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- Ibarz, Mercedes, et al.
(författare)
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Sepsis at ICU admission does not decrease 30-day survival in very old patients : a post-hoc analysis of the VIP1 multinational cohort study
- 2020
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Ingår i: Annals of Intensive Care. - : Springer. - 2110-5820. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival.RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85].CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
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| 2. |
- Kluska, J., et al.
(författare)
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VLTI images of circumbinary disks around evolved stars
- 2020
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Ingår i: Proceedings of SPIE - The International Society for Optical Engineering. - : SPIE. - 0277-786X .- 1996-756X. ; 11446
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Konferensbidrag (refereegranskat)abstract
- The new generation of VLTI instruments (GRAVITY, MATISSE) aims to produce routinely interferometric images to uncover the morphological complexity of different objects at high angular resolution. Image reconstruction is, however, not a fully automated process. Here we focus on a specific science case, namely the complex circumbinary environments of a subset of evolved binaries, for which interferometric imaging provides the spatial resolution required to resolve the immediate circumbinary environment. Indeed, many binaries where the main star is in the post-asymptotic giant branch (post-AGB) phase are surrounded by circumbinary disks. Those disks were first inferred from the infrared excess produced by dust. Snapshot interferometric observations in the infrared confirmed disk-like morphology and revealed high spatial complexity of the emission that the use of geometrical models could not recover without being strongly biased. Arguably, the most convincing proof of the disk-like shape of the circumbinary environment came from the first interferometric image of such a system (IRAS08544-4431) using the PIONIER instrument at the VLTI. This image was obtained using the SPARCO image reconstruction approach that enables to subtract a model of a component of the image and reconstruct an image of its environment only. In the case of IRAS08544-4431, the model involved a binary and the image of the remaining signal revealed several unexpected features. Then, a second image revealed a different but also complex circumstellar morphology around HD101584 that was well studied by ALMA. To exploit the VLTI imaging capability to understand these targets, we started a large programme at the VLTI to image post-AGB binary systems using both PIONIER and GRAVITY instruments.
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