Original article
Short-term prognostic factors in the elderly patients seen in emergency departments due to infections
Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por infección
Agustín Julián-Jiméneza,
, Juan González-del-Castillob, Mikel Martínez-Ortiz-de-Záratec, María Jesús Arranz-Nietod, Félix González-Martíneze, Pascual Piñera-Salmerónf, Carmen Navarro-Bustosg, César Henríquez-Camachoh, Eric Jorge García-Lamberechtsb, on behalf of the INFURG-SEMES group
Corresponding author
a Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain
b Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, Spain
c Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, Spain
d Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
e Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, Spain
f Servicio de Urgencias, Hospital Universitario Reina Sofía, Murcia, Spain
g Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
h Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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"apellidos" => "Henríquez-Camacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "Eric Jorge" "apellidos" => "García-Lamberechts" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 9 => array:1 [ "colaborador" => "on behalf of the INFURG-SEMES group" ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario de Basurto, Bilbao, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Reina Sofía, Murcia, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Virgen de la Macarena, Sevilla, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por infección" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1351 "Ancho" => 2915 "Tamanyo" => 171719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Predictive capacity of 30-day mortality in elderly patients in the emergency department. CI: confidence interval; CRP: C-reactive protein; PCT: procalcitonin; <span class="elsevierStyleItalic">p</span>-value: indicates the risk of type <span class="elsevierStyleSmallCaps">1</span> error in the null hypothesis test where the area under the ROC curve is 0.5; AUROC: area under the receiver operating characteristic curve; SBP: systolic blood pressure.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The number of patients over 75 years of age who attend emergency departments (EDs) due to infection has increased significantly over the last 10<span class="elsevierStyleHsp" style=""></span>years (from 24.8% to 31.7%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001),<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> as has the severity of the condition and short-term mortality (30<span class="elsevierStyleHsp" style=""></span>days).<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1–3</span></a> Suspecting and confirming infection in the ED is particularly important in elderly patients owing to their susceptibility to infection and infection severity, especially given that the clinical manifestations of infection are often nonspecific and variable.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a> This hinders the early detection of infection in these patients and results in a false diagnosis and subsequent erroneous patient referral, inappropriate complementary and analytical tests,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> the administration of unnecessary antimicrobials in more than 50% of cases or their delayed administration when their correct and early administration is vital for a positive patient outcome.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6–8</span></a> Immunosenescence leads to immune cell function deterioration and diminished humoral immune function, as well as a chronic proinflammatory state that alters the production of cytokines, chemokines and some biomarkers.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The challenge for emergency departments is to detect elderly patients at high vital risk and/or with severe infection (sepsis, severe sepsis or septic shock [SS]) as early as possible (from triage or the initial patient assessment), based purely on the patient's past medical history, physical examination and complementary tests that emergency departments usually have available.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In terms of objective tools to assist clinicians in establishing a prognosis and identifying the severity of the infection, the functional geriatric assessment (Lawton IADL scale or the Barthel index), comorbidities (Charlson index) and a reduced level of consciousness,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> as well as biomarkers and serum lactate, have come to the fore in recent years and are used by a growing number of EDs.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> Serum lactate, considered the best marker of hypoperfusion and tissue hypoxia, is included in all the emergency department assessment guidelines for patients with sepsis, severe sepsis and SS.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9,10</span></a> Patients with concentrations >2<span class="elsevierStyleHsp" style=""></span>mmol/l should be closely and clinically monitored as it is an independent predictor of poor clinical progression, mortality and severity of severe sepsis and SS.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9,10</span></a> However, few studies have been conducted specifically in patients >75 years of age.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In light of the above, the aim of this study was to determine which identifiable factors that are generally used in the initial emergency department assessment, including baseline and functional status, are related to short-term mortality in elderly patients (≥75 years) diagnosed with infection.