bachelorThesis
Validación puntaje PIRO en pacientes con sepsis severa y choque séptico en cuidado intensivo
Fecha
2013-12-09Registro en:
The EPISEPSIS Group. Episepsis: a reappraisal of the epidemiology and outcome of severe sepsis in
French intensive care units. Intensive Care Med 2004;30(4):580–8
Silva E, Pedro M de A, Sogayar AC, Mohovic T, Silva CL, Janiszewski M, et al. Brazilian Sepsis
Epidemiological Study (BASES study). Crit Care. 2004;8:R251-260.
Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States:
analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303–1310
Levy MM, Dellinger RP, Townsend SR, et al. The surviving sepsis campaign: results of an
international guideline-based performance improvement program targeting severe sepsis.
Intensive Care Med 2010; 36:222–231
Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit
Care Med 1985;13:818-29.
Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of
hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619-36.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a
European/North American multicenter study. JAMA 1993;270:2957-63.
Zimmerman JE, Kramer AA, McNair DS, et al. Acute Physiology and Chronic Health Evaluation
(APACHE) IV: hospital mortality assessment for today's critically ill patients. Crit Care Med
2006;34: 1297-310.)
Meyer AA, Messick WJ, Young P, Baker CC, Fakhry S, Muakkassa F et al. Prospective comparison of
clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients. J
Trauma 1992; 32(6):747-753)
Trzeciak S, Zanotti-Cavazzoni S, Parrillo JE, et al: Inclusion criteria for clinical trials in sepsis: Did
the American College of Chest Physicians/Society of Critical Care Medicine consensus conference
definitions of sepsis have an impact? Chest 2005; 127:242–245
Vincent JL: Dear SIRS, I’m sorry to say that I don’t like you … Crit Care Med 1997; 25:372–374
Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis
Definitions Conference. Crit Care Med 2003; 31:1250–1256
Rello J, Rodriguez A, Lisboa T, et al: PIRO score for community-acquired pneumonia: A new
prediction rule for assessment of severity in intensive care unit patients with community- acquired
pneumonia. Crit Care Med 2009; 37:456–462
Lisboa T, Diaz E, Sa-Borges M, et al: The ventilator-associated pneumonia PIRO score: A tool for
predicting ICU mortality and health-care resources use in ventilatorassociated pneumonia. Chest
2008; 134: 1208–1216
Howell M, Talmor D, Schuetz P. Proof of principle: The predisposition, infection, response, organ
failure sepsis staging system. Crit Care Med 2011; 39:322–327
Consensus Conference Organised by the ESICM and the SRLF (1994) Predicting outcome in ICU
patients. Intensive Care Med 20: 390-397
Oliveros H. Predicción de la Mortalidad en UCI Principios Metodológicos. Acta Colombiana de
Cuidado Intensivo. 2003 p: 34-42
Terrin N, Schmid C, Griffith J, et al. External validity of predinctive models: A comparison of logistic
regression, clasification trees, and neural networks. Journal of clinical Epidemiology 56 (2003)
721-729
Knaus WA, Zimmerman JE, Wagner DP, et al. APACHE, acute physiology and chronic health
evaluation : A physiologically based classification system. Crit Care Med 1981; 9:591-597
LeGall JR, Loirat A, Alperovitch A, et al. A simplified acute physiology score for ICU patients. Crit
Care Med 1984; 12:975-977
Lemeshow S, Teres D, Klar J, et al. Mortality probability models (MPM II) based on an international
cohort of intensive care unit patients. JAMA 1993; 270:2478-2486
Marulanda S, Caicedo JC, Agudelo J, Martínez O. APACHE II como predictor de muerte en
pancreatitis aguda. Rev Colomb Cir 2000; 15: 261-266.
Hernández, Albeiro; Oliveros, Henry. Validez de los marcadores de severidad en la predicción de
mortalidad en pancreatitis aguda Revista Med, vol. 15, núm. 001, enero, 2007, pp. 48-53.
Universidad Militar Nueva Granada Colombia
Justice AC, Covinsky KE, Berlin JA. Assessing the generalizability of prognostic information. Ann
Intern Med 1999;130:515–24.
Harrell FE, Lee KL, Mark DB. Tutorial in biostatistics multivariable prognostic models: issues in
developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat
Med 1996;15:361–87
Steyerberg EW, Harrell FE Jr, Borsboom GJJM, et al. Internal validation of predictive models:
efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 2001;54:774–81.
Schuster DP(1992) Predicting outcome after ICU admission. The art and science of assessing risk.
Chest 101:1861-1870
Hosmer D W, Lemeshow S. Assessing the Fit of the Model. In: Wiley Inter-Science, editor. Applied
Logistic Regression. New York: 2000: 143-299.
