Procalcitonina sérica, sofa y apache II, como predictores de mortalidad en pacientes oncológicos sépticos, SOLCA, año 2015
Fecha
2017
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 adulto oncológico, se encuentra expuesto a complicaciones amenazantes
como una sepsis. Estos pacientes necesitan una evaluación lo más certera posible, ante la
posibilidad de ser ingresado a unidades más complejas. El objetivo es determinar la
Procalcitonina, SOFA y APACHE II como predictores de mortalidad en paciente oncológico
séptico en SOLCA Guayaquil, año 2015. Se trata de un estudio de cohorte transversal
retrospectivo, descriptivo, correlacional. Se analizaron las historias clínicas de 90 pacientes,
con diagnóstico de sepsis, que cumplieron los criterios de inclusión. Se estableció el valor
de corte de procalcitonina, escala SOFA y APACHE II más idóneo para con mortalidad, a
través de curva ROC e índice de Youden. Del valor obtenido se obtuvo la respectiva
suficiencia pronóstica mediante los indicadores de: sensibilidad, especificidad, valor
predictivo positivo (VPP), valor predictivo negativo (VPN) y coincidencia observada. La
correlación entre procalcitonina, SOFA y APACHE II para con mortalidad se estableció
mediante análisis univariado, a través de regresión logística binaria y prueba de Hosmer
Lemeshow. Se obtuvo como resultados un valor de corte de procalcitonina, escala SOFA y
APACHE II para con pronóstico de mortalidad, respectivamente de: 2.08, 5.5 y 28.5. La
prueba de Hosmer-Lemeshow fue poco significativa en todos los casos. La correlación entre
SOFA y APACHE II, en el análisis global como en el subanálisis entre tumores sólidos, fue
directamente proporcional y estadísticamente muy significativa. Se concluyo que la
Procalcitonina, escala SOFA y APACHE II presentan una baja utilidad en el pronóstico de
mortalidad asociada a sepsis en pacientes oncológicos.
The adult oncology patient is exposed to threatening complications such as sepsis. These patients need an assessment as accurate as possible, given the possibility of being admitted to more complex units. The objective is to determine Procalcitonin, SOFA and APACHE II as predictors of mortality in septic cancer patients in SOLCA Guayaquil, year 2015. This is a transverse-retrospective, descriptive, correlational cohort study. We analyzed the clinical histories of 90 patients, with diagnosis of sepsis, who met the inclusion criteria. The cut-off value of procalcitonin, scale SOFA and APACHE II was most suitable for mortality, through ROC curve and Youden index. From the value obtained, the respective prognostic adequacy was obtained through the indicators of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and observed coincidence. The correlation between procalcitonin, SOFA and APACHE II for mortality was established by univariate analysis, using binary logistic regression and Hosmer-Lemeshow test. A cut-off value of procalcitonin, SOFA scale and APACHE II was obtained as results, with a mortality prognosis, respectively: 2.08, 5.5 and 28.5. The Hosmer-Lemeshow test was insignificant in all cases. The correlation between SOFA and APACHE II, in the global analysis as in the sub-analysis between solid tumors, was directly proportional and statistically very significant. It was concluded that Procalcitonin, scale SOFA and APACHE II have a low utility in the prognosis of mortality associated with sepsis in cancer patients.
The adult oncology patient is exposed to threatening complications such as sepsis. These patients need an assessment as accurate as possible, given the possibility of being admitted to more complex units. The objective is to determine Procalcitonin, SOFA and APACHE II as predictors of mortality in septic cancer patients in SOLCA Guayaquil, year 2015. This is a transverse-retrospective, descriptive, correlational cohort study. We analyzed the clinical histories of 90 patients, with diagnosis of sepsis, who met the inclusion criteria. The cut-off value of procalcitonin, scale SOFA and APACHE II was most suitable for mortality, through ROC curve and Youden index. From the value obtained, the respective prognostic adequacy was obtained through the indicators of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and observed coincidence. The correlation between procalcitonin, SOFA and APACHE II for mortality was established by univariate analysis, using binary logistic regression and Hosmer-Lemeshow test. A cut-off value of procalcitonin, SOFA scale and APACHE II was obtained as results, with a mortality prognosis, respectively: 2.08, 5.5 and 28.5. The Hosmer-Lemeshow test was insignificant in all cases. The correlation between SOFA and APACHE II, in the global analysis as in the sub-analysis between solid tumors, was directly proportional and statistically very significant. It was concluded that Procalcitonin, scale SOFA and APACHE II have a low utility in the prognosis of mortality associated with sepsis in cancer patients.
Descripción
PDF
Palabras clave
PROCLASITONINA, SOFA, APACHE II, MOSTALIDAD, SEPSIS, ONCOLOGIA, HOSPITAL SOLCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR