Luis Fernando Lisboa

Predicting mortality and cost of hematopoietic stem-cell transplantation.

OBJECTIVE To evaluate whether the Pretransplantion Assesment of Mortality risk score is associated to transplant costs and can be used not only to predict mortality but also as a cost management tool. METHODS We evaluated consecutively patients submitted to allogeneic (n = 27) and autologous (n = 89) hematopoietic stem cell-transplantation from 2004 to 2006 at Hospital Israelita Albert Einstein (SP), Brazil. Participants mean age at hematopoietic stem cell-transplantation was 42 (range 1 to 72) years; there were 69 males and 47 females; 30 patients had multiple myeloma; 41 had non-Hodgkin and Hodgkins lymphomas; 22 had acute leukemia; 6 had chronic leukemia; and 17 had non-malignant disease. The Pretransplantion Assesment of Mortality risk score was applied in all patients using the available web site (http://cdsweb.fhcrc.org/ pam/). RESULTS Patients could be classified in three risk categories: high, intermediate and low, having significant difference in survival (p = 0.0162). The median cost in US dollars for each group was

Mortality rate reduction associated with a severe sepsis management protocol implementation

281.000,

Implementation strategy of a severe sepsis management protocol in a tertiary hospital

73.300 and

Georeferencing of deaths from sepsis in the city of São Paulo

54.400 for high, intermediate and low risk, respectively. The cost of hematopoietic stem cell-transplantation significantly differed for each Pretransplantin Assesment of Mortality risk group (p = 0.008). CONCLUSION The validation of the Pretransplantion Assesment of Mortality risk score in our patients confirmed that this system is an important tool to be used in transplantation units, being easy to apply and fully reproducible.

Georeferencing sepsis in São Paulo city

The Surviving Sepsis Campaign is an international effort to reduce severe-sepsis-associated mortality. We have decided to implement the recommendations proposed by the Campaign through a management protocol in our institution.

Melhoria de desempenho e desfechos (mortalidade) após implementação de um protocolo institucional de atendimento a pacientes sépticos

Large variability in clinical practice, in addition to the increasing awareness that certain processes of care are associated with improved medical outcome, has led to the development of clinical practice guidelines. Severe sepsis guidelines have been developed and there is a multinational effort to implement them at bedside.

Impacto de cada ação dos pacotes da Surviving Sepsis Campaign na mortalidade hospitalar de pacientes portadores de sepse grave/choque séptico

OBJECTIVE The aim of the present study was to obtain information about deaths due to sepsis in São Paulo from 2004 to 2009 and their relationship with geographical distribution. METHODS Causes of death, both main and secondary, were defined according to the codes of the International Classification of Disease version 10 (ICD-10) contained in the database. Sepsis, septic shock, multiple organ failure, pneumonia, urinary tract infection, peritonitis and other intraabdominal infections, skin and soft tissue infections (including surgical wound infection) and meningitis were considered as immediate cause of death or as the condition leading to the immediate cause of death related or associated to sepsis. RESULTS In the analyzed period, there was a 15.3% increase in the absolute number of deaths from sepsis in São Paulo. The mean number of deaths during this period was 28,472±1566. Most deaths due to sepsis and sepsis-related diseases over the studied period occurred in a hospital or health care facility, showing that most of the patients received medical care during the event that led to death. We observed a significant concentration of deaths in the most populous regions, tending more toward the center of the city. CONCLUSIONS Georeferencing data from death certificates or other sources can be a powerful tool to uncover regional epidemiological differences between populations. Our study revealed an even distribution of sepsis all over the inhabited areas of São Paulo.

Georeferencing of sepsis in São Paulo

Sepsis is a worldwide disease with heterogeneous outcome. The main factors related to prognosis are age, associated comorbidities, invader virulence, and time to therapeutic initiation. Data related to social-economical attributes have been scarcely investigated.