Francesca Rubulotta, MD; John C. Marshall, MD; Graham Ramsay, MD; David Nelson, MS; Mitchell
Levy, MD; Mark Williams, MD, FCCM. Predisposition, insult/infection, response, and organ
dysfunction: A new model for staging severe sepsis. Crit Care Med 2009; 37:1329–1335
Martin GS, Mannino DM, Eaton S, et al: The epidemiology of sepsis in the United States from 1979
through 2000. N Engl J Med 2003; 348:1546–1554)
Bone RC, Balk RA, Cerra FB, et al: American College of Chest Physicians/Society of Critical Care
Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use
of innovative therapies in sepsis. Chest 1992; 101:1644–1655
Michael D. Howell, MD, MPH; Daniel Talmor, MD, MPH; Philipp Schuetz, MD; Sabina Hunziker, MD;
Alan E. Jones, MD; Nathan I. Shapiro, MD, MPH. Proof of principle: The predisposition, infection,
response, organ failure sepsis staging system. Crit Care Med 2011; 39:322–327.
Le Gall JR, Lemeshow S, Leleu G, Klar J, Huillard J, Rué M, Teres D, Artigas A. Customized probability
models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group.
JAMA. 1995 Feb 22;273(8):644-50)
Arabi Y, Al Shirawi N, Memish Z, Venkatesh S, Al-Shimemeri A. Assessment of six mortality
prediction models in patients admitted with severe sepsis and septic shock to the intensive care
unit: a prospective cohort study. Crit Care. 2003 Oct;7(5):R116-22. Epub 2003 Aug 28
Nguyen HB, Van Ginkel C, Batech M, Banta J, Corbett SW. Comparison of Predisposition,
Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health
Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early
goal-directed therapy and the severe sepsis resuscitation bundle. J Crit Care. 2011 Oct 25. [Epub
ahead of print]
Arriagada D, Díaz F, Donoso A, Cruces P. Clasificación PIRO en sepsis grave y shock séptico
pediátrico: Nuevo modelo de estratificación y su utilidad en pronóstico. Rev Chil Infect 2010; 27(1):
17-23
Guillermo Ortiz; Antonio Lara; Mauricio Moreno; Alejandro Reyes; Jorge Ordoñez; Rafael Miranda;
Carmelo Dueñas. Puntaje PIRO en neumonía asociada al ventilador. Acta Colombiana de Cuidado
Intensivo 2010; 10(1): 10-15
Francesca Rubulotta, MD, Outcomes in severe sepsis and patients with septic shock do not matter!
PIRO is a score to treat severe septic and septic shock patients not to measure outcomes. To the
Editor: Crit Care Med 2012 Vol. 40, No. 2
Mario Mercado, MD. Rómulo Salazar, MD. Ricardo Buitrago, MD. Henry Oliveros, MD. Validación del
puntaje PIRO en pacientes con sepsis severa y choque séptico en la Unidad de Cuidado Intensivo.
Acta Colombiana de Cuidado Intensivo 2012; 12(1): 27-33.
256128
TE06095
Autor
Poveda Henao, Marcela
Buitrago Bernal, Ricardo Antonio
Oliveros Rodríguez, Henry
Institución
Resumen
Los pacientes en estado crítico que ingresan con diagnóstico de sepsis severa o choque séptico representan un elevado porcentaje de la admisión anual a las unidades de cuidado intensivo. La incidencia reportada oscila entre 51 - 100 casos por cada 100.000 individuos 1 y de acuerdo a estudios latinoamericanos hasta el 25% de los pacientes tienen o tendrán un diagnóstico de sepsis durante su estancia en la unidad de cuidados intensivos 2. A pesar del desarrollo tecnológico en los sistemas de monitoria así como la constante mejora en estrategias diagnósticas y terapéuticas tempranas, la sepsis continua teniendo una elevada mortalidad atribuible que va desde el 18% hasta el 50% 3. Debido a lo anterior, múltiples grupos de trabajo, sociedades académicas y líderes de opinión han encaminado sus esfuerzos a realizar intervenciones efectivas que permitan disminuir la elevada mortalidad en el campo de la sepsis. Estos esfuerzos involucran una redefinición de la respuesta inflamatoria sistémica, de la sepsis, la sepsis severa, el choque séptico y la disfunción orgánica múltiple que sea universal y acorde con los nuevos marcadores asociados a mortalidad, así como a la aplicación de escalas específicas que permitan identificar tempranamente los pacientes con mayor riesgo de muerte y que probablemente se beneficien de estrategias de manejo aún más agresivas y tempranas en el curso de la enfermedad.