Factores de riesgo de la hemorragia digestiva variceal en pacientes cirróticos
Fecha
2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
La hemorragia digestiva variceal (HDV), es resultado del aumento de la presión portal considerada un problema grave en pacientes cirróticos por su morbimortalidad elevada. Las estadísticas del INEC – Ecuador ubica a la cirrosis y sus complicaciones como la HDV en el séptimo lugar como razón de defunción. El sexo masculino y la localización de la variz precipitan la HDV.
Objetivo: Determinar los factores de riesgo de la hemorragia digestiva variceal en pacientes cirróticos.
Metodología: El estudio es cuantitativo, retrospectivo, descriptivo, observacional, no experimental, analítico y de corte transversal.
Resultados: Se analizaron 300 casos. Se realizó un análisis univariado que demostró asociación estadística entre el fallecimiento, mayores de 64 años, sexo femenino y consumo de AINES; además se prosiguió con un análisis multivariado con asociaciones estadísticamente significativas de 3 variables: creatinina (OR: 1,4; IC: 1,1 - 2; p-value 0,013), Score MELD (OR: 1,6; IC: 1 – 2,5; p-value 0,034) y localización de la variz (OR: 1,5; IC:1 – 2,4; p-value 0,033) considerándolos factores pronósticos principales de mortalidad.
Conclusión: El consumo de AINES de manera frecuente es un factor de riesgo significante; además el nivel elevado de creatinina sérica tuvo el doble de riesgo asociado a la mortalidad en pacientes cirróticos con HDV.
“RISK FACTORS FOR VARICEAL BLEEDING IN CIRRHOTIC PATIENTS”
Author: Diana Katherine Aguilar Sánchez
María Elizabeth Malla Torres
Advisor: Dr. Miguel Soria Alcívar
Variceal digestive hemorrhage (HDV) is the result of increased portal pressure considered a serious problem in cirrhotic patients due to its high morbidity and mortality. The statistics of the INEC - Ecuador locates the cirrhosis and its complications as the HDV in the seventh place as a reason of death. The male sex and the location of the varix precipitate the HDV. Objective: To determine the risk factors of variceal digestive hemorrhage in cirrhotic patients. Methodology: The study is quantitative, retrospective, descriptive, observational, non-experimental, analytical and cross-sectional. Results: 300 cases were analyzed. A univariate analysis was performed that showed a statistical association between death, over 64 years of age, female sex, and NSAID use; In addition, we continued with a multivariate analysis with statistically significant associations of 3 variables: creatinine (OR: 1.4, CI: 1.1-2, p-value 0.013), MELD score (OR: 1.6, CI: 1 - 2.5; p-value 0.034) and location of the varix (OR: 1.5, CI: 1 - 2.4, p-value 0.033), considering them to be the main prognostic factors of mortality. Conclusion: The use of NSAIDs frequently is a significant risk factor; In addition, the elevated serum creatinine level had twice the risk associated with mortality in cirrhotic patients with HDV.
Variceal digestive hemorrhage (HDV) is the result of increased portal pressure considered a serious problem in cirrhotic patients due to its high morbidity and mortality. The statistics of the INEC - Ecuador locates the cirrhosis and its complications as the HDV in the seventh place as a reason of death. The male sex and the location of the varix precipitate the HDV. Objective: To determine the risk factors of variceal digestive hemorrhage in cirrhotic patients. Methodology: The study is quantitative, retrospective, descriptive, observational, non-experimental, analytical and cross-sectional. Results: 300 cases were analyzed. A univariate analysis was performed that showed a statistical association between death, over 64 years of age, female sex, and NSAID use; In addition, we continued with a multivariate analysis with statistically significant associations of 3 variables: creatinine (OR: 1.4, CI: 1.1-2, p-value 0.013), MELD score (OR: 1.6, CI: 1 - 2.5; p-value 0.034) and location of the varix (OR: 1.5, CI: 1 - 2.4, p-value 0.033), considering them to be the main prognostic factors of mortality. Conclusion: The use of NSAIDs frequently is a significant risk factor; In addition, the elevated serum creatinine level had twice the risk associated with mortality in cirrhotic patients with HDV.
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Palabras clave
Cirrosis hepática, Factores de riesgo, Varices esofágicas y gástricas, Mortalidad, Hemorragia gastrointestinal, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Hematemesis