreciative to Dr. Jouffroy and Pr. Vivien for their responses and insights, and we agree with their words about the controversial aspect timing to antibiotic administration. Nevertheless, we stand firmly that it is not just about the time of administration of antimicrobials, but the early recognition and the comprehensive approach to recognize the most severe patients.
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http://dx.doi.org/10.1186/s40560-020-00472-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376705PMC
July 2020

Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study.

Clin Rheumatol 2021 Jan 11;40(1):181-191. Epub 2020 Jun 11.

Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.

Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE).

Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed.

Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051).

Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB.
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http://dx.doi.org/10.1007/s10067-020-05225-xDOI Listing
January 2021

Antimicrobials administration time in patients with suspected sepsis: is faster better? An analysis by propensity score.

J Intensive Care 2020 22;8:28. Epub 2020 Apr 22.

1GRAEPIC-Clinical Epidemiology Academic Group (Grupo Académico de Epidemiología Clínica), the University of Antioquia, Medellín, Colombia.

Background: Early use of antimicrobials is a critical intervention in the treatment of patients with sepsis. The exact time of initiation is controversial and its early administration may be a difficult task in crowded emergency departments (ED). The aim of this study was to estimate, using a matched propensity score, the effect on hospital mortality of administration of antimicrobials within 1 or 3 hours, in patients admitted to the ED with sepsis.

Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years, hospitalized between 2014 and 2016 with suspected sepsis, and admitted to ED of three tertiary care university hospitals in Medellín, Colombia. A propensity score analysis for administration of antimicrobials, both within 1 and 3 h of admission by the ED, was fitted with 28 variables related with clinical attention and physiological changes. As a sensitivity analysis, a logistic regression model was fitted for antimicrobial use adjusted both by propensity score and confounding variables.

Results: The study cohort was composed of 2454 patients with a median age of 62 years (IQR = 46-74). Among them, 32% ( = 781) received antibiotics within 3 h and 14% ( = 340) within the first hour. The main diagnoses were urinary tract infection (28%, = 682) and pneumonia (27%, = 671). Blood cultures were obtained in 87% ( = 2140) and yielded positive in 29% ( = 629), mainly with (37%, = 230), (21%, = 132), and (10.2%, = 64). The hospital mortality rate was 11.5% ( = 283). There were no significant differences in mortality, after adjustment, using antimicrobials either in the first hour (OR 1.03; 95% CI = 0.63; 1.70) or 3 h (OR 0.85; 95% CI = 0.61; 1.20). There were no changes with different models for sensitivity analysis.

Conclusions: Despite the obvious constraints given for sample size and residual confounding, our results suggest that we need a more comprehensive approach to sepsis and its treatment, considering early detection, multiple interventions, and goals beyond the simple time-to-antimicrobials.
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http://dx.doi.org/10.1186/s40560-020-00448-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178597PMC
April 2020

Organ Dysfunction in Sepsis: An Ominous Trajectory From Infection To Death.

Yale J Biol Med 2019 12 20;92(4):629-640. Epub 2019 Dec 20.

Academic Group of Clinical Epidemiology, School of Medicine, University of Antioquia, Medellín, Colombia.

Sepsis is a highly complex and lethal syndrome with highly heterogeneous clinical manifestations that makes it difficult to detect and treat. It is also one of the major and most urgent global public health challenges. More than 30 million people are diagnosed with sepsis each year, with 5 million attributable deaths and long-term sequalae among survivors. The current international consensus defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Over the past decades substantial research has increased the understanding of its pathophysiology. The immune response induces a severe macro and microcirculatory dysfunction that leads to a profound global hypoperfusion, injuring multiple organs. Consequently, patients with sepsis might present dysfunction of virtually any system, regardless of the site of infection. The organs more frequently affected are kidneys, liver, lungs, heart, central nervous system, and hematologic system. This multiple organ failure is the hallmark of sepsis and determines patients' course from infection to recovery or death. There are tools to assess the severity of the disease that can also help to guide treatment, like the Sequential Organ Failure Assessment (SOFA) score. However, sepsis disease process is vastly heterogeneous, which could explain why interventions targeted to directly intervene its mechanisms have shown unsuccessful results and predicting outcomes with accuracy is still elusive. Thus, it is required to implement strong public health strategies and leverage novel technologies in research to improve outcomes and mitigate the burden of sepsis and septic shock worldwide.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913810PMC
December 2019

[Severe sepsis and septic shock by Escherichia coli, clinical and microbiological analysis in Medellin, Colombia].

