Loading...
Publication
“Quick Sequential Organ Failure Assessment" e "Sequential Organ Failure Assessment with lactate", em cães em unidade de cuidados intensivos
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 2.45 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Uma pontuação qSOFA (quick Sequencial Organ Failure Assessment)
superior ou igual a dois pontos aumenta a probabilidade de cães morrerem ou
serem eutanasiados em comparação com cães com uma pontuação inferior, no
entanto a escala apresenta baixa sensibilidade na deteção precoce de pacientes
críticos. A combinação das três variáveis do qSOFA, juntamente com a
concentração plasmática de lactato (LqSOFA) melhora significativamente a
capacidade de identificação de pacientes em risco. Os objetivos do estudo foram
aplicar e comparar as escalas qSOFA e LqSOFA em pacientes hospitalizados
na UCI, de forma a verificar a sua utilidade prognóstica. Para a aplicação da
escala qSOFA foram utilizados os critérios: frequência respiratória ≥22rpm,
pressão arterial sistólica ≤100mmHg e alteração do estado mental. Para a escala
LqSOFA adicionou-se a escala qSOFA um ponto, para níveis de lactato
≥3mmol/L. As medições foram realizadas na admissão (T0), 24h (T24) e 48h
(T48) após a admissão dos cães. Conclui-se que a adição do lactato à escala
qSOFA aumentou a sua sensibilidade em 20% em T0 e em 33,7% em T48, mas
diminuiu a especificidade. Entre T0 e T24, 25% dos animais que diminuíram a
sua pontuação sobreviveram e 17% dos animais que aumentaram vieram a
óbito. A escala LqSOFA foi mais útil na previsão da mortalidade quando avaliada
em T24 (AUC=0,707) ou quando utilizada a média das pontuações obtidas ao
longo das 48 horas (AUC=0,822). A escala qSOFA e LqSOFA apresentam a
mesma sensibilidade na identificação de pacientes séptico em T0 (75%). Os
critérios SIRS estiveram presentes em 86,5% dos pacientes críticos, mas
demonstraram baixa especificidade 18,5%, além disso a capacidade de prever
mortalidade hospitalar (AUC=0,507) foi inferior às escalas LqSOFA (AUC=0,604)
e qSOFA (AUC=0,533). As escalas têm utilidade clínica, no entanto não devem
ser usadas como uma ferramenta única no processo de tomada de decisão.
A qSOFA (quick Sequential Organ Failure Assessment) score of two or higher increases the likelihood of dogs dying or being euthanized compared to dogs with a lower score, however, the scale has low sensitivity in early detection of critical patients. The combination of the three qSOFA variables along with plasma lactate concentration (LqSOFA) significantly improves the ability to identify at-risk patients. The study aims were to apply and compare the qSOFA and LqSOFA scales in hospitalized patients in the ICU to determine their prognostic utility. The qSOFA scale was applied using the criteria: respiratory rate ≥22rpm, systolic blood pressure ≤100mmHg, and altered mental status. The LqSOFA scale added one point to the qSOFA scale for lactate levels ≥3mmol/L. Measurements were taken on admission (T0), 24h (T24), and 48h (T48) after admission of canine patients. It was concluded that the addition of lactate to the qSOFA scale increased its sensitivity by 20% at T0 and 33.7% at T48, but decreased specificity. Between T0 and T24, 25% of animals that decreased their score survived and 17% of animals that increased their score died. The LqSOFA scale was more useful in predicting mortality when evaluated at T24 (AUC=0.707) or when the average scores obtained over 48 hours was used (AUC=0.822). The qSOFA and LqSOFA scales had the same sensitivity in identifying septic patients at T0 (75%). The SIRS criteria were present in 86.5% of critical patients but showed low specificity (18.5%), and the ability to predict in-hospital mortality (AUC=0.507) was lower than the LqSOFA (AUC=0.604) and qSOFA (AUC=0.533) scales. The scales have clinical utility; however, they should not be used as the sole tool in the decision-making process.
A qSOFA (quick Sequential Organ Failure Assessment) score of two or higher increases the likelihood of dogs dying or being euthanized compared to dogs with a lower score, however, the scale has low sensitivity in early detection of critical patients. The combination of the three qSOFA variables along with plasma lactate concentration (LqSOFA) significantly improves the ability to identify at-risk patients. The study aims were to apply and compare the qSOFA and LqSOFA scales in hospitalized patients in the ICU to determine their prognostic utility. The qSOFA scale was applied using the criteria: respiratory rate ≥22rpm, systolic blood pressure ≤100mmHg, and altered mental status. The LqSOFA scale added one point to the qSOFA scale for lactate levels ≥3mmol/L. Measurements were taken on admission (T0), 24h (T24), and 48h (T48) after admission of canine patients. It was concluded that the addition of lactate to the qSOFA scale increased its sensitivity by 20% at T0 and 33.7% at T48, but decreased specificity. Between T0 and T24, 25% of animals that decreased their score survived and 17% of animals that increased their score died. The LqSOFA scale was more useful in predicting mortality when evaluated at T24 (AUC=0.707) or when the average scores obtained over 48 hours was used (AUC=0.822). The qSOFA and LqSOFA scales had the same sensitivity in identifying septic patients at T0 (75%). The SIRS criteria were present in 86.5% of critical patients but showed low specificity (18.5%), and the ability to predict in-hospital mortality (AUC=0.507) was lower than the LqSOFA (AUC=0.604) and qSOFA (AUC=0.533) scales. The scales have clinical utility; however, they should not be used as the sole tool in the decision-making process.
Description
Keywords
Cão LqSOFA qSOFA sépsis SIRS Dog