Acta Médica Colombiana

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Vol 42 # 2
Vol 42 # 2
VOL. 42 No 2 - 2017-07-28

Trabajos originales / Original works
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VOL. 42 No 2 - 2017-07-28

Asociacin de variables clnicas de hipoperfusin con el lactato y la mortalidad

Jessica Mara Londoo, Csar Daniel Nio, James Daz, Carlos Morales, Jimmy P. Len, Elisa Bernal, Leonardo Meja, Csar Caraballo, Daniela Garcs, Carolina Hincapi, Johana Ascuntar, Alba L. Len, Fabin A. Jaimes

Introduccin: entre los pacientes con infeccin la hiperlactatemia identifica una poblacin de mayor gravedad. Este estudio pretende determinar en pacientes de urgencias la correlacin y asociacin entre los parmetros clnicos de perfusin y los valores de lactato en el momento de admisin; as como el cambio en los parmetros clnicos con la depuracin del lactato. Adems, determinar la asociacin entre estas variables y la mortalidad intrahospitalaria.

Mtodos: cohorte prospectiva de pacientes que ingresaron con sospecha de infeccin a un hospital de tercer nivel. Se midi el lactato en la admisin a las 6 y 24 horas, concomitantemente con las variables llenado capilar, ndice de choque y presin de pulso, entre otras. Se realiz correlacin de Spearman entre las variables clnicas, los niveles de lactato y su depuracin; as como curvas ROC para determinar la capacidad discriminativa de las variables clnicas para detectar hiperlactatemia. Se realiz un modelo de regresin logstica multivariable para mortalidad.

Resultados: se evaluaron 2257 pacientes, 651 correspondan a infeccin confirmada. No se encontr ninguna correlacin de utilidad entre las variables clnicas y el lactato (r<0.25); y tampoco se detect adecuada capacidad discriminativa para la deteccin de hiperlactatemia con ninguna variable clnica (AUC<0.61). En el modelo de regresin logstica multivariada el valor del lactato al ingreso fue la nica variable que se asoci de manera independiente con mortalidad (OR=1.4, IC95%=1.3-1.6).

Conclusiones: entre los pacientes que ingresan a urgencias con infeccin no se encontr correlacin entre las variables clnicas y el lactato; sin embargo, el lactato al ingreso es un marcador pronstico independiente de mortalidad.

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Association of clinical variables of hypoperfusion with lactate and mortality

Jessica Mara Londoo, Csar Daniel Nio, James Daz, Carlos Morales, Jimmy P. Len, Elisa Bernal, Leonardo Meja, Csar Caraballo, Daniela Garcs, Carolina Hincapi, Johana Ascuntar, Alba L. Len, Fabin A. Jaimes

Introduction: among patients with infection, hyperlactatemia identifies a population of greater severity. This study aims to determine the correlation and association between clinical perfusion parameters and lactate values in emergency patients at the time of admission, as well as the change in clinical parameters with lactate clearance. In addition, to determine the association between these variables and in-hospital mortality.

Methods: Prospective cohort of patients admitted with suspected infection to a third level hospital. Lactate was measured at admission, at 6 and 24 hours, concomitantly with the variables capillary filling, shock index and pulse pressure, among others. Among the clinical variables, Spearman correlation, lactate levels and their clearance, as well as ROC curves to determine the discriminative ability of clinical variables to detect hyperlactatemia were performed. A multivariate logistic regression model for mortality was carried out.

Results: 2257 patients were evaluated. 651 were confirmed with infections. No utility correlation was found between clinical variables and lactate (r <0.25), and no discriminative capacity was detected for the detection of hyperlactatemia with any clinical variable (AUC <0.61). In the multivariate logistic regression model the lactate value at admission was the only variable that was independently associated with mortality (OR = 1.4, 95% CI = 1.3-1.6).

Conclusions: no correlation was found between clinical variables and lactate among patients admitted to the emergency department with infection; however lactate at admission is an independent prognostic marker of mortality

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Palabras claves / Key Words
lactato, hipoperfusin, choque, sepsis, infeccin, deteccin tempranalactato, hipoperfusin, choque, sepsis, infeccin, deteccin temprana
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