Gradiente alveolo arterial y oximetría como pronóstico en pacientes adultos oncohematológicos con neumonía comunitaria
Fecha
2017
Autores
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El paciente oncológico por ser un paciente inmunocomprometido, es más
susceptible de infecciones, y entre estas, Neumonía comunitaria, es causa de morbimortalidad
elevada. El Objetivo de este trabajo es investigar el impacto de valores subóptimos de oximetría
y gradiente alveolo arterial elevado como pronóstico de gravedad en adultos oncohematológicos
del Hospital Solca, que ingresaron por Neumonía de la Comunidad. Metodología: Se revisó
historias clínicas desde Enero 2014 a Junio 2017, de las cuales se tomaron pacientes
oncohematológicos que por clínica e imágenes fueron diagnosticados de Neumonía de la
Comunidad, que son 118; a ellos se aplicó un estudio analítico, descriptivo, retrospectivo. Se
analizaron con el sistema R, análisis Chi cuadrado, regresión logística y Test de Student.
Resultados: La edad promedio fue 58 años. Predominó género femenino (57%). La
comorbilidad más frecuente fue hipertensión arterial. 64% correspondió a tumores sólidos, más
frecuente cabeza y cuello, seguido de estómago y mama. El estadio clínico más frecuente fue el
avanzado. Germen más frecuente fue K. neumoniae, seguido de E. aerogenes. La letalidad
hospitalaria fue 38%, no existiendo diferencia estadísticamente significativa entre esta situación,
con las características socio-demográficas y clínicas. Una oximetría <90%, gradiente A-a >50 o
CURB-65 ≥2 fue estadísticamente muy significativa para con letalidad hospitalaria relacionada
con NAC. Sin embargo, en el sub-análisis según el tipo de tumor, esto solo se mantuvo para con
gradiente A-a y CURB-65. La mayor coincidencia observada se evidenció en CURB-65 en la
predicción de letalidad hospitalaria relacionada con NAC en pacientes hematológicos.
Conclusiones: La oximetría y gradiente A-a presentan utilidad limitada en el pronóstico de neumonia comunitaria en pacientes oncológicos.
The oncological patient, being an immunocompromised patient, is more susceptible to infections, and among these, community pneumonia, is a cause of high morbidity and mortality. The objective of this work is to investigate the impact of suboptimal values of oximetry and elevated alveolar arterial gradient as a prognosis of severity in oncohematological adults of the Hospital Solca, who were admitted due to Community Pneumonia. Methodology: Clinical histories were reviewed from January 2014 to June 2017, of which oncohematological patients were taken, who for clinical and images were diagnosed with Community Pneumonia, which are 118; an analytical, descriptive, retrospective study was applied to them. They were analyzed with the R system, Chi square analysis, logistic regression and Student's test. Results: The average age was 58 years. Female gender predominated (57%). The most frequent comorbidity was arterial hypertension. 64% corresponded to solid tumors, most frequent head and neck, followed by stomach and breast. The most frequent clinical stage was advanced. The most frequent germ was K. neumoniae, followed by E. aerogenes. The hospital mortality was 38%, there being no statistically significant difference between this situation, with the sociodemographic and clinical characteristics. An oximetry <90%, gradient A-a> 50 or CURB-65 ≥2 was statistically very significant for hospital lethality related to CAP. However, in the subanalysis according to the type of tumor, this was only maintained for gradients A-a and CURB- 65. The greatest coincidence observed was evidenced in CURB-65 in the prediction of hospital lethality related to CAP in hematological patients. Conclusions: Oximetry and A-a gradient have limited utility in the prognosis of community pneumonia in cancer patients
The oncological patient, being an immunocompromised patient, is more susceptible to infections, and among these, community pneumonia, is a cause of high morbidity and mortality. The objective of this work is to investigate the impact of suboptimal values of oximetry and elevated alveolar arterial gradient as a prognosis of severity in oncohematological adults of the Hospital Solca, who were admitted due to Community Pneumonia. Methodology: Clinical histories were reviewed from January 2014 to June 2017, of which oncohematological patients were taken, who for clinical and images were diagnosed with Community Pneumonia, which are 118; an analytical, descriptive, retrospective study was applied to them. They were analyzed with the R system, Chi square analysis, logistic regression and Student's test. Results: The average age was 58 years. Female gender predominated (57%). The most frequent comorbidity was arterial hypertension. 64% corresponded to solid tumors, most frequent head and neck, followed by stomach and breast. The most frequent clinical stage was advanced. The most frequent germ was K. neumoniae, followed by E. aerogenes. The hospital mortality was 38%, there being no statistically significant difference between this situation, with the sociodemographic and clinical characteristics. An oximetry <90%, gradient A-a> 50 or CURB-65 ≥2 was statistically very significant for hospital lethality related to CAP. However, in the subanalysis according to the type of tumor, this was only maintained for gradients A-a and CURB- 65. The greatest coincidence observed was evidenced in CURB-65 in the prediction of hospital lethality related to CAP in hematological patients. Conclusions: Oximetry and A-a gradient have limited utility in the prognosis of community pneumonia in cancer patients
Descripción
PDF
Palabras clave
Neumonía, Gradiente alveolo arterial, Oximetría, Neoplasias, Salud pública, Oncología médica, Epidemiología descriptiva, Epidemiología analítica, Estudios retrospectivos, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador, Adulto