Comparación de PCR cuantitativa Y procalcitonina como biomarcador temprano de sepsis e inflamación en pacientes que acuden a un hospital de segundo nivel del norte de Quito en el periodo Abril - Junio 2014
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Fecha
2015
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Universidad de Guayaquil. Facultad de Ciencias Químicas
Resumen
La sepsis severa y el shock séptico afectan cada año a millones de individuos alrededor del mundo, provocando la muerte en 1 de cada 4 pacientes. En el Ecuador, en el año
2011, se reportaron 1375 casos con una mortalidad del 35.4%, en el Hospital Eugenio Espejo. El biomarcador debe proporcionar información adicional a los datos clínicos del paciente y contribuir tempranamente a la toma de decisiones.
El presente estudio comparó la sensibilidad, especificidad, valor predictivo positivo y predictivo negativo, y definió un punto de corte de la PCR frente a la PCT, dicha investigación se desarrolló en el período entre abril y junio del 2014, en un hospital privado de la ciudad de Quito; se tomó como muestra 63 pacientes, clasificados de acuerdo a su información clínica: 26 de ellos presentaron un cuadro de sepsis (41.3%) y
37, un cuadro de SIRS (58.7%).
De acuerdo con los puntos de corte significativos, tanto para la PCR (97 mg/L; S: 68%; E: 57%; VPP: 48% y VPN: 48%) como para la PCT (0.4 ng/mL; S: 73% y E: 73%; VPP: 66 % y VPN: 79%), se puede establecer que la procalcitonina es un test con mayor capacidad de discriminar a los pacientes con sepsis de los pacientes con SIRS; por eso es menos probable (66%) que existan falsos positivos y, de igual forma, menos probable (79%) que hayan falsos negativos en relación a la PCR cuantitativa, que presenta una probabilidad de casi el 50% de que existan falsos positivos y negativos.
Con base en los resultados obtenidos y en los estudios relacionados que se han realizado en diferentes partes del mundo se puede recomendar el uso de la PCR de forma muy limitada, tomando en cuenta que siempre deben evaluarse otros biomarcadores de mayor acceso, principalmente, es muy importante, la información clínica del paciente, el contaje de glóbulos blancos, realizar una buena toma de signos vitales y analizar su historia clínica, para con ello reducir los tiempos de diagnóstico y disminuir los niveles de morbimortalidad
Severe sepsis and septic shock affect millions Individuals worldwide each year, dies 1 in 4. In Ecuador in 2011, 1,375 cases with a mortality 35.4% in the Eugenio Espejo Hospital were reported. Biomarker must provide additional information to clinical Patient data and contribute to early decisions. The present study compared the sensitivity, specificity, positive predictive value and negative predictive, and has Defined a cutoff of PCR versus the PCT, this research was Developed in the period April to June 2014, at a private hospital in the city Quito, with a population of 63 patients, which Were classified according their clinical data in this way : 26 patients of sepsis (41.3%) and 37 patients of SIRS (58.7%). Based on a significative cut points of both PCR (97 mg / L; S: 68% E: 57%, PPV 48% and NPV 48%) as to PCT (0.4 ng / ml; S: E 73% and 73%, PPV 66% and NPV 79%) can be established which procalcitonin is a test with the better capacity discriminate patients with sepsis of patients with SIRS; for that is less frecuent (66%) that appear false positives and similarly, less likely (79%) that there are false negatives, in relation to the quantitative PCR which has a probability of almost 50% of false positives and false negative. On the basis of the results obtained and related studies have been conducted in the World, can recommend the use of PCR in a very limited way and always evaluating other biomarkers with most access, the most important is the Patient Clinical data, counting white blood cells, a good taking vital signs and medical history, for thereby reduce diagnosis times and lower levels of morbility and mortality
Severe sepsis and septic shock affect millions Individuals worldwide each year, dies 1 in 4. In Ecuador in 2011, 1,375 cases with a mortality 35.4% in the Eugenio Espejo Hospital were reported. Biomarker must provide additional information to clinical Patient data and contribute to early decisions. The present study compared the sensitivity, specificity, positive predictive value and negative predictive, and has Defined a cutoff of PCR versus the PCT, this research was Developed in the period April to June 2014, at a private hospital in the city Quito, with a population of 63 patients, which Were classified according their clinical data in this way : 26 patients of sepsis (41.3%) and 37 patients of SIRS (58.7%). Based on a significative cut points of both PCR (97 mg / L; S: 68% E: 57%, PPV 48% and NPV 48%) as to PCT (0.4 ng / ml; S: E 73% and 73%, PPV 66% and NPV 79%) can be established which procalcitonin is a test with the better capacity discriminate patients with sepsis of patients with SIRS; for that is less frecuent (66%) that appear false positives and similarly, less likely (79%) that there are false negatives, in relation to the quantitative PCR which has a probability of almost 50% of false positives and false negative. On the basis of the results obtained and related studies have been conducted in the World, can recommend the use of PCR in a very limited way and always evaluating other biomarkers with most access, the most important is the Patient Clinical data, counting white blood cells, a good taking vital signs and medical history, for thereby reduce diagnosis times and lower levels of morbility and mortality
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Palabras clave
SEPSIS, BIOMARCADOR, PCR CUANTITATIVA, PROCALCITONINA