{"id":117103,"date":"2015-05-02T00:00:00","date_gmt":"2015-05-02T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/region-media-de-la-pro-adrenomedulina-como-biomarcador-pronostico-de-mortalidad-en-pacientes-sometidos-a-ventilacion-no-invasiva-en-urgencias\/"},"modified":"2015-05-02T00:00:00","modified_gmt":"2015-05-02T00:00:00","slug":"region-media-de-la-pro-adrenomedulina-como-biomarcador-pronostico-de-mortalidad-en-pacientes-sometidos-a-ventilacion-no-invasiva-en-urgencias","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/region-media-de-la-pro-adrenomedulina-como-biomarcador-pronostico-de-mortalidad-en-pacientes-sometidos-a-ventilacion-no-invasiva-en-urgencias\/","title":{"rendered":"Regi\u00f3n media de la pro-adrenomedulina como biomarcador pron\u00f3stico de mortalidad en pacientes sometidos a ventilaci\u00f3n no invasiva en urgencias."},"content":{"rendered":"

Tesis doctoral de Manuel Pi\u00f1ero Zapata <\/strong><\/h2>\n

T\u00edtulo: regi\u00f3n media de la pro-adrenomedulina como biomarcador pron\u00f3stico de mortalidad en pacientes sometidos a ventilaci\u00f3n no invasiva en urgencias.\t la disnea aguda es una de las causas m\u00e1s frecuentes de consulta en los servicios de urgencias hospitalarios. En las situaciones de mayor gravedad que provocan disnea tales como el edema agudo de pulm\u00f3n o la insuficiencia respiratoria hiperc\u00e1pnica, e incluso la sepsis grave, entre otras, la ventilaci\u00f3n mec\u00e1nica no invasiva (vmni) es el procedimiento terap\u00e9utico de elecci\u00f3n para el manejo de los pacientes que padecen disnea en el servicio de urgencias. El diagn\u00f3stico temprano y la precoz intervenci\u00f3n es determinante para obtener buenos resultados. El uso de biomarcadores es cada vez m\u00e1s apreciado para la precisi\u00f3n del diagn\u00f3stico y el manejo m\u00e1s adecuado de los pacientes cr\u00edticos. La regi\u00f3n media del p\u00e9ptido proadrenomedulina (mr-proadm) es un biomarcador de omnipresente distribuci\u00f3n tisular en el cuerpo humano con niveles aumentados en el curso de algunas patolog\u00edas de gran importancia para el compromiso vital y cuyo curso cl\u00ednico va frecuentemente asociado a la disnea. el objetivo principal de nuestro estudio fue establecer la asociaci\u00f3n existente entre los niveles plasm\u00e1ticos del p\u00e9ptido mr-proadrenomedulina y la mortalidad intrahospitalaria en pacientes sometidos a vmni por insuficiencia respiratoria aguda o cr\u00f3nica agudizada con independencia de la patolog\u00eda de origen. el estudio se realiz\u00f3 sobre una cohorte de 191 pacientes seleccionados por ser tratados con vmni por disnea aguda o cr\u00f3nica agudizada de cualquier etiolog\u00eda, excepto quir\u00fargica o neuromuscular, en el servicio de urgencias del hospital general universitario reina sof\u00eda de murcia entre noviembre de 2012 y diciembre de 2013. la mediana de edad de nuestros pacientes estuvo en 79 a\u00f1os con un 61,78% de mayores de 75. El antecedente con mayor presencia fue el hipertensi\u00f3n arterial con un 86,9%; y el tabaquismo estuvo presente en el 85,4% de los varones frente al 16,5% de las mujeres. Los diagn\u00f3sticos de "insuficiencia card\u00edaca congestiva" y de "insuficiencia respiratoria" fueron los m\u00e1s frecuentes con diferencia sobre los dem\u00e1s y distribuidos casi a la par. La mortalidad en el servicio de urgencias fue del 3,1% y la total fue del 28,3% con un 16,8% de mortalidad intrahospitalaria, destacando la mortalidad en la "sepsis" con un 83,3%. El porcentaje de mortalidad encontrada fue del 16,8% para la intrahospitalaria, del 22% a los 30 d\u00edas desde su ingreso, del 25,7% a los 60 d\u00edas y del 28,3% a los 90. La mr-proadrenomedulina present\u00f3 una mediana de 0,57 nmol\/l (0,29-3,19 nmol\/l) y no se encontr\u00f3 correlaci\u00f3n de \u00e9sta con los d\u00edas de estancia hospitalaria ni tampoco con la mortalidad de los pacientes en ninguno de los segmentos de seguimiento (intrahospitalaria, 30, 60 y 90 d\u00edas). en conclusi\u00f3n y a pesar de no haber encontrado relaci\u00f3n alguna entre la mr-proadm y la mortalidad intrahospitalaria de los pacientes de nuestro estudio, s\u00ed hemos encontrado que la "edad > 75 a\u00f1os", la "procalcitonina > 2 ng\/ml" y la "creatinina > 1,5 mg\/dl" han sido las variables que han presentado mayor capacidad de predicci\u00f3n para la "mortalidad intrahospitalaria"; y para la "mortalidad a 30 d\u00edas" fueron, el nt-probnp > 3.120 pg\/ml y el diagn\u00f3stico de "sepsis". \t palabras clave proadrenomedulina, mr-proadm, biomarcadores en disnea, proadrenomedulina en la insuficiencia respiratoria aguda, ventilaci\u00f3n mec\u00e1nica no invasiva, vmni. abstract title: mid-regional pro-adrenomedullin as a mortality prognosis biomarker in patients treated with non-invasive ventilation in the emergencies department. acute dyspnoea is one of the most common causes for visits to emergency departments. In more serious situations that cause dyspnoea such as pulmonary oedema, hypercapnic respiratory failure, and severe sepsis, among others, non-invasive ventilation (niv) is the therapeutic method of choice for the management of patients with dyspnoea in the emergency department. Early diagnosis and early intervention is crucial to obtain good results. The use of biomarkers is increasingly appreciated for accurate diagnosis and more suitable management of critically ill patients. The middle region of proadrenomedullin peptide (mr-proadm) is a ubiquitous biomarker tissue distribution in the human body with increased levels in the course of certain diseases of great importance for vital engagement and whose clinical course is often associated with dyspnoea. the first aim of our study was to establish the association between plasma levels of mr-proadm and in-hospital mortality in patients undergoing niv for acute respiratory failure regardless of source. the study was conducted on a cohort of 191 patients selected to be treated with niv for acute or exacerbated chronic dyspnoea from any cause, except surgical or neuromuscular, in the emergency department of the "reina sofia" universitary general hospital in murcia between november 2012 and december 2013. \tthe median age of patients was 79 years old with a 61.78% of over 75's. The greatest presence antecedent was the hypertension with 86.9%; and smoking was present in 85.4% of men compared to 16.5% of women. Diagnostics "congestive heart failure" and "respiratory failure" were the most common by far over the other and distributed almost at par. Mortality in the ed was 3.1% and the total was 28.3% with 16.8% in-hospital mortality, highlighting mortality in "sepsis" with 83.3%. The percentage of mortality was found for 16.8% in-hospital, 22% at 30 days from admission, 25.7% at 60 days and 28.3% at 90. Mid-regional pro-adrenomedullin presented a median of 0.57 nmol\/l (from 0.29 to 3.19 nmol\/l) and no correlation was found with this hospital stay nor the mortality of patients in any of the segments up (in-hospital, 30, 60 and 90 days). \tin conclusion and despite not find any relationship between mid-regional pro-adrenomedullin and in-hospital mortality of patients in our work, we did find that the "age > 75 years old," the "procalcitonin > 2 ng\/ml" and the "creatinine > 1.5 mg\/dl" variables have been made available to greater predictability for the "in-hospital mortality"; and to the "mortality at 30 days" were, "nt-probnp > 3,120 pg\/ml" and the diagnosis of "sepsis". keywords proadrenomedullin, mr-proadm, biomarkers in dyspnoea, proadrenomedullin in acute respiratory failure, noninvasive ventilation, niv.<\/p>\n