Rev Chilena Infectol 2019 Aug;36(4):447-454

Universidad de Antioquia, Medellín, Colombia.

Background: Escherichia coli is a common cause of a broad spectrum of infections, from non-complicated urinary tract infection, to severe sepsis and septic shock, that are associated to high impact outcomes, such as ICU admission and mortality.

Aims: To establish differences in mortality, ICU admission, ESBL positive strains and antibiotic treatment, between patients with E. coli related severe sepsis and septic shock, with or without bacteremia and its variability based on the source of infection.

Method: Secondary data analysis of a multicentric prospective cohort study.

Results: From 458 patients with E. coli isolation, 123 had E. coli exclusively in blood culture, 222 solely in urine culture, and 113 in both samples. Escherichia coli isolation exclusively in blood culture was associated with higher frequency of ICU admission (n = 63; 51.2%), higher rate of mechanical ventilation requirement (n = 19; 15.5%), higher mortality and longer hospital stay (n = 22; 18%; median of 12 days, IQR= 7 - 17, respectively); but with a lower occurrence of ESBL strains, compared to patients with positive urine culture and positive blood/urine cultures (n = 20; 17.7% and n = 46; 20.7%, respectively). 424 patients (92.6%) received antibiotic treatment in the first 24 hours. The most commonly prescribed was piperacilin/tazobactam (n = 256;60.3%). The proportion of patients empirically treated with carbapenems vs non-carbapenems was similar in the three groups.

Discussion: The source of infection, associated with ESBL strains risk factors, are useful tools to define prognosis and treatment in this population, because of their clinical and microbiological variability.

Conclusion: Patients with E. coli isolation exclusively in the blood culture had higher frequency of non-favorable outcomes in comparison to patients with E. coli in urine culture with or without bacteremia. Additionally, in our population patients with E. coli solely in blood culture have lower prevalence of ESBL positive strains.
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http://dx.doi.org/10.4067/S0716-10182019000400447DOI Listing
August 2019

Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia.

Rev Bras Ter Intensiva 2019 Jan-Mar;31(1):47-56

Grupo Académico de Epidemiología Clínica, Universidad de Antioquia - Medellín, Colombia.

Objective: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department.

Methods: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality.

Results: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024).

Conclusions: There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.
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http://dx.doi.org/10.5935/0103-507X.20190011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443304PMC
August 2019

Antimicrobial agent prescription: a prospective cohort study in patients with sepsis and septic shock.

Trop Med Int Health 2019 02 13;24(2):175-184. Epub 2018 Dec 13.

Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia.

Objective: To assess the true association between appropriate prescription of antibiotics and prognosis in patients with sepsis, a key issue in health care and quality improvement strategies.

Methods: Prospective cohort study in three university hospitals to determine whether the empirical prescription of antibiotics was adequate or inadequate, and to compare hospital death rates and length of stay according to different classifications of antibiotics prescription. Logistic regression models for risk estimation were fitted.

Results: A total of 705 patients with severe sepsis were included. No differences were found in positive-culture patients (n = 545) regarding the risk of death with insufficient spectrum antibiotics, compared to patients who received adequate spectrum antibiotics (OR = 0.90; 95% CI = 0.55-1.48). Delay in initiating antibiotics was not associated with the risk of death in patients with adequate spectrum of antibiotics, either with positive (OR = 1.04; 95% CI = 0.99-1.08) or negative cultures (OR = 0.98; 95% CI = 0.92-1.04). There were no differences in the length of hospital stay, according to the antibiotic prescription (median 11 days, IQR = 7-18 days for the whole cohort).

Conclusions: No associations were found between inadequate antibiotic prescription or delay to initiate therapy and mortality or length of stay.
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http://dx.doi.org/10.1111/tmi.13186DOI Listing
February 2019

Antibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis.

J Crit Care 2018 12 30;48:191-197. Epub 2018 Aug 30.

Department of Internal Medicine, University of Antioquia, Medellín, Colombia; GRAEPIC - Clinical Epidemiology Academic Research Group (Grupo Académico de Epidemiología Clínica), University of Antioquia; Medellín, Colombia; Research Direction, Hospital Universitario San Vicente Fundación, Medellín, Colombia. Electronic address:

Purpose: To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality.