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive, multi-centre, analytical and observational study conducted at the 8 emergency departments of the participating investigators (<a class="elsevierStyleCrossRef" href="#sec0035">Annex</a>), belonging to the INFURG-SEMES (Emergency Department Infections Study Group of the Spanish Society of Emergency Medicine) network of centres. Patients ≥75<span class="elsevierStyleHsp" style=""></span>years of age who completed 30 days of follow-up with a diagnosis of infection were consecutively enrolled by chance (when the investigators were on duty) upon clinical diagnosis of the infection in the EDs. The variables were recorded on an encrypted electronic case report form (online). The various criteria, definitions and parameters were defined in advance by the INFURG-SEMES scientific committee and were agreed by the investigators. The study was approved by the Hospital Universitario de Basurto Independent Ethics Committee and met the ethical standards of all the participating centres. All the encrypted data were kept strictly confidential. Patients or family members were informed both orally and in writing, and informed consent was required prior to enrolment. The study did not involve any therapeutic procedure or have any clinical implications.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Unadjusted 30-day mortality was considered a dependent variable. Independent variables that were deemed to be able to support the prognosis during the patient's initial assessment in the ED were chosen, as detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>: demographic variables (age, gender), comorbidity (Charlson index<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> and dichotomised index<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3), functional variables (Barthel index<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> and dichotomised index<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60), clinical variables (altered level of consciousness, systolic blood pressure [SBP] and SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg, sepsis, severe sepsis or septic shock criteria and their defining variables according to the 2001 International Sepsis Definitions Conference<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>) and analytical variables (kidney failure if urea ><span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg/dl or Cr<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1.2<span class="elsevierStyleHsp" style=""></span>mg/dl), leucocyte count, concentration of serum lactate (mmol/l), C-reactive protein (CRP) and procalcitonin (PCT). Serum lactate 5–20<span class="elsevierStyleHsp" style=""></span>mg/dl (0.55–2.22<span class="elsevierStyleHsp" style=""></span>mmol/l), PCT<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>ng/ml and CRP 0–18<span class="elsevierStyleHsp" style=""></span>mg/l were adopted as normal reference values as agreed between the participating centres for patients ≥75 years, and these were dichotomised in accordance with the recommendations of a recent review.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">For the statistical analysis, means and their standard deviations (SD) were used for quantitative variables, and percentages for qualitative variables. The chi-square test, Fisher's exact test, Student's <span class="elsevierStyleItalic">t</span> test or Mann–Whitney <span class="elsevierStyleItalic">U</span> test were used, as applicable, to investigate the correlation between mortality and the independent variables (and the dichotomised variables). The groups were stratified beforehand by the centres variable to check homogeneity. A multivariate logistic regression analysis was conducted (the “enter method” was chosen to include all the chosen variables of the model, that is, all those that had statistical significance in the univariate analysis). The comparison results were expressed as <span class="elsevierStyleItalic">p</span>-values and odds ratios (OR) with a 95% confidence interval (95% CI). A <span class="elsevierStyleItalic">p</span>-value <0.05 or when the 95% CI of the OR excluded the value 1 was accepted as significant. The efficacy of the 30-day mortality prediction was assessed by analysing ROC (receiver operating characteristic) curves with a 95% CI of the area under the ROC curve (AUROC), which was compared against the neutral value (0.5). The bootstrap<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15,16</span></a> method on 1000 samples to evaluate their behaviour and reliability was used to perform internal validation of the model. The values of the <span class="elsevierStyleItalic">β</span> coefficients were used to assign the weight of each variable and the model's score. Youden's index was used to determine the cut-off points with the highest diagnostic value that maximised the difference between the true positive rate and the false positive rate, and their sensitivity (SEN) and specificity (SPE) were found. The statistical analysis was performed using IBM-SPSS<span class="elsevierStyleSup">®</span> Statistics 19 for Windows and STATA 12.0.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">488 cases that met the inclusion and follow-up criteria (maintaining the infection diagnosis established by the ED at 30<span class="elsevierStyleHsp" style=""></span>days) were collected by the 8 investigators during the study period. The baseline, functional, comorbidity, clinical-epidemiological and analytical characteristics analysed during the patient's initial assessment in the ED are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Of these, 92 (18.9%) died within 30<span class="elsevierStyleHsp" style=""></span>days following their consultation in the ED. