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Comparación del EuroSCORE LOG y II dentro de la caracterización de variables asociadas a mortalidad postquirúrgica en una cohorte de pacientes adultos con cardiopatía isquémica de dos instituciones de la zona metropolitana de Bucaramanga

dc.contributor.advisorNaranjo Junoy, Francisco Fernando
dc.contributor.authorOrtega Ramírez, Gustavo Andrés
dc.contributor.authorRojas Restrepo, Luis Alberto
dc.coverage.spatialBucaramanga (Santander, Colombia)spa
dc.coverage.temporal2014spa
dc.date.accessioned2023-02-21T18:13:15Z
dc.date.available2023-02-21T18:13:15Z
dc.date.issued2014
dc.identifier.urihttp://hdl.handle.net/20.500.12749/19071
dc.description.abstractEl manejo del infarto de miocardio incluye una cadena sistemática de acciones como la estratificación del riesgo pre quirúrgico para mejorar la calidad de la atención y la asignación y uso óptimo de los recursos disponibles. Esto requiere una actualización constante de los score, para optimizar la discriminación del desenlace. Objetivo general: Comparar la probabilidad de mortalidad postquirúrgica dada por el EuroSCORE LOG y II en una cohorte de pacientes adultos con cardiopatía isquémica atendida en dos instituciones de la zona metropolitana de Bucaramanga, Colombia. Metodología: estudio observacional analítico tipo cohorte retrospectiva, con muestreo no probabilístico de casos concurrentes. Pacientes mayores de 18 años, captados entre 2011- 2014, en dos instituciones de la zona metropolitana de Bucaramanga. Se realizó análisis descriptivo, bivariado y capacidad discriminativa (curvas ROC), sensibilidad y especificidad. Resultados: En los fallecidos la edad promedio fue mayor (M: 75.6 años), la fracción de eyección estaba más comprometida (35.8%) y el índice del EuroSCORE LOG y del EuroSCORE II fueron más altos (17.5 vs. 11.31). También se observó mayor disfunción neurológica (16.67% vs. 1%), proporción de pacientes en estado preoperatorio crítico (50% vs.9%) y alteración en la movilidad (16.67% vs. 1%34% fueron complicaciones postoperatorias de tipo cardíaco,(choque intraoperatorio:(29/36¡ 80.5%). Dentro de las complicaciones postoperatorias no cardíacas (5%) el mayor exponente fue el sangrado (3/5; 60%). Solo el 6% de los pacientes fallecieron para una tasa de letalidad de 5.6%. Conclusión: Uno de los problemas principales, es que los score suelen ser estáticos por la carencia de una continua actualización por lo que pueden sobreestimar el riesgo. En el presente estudio, se predijo una mortalidad del 10% con elEuroSCORE LOG y del 16% con el EuroSCORE II en comparación con la realmente observada en la cohorte de 5.6%. Se podría concluir entonces que pese a su calibración y capacidad discriminatoria satisfactoria, se subestimo los pacientes de alto riesgo, estableciendo una necesidad de diferenciar su aplicación como emergencia vs. Intervención programada.spa
dc.description.tableofcontentsINTRODUCCION 12 1. PLANTEAMIENTO Y JUSTIFICACION DEL PROBLEMA 13 2. PREGUNTA DE INVESTIGACION 15 3. MARCO TEORICO 16 3.1. EPIDEMIOLOGIA DE LA ENFERMEDAD CARDIACA ISQUEMICA 16 3.2. ESTADO DEL ARTE DE LA CIRUGÍA CARDIACA 16 3.2.1. Importancia de la cirugía coronaria en los pacientes postinfarto 19 agudo de miocardio 3.2.2. Implementación de la revascularización miocárdica 20 3.2.3. Técnicas en la cirugía de revascularización miocárdica 22 3.3. MODELOS PREDICTIVOS DE MORTALIDAD POSTQUIRURGICA 22 4. OBJETIVOS 26 4.1. OBJETIVO GENERAL 26 4.2. OBJETIVOS ESPECÍFICOS 26 5. DISEÑO METODOLÓGICO 27 5.1. DISEÑO DEL ESTUDIO 27 5.2. POBLACIÓN 27 5.2.1. Población de referencia 27 5.2.2. Población blanco o diana 27 5.2.3. Población de estudio 27 5.3. CRITERIOS DE INCLUSIÓN 27 5.4. CRITERIOS DE EXCLUSIÓN 27 5.5. MUESTREO 28 5.5.1. Tamaño de muestra 28 5.6. VARIABLES 28 5.6.1. Variables sociodemográficas 28 5.6.2. EuroSCORE Logístico 28 5.6.3. EuroSCORE II 29 5.6.4. Paraclínicos Ingreso 5.6.5. Desenlaces 5.6.5.1. Mortalidad 31 5.6.5.2. Complicación postoperatoria intrahospitalaria cardiovascular 5.6.5.3. Complicación postoperatoria intrahospitalaria no cardiovascular 5.7. PROCEDIMIENTOS PARA RECOLECCIÓN DE INFORMACIÓN 5.7.1. Evaluación inicial 34 5.8. PROCESAMIENTO Y CONTROL DE CALIDAD DE LOS DATOS 34 5.8.1. Conducción del estudio 34 5.8.1.1. Grupo de Base de datos 5.8.1.2. Supervisión 5.8.1.3. Director del Proyecto 5.8.4.4. Coinvestigadores del proyecto 6. ANÁLISIS ESTADÍSTICO DE LAS VARIABLES 6.1. ANÁLISIS UNIVARIADO 6.2. ANÁLISIS BIVARIADO 6.3. ANÁLISIS DEL DESEMPEÑO DE LOS MODELOS 7. CONSIDERACIONES ÉTICAS 8. RESULTADOS 38 8.1. CONSTRUCCION DE LA COHORTE 8.2. ANÁLISIS UNIVARIADO 8.2.1. Características del paciente 8.3. ANÁLISIS BIVARIADO 8.4. EVALUACIÓN DEL DESEMPEÑO DE EUROSCORE LOG 8.4.1. Evaluación de la presencia de Error de especificación 8.4.2. Bondad de ajuste del modelo 8.4.3. Estadísticas de Clasificación 8.4.4. Evaluación de la capacidad Discriminativa 8.5. Evaluación del Desempeño de EuroSCORE II 8.5.1. Evaluación de la presencia de Error de especificación 8.5.2. Bondad de ajuste del modelo 44 8.5.3. Estadísticas de Clasificación 44 8.5.4. Evaluación de la capacidad Discriminativa 44 9. DISCUSIÓN 48 10. CONCLUSIONES 52 11. BIBLIOGRAFÍA 53spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleComparación del EuroSCORE LOG y II dentro de la caracterización de variables asociadas a mortalidad postquirúrgica en una cohorte de pacientes adultos con cardiopatía isquémica de dos instituciones de la zona metropolitana de Bucaramangaspa
