To determine whether blood concentrations of Bcl-2 during the 1st week of sepsis could help predict mortality.
Serum Bcl-2 concentrations were determined at the 1st, 4th and 8th days of sepsis ...diagnosis.
Thirty-day surviving patients (n = 168) showed higher serum Bcl-2 levels at the 1st (p = 0.002), 4th (p < 0.001) and 8th days (p < 0.001) of sepsis diagnosis than non-surviving patients (n = 91). An association between serum Bcl-2 concentrations at the 1st (p = 0.003), 4th (p < 0.001) and 8th days (p = 0.01) and 30-day mortality after controlling for diabetes mellitus, Sepsis-related Organ Failure Assessment, lactic acid and age was found in the multiple logistic regression analysis.
The novel finding is that blood Bcl-2 concentrations at any time in the 1st week of sepsis are associated with mortality.
Abstract
Background
Social cognition and metacognition have emerged as cornerstones of research and treatment of schizophrenia. Both constructs are known to influence the onset of psychosis, to ...predict functional outcome and to be associated with symptoms. However, whether the deficits in first-episode psychosis are homogeneous or group in patterns remains to be studied. This study aimed to analyze patterns of social cognitive and metacognitive variables in a sample of subjects with first-episode psychosis.
Methods
We recruited 192 subjects with first-episode psychosis from ten public mental-health services in Spain. We collected: demographic information, measures of functioning, performance in social cognition (the Faces Test, IPSAQ and the Hinting Task), a battery of metacognitive tasks (BCIS, and the Beads Task) and a neuropsychological assessment. We performed a Latent Profile Analysis (LPA) with the metacognitive and social-cognitive variables. The variable importance was assessed via a classification tree (CART) and the mean differences among the resulting groups for clinical, neuropsychological and functioning variables were calculated with ANOVA and Kruskal-Wallis tests.
Results
Our sample was comprised of 192 (62 women) with first-episode psychosis. The mean age of the sample was 27.93(1.39). The mean PANSS total score of the sample was 58.48 (17.79). The average GAF score was 58.93 (12.25). We included 174 cases with complete social-cognitive and metacognitive data in the cluster analysis. We identified three type-VEE clusters (i.e. ellipsoidal clusters with equal shape and orientation) according to BIC (BIC=-3600.651). The 85-15 condition of the Beads Task and the Hinting Task emerged as the most important variables in determining the clustering structure. The first cluster (60.9%) was characterized by average scores in most of the metacognitive and social cognitive variables, but the presence of the jumping to conclusions bias. The second cluster (5.7%) was characterized by low self-reflectiveness, presence of personalizing bias and an excessive number of trials in the beads task. The third cluster (33.5%) was characterized by average scores in all metacognitive tasks but low scores in the social cognitive tasks.
Discussion
We found three clusters in a large sample of subjects with first-episode psychosis. Our results indicate that the three groups differ in the proneness to present deficits in specific domains. Furthermore, in our sample, patients may not exhibit a homogeneous deficit in all social-cognitive and metacognitive variables. Instead, the impairment may be particularly prominent in either social-cognitive or metacognitive variables. Subjects in different clusters may present differences in their clinical characteristics, what could be relevant in the treatment. Therefore, with further research, a thorough assessment of social cognition and metacognition may help personalize the treatment according to the person’s subtype of the deficit.
This study investigates, for the first time, clinical, cognitive, social cognitive and metacognitive differences in people diagnosed with first-episode of psychosis (FEP) with and without a family ...history of mental disorder split by maternal and paternal antecedents. A total of 186 individuals with FEP between 18 and 45 years old were recruited in community mental-health services. A transversal, descriptive, observational design was chosen for this study. Results suggest that there is a higher prevalence of maternal history of psychosis rather than paternal, and furthermore, these individuals exhibit a specific clinical, social and metacognitive profile. Individuals with a maternal history of mental disorder scored higher in delusional experiences, inhibition of the response to a stimulus and higher emotional irresponsibility while presenting a poorer overall functioning as compared to individuals without maternal history. Individuals with paternal history of mental disorder score higher in externalizing attributional bias, irrational beliefs of need for external validation and high expectations. This study elucidates different profiles of persons with FEP and the influence of the maternal and paternal family history on clinical, cognitive, social and metacognitive variables, which should be taken into account when offering individualized early treatment.
Best clinical practice for patients with suspected catheter-related infection (CRI) remains unclear according to the latest Infectious Diseases Society of America (IDSA) guidelines. Thus, the ...objective of this study was to analyze clinical practice concerning the central venous catheter (CVC) and its impact on prognosis in patients with suspected CRI.
We performed a prospective, multicenter, observational study in 18 Spanish Intensive Care Units (ICUs). Inclusion criteria were patients with CVC and suspected CRI. The following exclusion criteria were used: age less than 18 years; pregnancy; lactation; human immunodeficiency virus; neutropenia; solid or haematological tumor; immunosuppressive or radiation therapy; transplanted organ; intravascular foreign body; haemodynamic instability; suppuration or frank erythema/induration at the insertion site of the CVC, and patients with bacteremia or fungemia. The end-point of the study was mortality at 30 days of CRI suspicion.
The study included 384 patients. In 214 (55.8%) patients, CVC was removed at the moment of CRI suspicion, in 114 (29.7%) CVC was removed later and in 56 (14.6%) CVC was not removed. We did not find significant differences between survivors (n =311) and non-survivors (n =73) at 30 days according to CVC decision (P =0.26). The rate of confirmed catheter-related bloodstream infection (CRBSI) was higher in survivors than in non-survivors (14.5% versus 4.1%; P =0.02). Mortality rate was lower in patients with CRBSI than in the group of patients whose clinical symptoms were due to other causes (3/48 (6.25%) versus 70/336 (20.8%); P =0.02). We did not find significant differences in mortality in patients with confirmed CRBSI according to CVC removal at the moment of CRI suspicion (n =38) or later (n =10) (7.9% versus 0; P =0.99).
In patients with suspected CRI, immediate CVC removal may be not necessary in all patients. Other aspects should be taken into account in the decision-making, such as vascular accessibility, the risk of mechanical complications during new cannulation that may be life-threatening, and the possibility that the CVC may not be the origin of the suspected CRI.
PDF