Methods: Prospective cohort in three hospitals. Adult patients admitted by the Emergency Rooms (ER) with infection and any of systolic blood pressure < 90 mmHg or lactate >4 mmol/L. An instrumental analysis with hospital of admission as the instrumental variable was performed to estimate the effect of each intervention on hospital mortality and secondary outcomes.

Results: Among 2587 patients evaluated 884 met inclusion criteria, with a hospital mortality rate of 17% (n = 150). In the instrumental analysis, the only intervention associated with an absolute reduction in mortality (21%) was the use of antibiotics in the first 3 h. In patients with lactate values ≥4 mmol/L in the ER, a non-decrease of at least 10% at six hours was independently associated with mortality (OR = 3.1; 95%CI = 1.5-6.2).

Conclusions: Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4 mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.
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http://dx.doi.org/10.1016/j.jcrc.2018.08.035DOI Listing
December 2018

Positive Culture and Prognosis in Patients With Sepsis: A Prospective Cohort Study.

J Intensive Care Med 2020 Aug 20;35(8):755-762. Epub 2018 Jun 20.

GRAEPIC Research Group, Universidad de Antioquia, Medellín, Colombia.

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.
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http://dx.doi.org/10.1177/0885066618783656DOI Listing
August 2020

Grouping of body areas affected in traffic accidents. A cohort study.

J Clin Orthop Trauma 2018 Mar 24;9(Suppl 1):S49-S55. Epub 2017 Nov 24.

Universidad de Antioquia and Senior Investigator Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia.

Background: Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population.

Methods: Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim.

Results: Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas.

Conclusions: Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources.
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http://dx.doi.org/10.1016/j.jcot.2017.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883909PMC
March 2018

Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality.

Shock 2018 09;50(3):286-292

Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Medellin, Colombia.

Background: Lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination may replace it as screening tool. We have determined the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 h of resuscitation; and the association between clinical parameters, lactate, and mortality.

Methods: Prospective cohort study of adult patients hospitalized in the emergency room with infection, polytrauma, or other causes of hypotension. We measured serum lactate, capillary refill time, shock index, and pulse pressure at 0, 6, and 24 h after admission. A Spearman's correlation was performed between clinical variables and lactate levels, as well as between changes in clinical parameters and lactate clearance. The operative characteristics of these variables were determined by area under the receiver operating characteristic curve analysis and the association between lactate, clinical variables, and mortality through logistic regression.

Results: A total of 1,320 patients met the inclusion criteria, 66.7% (n = 880) confirmed infection, 19% (n = 251) polytrauma, and 14.3% (n = 189) another etiology. No significant correlation was found between any clinical variable and lactate values (r < 0.28). None of the variable had an adequate discriminatory capacity to detect hyperlactatemia (AUC < 0.62). In the multivariate model, lactate value at admission was the only variable independently associated with mortality (OR 1.2; 95% CI = 1.1-1.1).

Conclusions: Among patients with hypoperfusion risk or shock, no correlation was found between clinical variables and lactate. Of the set of parameters collected, lactate at admission was the only independent marker of mortality.
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http://dx.doi.org/10.1097/SHK.0000000000001066DOI Listing
September 2018

Development and Internal Validation of a Prediction Model to Estimate the Probability of Needing Aggressive Immunosuppressive Therapy With Cytostatics in de Novo Lupus Nephritis Patients.

Reumatol Clin (Engl Ed) 2019 Jan - Feb;15(1):27-33. Epub 2017 Jul 18.

Hospital Pablo Tobón Uribe, Medellin, Colombia; Department of Internal Medicine and Clinical Epidemiology Academic Research Group-GRAEPIC - (in Spanish Grupo Académico de Epidemiología Clínica at Universidad de Antioquia), Medellin, Colombia.

Objective: To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies.

Methods: Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer-Lemeshow test (H-L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve.

Results: Data from 242 patients was gathered; of these, 18.2% (n=44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC=0.929; 95% CI=0.894-0.963) and adequate calibration (H-L, P=.959).

Conclusion: In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies.
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http://dx.doi.org/10.1016/j.reuma.2017.05.010DOI Listing
June 2019

[Clinical and demographic profile and risk factors for Clostridium difficile infection].

Biomedica 2017 Jan 24;37(1):53-61. Epub 2017 Jan 24.

Departamento de Cuidado Crítico, Hospital Pablo Tobón Uribe, Medellín, Colombia.

Introduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease.

Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection.

Materials And Methods: We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications.

Results: We collected data from 123 patients during the follow-up period, 30 of whom were positive for the toxin. Mean age in the study population was 49 years and 60% were men. The main symptoms were abdominal pain (35%) and fever (34%). The principal complications were electrolytic alteration and severe sepsis with secondary acute kidney injury. Mortality was 13% and independent factors associated to the appearance of the infection were the use of proton pump inhibitors and previous gastrointestinal tract surgery.

Conclusions: The use of proton pump inhibitors and previous gastrointestinal tract surgery were factors associated to C. difficile infection.
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http://dx.doi.org/10.7705/biomedica.v37i1.2915DOI Listing
January 2017

Risk factors for acute kidney injury in a pediatric intensive care unit: a retrospective cohort study.

Medwave 2017 Apr 27;17(3):e6940. Epub 2017 Apr 27.

Departamento de Investigación, Hospital Pablo Tobón Uribe, Universidad de Antioquia, Medellín, Colombia.

Background: The incidence of acute kidney injury in the pediatric population and its associated risk factors are currently not clear.

Objectives: The objective of the study was to assess the incidence of acute kidney injury in critically ill pediatric patients and to determine its associated risk factors.

Methods: We conducted a retrospective study of pediatric patients (<14 years old) admitted to a tertiary pediatric intensive care unit. Acute kidney injury (AKI) was classified using the Kidney Disease: Improving Global Outcomes definition KDIGO.

Results: A total number of 382 patients were assessed: acute kidney injury was found in 11.5% of them (incidence rate 0.99 persons-day). The following parameters analyzed with multivariate regression analysis were associated with acute kidney injury: low platelet count (R = 2.947; 95% CI= 1.276-6.805) and the need of vasopressor support (OR= 4.601; 95% CI= 1.665-12.710). Children with acute kidney injury had an increased length of stay in the hospital and an increased mortality compared with patients with no kidney injury (19 days vs. 5 days and 3.7/person-day vs. 0.32/person-day).

Conclusions: Acute kidney injury is common among critically ill children and it is associated with adverse outcomes, including increased length of stay in the hospital and death. Low platelet count and vasopressor support were independently associated with the development of acute kidney injury in this population.
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http://dx.doi.org/10.5867/medwave.2017.03.6940DOI Listing
April 2017

Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study.

J Neurosurg 2018 01 10;128(1):262-271. Epub 2017 Mar 10.

1Academic Group of Clinical Epidemiology (GRAEPIC), School of Medicine, Universidad de Antioquia.

OBJECTIVE Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. METHODS A cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule. RESULTS Among 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94). CONCLUSIONS The prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.
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http://dx.doi.org/10.3171/2016.10.JNS16379DOI Listing
January 2018

Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery.

Arch Cardiol Mex 2018 Apr - Jun;88(2):100-106. Epub 2017 Mar 11.

Universidad de Antioquia, Research Unit Hospital Pablo Tobón Uribe, Medellín, Colombia. Electronic address:

Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality.

Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery.

Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4mL/kg of HS or NS intravenously for 30min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle.

Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59±14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes.

Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group.
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http://dx.doi.org/10.1016/j.acmx.2017.02.004DOI Listing
February 2019

TIMP1 and MMP9 are predictors of mortality in septic patients in the emergency department and intensive care unit unlike MMP9/TIMP1 ratio: Multivariate model.

PLoS One 2017 13;12(2):e0171191. Epub 2017 Feb 13.

Department of Pharmacology, Medicine Program, Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia.

Introduction: Matrix metalloproteinases and tissue inhibitors of metalloproteinases could be promising biomarkers for establishing prognosis during the development of sepsis. It is necessary to clarify the relationship between matrix metalloproteinases and their tissue inhibitors. We conducted a cohort study with 563 septic patients, in order to elucidate the biological role and significance of these inflammatory biomarkers and their relationship to the severity and mortality of patients with sepsis.

Materials And Methods: A multicentric prospective cohort was performed. The sample was composed of patients who had sepsis as defined by the International Conference 2001. Serum procalcitonin, creatinine, urea nitrogen, C-Reactive protein, TIMP1, TIMP2, MMP2 and MMP9 were quantified; each patient was followed until death or up to 30 days. A descriptive analysis was performed by calculating the mean and the 95% confidence interval for continuous variables and proportions for categorical variables. A multivariate logistic regression model was constructed by the method of intentional selection of covariates with mortality at 30 days as dependent variable and all the other variables as predictors.

