{"id":114934,"date":"2013-02-12T00:00:00","date_gmt":"2013-02-12T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/estudio-sobre-la-sepsis-grave-de-origen-abdominal-utilidad-de-la-procalcitonina-y-otros-marcadores-pronosticos\/"},"modified":"2013-02-12T00:00:00","modified_gmt":"2013-02-12T00:00:00","slug":"estudio-sobre-la-sepsis-grave-de-origen-abdominal-utilidad-de-la-procalcitonina-y-otros-marcadores-pronosticos","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/cirugia-abdominal\/estudio-sobre-la-sepsis-grave-de-origen-abdominal-utilidad-de-la-procalcitonina-y-otros-marcadores-pronosticos\/","title":{"rendered":"Estudio sobre la sepsis grave de origen abdominal. utilidad de la procalcitonina y otros marcadores pron\u00f3sticos."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Ada Gonzalez Lisorge <\/strong><\/h2>\n<p>Estudio sobre la sepsis grave de origen abdominal. utilidad de la procalcitonina y otros marcadores pron\u00f3sticos.  introducci\u00f3n: la sepsis es una de las principales causas de morbimortalidad en las unidades de cuidados intensivos (ucis). La sepsis grave de origen abdominal es uno de los cuadros m\u00e1s frecuentes en las ucis posquir\u00fargicas. Su mortalidad es elevada y oscila entre 40% y el 70% seg\u00fan las series. Sin embargo, es un cuadro que suele tener poco protagonismo en la literatura cient\u00edfica.  los biomarcadores son elementos fundamentales para el diagn\u00f3stico, seguimiento y pron\u00f3stico de la sepsis. Uno de los biomarcadores m\u00e1s estudiados en las \u00faltimas d\u00e9cadas ha sido la procalcitonina. Muchos autores consideran que su cin\u00e9tica se relaciona con la evoluci\u00f3n, el pron\u00f3stico o con un tratamiento correcto de diversas patolog\u00edas.  las escalas de gravedad, como el acute physiology and chronic health evaluation ii (apache ii) y la escala sequential organ failure assessment (sofa) tienen utilidad pron\u00f3stica en pacientes cr\u00edticos. El apache ii no es espec\u00edfico para pacientes s\u00e9pticos, pero identifica pacientes con gravedad aumentada. La escala sofa es un sistema espec\u00edfico de valoraci\u00f3n de la gravedad del paciente s\u00e9ptico. Se dise\u00f1\u00f3 para evaluar la afectaci\u00f3n org\u00e1nica secundaria a la sepsis, aunque posteriormente, tambi\u00e9n se ha empleado con fines pron\u00f3sticos.  el objetivo principal de esta tesis doctoral es identificar los factores que influyen en la evoluci\u00f3n (\u00e9xitus o supervivencia) de los pacientes con sepsis grave de origen abdominal. Analizamos la utilidad de la procalcitonina como marcador de supervivencia y evaluamos si las escalas de gravedad, apache ii y sofa, permiten predecir la mortalidad de estos pacientes. material y m\u00e9todo: se incluyeron en el estudio todos los pacientes con diagn\u00f3stico de sepsis grave de origen abdominal ingresados en una unidad de cuidados cr\u00edticos posquir\u00fargicos entre los a\u00f1os 2007 y 2008. Se recogieron datos demogr\u00e1ficos, los valores de la procalcitonina en los d\u00edas primero, tercero y s\u00e9ptimo de ingreso y se calcularon las puntuaciones de las escalas apache ii y sofa al ingreso y de la escala sofa en los d\u00edas tercero y s\u00e9ptimo. resultados: estudiamos 69 pacientes. La mortalidad de nuestra serie fue del 23,19% (ic95%: 13,19;33,19%). La edad media de estos pacientes fue 64,94 a\u00f1os (ic95%: 61;69 a\u00f1os). La mayor\u00eda de los pacientes (57,97%) present\u00f3 sepsis de origen comunitario (p&lt;0,05). La patolog\u00eda previa m\u00e1s frecuente fue la hipertensi\u00f3n arterial (49,27%; ic95%: 37,27;61,27%), seguida de la diabetes mellitus (24,63%; ic95%: 14,43;34,83%) el foco de infecci\u00f3n m\u00e1s frecuente fue el intestino grueso (40,57%; ic95%: 28,57;52,57%). La puntuaci\u00f3n apache ii media al ingreso fue de 16,43 puntos (ic95%: 14,95;17,91puntos) y fue superior entre los \u00e9xitus (p&lt;0,00001). La puntuaci\u00f3n sofa media al ingreso fue de 6,46 puntos (ic95%: 5,71;7,2puntos). En el estudio de regresi\u00f3n log\u00edstica binario, los dos factores que m\u00e1s influyeron en la mortalidad de estos pacientes fueron la edad y el ascenso de las puntuaciones de la escala sofa entre los d\u00edas primero y s\u00e9ptimo. La procalcitonina present\u00f3 una din\u00e1mica diferente entre \u00e9xitus, cuyos valores se mantuvieron elevados y supervivientes, en los que los valores disminuyeron con el tiempo (p&lt;0,05). El valor de procalcitonina que mejor identific\u00f3 pron\u00f3stico fue el del d\u00eda s\u00e9ptimo (auc-roc 0,768), niveles mayores o iguales a 3,5ng\/ml detectaron mortalidad con una sensibilidad del 55% y una especificidad del 73%. conclusiones: en nuestra serie de pacientes con sepsis grave posquir\u00fargica de origen abdominal, el valor de procalcitonina en el s\u00e9ptimo d\u00eda de observaci\u00f3n se relaciona con el pron\u00f3stico. El ascenso en la puntuaci\u00f3n de la escala sofa entre los d\u00edas primero y s\u00e9ptimo, junto con la edad, fueron los elementos que mejor identificaron el pron\u00f3stico de los pacientes con sepsis grave de origen abdominal.  