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

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 S...

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Autores:
Rueda Galvis, Myriam Vanessa
Tipo de recurso:
Fecha de publicación:
2018
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/1734
Acceso en línea:
http://hdl.handle.net/20.500.12749/1734
Palabra clave:
Systemic inflammatory response syndrome
Septic cardiomyopathy
Sepsis
Troponin I
Medicine
Internal medicine
Investigations
Complications
Patients
Prevention and control
Third consensus
Mortality
Systolic dysfunction
Diastolic dysfunction
Septic shock
Intensive care unit
Síndrome de respuesta inflamatoria sistémica
Miocardiopatía séptica
Sepsis
Troponina I
Medicina
Medicina interna
Investigaciones
Complicaciones
Pacientes
Prevención y control
Tercer consenso
NT pro BNP
Mortalidad
Disfunción sistólica
Disfunción diastólica
Choque séptico
Unidad de cuidados intensivos
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_1d4dfbef12b865c783ff92859ce96514
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/1734
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
dc.title.translated.eng.fl_str_mv Strength of association between Troponin I, NT-pro BNP and adverse outcomes in sepsis
title Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
spellingShingle Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
Systemic inflammatory response syndrome
Septic cardiomyopathy
Sepsis
Troponin I
Medicine
Internal medicine
Investigations
Complications
Patients
Prevention and control
Third consensus
Mortality
Systolic dysfunction
Diastolic dysfunction
Septic shock
Intensive care unit
Síndrome de respuesta inflamatoria sistémica
Miocardiopatía séptica
Sepsis
Troponina I
Medicina
Medicina interna
Investigaciones
Complicaciones
Pacientes
Prevención y control
Tercer consenso
NT pro BNP
Mortalidad
Disfunción sistólica
Disfunción diastólica
Choque séptico
Unidad de cuidados intensivos
title_short Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
title_full Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
title_fullStr Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
title_full_unstemmed Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
title_sort Fuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsis
dc.creator.fl_str_mv Rueda Galvis, Myriam Vanessa
dc.contributor.advisor.spa.fl_str_mv Machado Romero, Carlos Alfonso
Higuera Cobos, Juan Diego
Ochoa Vera, Miguel Enrique
dc.contributor.author.spa.fl_str_mv Rueda Galvis, Myriam Vanessa
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001543126
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001692834
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0002-4552-3388
https://orcid.org/0000-0003-2622-9412
dc.contributor.scopus.*.fl_str_mv https://www.scopus.com/authid/detail.uri?authorId=36987156500
dc.contributor.researchgate.*.fl_str_mv https://www.researchgate.net/profile/Miguel_Ochoa7
dc.contributor.researchgroup.spa.fl_str_mv Grupo de Investigación en Ciencias y Educación en Salud
Grupo de Investigaciones Clínicas
dc.subject.keywords.eng.fl_str_mv Systemic inflammatory response syndrome
Septic cardiomyopathy
Sepsis
Troponin I
Medicine
Internal medicine
Investigations
Complications
Patients
Prevention and control
Third consensus
Mortality
Systolic dysfunction
Diastolic dysfunction
Septic shock
Intensive care unit
topic Systemic inflammatory response syndrome
Septic cardiomyopathy
Sepsis
Troponin I
Medicine
Internal medicine
Investigations
Complications
Patients
Prevention and control
Third consensus
Mortality
Systolic dysfunction
Diastolic dysfunction
Septic shock
Intensive care unit
Síndrome de respuesta inflamatoria sistémica
Miocardiopatía séptica
Sepsis
Troponina I
Medicina
Medicina interna
Investigaciones
Complicaciones
Pacientes
Prevención y control
Tercer consenso
NT pro BNP
Mortalidad
Disfunción sistólica
Disfunción diastólica
Choque séptico
Unidad de cuidados intensivos
dc.subject.lemb.spa.fl_str_mv Síndrome de respuesta inflamatoria sistémica
Miocardiopatía séptica
Sepsis
Troponina I
Medicina
Medicina interna
Investigaciones
Complicaciones
Pacientes
Prevención y control
dc.subject.proposal.none.fl_str_mv Tercer consenso
NT pro BNP
Mortalidad
Disfunción sistólica
Disfunción diastólica
Choque séptico
Unidad de cuidados intensivos
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)
publishDate 2018
dc.date.issued.none.fl_str_mv 2018
dc.date.accessioned.none.fl_str_mv 2020-06-26T19:59:54Z
dc.date.available.none.fl_str_mv 2020-06-26T19:59:54Z
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/1734
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
url http://hdl.handle.net/20.500.12749/1734
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv 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.publisher.grantor.spa.fl_str_mv Universidad Autónoma de Bucaramanga UNAB
dc.publisher.faculty.spa.fl_str_mv Facultad Ciencias de la Salud
dc.publisher.program.spa.fl_str_mv Especialización en Medicina Interna
institution Universidad Autónoma de Bucaramanga - UNAB
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spelling Machado Romero, Carlos Alfonso9d3238ed-2da9-474d-a7c3-f672667a87cf-1Higuera Cobos, Juan Diego186d9eee-08a0-49b0-aa1d-20f6d2234f70-1Ochoa Vera, Miguel Enriquebf83ca83-93c9-401e-91d3-b424889e868f-1Rueda Galvis, Myriam Vanessaf568b178-79af-4ba3-a303-03d25bad2c29-1https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001543126https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001692834https://orcid.org/0000-0002-4552-3388https://orcid.org/0000-0003-2622-9412https://www.scopus.com/authid/detail.uri?authorId=36987156500https://www.researchgate.net/profile/Miguel_Ochoa7Grupo de Investigación en Ciencias y Educación en SaludGrupo de Investigaciones Clínicas2020-06-26T19:59:54Z2020-06-26T19:59:54Z2018http://hdl.handle.net/20.500.12749/1734instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABIntroducción: 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)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 .................................................................................................................... 88EspecializaciónBackground: 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)Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaFuerza de asociación entre Troponina I, NT-pro BNP y desenlaces adversos en sepsisStrength of association between Troponin I, NT-pro BNP and adverse outcomes in sepsisEspecialista en Medicina InternaBucaramanga (Santander, Colombia)UNAB Campus BucaramangaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Internainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMSystemic inflammatory response syndromeSeptic cardiomyopathySepsisTroponin IMedicineInternal medicineInvestigationsComplicationsPatientsPrevention and controlThird consensusMortalitySystolic dysfunctionDiastolic dysfunctionSeptic shockIntensive care unitSíndrome de respuesta inflamatoria sistémicaMiocardiopatía sépticaSepsisTroponina IMedicinaMedicina internaInvestigacionesComplicacionesPacientesPrevención y controlTercer consensoNT pro BNPMortalidadDisfunción sistólicaDisfunción diastólicaChoque sépticoUnidad de cuidados intensivosRueda Galvis, Myriam Vanessa (2018). 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