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows case distribution by type of infection in relation to mortality, demonstrating respiratory infections to be the most common (51.8%) and UTIs to cause the highest mortality proportionally. More patients with a UTI than with a respiratory infection were found to have a Barthel index (BI)<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60 and SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg, although both were found to have serum lactate >4<span class="elsevierStyleHsp" style=""></span>mmol/l. These differences were not maintained after the multivariate analysis was adjusted for infection type. The univariate study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) showed mortality to be directly related to 10 variables: Charlson comorbidity index (CI), Barthel index (BI) (specifically severe functional dependence with a BI<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60), confusion/altered level of consciousness, SBP in mmHg (and SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg), sepsis, severe sepsis/septic shock criteria (and heart rate [HR] and respiratory rate [RR] individually), kidney failure, lactacidaemia in mmol/l (and after dichotomising into >2<span class="elsevierStyleHsp" style=""></span>mmol/l and >4<span class="elsevierStyleHsp" style=""></span>mmol/l), leucocyte count/mm<span class="elsevierStyleSup">3</span> (and dichotomised when >12,000 or <4000 or >10% band cells), CRP in mg/l and PCT in ng/ml (and dichotomised into >0.5 and >1<span class="elsevierStyleHsp" style=""></span>ng/ml). However, after performing the multivariate logistic regression analysis, just three maintained statistical significance as predictors of 30-day mortality: severe functional dependence with a BI<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60 (OR 8.92; 95% CI: 4.98–15.98, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003), SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg (OR 7.34; 95% CI: 4.39–12.26, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005) and lactacidaemia >4<span class="elsevierStyleHsp" style=""></span>mmol/l (OR 21.14; 95% CI: 8.94–49.97, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). The serum lactate cut-off point found to have greatest diagnostic value was 3.84<span class="elsevierStyleHsp" style=""></span>mmol/l (60% sensitivity and 100% specificity), while for the BI it was found to be ≤60<span class="elsevierStyleHsp" style=""></span>points (41% sensitivity and 96% specificity) and for SBP it was found to be <90<span class="elsevierStyleHsp" style=""></span>mmHg (72% sensitivity and 63% specificity).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> depicts the area under the ROC curve of the 3 variables that maintained an independent association with 30-day mortality and which achieved the best outcomes (serum lactate, BI and SBP). <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the ROC curve generated by the model that includes the 3 variables (LIBPAS model: serum <span class="elsevierStyleItalic">L</span>actate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l, <span class="elsevierStyleItalic">B</span>arthel <span class="elsevierStyleItalic">I</span>ndex ≤60 and <span class="elsevierStyleItalic">SBP</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg), obtaining an area under the ROC curve of 0.971 (95% CI: 0.951–0.991; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). After correction by the bootstrap method, the model maintained its performance with an area under the ROC curve of 0.910 (95% CI: 0.885–0.935).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">For the LIBPAS model, the weight of each variable was weighed against the individual weight obtained (the results are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> presents the probability of elderly patient 30-day mortality in relation to the various LIBPAS model combinations of variables.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The results of our study confirm that after the emergency assessment conducted on elderly patients with infection, serum lactate, baseline status (and specifically severe functional dependence with a BI<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60) and SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg are the significantly-correlated independent factors and the strongest prognostic indicators for short-term mortality (30<span class="elsevierStyleHsp" style=""></span>days). These 3 factors that are readily available in the ED make up a new predictive model (LIBPAS), the mandatory use of which should be key in establishing an initial prognosis and in guiding this patient subgroup to the most appropriate resources and healthcare setting.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Serum lactate, which is the best hypoperfusion-tissue hypoxia marker, is included in the emergency department assessment guidelines for patients with sepsis, severe sepsis and septic shock.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> However, it should also be included in the assessment guidelines for elderly patients with or without hypotension, as concentrations >2<span class="elsevierStyleHsp" style=""></span>mmol/l would necessitate close and clinical patient monitoring.