{"id":116751,"date":"2014-02-12T00:00:00","date_gmt":"2014-02-12T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/diseno-y-validacion-de-un-modelo-predictivo-de-mediastinitis-en-ciruga%c2%ada-carda%c2%adaca\/"},"modified":"2014-02-12T00:00:00","modified_gmt":"2014-02-12T00:00:00","slug":"diseno-y-validacion-de-un-modelo-predictivo-de-mediastinitis-en-ciruga%c2%ada-carda%c2%adaca","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/medicina-interna\/diseno-y-validacion-de-un-modelo-predictivo-de-mediastinitis-en-ciruga%c2%ada-carda%c2%adaca\/","title":{"rendered":"Dise\u00f1o y validaci\u00f3n de un modelo predictivo de mediastinitis en cirugia card\u00edaca"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Mercedes Nieto Cabrera <\/strong><\/h2>\n<p>Introducci\u00f3n y objetivos. Las mediastinitis son una complicaci\u00f3n infrecuente pero devastadora tras cirug\u00eda card\u00edaca. Se asocian con morbi-mortalidad elevada, estancias prolongadas e incremento de costes. Es necesario identificar sus factores de riesgo para  prevenirlas eficazmente.  El objetivo principal de este estudio es dise\u00f1ar y validar una puntuaci\u00f3n de riesgo de mediastinitis y compararla con otros \u00edndices de riesgo. Material y m\u00e9todo.  Cohorte de 4.526 pacientes que ingresan en la uci cardiovascular del hospital cl\u00ednico san carlos de Madrid, tras cirug\u00eda cardiaca, de enero 2005 a junio 2011. Tras  exclusi\u00f3n de 556 pacientes, 3.970 fueron analizados. Un modelo predictivo de mediastinitis fue generado mediante regresi\u00f3n log\u00edstica, en un subgrupo de 2.618 pacientes seleccionados al azar y validado en una segunda cohorte de 1.352. El poder discriminatorio fue evaluado por el \u00e1rea bajo la curva roc (au-roc) y su calibraci\u00f3n mediante comparaci\u00f3n de la probabilidad observada y la predicha por el modelo y el test de hosmer-lemeshow. La puntuaci\u00f3n de riesgo que denominamos \u00c2\u00bfmed-score\u00c2\u00bf se ha creado a partir de los coeficientes beta de cada variable. Al aplicarla se estratific\u00f3 la poblaci\u00f3n en tres niveles de riesgo. Se evalu\u00f3 la capacidad de -med-score, euroscore log\u00edstico (eslog), y la puntuaci\u00f3n de la sociedad americana de cirujanos tor\u00e1cicos (sts) para predecir mediastinitis. Se utiliz\u00f3  spss 15.0 y stata 11.0. Mediastinitis se defini\u00f3 seg\u00fan criterios cdc. Resultados. 94 (2,4 por ciento) pacientes presentaron mediastinitis. Cuatro factores de riesgo preoperatorios [edad meno 70 (or 2,26), epoc (or 2,41), imc menor 30 (or 2,13) y antiagregaci\u00f3n (or 2,26)] y 3 perioperatorios [tiempo de isquemia (or 2,91), reintervenci\u00f3n de emergencia (or 3,85) e intubaci\u00f3n prolongada (or 3,63)] constituyeron el modelo log\u00edstico, con un poder de discriminaci\u00f3n excelente (au-roc 0,80). Hosmer-lemeshow p = 0,46. Las au-roc para sts preoperatorio (0.623), sts combinado (0.626) y eslog (0.550) tuvieron un poder de discriminaci\u00f3n menor que med-score (0.793). Conclusiones. El \u00edndice de riesgo -med-score- ofrece una herramienta sencilla para  estratificar  los pacientes intervenidos de cirug\u00eda cardiaca en nuestro hospital en tres niveles de riesgo de mediastinitis. El \u00c2\u00bfmed-score- tiene  mejor rendimiento predictivo en nuestra cohorte.  Los scores de sts y eslog son predictores sub\u00f3ptimos.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Dise\u00f1o y validaci\u00f3n de un modelo predictivo de mediastinitis en cirugia card\u00edaca<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Dise\u00f1o y validaci\u00f3n de un modelo predictivo de mediastinitis en cirugia card\u00edaca <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Mercedes Nieto Cabrera <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Complutense de Madrid<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 02\/12\/2014<\/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>Elpidio Miguel Calvo Manuel<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: emilio Bouza Santiago <\/li>\n<li>Juan  Jos\u00e9 Rubio mu\u00f1oz (vocal)<\/li>\n<li>abelardo Garc\u00eda de lorenzo (vocal)<\/li>\n<li>Manuel Dur\u00e1n poveda (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Mercedes Nieto Cabrera Introducci\u00f3n y objetivos. Las mediastinitis son una complicaci\u00f3n infrecuente pero devastadora tras cirug\u00eda card\u00edaca. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[986,139],"tags":[30025,147951,5227,214270,84006,230353],"class_list":["post-116751","post","type-post","status-publish","format-standard","hentry","category-complutense-de-madrid","category-medicina-interna","tag-abelardo-garcia-de-lorenzo","tag-elpidio-miguel-calvo-manuel","tag-emilio-bouza-santiago","tag-juan-jose-rubio-munoz","tag-manuel-duran-poveda","tag-mercedes-nieto-cabrera"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116751","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=116751"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116751\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=116751"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=116751"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=116751"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}