1.Accuracy of Quick Sequential Organ Failure Assessment (qSOFA) scoring as in-hospital mortality predictor in adult patients with sepsis secondary to urinary tract infection admitted in a local tertiary hospital in Davao City: A cross-sectional study
Angela Libby Y. Tan ; Jose Paolo P. Panuda
Philippine Journal of Internal Medicine 2024;62(2):93-99
Background:
The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third International Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive
care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity
and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in identifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection.
Methodology:
A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of
adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013
to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP),
respiratory rate (RR), and Glasgow Coma Scale (GCS).
Results:
Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%)
survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes
Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean
length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance
results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and
positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76.
Conclusion
Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy
for in-hospital mortality.
Sepsis
;
Urinary Tract Infections
;
Hospital Mortality
2.Lithium as pre-radioablative treatment of Graves’ Disease Complicated by Thyroid Storm and Methimazole-induced Agranulocytosis: A case report
Valerie R. Ramiro ; Jose Paolo P. Panuda ; Cecileen Anne M. Tuazon ; Roland Reuben B. Angeles ; Iris Thiele Isip-Tan
Philippine Journal of Internal Medicine 2022;60(2):143-146
Thyroid storm and thionamide-induced agranulocytosis are both rare and serious medical emergencies. We report a case of a patient in which these two rare events simultaneously occurred. A 33-year-old male, maintained on Methimazole for Graves’ Disease, presented with fever, throat pain, and uncontrolled thyrotoxic symptoms. Methimazole was promptly discontinued. Thyroid storm was alternatively treated with lithium, hydrocortisone, and propranolol. Agranulocytosis was managed supportively with GCSF and empiric antibiotics. Lithium was maintained until after radioablation. When thionamides are contraindicated, lithium is a viable option for the acute management of thyroid storm and a bridge to definitive therapy.
Methimazole
;
Lithium