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Introduction: Reviewing the profile of patients admitted at the Burns Intensive Care Unit at São Paulo Hospital - UNIFESP, as well as the available literature, it becomes evident the need for tools able to predict those patients' outcomes. Distinct score models are used in different health centers, not only as prognostic models, but also as research and quality control tools. Amongst these prognostic scores, there are two strands, the burns specific scores - which consider the injury's characteristics - and the general critical patient's scores.Objective: This study aims to analyze the differences and tendencies in mortality prediction of two broadly used scores when applied to São Paulo Hospital's Burns Intensive Care Unit patients, ABSI - burns specific score - and SAPS 3 - general score for critical patients.Methods: This is an individual, observational, retrospective and comparative study, developed with medical records review. Both scores were applied to every patient admitted at São Paulo Hospital's Burns Intensive Care Unit from 2011 to 2016. Statistical analyses used the non-parametric test of Kolmogorov-Smirnov, a p-value <0.05 was considered significant.Results: 122 patients were included, the average age was 34,4 years old. 70,5% of patients were male and 49% had a total body surface area burned of 20%. 27% of the patients died. Statistical analyses do not show significant differences between ABSI and SAPS3 mortality predictions for burns patients at this health center.Conclusion: The study evidences that SAPS 3 score, frequently used at general Intensive Care Units, has a similar performance to ABSI score, which is specific for burns populations. ABSI score is easier to implement, as it is simpler and able to show instant results. [ABSTRACT FROM AUTHOR]

Carbapenem-resistant Enterobacteriaceae (CRE) colonization is common in hospital patients admitted to intensive care units (ICU) from the emergency department. We evaluated the effect of previous hospitalization in the emergency department on CRE colonization at ICU admission. Our case-control study included 103 cases and 201 controls; cases were patients colonized by CRE at admission to ICU and controls were patients admitted to ICU and not colonized. Risk factors were emergency department stay, use of carbapenem, Simplified Acute Physiology Score, upper digestive endoscopy, and transfer from another hospital. We found that ED stay before ICU admission was associated with CRE colonization at admission to the ICU. Our findings indicate that addressing infection control problems in EDs will help to control carbapenem resistance in ICUs. [ABSTRACT FROM AUTHOR]

• Among 114 intensive care patients studied with YF, mortality rate was 47.4%. • Prothrombin time, encephalopathy and APACHE 2 were associated with YF mortality. • Early evolution to liver failure predicts higher mortality in YF. • Markers of hepatic inflammation were not independently associated with YF mortality. Yellow fever (YF) is a viral hemorrhagic disease caused by an arbovirus from the Flaviviridae family. Data on the clinical profile of severe YF in intensive care units (ICUs) are scarce. This study aimed to evaluate factors associated with YF mortality in patients admitted to a Brazilian ICU during the YF outbreaks of 2017 and 2018. This was a longitudinal cohort case series study that included YF patients admitted to the ICU. Demographics, clinical and laboratory data were analyzed. Cox regression identified independent predictors of death risk. A total of 114 patients were studied. The median age was 48 years, and 92.1% were males. In univariate analysis, jaundice, leukopenia, bradycardia, prothrombin time, expressed as a ratio to the international normalized ratio-(PT-INR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, lactate, arterial pH and bicarbonate, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score 3 (SAPS 3) severity scores, transfusion of fresh frozen plasma, acute renal failure (Acute Kidney Injury Network stage III (AKIN III)), hemodialysis, cumulative fluid balance at 72 h of ICU, vasopressor use, seizures and grade IV encephalopathy were significantly associated with mortality. In multivariate analysis, factors independently associated with YF mortality were PT-INR, APACHE II, and grade IV hepatic encephalopathy. In the large outbreak in Brazil, factors independently associated with death risk in YF were: PT-INR, APACHE II, and grade IV hepatic encephalopathy. Early identification of patients with YF mortality risk factors may be very useful. Once these patients with a poor prognosis have been identified, proper management should be promptly implemented. [ABSTRACT FROM AUTHOR]

Objective: To assess the functional status of post-ICU patients using the Barthel Index (BI) and the Katz Index (KI) and to assess which is more suitable for this population.Design: Retrospective longitudinal study.Setting: Public tertiary hospital in São Paulo (Brazil).Participants: Patients aged ≥18 years old, admitted to ICU, who were treated with mechanical ventilation (MV) ≥ 24 h and were discharged to ward.Exclusion Criteria: Inability to answer the BI and the KI; limiting neurological or orthopaedic conditions; ICU stay ≥90 days. Patients transferred to or from other hospitals or who died in the wards were not analysed.Intervention: BI and KI were scored pre-ICU and post-ICU and the variation was calculated.Main Outcome Measures: BI and KI scores were compared using analysis based on item response theory (IRT), using degree of difficulty and discriminating items as parameters.Results: Median age was 52 years old, median APACHE II score was 15. Median ICU stay was 11 days and median MV duration was 4 days. BI variation was 44% and KI variation was 55%. In IRT analysis, BI considered a larger number of items with different levels of difficulty.Conclusion: Both the BI and the KI revealed significant deterioration of functional status after ICU discharge. The IRT analysis suggested that the Barthel Index might be a better scale than the Katz Index for the assessment of functional status of patients discharged from ICU, since it presented better discrimination of the ability to carry out the tasks. [ABSTRACT FROM AUTHOR]