Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos

Introducción: la sepsis es un problema de salud pública que permanece con una alta incidencia y morbimortalidad, El uso de biomarcadores puede mejorar el diagnóstico e inicio de terapia tempranos y por lo tanto influir en el desenlace de morbilidad y mortalidad. En las últimas dos décadas, las Metal...

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Autores:
Sanabria Reyes, Marelbi Stella
Puerto Chaparro, Ricardo Giovanni
Tipo de recurso:
Fecha de publicación:
2017
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/1723
Acceso en línea:
http://hdl.handle.net/20.500.12749/1723
Palabra clave:
Septic syndrome
Public health
Mortality
Metalloproteinases
Medicine
Critical medicine
Adult intensive care
Investigations
Relationship with patients
Metalloproteinases (MMPs)
Tissue metalloproteinase inhibitors (TIMPs)
Síndrome séptico
Salud pública
Mortalidad
Metaloproteinasas
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Sepsis
Metaloproteinasas (MMPs)
Inhibidores tisulares de metaloproteinasas (TIMPs)
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_a781aa0b0e2c43446245a944958f93e6
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/1723
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
dc.title.translated.eng.fl_str_mv Association between mortality and metalloproteinases and their inhibitors in septic patients
title Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
spellingShingle Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
Septic syndrome
Public health
Mortality
Metalloproteinases
Medicine
Critical medicine
Adult intensive care
Investigations
Relationship with patients
Metalloproteinases (MMPs)
Tissue metalloproteinase inhibitors (TIMPs)
Síndrome séptico
Salud pública
Mortalidad
Metaloproteinasas
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Sepsis
Metaloproteinasas (MMPs)
Inhibidores tisulares de metaloproteinasas (TIMPs)
title_short Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
title_full Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
title_fullStr Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
title_full_unstemmed Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
title_sort Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos
dc.creator.fl_str_mv Sanabria Reyes, Marelbi Stella
Puerto Chaparro, Ricardo Giovanni
dc.contributor.advisor.spa.fl_str_mv Torres Dueñas, Diego
Naranjo Junoy, Francisco Fernando
Meléndez Flórez, Héctor Julio
dc.contributor.author.spa.fl_str_mv Sanabria Reyes, Marelbi Stella
Puerto Chaparro, Ricardo Giovanni
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095;https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000066885
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0002-8006-7461
dc.contributor.scopus.*.fl_str_mv https://www.scopus.com/authid/detail.uri?authorId=24282065800
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 Septic syndrome
Public health
Mortality
Metalloproteinases
Medicine
Critical medicine
Adult intensive care
Investigations
Relationship with patients
Metalloproteinases (MMPs)
Tissue metalloproteinase inhibitors (TIMPs)
topic Septic syndrome
Public health
Mortality
Metalloproteinases
Medicine
Critical medicine
Adult intensive care
Investigations
Relationship with patients
Metalloproteinases (MMPs)
Tissue metalloproteinase inhibitors (TIMPs)
Síndrome séptico
Salud pública
Mortalidad
Metaloproteinasas
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
Sepsis
Metaloproteinasas (MMPs)
Inhibidores tisulares de metaloproteinasas (TIMPs)
dc.subject.lemb.spa.fl_str_mv Síndrome séptico
Salud pública
Mortalidad
Metaloproteinasas
Medicina
Medicina crítica
Cuidado intensivo del adulto
Investigaciones
Relación con los pacientes
dc.subject.proposal.none.fl_str_mv Sepsis
Metaloproteinasas (MMPs)