Results: Of the 563 patients, 68 patients (12.1%) died within the first 30 days of hospitalization in the ICU. The mean values for TIMP1, TIMP2 and MMP2 were lower in survivors, MMP9 was higher in survivors. Multivariate logistic regression showed that age, SOFA and Charlson scores, along with TIMP1 concentration, were statistically associated with mortality at 30 days of septic patients; serum MMP9 was not statistically associated with mortality of patients, but was a confounder of the TIMP1 variable.

Conclusion: It could be argued that plasma levels of TIMP1 should be considered as a promising prognostic biomarker in the setting of sepsis. Additionally, this study, like other studies with large numbers of septic patients does not support the predictive value of TIMP1 / MMP9.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171191PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305237PMC
August 2017

Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population.

Eur J Orthop Surg Traumatol 2017 Feb 20;27(2):213-220. Epub 2016 Dec 20.

Universidad de Antioquia and Hospital Pablo Tobón Uribe, Medellín, Colombia.

Background: Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting.

Materials And Methods: Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics.

Results: Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10-21), 17 (IQR = 11-27), 4.21 (IQR = 2.95-5.05) and 7.84 (IQR = 6.90-7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration.

Conclusion: Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma.
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http://dx.doi.org/10.1007/s00590-016-1892-6DOI Listing
February 2017

Attenuation of the physiological response to infection on adults over 65 years old admitted to the emergency room (ER).

Aging Clin Exp Res 2017 Oct 16;29(5):847-856. Epub 2016 Nov 16.

Clinical Epidemiology Academic Group - GRAEPIC - (Grupo Académico de Epidemiología Clínica), Hospital Pablo Tobon Uribe Research Unit, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Calle 64 No 51D-154 - Bloque 7 - Segundo Piso, Medellín, Colombia.

It has been considered that the elderly have clinical manifestations different from the ones observed in middle-age adults during an injury event. This hypothesis has not been extensively explored in sepsis and bacterial infections. Secondary analysis of two prospective studies including 2611 patients over 18 years of age admitted to the emergency room with confirmed or probable bacterial infections and sepsis. The outcome measures were heart rate, respiratory rate, systolic blood pressure, temperature, Glasgow Coma Scale, creatinine, PaO/FiO and platelets daily during the first week. Compared to survivors younger than 65, the deceased under 65 had an average heart rate of 12.5 beats per minute per day higher (95% CI 9.32; 15.61), while patients over 65 who died barely had an average 5.7 beats per minute per day higher than the same reference group (95% CI 3.45; 8.06). The systolic blood pressure had a significant decreased in those who died younger than 65, compared to survivors with the same age, in both cohorts (-5.2 mmHg, 95% CI -8.17; -2.23 and -8.5 mmHg, 95% CI -13.48; -3.54, respectively), while those older than 65 who died had a nonsignificant increase (+1.6 mmHg, 95% CI -1.33; 4.62 and +0.1, 95% CI -6.48; 6.72, respectively) compared to the same reference group. The behavior of most clinical and laboratory variables suggests a less pronounced response of subjects above 65 years of age who died 28 days after being diagnosed with sepsis.
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http://dx.doi.org/10.1007/s40520-016-0679-2DOI Listing
October 2017

Variants in LTA, TNF, IL1B and IL10 genes associated with the clinical course of sepsis.

Immunol Res 2016 12;64(5-6):1168-1178

Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.

