Aplicación de la clasificación rifle para establecer pronóstico de mortalidad en pacientes críticos con lesión renal aguda, Hospital Regional II IESS Dr. Teodoro Maldonado Carbo, 2010
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2011
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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La Insuficiencia renal aguda (IRA) desarrollada por un paciente críticamente enfermo puede implicar la muerte, sin embargo una intervención oportuna previendo su desarrollo puede cambiar esta situación. Se ha señalado que la forma tradicional basada en la creatininemia tiene poca sensibilidad para pronosticar evolución adversa y mortalidad, mientras que la clasificación RIFLE que valora y califica la IRA en: Riesgo, Injuria, Falla , Pérdida de función y Enfermedad Renal en Estadío Terminal, podría ayudar a establecer el pronóstico de muerte de forma anticipada ayudando a realizar intervenciones preventivas de esta entidad n0sológica. Sin embargo su uso en el hospital Regional 2 IESS “Dr. Teodoro Maldonado Carbo” no se hace con frecuencia debido a la falta de pruebas objetivas de validez, pese a que esta institución atiende anualmente aproximadamente más de 300 pacientes en la Unidad De Cuidados Intensivos (UCI). Con el objetivo de establecer el valor de esta clasificación en pacientes críticos que desarrollan insuficiencia renal aguda para pronóstico de mortalidad, se realizó un estudio observacional correlacional, de diseño no experimental longitudinal – retrospectivo durante 2009 y 2010, en el que se incluyeron de manera no aleatoria 100pacientes críticos: 50 con IRA que murieron y 50 que sobrevivieron. Para el análisis estadístico se emplearon tasas, frecuencias simples, promedio, prueba de Chi2, prueba exacta de Fisher, sensibilidad, especificidad. Mediante la clasificación de RIFLE el 10% de los pacientes que vivieron tuvieron una categorización de falla, mientras entre los fallecidos el 18 %.Según la clasificación Estándar el 16% de los pacientes vivos tuvieron una categorización de grave, y el 26% de los pacientes que fallecieron tuvieron dicha categoría. Con RIFLE para estratificar el pronóstico de mortalidad en los pacientes tuvo una sensibilidad del 74% y una especificidad del 86%. Con la clasificación estándar la sensibilidad fue del 26% y la especificidad del 81%
Acute renal failure (ARF) developed by a critically ill patient can mean death, but a timely intervention in anticipation of its development may change this. It has been suggested that traditional form of diagnosis based on serum creatinine has little sensitivity to predict adverse outcomes and mortality, while the RIFLE classification rating and qualifies the Risk, Injury, Failure, Loss of function and End-Stage Renal Disease , could help to establish mortality prognosis in advance to help making preventive interventions to avoid development of this disease. However its use at Dr. Teodoro Maldonado hospital, is not often due to lack of objective evidence of validity, although this institution annually serves approximately 300 patients at Intensive Care Unit (ICU). In order to establish the value of this classification in critically ill patients who develop acute renal failure for prognosis of mortality, a retrospective longitudinal observational non-experimental design study was conducted during 2009 - 2010. Non-random 100 critically ill patients were included: 50 with ARF who died and 50 who survived. For statistical analysis, rates were used, simple frequencies, average, Chi2 test, Fisher exact test, sensitivity, specificity. RIFLE classification by 10% of patients who had experienced a categorization of failure, while deceased was 18%. According to the classification standard for 16% of patients who died had a severe categorization, and 26% of patients who died. RIFLE to stratify the prognosis of mortality in patients had a sensitivity of 74% and a specificity of 86%. With the standard classification the sensitivity was 26% and specificity of 81%.
Acute renal failure (ARF) developed by a critically ill patient can mean death, but a timely intervention in anticipation of its development may change this. It has been suggested that traditional form of diagnosis based on serum creatinine has little sensitivity to predict adverse outcomes and mortality, while the RIFLE classification rating and qualifies the Risk, Injury, Failure, Loss of function and End-Stage Renal Disease , could help to establish mortality prognosis in advance to help making preventive interventions to avoid development of this disease. However its use at Dr. Teodoro Maldonado hospital, is not often due to lack of objective evidence of validity, although this institution annually serves approximately 300 patients at Intensive Care Unit (ICU). In order to establish the value of this classification in critically ill patients who develop acute renal failure for prognosis of mortality, a retrospective longitudinal observational non-experimental design study was conducted during 2009 - 2010. Non-random 100 critically ill patients were included: 50 with ARF who died and 50 who survived. For statistical analysis, rates were used, simple frequencies, average, Chi2 test, Fisher exact test, sensitivity, specificity. RIFLE classification by 10% of patients who had experienced a categorization of failure, while deceased was 18%. According to the classification standard for 16% of patients who died had a severe categorization, and 26% of patients who died. RIFLE to stratify the prognosis of mortality in patients had a sensitivity of 74% and a specificity of 86%. With the standard classification the sensitivity was 26% and specificity of 81%.
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Insuficiencia renal, Clasificación rifle, Mortalidad, Estudios retrospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador