Study design: a descriptive, prospective cohort study. Objectives: identify the risk factors associated with SAPS 3 and APACHE II score to improve mortality prediction in elderly admitted in the intensive care unit (ICU). Methodology: a cohort study with 174 elderly patients admitted in ICU from July 2016 to June 2017. The primary independent variables analyzed were: presence of stress hyperglycemia, the need for invasive mechanical ventilation (IMV), acute renal failure, level of consciousness and use of vasopressors. The outcomes studied were death and hospital discharge. Results: ICU and hospital mortality were 17.8% and 29.8%, respectively. The multivariate analysis of factors associated with hospital death not contemplated in the obtaining of SAPS 3 demonstrated that IMV, Chronic Obstructive Pulmonary Disease (COPD) and Mean Arterial Pressure (MAP) <70 mmHg improved the prediction of mortality. The Hosmer-Lemeshow test (p=0.472) and area under ROC curve=0.80 (CI95%:0.731-0.872) confirmed, respectively, an appropriate calibration and acceptable-to-excellent discriminatory power for this model. IMV and COPD were also factors associated with the APACHE II score in prediction of mortality with appropriated calibration (p=0.471) and acceptable-to-excellent discriminatory power (area under ROC curve=0.80 [CI95%:0.730-0.868]). Conclusion: IMV, COPD, and MAP <70 mmHg were associated with SAPS3 and APACHE II to predict mortality in elderly admitted to ICU.
Chagas disease has become globalized as a result of the migratory process of infected patients to non-endemic areas. With the considerable number of individuals affected by the disease, detection and treatment of its chronic manifestations is a relevant and necessary issue. Growing attention has been paid to chronic Chagas cardiomyopathy (CCC), which includes heart failure, malignant arrhythmias, conduction disturbances and thromboembolic events. Many pharmacological and nonpharmacological treatments for CCC are still extrapolations of existing evidence on the treatment of other clinical conditions, highlighting the need of including this group of patients in future studies. In this review, we will discuss the most recent data from the literature and clinical practice on the diagnosis and treatment of CCC.
IntrodutionChagas disease (CD) is a neglected tropical disease that affects socially vulnerable individuals that experience stigma, discrimination and high morbidity and mortality, especially those with the cardiac form of the disease. 1,2 Changes in the epidemiological landscape of CD have been described worldwide.With the migratory phenomenon, CD has become globalized. Especially coming from the Latin America, CD
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