 <\/p>\n

Datos acad\u00e9micos de la tesis doctoral \u00abRegi\u00f3n media de la pro-adrenomedulina como biomarcador pron\u00f3stico de mortalidad en pacientes sometidos a ventilaci\u00f3n no invasiva en urgencias.<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 Regi\u00f3n media de la pro-adrenomedulina como biomarcador pron\u00f3stico de mortalidad en pacientes sometidos a ventilaci\u00f3n no invasiva en urgencias. <\/li>\n
  • Autor:<\/strong>\u00a0 Manuel Pi\u00f1ero Zapata <\/li>\n
  • Universidad:<\/strong>\u00a0 Murcia<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 05\/02\/2015<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Lorenzo Cinesi G\u00f3mez<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: eduardo javier Osuna carrillo-albornoz <\/li>\n
        • pere Llorens soriano (vocal)<\/li>\n
        • Jos\u00e9 Mu\u00f1oz ruiz-seiquer (vocal)<\/li>\n
        • Ortega liarte Juan vicente (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de Manuel Pi\u00f1ero Zapata T\u00edtulo: regi\u00f3n media de la pro-adrenomedulina como biomarcador pron\u00f3stico de mortalidad en pacientes sometidos […]<\/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":[9,258,968,8235,384],"tags":[22252,230914,133776,230913,63398,207505],"class_list":["post-117103","post","type-post","status-publish","format-standard","hentry","category-ciencias-medicas","category-hormonas","category-medicina-forense","category-murcia","category-patologia-clinica","tag-eduardo-javier-osuna-carrillo-albornoz","tag-jose-munoz-ruiz-seiquer","tag-lorenzo-cinesi-gomez","tag-manuel-pinero-zapata","tag-ortega-liarte-juan-vicente","tag-pere-llorens-soriano"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117103","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=117103"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117103\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117103"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117103"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117103"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}