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9,17</span></a> Although few studies have been conducted specifically in elderly patients, Del Portal et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> found serum lactate >2<span class="elsevierStyleHsp" style=""></span>mmol/l in the ED to be associated with a relative risk of 30-day mortality of 1.7–2.6, consistent with other studies and reviews where significant differences were also found in adult patients.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> Thus, as in our results, significant differences are obtained with a serum lactate cut-off point >2 or >4<span class="elsevierStyleHsp" style=""></span>mmol/l. In a recently-published study on elderly patients with pneumonia with or without hypotension, Julián-Jiménez et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> found serum lactate concentrations >2.5<span class="elsevierStyleHsp" style=""></span>mmol/l to be correlated to 30-day mortality, with an area under the ROC curve of 0.85 (95% CI: 0.78–0.92), in line with our results. In our study, lactacidaemia >4<span class="elsevierStyleHsp" style=""></span>mmol/l gave an OR of 21.1 (95% CI: 8.9–49.9, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002). The optimal cut-off point with a SPE of 100% was 3.84<span class="elsevierStyleHsp" style=""></span>mmol/l, similar to findings in adult patients.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9,10,17,18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Severe functional dependence and comorbidity are determining prognosis factors that have become more relevant than ever, and their assessment in EDs is becoming increasingly widespread.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> Specific warning signals comprising serum lactate, baseline and functional status and other specific measures<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> are also recommended for elderly patients who are submitted to classic triage or computer-aided simple triage.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> Finally, as already shown, SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg is confirmed as the haemodynamic factor with the highest prognostic value for mortality in elderly patients with infection.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Although it is known that the appropriateness of hospital admission is higher in elderly patients, with a positive association having been found between appropriateness and age (OR 1.021; 95% CI: 1.008–1.035),<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> prognostic assessment in the ED could be objectively and significantly improved through the widespread application of LIBPAS and, due to their weight, assessment of individual serum lactate values, to guide decision-making towards discharge rather than admission and towards the appropriate healthcare setting.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Elderly patients with a LIBPAS model score of 0 points and a serum lactate value of <2<span class="elsevierStyleHsp" style=""></span>mmol/l could be discharged or referred to in-home care or a day hospital. There, patients could be kept under observation for a few hours and receive initial antimicrobial treatment and other therapeutic measures,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> provided that the infection does not require admission or any other urgent procedure.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Elderly patients with a score of 0–1 points and serum lactate concentrations between 2 and 4<span class="elsevierStyleHsp" style=""></span>mmol/l should always be admitted. Although experience with elderly patients in short-stay units in recent years has shown the practice to be a safe and effective alternative to conventional hospitalisation,<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">23,24</span></a> decision-making should be based on each patient's baseline status and the resources available.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Elderly patients with a score of 2 points should be admitted to units that provide more intensive clinical monitoring and continuous testing.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Depending on their personal situation, intensive care unit admission should be considered for all patients with ≥3 points or serum lactate >4<span class="elsevierStyleHsp" style=""></span>mmol/l.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Given that this was a multicentre study with patients enrolled by chance, its main limitation is selection bias resulting from the inclusion of patients only when each centre's investigator was on duty, despite the fact that enrolment was consecutive during the recruitment period. Given that the various criteria, definitions and parameters were defined in advance by the INFURG-SEMES scientific committee and were agreed by the investigators, some infection type classification errors may have occurred in the clinical diagnoses. Furthermore, patient characteristics and differences in mortality between different infection types were not analysed as they did not form part of the study objective. As such, some infection types, such as respiratory, were assumed to be heterogeneous and comprised both viral and bacterial infections, which could explain the differences found between them.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The selection of clinical variables could also have been more comprehensive (if it were not for the lack of data) and lab tests were only conducted for those variables available and generally formalised in the emergency department protocols.