dc.title.translatedComparison of EuroSCORE LOG and II within the characterization of variables associated with postoperative mortality in a cohort of adult patients with ischemic heart disease from two institutions of the Bucaramanga metropolitan areaspa
dc.degree.nameEspecialista en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Crítica y Cuidado Intensivo del Adultospa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsCritical care medicinespa
dc.subject.keywordsPatient monitoringspa
dc.subject.keywordsAcute myocardial infarctionspa
dc.subject.keywordsPredictionspa
dc.subject.keywordsMortality post-surgicalspa
dc.subject.keywordsMyocardial ischemiaspa
dc.subject.keywordsCardiovascular diseasesspa
dc.subject.keywordsDemographic profilespa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
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dc.contributor.cvlacNaranjo Junoy, Francisco Fernando [0000176095]spa
dc.contributor.orcidNaranjo Junoy, Francisco Fernando [0000-0001-8628-8743]spa
dc.contributor.researchgateNaranjo Junoy, Francisco Fernando [Francisco-Naranjo-Junoy-2075424896]spa
dc.subject.lembCiencias médicasspa
dc.subject.lembCuidados intensivos (Medicina)spa
dc.subject.lembMonitoreo de pacientesspa
dc.subject.lembIsquemia miocárdicaspa
dc.subject.lembEnfermedades cardiovascularesspa
dc.subject.lembPeril demográficospa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishThe management of myocardial infarction includes a systematic chain of actions such as pre-surgical risk stratification to improve the quality of care and the allocation and optimal use of available resources. This requires constant updating of the scores, to optimize the discrimination of the outcome. General objective: To compare the probability of postoperative mortality given by the EuroSCORE LOG and II in a cohort of adult patients with ischemic heart disease treated in two institutions in the metropolitan area of Bucaramanga, Colombia. Methodology: retrospective cohort-type analytical observational study, with non-sampling probability of concurrent cases. Patients older than 18 years, recruited between 2011- 2014, in two institutions in the metropolitan area of Bucaramanga. analysis was performed descriptive, bivariate and discriminative capacity (ROC curves), sensitivity and specificity. Results: In the deceased, the average age was higher (M: 75.6 years), the fraction of ejection was more compromised (35.8%) and the EuroSCORE LOG index and the EuroSCORE II were higher (17.5 vs. 11.31). Dysfunction was also observed neurological (16.67% vs. 1%), proportion of patients in critical preoperative state (50% vs. 9%) and alteration in mobility (16.67% vs. 1%34% were postoperative complications of cardiac type, (intraoperative shock: (29/36¡ 80.5%). Among the complications non-cardiac postoperative (5%) the greatest exponent was bleeding (3/5; 60%). only 6% of the patients died for a case fatality rate of 5.6%. Conclusion: One of the main problems is that the scores are usually static due to the lack of continuous updating, so they can overestimate the risk. In it present study, a mortality of 10% was predicted with the EuroSCORE LOG and 16% with the EuroSCORE II compared to that actually observed in the 5.6% cohort. you could conclude then that despite its calibration and satisfactory discriminatory capacity, it underestimated high-risk patients, establishing a need to differentiate their application as emergency vs. Scheduled intervention.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalPredicciónspa
dc.subject.proposalEuroSCOREspa
dc.subject.proposalMortalidad postquirúrgicaspa
dc.subject.proposalInfarto agudo de miocardiospa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aaspa
dc.relation.uriapolohttps://apolo.unab.edu.co/en/persons/francisco-fernando-alberto-gabino-naranjo-junoyspa
dc.contributor.apolounabNaranjo Junoy, Francisco Fernando [francisco-fernando-alberto-gabino-naranjo-junoy]spa
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa


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