The aim of this study was to explore the association between some SNPs of the TNF, LTA, IL1B and IL10 genes with cytokine concentrations and clinical course in Colombian septic patients. We conducted a cross-sectional study to genotype 415 septic patients and 205 patients without sepsis for the SNPs -308(G/A) rs1800629 of TNF; +252 (G/A) rs909253 of LTA; -511(A/G) rs16944 and +3953(C/T) rs1143634 of IL1B; and -1082(A/G) rs1800896, -819(C/T) rs1800871 and -592(C/A) rs1800872 of IL10. The association of theses SNPs with the following parameters was evaluated: (1) the presence of sepsis; (2) severity and clinical outcomes; (3) APACHE II and SOFA scores; and (4) procalcitonin, C-reactive protein, tumor necrosis factor, lymphotoxin alpha, interleukin 1 beta and interleukin 10 plasma concentrations. We found an association between the SNP LTA +252 with the development of sepsis [OR 1.29 (1.00-1.68)]; the SNP IL10 -1082 with sepsis severity [OR 0.53 (0.29-0.97)]; the TNF -308 with mortality [OR 0.33 (0.12-0.95)]; and the IL10 -592 and IL10 -1082 with admission to the intensive care unit (ICU) [OR 3.36 (1.57-7.18)] and [OR 0.18 (0.04-0.86)], respectively. None of the SNPs were associated with cytokine levels, procalcitonin and C-reactive protein serum concentrations, nor with APACHE II and SOFA scores. Our results suggest that these genetic variants play an important role in the development of sepsis and its clinical course.
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http://dx.doi.org/10.1007/s12026-016-8860-4DOI Listing
December 2016

[Development and validation of a predictive model for bacteremia in patients hospitalized by the emergency department with suspected infection].

Rev Chilena Infectol 2016 Apr;33(2):150-8

Background: Positive blood cultures usually indicate disseminated infection that is associated with a poor prognosis and higher mortality. We seek to develop and validate a predictive model to identify factors associated with positive blood cultures in emergency patients.

Methods: Secondary analysis of data from two prospective cohorts (EPISEPSIS: developing cohort, and DISEPSIS: validation cohort) of patients with suspected or confirmed infection, assembled in emergency services in 10 hospitals in four cities in Colombia between September 2007 and February 2008. A logistic multivariable model was fitted to identify clinical and laboratory variables predictive of positive blood culture.

Results: We analyzed 719 patients in developing and 467 in validation cohort with 32% and 21% positive blood cultures, respectively. The final predictive model included variables with significant coefficients for both cohorts: temperature > 38° C, Glasgow < 15 and platelet < 150.000 cells/mm³, with calibration (goodness-of-fit H-L) p = 0.0907 and p = 0.7003 and discrimination AUC = 0.68 (95% CI = 0.65-0.72) and 0.65 (95% CI = 0.61-0.70) in EPISEPSIS and DISEPSIS, respectively. Specifically, temperature > 38 °C and platelets < 150.000 cells/mm³ and normal Glasgow; or Glasgow < 15 with normal temperature and platelets exhibit a LR between 1,9 (CI 95% = 1,2-3,1) and 2,3 (CI 95% = 1,7-3,1). Glasgow < 15 with any of low platelets or high temperature shows a LR between 2,2 (CI 95% = 1,1-4,4) and 2,6 (CI 95% = 1,7-4,3).

Discussion: Temperature > 38° C, platelet count < 150,000 cells/mm³ and GCS < 15 are variables associated with increased likelihood of having a positive blood culture.
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http://dx.doi.org/10.4067/S0716-10182016000200004DOI Listing
April 2016

[Epidemiology and prognosis of patients with bloodstream infection in 10 hospitals in Colombia].

Rev Chilena Infectol 2016 Apr;33(2):141-9

Background: Knowing the local epidemiology and etiology of bloodstream infections allows tailoring the empirical initial antimicrobial therapy to obtain a better outcome for these episodes.

Aim: To describe the epidemiological and microbiological aspects as well as the factors associated with mortality in patients with bloodstream infection in Colombian hospitals.

Methods: Sub-analysis of a prospective cohort study of 375 consecutive patients with bloodstream infection in 10 hospitals in Colombia, admitted between September first 2007 and Febrnary 29, 2008.

Results: The most frequently isolated bacteria were Gram-negative bacilli in 54% of patients, followed by Gram-positive cocci in 38.4%. The source of infection was known in 67%, unknown in 24% and associated with intravascular catheter in 9%. The most frequently isolated bacteria were Escherichia coli (46%), coagulase-negative Staphylococci (16%), Klebsiella pneumoniae (8.9%) and Staphylococcus aureus (7.8%). Staphylococcus aureus was methicillin sensitive in 82% of patients (46/56). Overall 28-day mortality was 25% and their independent associated factors were age, SOFA score and APACHE II score.

Conclusions: In our study the most frequently isolated bacteria in bloodstream infections were Gram-negative bacilli, contrasting those reported in developed countries. The overall mortality rate was high and the factors associated with mortality were age and severity scores.
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http://dx.doi.org/10.4067/S0716-10182016000200003DOI Listing
April 2016
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