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a> Despite these limitations, we believe that the study is a true reflection of actual clinical practice in our EDs.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion, the inclusion of serum lactate in the requested lab tests, together with the functional and haemodynamic assessment of all elderly patients with infection in the emergency departments’ initial assessment, have been found to be effective prognostic indicators of short-term mortality. In the future, these measures could significantly improve the prognostic power and comprehensive assessment of patients with sepsis from the moment they arrive at the ED, when used in conjunction with prognostic scores, other biomarkers (such as PCT) or detection systems. The LIBPAS model, which encompasses hyperlactacidaemia >4<span class="elsevierStyleHsp" style=""></span>mmol/l, significant functional dependence and SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg, is a very effective predictor of short-term mortality in elderly patients with infection treated by EDs. Future external validation studies of the model are required.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">No funding was received from any public or private body to complete this manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest with regards to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres827759" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec824074" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres827758" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec824073" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-04" "fechaAceptado" => "2015-10-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec824074" "palabras" => array:6 [ 0 => "Mortality" 1 => "Emergency department" 2 => "Prognostic factors" 3 => "Functional dependence" 4 => "Serum lactate" 5 => "Elderly" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec824073" "palabras" => array:6 [ 0 => "Mortalidad" 1 => "Servicios de urgencias" 2 => "Factores pronósticos" 3 => "Dependencia funcional" 4 => "Lactato sérico" 5 => "Anciano" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse factors associated with short-term mortality in elderly patients seen in emergency departments (ED) for an episode of infectious disease.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective, observational, multicentre, analytical study was carried out on patients aged 75<span class="elsevierStyleHsp" style=""></span>years and older who were treated in the ED of one of the eight participating hospitals. An assessment was made of 26 independent variables that could influence mortality at 30<span class="elsevierStyleHsp" style=""></span>days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Multivariate logistic regression analysis was performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included 488 consecutive patients, 92 (18.9%) of whom died within 30<span class="elsevierStyleHsp" style=""></span>days of visiting the ED. Three variables were significantly associated with higher mortality: severe functional dependence, with Barthel index<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60 [odds ratio (OR) 8.92; 95% confidence interval (CI): 4.98–15.98, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003], systolic blood pressure <90<span class="elsevierStyleHsp" style=""></span>mmHg [OR 7.34; 95% CI: 4.39–12.26, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005] and serum lactate >4<span class="elsevierStyleHsp" style=""></span>mmol/l [OR 21.14; 95% CI: 8.94–49.97, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001]. The area under the curve for the model was 0.971 (95% CI: 0.951–0.991; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Several factors evaluated in an initial assessment in the ED, including the level of functional dependence, systolic blood pressure and, especially, serum lactate, were found to determine a poor short-term prognosis in the elderly patients who presented with an episode of an infectious disease.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar los factores asociados a la mortalidad a corto plazo en los pacientes ancianos que acuden al servicio de urgencias (SU) por un episodio de infección.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional, prospectivo, multicéntrico y analítico. Se incluyó consecutivamente a pacientes de 75 o más años atendidos en 8 servicios de SU por un proceso infeccioso. Se analizaron 26 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30<span class="elsevierStyleHsp" style=""></span>días). Se realizó un estudio multivariable mediante regresión logística.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a 488 pacientes, de los que 92 (18,9%) habían fallecido a los 30<span class="elsevierStyleHsp" style=""></span>días tras su consulta en el SU. Tres variables se asociaron de forma significativa con la mortalidad: la dependencia funcional basal grave con índice de Barthel ≤<span class="elsevierStyleHsp" style=""></span>60 (<span class="elsevierStyleItalic">odds ratio</span> [OR] 8,92; intervalo de confianza [IC] del 95%: 4,98-15,98, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003), la existencia de una presión arterial sistólica (PAS)<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg (OR 7,34; IC<span class="elsevierStyleHsp" style=""></span>95%: 4,39-12,26, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005) y lactato sérico ><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l (OR 21,14; IC 95%: 8,94-49,97, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001). El área bajo la curva-ROC del modelo fue 0,971 (IC 95%: 0,951-0,991; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Existen varios factores disponibles tras una primera atención en el SU—entre ellos la valoración funcional, la PAS y, el más importante, el lactato sérico—que determinan un mal pronóstico a corto plazo del paciente anciano que consulta por un proceso infeccioso.