Hiponatremia como factor pronóstico de mortalidad en cirróticos en el período de enero 2014 a diciembre 2015 estudio realizado en Hospital Nacional de Especialidades Abel Gilbert Pontón de la ciudad de Guayaquil
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
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OBJETIVO: Determinar el factor pronóstico de la hiponatremia como posible causa de muerte en pacientes cirróticos en el Hospital Abel Gilbert Pontón de la ciudad de Guayaquil.
METODO: Se realizaron un estudio de casos y controles de tipo retrospectivo, y Analítico de todos los pacientes diagnosticados con cirrosis hepática y fundamentada en las Historias clínicas de cada uno de ellos; el HAGP (Hospital Abel Gilbert Pontón) en el período de Enero del 2014 a diciembre del 2015. La población se constituye de 130 pacientes con diagnósticos de cirrosis hepática por biopsia o sin diagnostico de cirrosis hepática pero con datos clínicos propios de la enfermedad, excluyendo a aquellos pacientes cirróticos q no tenían sodio sérica al momento de su ingreso y a aquellos q cursaban con otras enfermedades crónicas. Con los datos obtenidos se realizo análisis con estadística descriptiva que incluyo tabulación de datos, gráficos, y presentación de la información en tablas porcentuales.
RESULTADOS: El universo incluyo 80.420 pacientes atendidos en HAGP (Hospital Abel Gilbert Pontón)en el periodo comprendido desde Enero del 2014 hasta Diciembre del 2015, de esa cantidad, se obtuvo una población de 680 historias clínicas, pero según dichos criterios de inclusión y exclusión solo fueron validadas para nuestro estudio una muestra de 130 pacientes. La muestra estuvo constituida por 130 pacientes de los cuales 22 fueron cirróticos fallecidos y 108 cirróticos vivos. Los valores de natremia de los pacientes que fueron internados en HAGP durante el periodo de estudio, no reportaron diferencias significativas, evidenciándose q de los 29 pacientes un 22% eran normonatremicos, por otra parte se observo que de los 39 pacientes el 30% eran hiponatremicos leves, e igualmente un 23% eran hiponatremicos moderados y un 25% corresponden hiponatremicos severos.
CONCLUSIONES: Los cirróticos hiponatrémicos presentaron mayor deterioro de la función hepática, disfunción renal y mayor mortalidad que los cirróticos normonatrémicos. El 78% de los pacientes cirróticos ingresados en HAGP (Hospital Abel Gilbert Pontón) durante el periodo de estudio, presentaban algún grado de hiponatremia. Finalmente, se puede inferir que la hiponatremia probablemente es un factor crítico que pronostica la evolución de la enfermedad en un paciente cirrótico, en el HAGP, (Hospital Abel Gilbert Pontón) ya que de los 22 pacientes que fallecieron, en un periodo de 2 años, 18 de ellos tenían niveles por debajo de los 125 mEq/L.
PALABRAS CLAVES: Cirrosis hepática, hiponatremia, ascitis, hiponatremia dilucional, cirrosis hepática descompensada, Natremia.
SUMMARY OBJECTIVE: To determine the prognostic factor of hyponatremia as a possible cause of death in cirrhotic patients in the hospital Abel Gilbert Ponton in the city of Guayaquil. METHOD: A case-control study of retrospective were performed, and Analytical all patients diagnosed with liver cirrhosis and based on the medical records of each; the HAGP in the period January 2014 to December 2015. The population is made up of 130 patients diagnosed with liver cirrhosis or nondiagnostic biopsy of liver cirrhosis but with own clinical data of the disease, excluding those patients not cirrhotic q they had serum sodium at admission and those q coursing with other chronic diseases. performing tabulation proceeded in a database and statistical analysis, which subsequently were designed graphics and percentage tables. RESULTS: The universe included 80,420 patients treated at HAGP (Hospital Abel Gilbert Ponton) in the period from January 2014 to December 2015, of that amount, a population of 680 medical records was obtained, but according to the criteria of inclusion and exclusion they were validated only for our study a sample of 130 patients. The sample consisted of 130 patients of whom 22 were killed and 108 cirrhotic cirrhotic alive. The values of serum sodium of patients who were admitted to HAGP during the study period, reported no significant differences, showing q of the 29 patients 22% were normonatremic, on the other hand it was observed that of the 39 patients 30% were Hyponatremic slight, and similarly 23% were moderate, and 25% hyponatremic correspond hyponatremic severe. CONCLUSIONS:Hyponatremic cirrhotic showed further deterioration of liver function, renal dysfunction and higher mortality than normonatremic cirrhotic. 78% of cirrhotic patients admitted to HAGP during our study period, showed some degree of hyponatremia. Finally, we can conclude truthfully that hyponatremia if a critical factor that predicts the evolution of the disease in a cirrhotic patient in HAGP because of the 22 patients who died, over a period of two years, 18 of them had levels below 125 mEq / L.
SUMMARY OBJECTIVE: To determine the prognostic factor of hyponatremia as a possible cause of death in cirrhotic patients in the hospital Abel Gilbert Ponton in the city of Guayaquil. METHOD: A case-control study of retrospective were performed, and Analytical all patients diagnosed with liver cirrhosis and based on the medical records of each; the HAGP in the period January 2014 to December 2015. The population is made up of 130 patients diagnosed with liver cirrhosis or nondiagnostic biopsy of liver cirrhosis but with own clinical data of the disease, excluding those patients not cirrhotic q they had serum sodium at admission and those q coursing with other chronic diseases. performing tabulation proceeded in a database and statistical analysis, which subsequently were designed graphics and percentage tables. RESULTS: The universe included 80,420 patients treated at HAGP (Hospital Abel Gilbert Ponton) in the period from January 2014 to December 2015, of that amount, a population of 680 medical records was obtained, but according to the criteria of inclusion and exclusion they were validated only for our study a sample of 130 patients. The sample consisted of 130 patients of whom 22 were killed and 108 cirrhotic cirrhotic alive. The values of serum sodium of patients who were admitted to HAGP during the study period, reported no significant differences, showing q of the 29 patients 22% were normonatremic, on the other hand it was observed that of the 39 patients 30% were Hyponatremic slight, and similarly 23% were moderate, and 25% hyponatremic correspond hyponatremic severe. CONCLUSIONS:Hyponatremic cirrhotic showed further deterioration of liver function, renal dysfunction and higher mortality than normonatremic cirrhotic. 78% of cirrhotic patients admitted to HAGP during our study period, showed some degree of hyponatremia. Finally, we can conclude truthfully that hyponatremia if a critical factor that predicts the evolution of the disease in a cirrhotic patient in HAGP because of the 22 patients who died, over a period of two years, 18 of them had levels below 125 mEq / L.
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Hiponatremia, Cirrosis hepática, Epidemiología descriptiva, Pronóstico, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Mortalidad