Letter to the Editor
Short-term prognostic value of NT-proBNT in acute infection
Valor pronóstico a corto plazo del NT-proBNT en los pacientes con infección aguda
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2387020618302018" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.05.010" "estado" => "S300" "fechaPublicacion" => "2018-07-13" "aid" => "4341" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:e1-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775317308874" "issn" => "00257753" "doi" => "10.1016/j.medcli.2017.11.012" "estado" => "S300" "fechaPublicacion" => "2018-07-13" "aid" => "4341" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:e1-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 16 "formatos" => array:2 [ "HTML" => 10 "PDF" => 6 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Valor pronóstico a corto plazo del NT-proBNT en los pacientes con infección aguda" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e1" "paginaFinal" => "e2" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Short-term prognostic value of NT-proBNT in acute infection" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1300 "Ancho" => 1645 "Tamanyo" => 112847 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Curva ROC de mortalidad a 30 días.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PCR: proteína C reactiva; PCT: procalcitonina; ProBNP: fragmento N-terminal del propéptido natriurético cerebral; ROC: <span class="elsevierStyleItalic">receiver operating characteristic</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan González del Castillo, Cecilia Yañez, Francisco Javier Martín-Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "González del Castillo" ] 1 => array:2 [ "nombre" => "Cecilia" "apellidos" => "Yañez" ] 2 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020618302018" "doi" => "10.1016/j.medcle.2018.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618302018?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317308874?idApp=UINPBA00004N" "url" => "/00257753/0000015100000001/v1_201806230409/S0025775317308874/v1_201806230409/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S238702061830202X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.05.011" "estado" => "S300" "fechaPublicacion" => "2018-07-13" "aid" => "4344" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:e3-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Usefulness of the N-terminal pro brain natriuretic peptide as short-term prognostic factor for mortality in elderly patients with infection seen in emergency departments" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e3" "paginaFinal" => "e4" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rendimiento pronóstico de mortalidad a corto plazo del fragmento N-terminal del propéptido natriurético cerebral en ancianos con infección en el servicio de urgencias" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elisa García-Tercero, Sadaf Zafar Iqbal-Mirza, Agustín Julián-Jiménez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elisa" "apellidos" => "García-Tercero" ] 1 => array:2 [ "nombre" => "Sadaf Zafar" "apellidos" => "Iqbal-Mirza" ] 2 => array:2 [ "nombre" => "Agustín" "apellidos" => "Julián-Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317308904" "doi" => "10.1016/j.medcli.2017.11.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317308904?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061830202X?idApp=UINPBA00004N" "url" => "/23870206/0000015100000001/v1_201807170422/S238702061830202X/v1_201807170422/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020618302006" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.05.009" "estado" => "S300" "fechaPublicacion" => "2018-07-13" "aid" => "4339" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:42-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Systemic reaction and mediastinal involvement secondary to breast implant rupture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "43" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reacción sistémica y afectación mediastínica secundaria a rotura de implante protésico de mama" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 912 "Ancho" => 2500 "Tamanyo" => 255430 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT angiography: (A) subcarinal lymphadenopathy corresponding to siliconoma; (B) right prosthetic rupture and (C) left pulmonary parenchyma showing bullae, some bronchiectasis and hypovascularity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz María Jiménez-Rodríguez, Laura Gallo-Padilla, Ana Dolores Romero-Ortiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Beatriz María" "apellidos" => "Jiménez-Rodríguez" ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Gallo-Padilla" ] 2 => array:2 [ "nombre" => "Ana Dolores" "apellidos" => "Romero-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317308850" "doi" => "10.1016/j.medcli.2017.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317308850?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618302006?idApp=UINPBA00004N" "url" => "/23870206/0000015100000001/v1_201807170422/S2387020618302006/v1_201807170422/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Short-term prognostic value of NT-proBNT in acute infection" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e1" "paginaFinal" => "e2" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan González del Castillo, Cecilia Yañez, Francisco Javier Martín-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Juan" "apellidos" => "González del Castillo" "email" => array:1 [ 0 => "jgonzalezcast@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cecilia" "apellidos" => "Yañez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria, Hospital San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor pronóstico a corto plazo del NT-proBNT en los pacientes con infección aguda" ] ] "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" => 1300 "Ancho" => 1645 "Tamanyo" => 103728 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">30-day mortality ROC curve.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CRP: C-reactive protein; PCT: procalcitonin; NT-ProBNP: N-terminal prohormone of brain natriuretic peptide; ROC: <span class="elsevierStyleItalic">receiver operating characteristic</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by García Villalba et al. which concludes that in septic patients, with a low risk of mortality, the levels of the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) obtained in the first 72<span class="elsevierStyleHsp" style=""></span>h after admission are a powerful predictor of mortality.