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Julián-Jiménez A, González-del-Castillo J, Martínez-Ortiz-de-Zárate M, Arranz-Nieto MJ, González-Martínez F, Piñera-Salmerón P, et al. Factores pronósticos a corto plazo en los ancianos atendidos en urgencias por infección. Enferm Infecc Microbiol Clin. 2017;35:214–219.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0120" class="elsevierStylePara elsevierViewall">Agustín Julián Jiménez (Complejo Hospitalario de Toledo), Juan González del Castillo and Eric Jorge García Lamberechts (Hospital Universitario Clínico San Carlos, Madrid), Mikel Martínez Ortiz de Zárate (Hospital Universitario de Basurto, Bilbao), María Jesús Arranz Nieto (Hospital Nuestra Señora del Prado, Talavera de la Reina), Félix González Martínez (Hospital Virgen de la Luz, Cuenca), Pascual Piñera Salmerón (Hospital Universitario Reina Sofía, Murcia), Carmen Navarro Bustos (Hospital Universitario Virgen de la Macarena, Seville), César Henríquez Camacho (Hospital Universitario Fundación Alcorcón).</p>" "etiqueta" => "Annex" "titulo" => "INFURG-SEMES (Emergency Department Infections Study Group of the Spanish Society of Emergency Medicine) investigators" "identificador" => "sec0035" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1351 "Ancho" => 2915 "Tamanyo" => 171719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Predictive capacity of 30-day mortality in elderly patients in the emergency department. CI: confidence interval; CRP: C-reactive protein; PCT: procalcitonin; <span class="elsevierStyleItalic">p</span>-value: indicates the risk of type <span class="elsevierStyleSmallCaps">1</span> error in the null hypothesis test where the area under the ROC curve is 0.5; AUROC: area under the receiver operating characteristic curve; SBP: systolic blood pressure.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1340 "Ancho" => 2914 "Tamanyo" => 107083 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Predictive capacity for 30-day mortality of the LIBPAS model. LIBPAS model: Spanish acronym of serum <span class="elsevierStyleItalic">L</span>actate ><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l, <span class="elsevierStyleItalic">B</span>arthel <span class="elsevierStyleItalic">I</span>ndex ≤<span class="elsevierStyleHsp" style=""></span>60 and <span class="elsevierStyleItalic">SBP</span> <<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg. CI: confidence interval; <span class="elsevierStyleItalic">p</span>-value: indicates the risk of type <span class="elsevierStyleSmallCaps">1</span> error in the null hypothesis test where the area under the ROC curve is 0.5; AUROC: area under the receiver operating characteristic curve; SBP: systolic blood pressure.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">bpm: beats per minute; breaths/min: breaths per minute; CRP: C-reactive protein; ED: emergency department; GCS: Glasgow Coma Scale; HR: heart rate; PCT: procalcitonin; RR: respiratory rate; SBP: systolic blood pressure; SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient characteristics (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>488) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 30-day survival<br>n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>396 (81.1%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient 30-day mortality<br>n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>92 (18.9%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Mean age (SD) in years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.68 (5.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.43 (5.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.256 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Male (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">199 (50.25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (46.73%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.312 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Comorbidities and functional status</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Charlson index in points (SD)</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.44 (2.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.92 (2.48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Charlson index<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">152 (38.38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (47.82%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Barthel index in points (SD)</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.71 (29.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.44 (28.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Barthel index<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (26.01%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (68.47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Clinical and severity variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Altered level of consciousness (GCS</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">15)</span>, n <span class="elsevierStyleItalic">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (27.77%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (59.34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SBP in mmHg (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126.91 (29.