severe sepsis of intraabdominal origin. utility of procalcitonin and other prognostic factors.  background: sepsis represents a major cause of morbidity and mortality in intensive care units (icu). Severe sepsis of intraabdominal origin is a frequent pathology in surgical icu. It presents a high mortality rate, 40% in some series, but even 70% has been reported. Nevertheless, it has little prominence in scientific literature. biomarkers are main elements in the battery of diagnostic, monitoring and prognostic tests. Procalcitonin has been one of the most studied markers in lasts decades. Many authors consider its dynamics well related with evolution, outcome or a correct treatment of different pathologies. severity scales, such as acute physiology and chronic health evaluation ii (apache ii) and sequential organ failure assessment score (sofa) are some of the prognostic tools used in critical patients. Apache ii is not specific for septic patients, but has utility identifying patients with augmented severity. Sofa score is a specific system for severity assessment in septic patients. It identifies and allows the monitoring of organ failure secondary to sepsis. Initially it was design for the evaluation of organ dysfunction during the icu stay of these patients, though its prognostic value has also been proved.  the purpose of this doctoral thesis is to study which elements characterize patients with severe sepsis of intraabdominal origin, and try to identify which factors can influence the outcome of these patients. We assess the utility of procalcitonin and severity scores, apache ii and sofa, as outcome predictors in patients with severe sepsis of intraabdominal origin. patients and method: we included all patients admitted in a surgical intensive care unit with the diagnosis of severe sepsis of intraabdominal origin, between 2007 and 2008. We recorded demographic data, procalcitonin levels at days one, three and seven, and apache ii and sofa scores on admission, as well as sofa score on days three and seven. results: 69 patients were included in the study. Mortality rate of our series was 23.19% (95%ic, 13.19-33.19%). Mean age of these patients was 64.94 (95%ic, 61;69y). More than 55% of patients had community acquired sepsis (p&lt;0.05). Most frequent previous pathologies were hypertension (49.27%; 95%ci, 37.27;61.27%), followed by mellitus diabetes (24.63%; 95%ci, 14.43;34.83%). The most frequent focus of infection was colonic (40.57%; 95%ci, 28.57;52.57%). Mean apache ii score on admission was 16.43 points (95%ci, 14.95;17.91points) and was higher in those patients who finally died (p&lt;0.00001). Mean sofa score on admission was 6.46 points (95%ci, 5.71;7.2points). In the binary regression logistic study, those factors identified as more related with outcome were age and the increase in sofa score between days one and seven. Procalcitonin presented a different dynamic among nonsurvivors (levels maintained or increased) and survivors (whose levels decreased)(p&lt;0.05). Procalcitonin levels on day seven identified better the outcome of these patients (auc-roc 0.768). Levels equal or higher than 3.5ng\/ml identified mortality with 55% sensibility and 73% specificity. conclusions: in our series of patients with severe sepsis of intraabdominal origin, procalcitonin does not identify outcome of patients on admission, but on day seven of observation. Increase on sofa score between days one and seven and age were the factors that identified outcome in a more accurate way on patients with severe sepsis of intraabdominal origin.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Estudio sobre la sepsis grave de origen abdominal. utilidad de la procalcitonina y otros marcadores pron\u00f3sticos.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Estudio sobre la sepsis grave de origen abdominal. utilidad de la procalcitonina y otros marcadores pron\u00f3sticos. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Ada Gonzalez Lisorge <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 02\/12\/2013<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Carlos Garc\u00eda Palenciano<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: manuel Canteras jordana <\/li>\n<li>Antonio Pi\u00f1ero madrona (vocal)<\/li>\n<li>Manuel Barbera alacreu (vocal)<\/li>\n<li>gerardo Aguilar aguilar (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Ada Gonzalez Lisorge Estudio sobre la sepsis grave de origen abdominal. utilidad de la procalcitonina y otros 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