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In this regard, we would like to make a series of comments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">First, it should be noted that NT-proBNP measurement was performed during the first 72<span class="elsevierStyleHsp" style=""></span>h. In this regard, we must bear in mind that there are numerous factors related to resuscitation and therapeutic intervention that occurred during the first days of care that can condition in-hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> For all these reasons, an evaluation of prognostic biomarkers seems more appropriate during the first patient care interval, to help in making decisions about risk stratification, treatment and final patient destination. Its greatest utility, from that first intervention, has to do with monitoring the therapeutic response.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly, it is known that the elevation of NT-proBNP is higher in patients with reduced systolic function compared to those with preserved function,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> so it would have been interesting to know their existence or lack of it in the studied patients, as well as to have considered it in the analysis, since it could behave as a confounding factor. This fact is even more important when the present study showed that heart failure was a predictor of biomarker elevation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirdly, it should be assessed whether the fact that 69% of the infectious processes were respiratory could influence the results obtained, and whether the predictive capacity of NT-pro-BNP is maintained in all infection models. In addition, there are other conditions that can modify NT-proBNP, such as age, sex, pulmonary hypertension or kidney failure.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Although the first 2 were included as independent variables, it does not appear from the wording of the article that the presence of renal insufficiency or pulmonary hypertension was included, and therefore this could have conditioned the findings described in the article.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, with regard to special populations, and in order to know the behavior of these biomarkers in elderly patients, we would like to provide the results of an analysis on the prospective cohort of the Infections Group of the Spanish Society of Emergency Medicine (INFURG-SEMES) that included infected patients ≥75 years of age from 69 hospitals where NT-proBNP, <span class="elsevierStyleSmallCaps">C</span>-reactive protein, procalcitonin and lactate determinations were available upon arrival at the emergency department.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> We included 468 patients with a mean age of 84.8 (SD: 5.9) years, of which 239 (51.1%) were male and 204 (43.6%) had a Charlson index ≥3. The main models of infection were respiratory (63.7%) and urinary (22.4%), and 248 (53%) met sepsis criteria. Fifty-six (12%) cases died in the first 30 days. The AUC of the NT-proBNP was 0.687 (95% CI: 0.593–0.780, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.048); for lactate 0.722 (95% CI: 0.620–0.825; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); for CRP 0.612 (95% CI: 0.514–0.710; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.050), and for PCT 0.662 (95% CI: 0.555–0.728; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.044) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we cannot assert that NT-proBNP is useful when stratifying the risk of patients treated for infection upon arrival at the emergency department, and its superiority, especially in the elderly patient, remains to be established above other biomarkers such as lactate, which has the advantage of its wide implementation in our health system, the speed in obtaining it, the greater experience in its interpretation and its lower cost.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González del Castillo J, Yañez C, Martín-Sánchez FJ. Valor pronóstico a corto plazo del NT-proBNT en los pacientes con infección aguda. Med Clin (Barc). 2018;151:e1–e2.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1300 "Ancho" => 1645 "Tamanyo" => 103728 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">30-day mortality ROC curve.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CRP: C-reactive protein; PCT: procalcitonin; NT-ProBNP: N-terminal prohormone of brain natriuretic peptide; ROC: <span class="elsevierStyleItalic">receiver operating characteristic</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The N-terminal pro brain natriuretic peptide is the best predictor of mortality during hospitalization in patients with low risk of sepsis-related organ failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. García Villalba" 1 => "E. Bernal Morell" 2 => "M.P. Egea" 3 => "I. Marín" 4 => "A. Alcaraz Garcia" 5 => "A. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2017" "volumen" => "149" "paginaInicial" => "189" "paginaFinal" => "195" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nomogram to predict a poor outcome in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. García-Villalba" 1 => "A. Cano-Sánchez" 2 => "A. Alcaraz-García" 3 => "C. Cinesi-Gómez" 4 => "P. Piñera-Salmerón" 5 => "I. Marín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "81" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28825248" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Before-after study of the effect of implementing a sepsis code for emergency departments in the community of Aragon" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Ferreras Amez" 1 => "B. Arribas Entrala" 2 => "M.A. Sarrat Torres" 3 => "A. García Noaín" 4 => "A. Caudevilla Martínez" 5 => "C. Colás Oros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "154" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28825234" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de factores precipitantes de insuficiencia cardiaca aguda y su impacto pronóstico: una revisión sistemática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Aguirre Tejedo" 1 => "O. Miró" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "185" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28825240" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "representing the Infectious Disease Group of the Spanish Emergency Medicine Society" "etal" => true "autores" => array:6 [ 0 => "J. González del Castillo" 1 => "A. Julian-Jiménez" 2 => "F. González-Martínez" 3 => "J. Álvarez-Manzanares" 4 => "P. Piñera" 5 => "C. Navarro-Bustos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10096-017-3068-7" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "2361" "paginaFinal" => "2369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28755060" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015100000001/v1_201807170422/S2387020618302018/v1_201807170422/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015100000001/v1_201807170422/S2387020618302018/v1_201807170422/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618302018?idApp=UINPBA00004N" ]