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.79 (28.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IF SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (11.47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sepsis criteria, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">199 (50.25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (30.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe sepsis/septic shock criteria, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (19.43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (64.12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Temperature in degrees (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.15 (1.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.90 (1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>HR in bpm (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.35 (20.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.18 (23.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>RR in breaths/min (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.81 (8.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.81 (7.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Laboratory findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Urea</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg/dl or creatinine > 1.2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg/dl</span>, n <span class="elsevierStyleItalic">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225 (57.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (76.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Serum lactate in mmol/l (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.72 (0.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.58 (2.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lactate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mmol/l, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (37.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (89.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lactate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (50.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leucocyte count (SD) per mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13,450 (8,645) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19,380 (12,526) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leukocytosis</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">12,000/mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">or <4000/mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">or >10% band cells</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">190 (48.34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (70%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CRP in mg/l (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128.35 (900.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.54 (140.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.916 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>CRP<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>mg/l, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174 (49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (65.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PCT in ng/ml (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.90 (11.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.85 (7.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PCT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.5 in ng/ml, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (58.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PCT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1 in ng/ml, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (47.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PCT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10 in ng/ml, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (29.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.161 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392752.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">CI: Charlson index.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a></p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">BI: Barthel index.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p> <p class="elsevierStyleNotepara" id="npar0015">The percentages exclude any lost data, if applicable.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clinical–epidemiological and analytical characteristics of patients over the age of 75 treated for infection in the ED (univariate analysis).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CNSI: central nervous system infection; IAI: intra-abdominal infection; LRTI: lower respiratory tract infection; OURTI: otolaryngological upper respiratory tract infection; SSTI: skin and soft tissue infection; TRAUMI: traumatic infection: UTI: urinary tract infection.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Type or focus n (%)</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survived \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Died \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (35.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (72.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (27.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LRTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">253 (51.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">221 (87.