Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis

Rueda Galvis, Myriam Vanessa

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dc.contributor	Machado Romero, Carlos Alfonso
dc.contributor	Higuera Cobos, Juan Diego
dc.contributor	Ochoa Vera, Miguel Enrique
dc.contributor	https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465
dc.contributor	https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001543126
dc.contributor	https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001692834
dc.contributor	https://orcid.org/0000-0002-4552-3388
dc.contributor	https://orcid.org/0000-0003-2622-9412
dc.contributor	https://www.scopus.com/authid/detail.uri?authorId=36987156500
dc.contributor	https://www.researchgate.net/profile/Miguel_Ochoa7
dc.contributor	Grupo de Investigación en Ciencias y Educación en Salud
dc.creator	Rueda Galvis, Myriam Vanessa
dc.date	2020-06-26T19:59:54Z
dc.date	2020-06-26T19:59:54Z
dc.date	2018
dc.date.accessioned	2022-03-14T20:09:37Z
dc.date.available	2022-03-14T20:09:37Z
dc.identifier	http://hdl.handle.net/20.500.12749/1734
dc.identifier	instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier	reponame:Repositorio Institucional UNAB
dc.identifier.uri	http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/22305
dc.description	Introducción: La sepsis representa una entidad que es generada por respuesta sistémica a la infección, inicialmente en 1992 se definió enfocada en el síndrome de respuesta inflamatoria sistémica(7), en el 2016 se modificó y ahora es considerada por The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) como una respuesta no regulada a la infección que causa disfunción orgánica múltiple y pone en peligro la vida. Los biomarcadores cardiacos (Troponina I, NT pro BNP) se demostraron útiles en la predicción de desenlaces adversos en sepsis, sin embargo con el advenimiento de la nueva definición esta relación no está probada. Métodos: Este es un estudio de evaluación de prueba diagnóstica en participantes del estudio ―Asociación entre la actividad de las Metaloproteinasas de matriz extracelular (MMPs) y la disfunción cardiovascular en pacientes con sepsis. Se calculó la asociación de NT pro BNP, troponina I y mortalidad, choque séptico, disfunción sistólica /diastólica e ingreso a UCI. Resultados: Se analizaron 289 registros. La mediana de edad de los pacientes fue de 63 años con un rango de edad entre 49-77 años. La mediana de NT-pro BNP fue 2099 (RIQ: 533-9051) y de la troponina I 0.1 (RIQ: 0.1-0.2). La mediana del SOFA de 4 (RIQ: 0-13), del APACHE II 13 (RIQ: 8-19) . El origen más frecuente de la sepsis fue tracto urinario (39.1%). El 28.37% (82) de los casos en la cohorte fallecieron. La disfunción sistólica estuvo presente en 39.83 %, la disfunción diastólica 69.11%. El 55.71% fueron manejados en unidad de cuidados intensivo, 47.06% presentaban sepsis. Se encontró una relación positiva estadísticamente significativa (p<0.001) entre niveles séricos de NT pro BNP, troponina I y mortalidad, disfunción sistólica y choque séptico, con AUC con capacidad predictiva pobre. No se halló asociación con NT pro BNP, troponina I y disfunción diastólica o ingreso a UCI. Conclusiones: Aún con criterios más específicos de clasificación de sepsis existe una asociación significativa entre biomarcadores de injuria miocárdica en sepsis y desenlaces adversos. Sus características psicométricas no son buenas, en este estudio son iguales a las de las escalas de riesgo conocidas a la fecha (SOFA-APACHE II)
dc.description	RESUMEN Y PALABRAS CLAVE ............................................................................................... 8 SUMMARY AND KEYWORDS .................................................................................................. 9 INTRODUCCIÓN ................................................................................................................... 10 1. OBJETIVOS ................................................................................................................... 13 Objetivos Específicos .......................................................................................................................... 13 2. PLANTEAMIENTO DEL PROBLEMA .................................................................................... 14 3.MARCO TEÓRICO Y ESTADO DEL ARTE .............................................................................. 16 3.1 Fisiopatología de la sepsis: ........................................................................................................... 16 3.2 Disfunción cardiaca en sepsis, fisiopatología : ............................................................................ 17 3.3 Alteraciones hemodinámicas en miocardiopatía séptica: ........................................................... 21 3.4 Definición de cardiomiopatía séptica: .......................................................................................... 22 3.5 Ventilación mecánica y cardiomiopatía séptica : ......................................................................... 24 3.6 Métodos diagnósticos de cardiomiopatía séptica ....................................................................... 25 3.7 Biomarcadores de origen cardiogénico........................................................................................ 27 3.8 Manifestaciones ecocardiográficas .............................................................................................. 34 3.9 Puntajes de predicción de riesgo: ............................................................................................... 36 4. METODOLOGÍA ................................................................................................................ 39 4.1 Tipo de estudio ............................................................................................................................. 39 4.2 Población ...................................................................................................................................... 39 4.3 Muestra ........................................................................................................................................ 39 4.4 Recolección de la información ..................................................................................................... 40 4.5 Procesamiento y control de calidad ............................................................................................. 