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (12.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">OURTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IAI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (13.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (76.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (23.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SSTI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (85.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (14.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TRAUMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CNSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other or fever without a focus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (79.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (20.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392750.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Types of infection and their correlation to 30-day mortality.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; OR: odds ratio; SBP: systolic blood pressure.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Coefficient <span class="elsevierStyleItalic">β</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum lactate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.14 (8.94–49.97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Barthel index<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.92 (4.98–15.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.34 (4.39–12.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392751.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">LIBPAS model: serum <span class="elsevierStyleItalic">L</span>actate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l, <span class="elsevierStyleItalic">B</span>arthel <span class="elsevierStyleItalic">I</span>ndex ≤ 60 and <span class="elsevierStyleItalic">SBP</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Barthel index<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>60 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SBP<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Probability of 30-day mortality (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Serum lactate ≤<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Serum lactate<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mmol/l</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1392753.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Probability of 30-day mortality based on the LIBPAS model.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio INFURG-SEMES: epidemiología de las infecciones en los servicios de urgencias hospitalarios y evolución durante la última década" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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| Year/Month | Html | Total | |
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| 2024 November | 3 | 1 | 4 |
| 2024 October | 30 | 6 | 36 |
| 2024 September | 10 | 4 | 14 |
| 2024 August | 19 | 2 | 21 |
| 2024 July | 13 | 3 | 16 |
| 2024 June | 9 | 6 | 15 |
| 2024 May | 22 | 2 | 24 |
| 2024 April | 22 | 11 | 33 |
| 2024 March | 23 | 4 | 27 |
| 2024 February | 21 | 5 | 26 |
| 2024 January | 22 | 3 | 25 |
| 2023 December | 20 | 5 | 25 |
| 2023 November | 17 | 9 | 26 |
| 2023 October | 18 | 4 | 22 |
| 2023 September | 10 | 3 | 13 |
| 2023 August | 12 | 1 | 13 |
| 2023 July | 11 | 3 | 14 |
| 2023 June | 11 | 1 | 12 |
| 2023 May | 39 | 7 | 46 |
| 2023 April | 44 | 4 | 48 |
| 2023 March | 25 | 4 | 29 |
| 2023 February | 14 | 4 | 18 |
| 2023 January | 13 | 5 | 18 |
| 2022 December | 24 | 9 | 33 |
| 2022 November | 16 | 12 | 28 |
| 2022 October | 25 | 16 | 41 |
| 2022 September | 24 | 7 | 31 |
| 2022 August | 25 | 10 | 35 |
| 2022 July | 19 | 8 | 27 |
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| 2022 May | 43 | 6 | 49 |
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| 2022 January | 69 | 11 | 80 |
| 2021 December | 74 | 10 | 84 |
| 2021 November | 79 | 9 | 88 |
| 2021 October | 35 | 10 | 45 |
| 2021 September | 40 | 10 | 50 |
| 2021 August | 36 | 8 | 44 |
| 2021 July | 33 | 10 | 43 |
| 2021 June | 28 | 10 | 38 |
| 2021 May | 37 | 12 | 49 |
| 2021 April | 52 | 12 | 64 |
| 2021 March | 13 | 6 | 19 |
| 2021 February | 15 | 7 | 22 |
| 2021 January | 29 | 13 | 42 |
| 2020 December | 17 | 4 | 21 |
| 2020 November | 24 | 2 | 26 |
| 2020 October | 14 | 2 | 16 |
| 2020 September | 35 | 11 | 46 |
| 2020 August | 55 | 10 | 65 |
| 2020 July | 23 | 9 | 32 |
| 2020 June | 28 | 10 | 38 |
| 2020 May | 35 | 9 | 44 |
| 2020 April | 18 | 2 | 20 |
| 2020 March | 33 | 8 | 41 |
| 2020 February | 43 | 3 | 46 |
| 2020 January | 38 | 12 | 50 |
| 2019 December | 33 | 6 | 39 |
| 2019 November | 15 | 11 | 26 |
| 2019 October | 16 | 11 | 27 |
| 2019 September | 24 | 2 | 26 |
| 2019 August | 13 | 3 | 16 |
| 2019 July | 29 | 9 | 38 |
| 2019 June | 28 | 22 | 50 |
| 2019 May | 90 | 32 | 122 |
| 2019 April | 43 | 5 | 48 |
| 2019 March | 13 | 1 | 14 |
| 2019 February | 18 | 3 | 21 |
| 2019 January | 14 | 11 | 25 |
| 2018 December | 17 | 1 | 18 |
| 2018 November | 25 | 4 | 29 |
| 2018 October | 18 | 3 | 21 |
| 2018 September | 21 | 5 | 26 |
| 2018 August | 6 | 0 | 6 |
| 2018 July | 15 | 2 | 17 |
| 2018 June | 15 | 0 | 15 |
| 2018 May | 10 | 4 | 14 |
| 2018 April | 15 | 0 | 15 |
| 2018 March | 6 | 0 | 6 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 9 | 0 | 9 |
| 2017 November | 7 | 1 | 8 |
| 2017 October | 13 | 0 | 13 |
| 2017 September | 1 | 0 | 1 |
| 2017 May | 1 | 0 | 1 |
| 2017 April | 5 | 0 | 5 |
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