42 4.6 Procesamiento y Análisis estadístico ........................................................................................... 42 5. CONSIDERACIONES ÉTICAS .............................................................................................. 43 6. RESULTADOS ................................................................................................................... 45 6.1 Características de base ................................................................................................................. 45 6.2 Desenlaces primarios ................................................................................................................... 45 6.2.1 Exactitud diagnostica de la NT- pro BNP ................................................................................... 46 6.2.2 Exactitud diagnostica de la Troponina I .................................................................................... 48 6.2.3. Desenlace SOFA modificado ..................................................................................................... 49 6.2.4. Desenlace APACHE II modificado ............................................................................................. 50 7. DISCUSIÓN ...................................................................................................................... 51 8.LIMITACIONES Y FORTALEZAS ........................................................................................... 55 9. CONCLUSIONES................................................................................................................ 57 10. BIBLIOGRAFIA ................................................................................................................ 58 TABLAS ................................................................................................................................ 64 FIGURAS .............................................................................................................................. 66 ANEXOS............................................................................................................................... 74 CRONOGRAMA .................................................................................................................... 88
dc.description	Especialización
dc.description	Background: Sepsis represents an entity that is generated by a systemic response to infection. In1992 was defined based on the systemic inflammatory response syndrome (7), in 2016 it was modified and is now considered by The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) as an unregulated response to infection, that causes multiple organ dysfunction and endangers life. The cardiac biomarkers (Troponin I, NT pro BNP) was useful in the prediction of adverse outcomes in sepsis, however with the new definition this relationship is not proven. Methods: This study is an evaluation study of the diagnostic test in participants of the study "Association between the activity of extracellular matrix metalloproteinases (MMPs) and cardiovascular dysfunction in patients with sepsis. The association of NT pro BNP, troponin I and mortality, septic shock, systolic / diastolic dysfunction and admission to the ICU was calculated. Results: We analyzed 289 records. The median age of the patients was 63 years with an age range between 49-77 years. The median NT-pro BNP was 2099 (RIQ: 533-9051) and troponin I 0.1 (RIQ: 0.1-0.2). The SOFA median of 4 (RIQ: 0-13), of the APACHE II 13 (RIQ: 8-19). The most frequent origin of sepsis was the urinary tract (39.1%). 28.37% (82) of the cases in the cohort died. Systolic dysfunction was present in 39.83%, diastolic dysfunction 69.11%. 55.71% were managed in intensive care unit, 47.06% had sepsis. A statistically significant positive relationship (p <0.001) was found between serum levels of NT pro BNP, troponin I and mortality, systolic dysfunction and septic shock, with AUC with poor predictive capacity. No association was found with NT pro BNP, troponin I and diastolic dysfunction or admission to the ICU. Conclusions: Even with more specific criteria for the classification of sepsis, there is a significant association between biomarkers of myocardial injury in sepsis and adverse outcomes. Its psychometric characteristics are not the best, but in this study are similar to the risk scales known to date (SOFA-APACHE II)
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dc.language	spa
dc.publisher	Universidad Autónoma de Bucaramanga UNAB
dc.publisher	Facultad Ciencias de la Salud
dc.publisher	Especialización en Medicina Interna
dc.relation	Rueda Galvis, Myriam Vanessa (2018). Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis. Bucaramanga (Santander, Colombia) : Universidad Autónoma de Bucaramanga UNAB
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dc.rights	http://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rights	Abierto (Texto Completo)
dc.rights	info:eu-repo/semantics/openAccess
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dc.rights	Atribución-NoComercial-SinDerivadas 2.5 Colombia
dc.subject	Systemic inflammatory response syndrome
dc.subject	Septic cardiomyopathy
dc.subject	Sepsis
dc.subject	Troponin I
dc.subject	Medicine
dc.subject	Internal medicine
dc.subject	Investigations
dc.subject	Complications
dc.subject	Patients
dc.subject	Prevention and control
dc.subject	Third consensus
dc.subject	Mortality
dc.subject	Systolic dysfunction
dc.subject	Diastolic dysfunction
dc.subject	Septic shock
dc.subject	Intensive care unit
dc.subject	Síndrome de respuesta inflamatoria sistémica
dc.subject	Miocardiopatía séptica
dc.subject	Sepsis
dc.subject	Troponina I
dc.subject	Medicina
dc.subject	Medicina interna
dc.subject	Investigaciones
dc.subject	Complicaciones
dc.subject	Pacientes
dc.subject	Prevención y control
dc.subject	Tercer consenso
dc.subject	NT pro BNP
dc.subject	Mortalidad
dc.subject	Disfunción sistólica
dc.subject	Disfunción diastólica
dc.subject	Choque séptico
dc.subject	Unidad de cuidados intensivos
dc.title	Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
dc.title	Strength of association between Troponin I, NT-pro BNP and adverse outcomes in sepsis
dc.type	info:eu-repo/semantics/masterThesis
dc.type	Tesis
dc.type	http://purl.org/coar/resource_type/c_bdcc
dc.type	info:eu-repo/semantics/acceptedVersion
dc.type	http://purl.org/redcol/resource_type/TM
dc.coverage	Bucaramanga (Santander, Colombia)