Inhibidores tisulares de metaloproteinasas (TIMPs)
description Introducción: la sepsis es un problema de salud pública que permanece con una alta incidencia y morbimortalidad, El uso de biomarcadores puede mejorar el diagnóstico e inicio de terapia tempranos y por lo tanto influir en el desenlace de morbilidad y mortalidad. En las últimas dos décadas, las Metaloproteinasas de matriz extracelular (MMPs)y sus inhibidores tisulares (TIMPs) han sido involucrados en diversas enfermedades de carácter inflamatorio, se perfilan como importantes biomarcadores para establecer el pronóstico del curso y desenlace de pacientes con sepsis o choque séptico. No obstante, es necesario aclarar controversias de su valor predictivo en este escenario. Objetivo General: Establecer la asociación entre las MMPs, los TIMPs y la mortalidad en pacientes sépticos. Metodología: se realizó un estudio de cohorte prospectivo de pacientes mayores de 18 años, captados en los proyectos G-SEPSIS Y MMACDyS en un grupo de pacientes hospitalizados en el servicio de urgencias y Unidades de Cuidados Intensivos adultos de 4 clínicas del área metropolitana de Bucaramanga, con diagnóstico de sepsis de acuerdo a la definición del tercer Consenso Internacional para sepsis y choque séptico (SEPSIS-3) de JAMA 2016. Se realizó análisis descriptivo, bivariado, capacidad discriminativa (curvas ROC) y modelo logístico multivariado. Resultados: de 289 pacientes con edades entre los 18 y 92 años, la incidencia de muerte fue de 28.4/100.000. En el análisis bivariado las concentraciones plasmáticas de TIMPs y MMP2 fueron mayores en los que fallecieron, en tanto que las de la MMP9 fueron mayores en los sobrevivientes. Los índices MMP/TIMPS, las actividades y las actividades ajustadas por concentración no presentaron diferencias estadísticamente significativas entre los pacientes que fallecieron y los sobrevivientes. En el modelo multivariado se encontró que los factores asociados a la mortalidad a 30 días eran el choque séptico, la edad, el BUN y el puntaje de Charlson. Conclusión: los factores encontrados que se asocian a la mortalidad a 30 días fueron el choque séptico, la edad, el BUN y el puntaje de Charlson. No se encontró asociación estadísticamente significativa para los índices MMP/TIMPS, las actividades de MMPs, y TIMPs y las actividades ajustadas por concentración y mortalidad en pacientes con sepsis y choque séptico.
publishDate 2017
dc.date.issued.none.fl_str_mv 2017
dc.date.accessioned.none.fl_str_mv 2020-06-26T19:59:27Z
dc.date.available.none.fl_str_mv 2020-06-26T19:59:27Z
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/20.500.12749/1723
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/20.500.12749/1723
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 Sanabria Reyes, Marelbi Stella, Puerto Chaparro, Ricardo Giovanni (2017). Asociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticos. Bucaramanga (Santander, Colombia) : Universidad Autónoma de Bucaramanga UNAB
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spelling Torres Dueñas, Diegof0f1f994-0632-469e-b8b3-47106713d415-1Naranjo Junoy, Francisco Fernando5a307c13-9352-4d86-b903-0177372f5624-1Meléndez Flórez, Héctor Julio20cc143a-86c7-44c4-bcab-57fb40719b36-1Sanabria Reyes, Marelbi Stellab2ed3b01-cd79-4af9-914b-52fe71db6df6-1Puerto Chaparro, Ricardo Giovannic8e4e276-8a40-4cf5-b598-61a49328bd3d-1https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000176095;https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000066885https://orcid.org/0000-0002-8006-7461https://www.scopus.com/authid/detail.uri?authorId=24282065800Grupo de Investigación en Ciencias y Educación en SaludGrupo de Investigaciones Clínicas2020-06-26T19:59:27Z2020-06-26T19:59:27Z2017http://hdl.handle.net/20.500.12749/1723instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABIntroducción: la sepsis es un problema de salud pública que permanece con una alta incidencia y morbimortalidad, El uso de biomarcadores puede mejorar el diagnóstico e inicio de terapia tempranos y por lo tanto influir en el desenlace de morbilidad y mortalidad. En las últimas dos décadas, las Metaloproteinasas de matriz extracelular (MMPs)y sus inhibidores tisulares (TIMPs) han sido involucrados en diversas enfermedades de carácter inflamatorio, se perfilan como importantes biomarcadores para establecer el pronóstico del curso y desenlace de pacientes con sepsis o choque séptico. No obstante, es necesario aclarar controversias de su valor predictivo en este escenario. Objetivo General: Establecer la asociación entre las MMPs, los TIMPs y la mortalidad en pacientes sépticos. Metodología: se realizó un estudio de cohorte prospectivo de pacientes mayores de 18 años, captados en los proyectos G-SEPSIS Y MMACDyS en un grupo de pacientes hospitalizados en el servicio de urgencias y Unidades de Cuidados Intensivos adultos de 4 clínicas del área metropolitana de Bucaramanga, con diagnóstico de sepsis de acuerdo a la definición del tercer Consenso Internacional para sepsis y choque séptico (SEPSIS-3) de JAMA 2016. Se realizó análisis descriptivo, bivariado, capacidad discriminativa (curvas ROC) y modelo logístico multivariado. Resultados: de 289 pacientes con edades entre los 18 y 92 años, la incidencia de muerte fue de 28.4/100.000. En el análisis bivariado las concentraciones plasmáticas de TIMPs y MMP2 fueron mayores en los que fallecieron, en tanto que las de la MMP9 fueron mayores en los sobrevivientes. Los índices MMP/TIMPS, las actividades y las actividades ajustadas por concentración no presentaron diferencias estadísticamente significativas entre los pacientes que fallecieron y los sobrevivientes. En el modelo multivariado se encontró que los factores asociados a la mortalidad a 30 días eran el choque séptico, la edad, el BUN y el puntaje de Charlson. Conclusión: los factores encontrados que se asocian a la mortalidad a 30 días fueron el choque séptico, la edad, el BUN y el puntaje de Charlson. No se encontró asociación estadísticamente significativa para los índices MMP/TIMPS, las actividades de MMPs, y TIMPs y las actividades ajustadas por concentración y mortalidad en pacientes con sepsis y choque séptico.INTRODUCCION 10 1. PLANTEAMIENTO Y JUSTIFICACION DEL PROBLEMA 11 2. PREGUNTA DE INVESTIGACION 14 3. MARCO TEÓRICO 15 3.1 DEFINICION DE SEPSIS 15 3.2 EPIDEMIOLOGÍA 17 3.3 CLASIFICACIÓN Y ESCALAS DE SEVERIDAD 18 3.4 FISIOPATOLOGÍA: INMUNOPATOGENESIS 20 3.5 METALOPROTEINASAS 21 3.6 DISFUNCIÓN CARDIOVASCULAR, DMF FMO 23 4. ESTADO DEL ARTE 24 5.1 OBJETIVOS 25 5.1 Objetivo general 25 5.2 Objetivos específicos 26 6. DISEÑO METODOLOGICO 27 6.1 DISEÑO DEL ESTUDIO 27 6.2 POBLACION 27 6.3 CRITERIOS DE INCLUSIÓN 27 6.4 CRITERIOS DE EXCLUSIÓN 27 6.5 MUESTREO 27 6.6 VARIABLES 28 6.7 PROCEDIMIENTOS PARA RECOLECCION DE INFORMACION 30 6.8 PROCESAMIENTO DE LOS DATOS 30 7. ANALISIS ESTADISTICO DE LAS VARIABLES 31 7.1 ANALISIS UNIVARIADO 31 7.2 ANALISIS BIVARIADO 32 8. CONSIDERACIONES ETICAS 32 9. RESULTADOS 34 9.1 CONSTRUCCION DE LA COHORTE 34 9.2 ANALISIS UNIVARIADO 34 9.3 ANALISIS BIVARIADO 37 9.4 REGRESION LOGISTICA BIVARIADA 37 9.5 REGRESION LOGISTICA MULTIVARIADA 38 9.6 EVALUACION DEL DESEMPEÑO 39 9.7 OBSERVACIONES INFLUYENTES 40 10. DISCUSION 40 11. CONCLUSIONES 44 12. BIBLIOGRAFIA 45EspecializaciónIntroduction: sepsis is a public health problem that remains with a high incidence and morbidity and mortality. The use of biomarkers can improve early diagnosis and initiation of therapy and therefore influence the outcome of morbidity and mortality. In the last two decades, extracellular matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) have been involved in various inflammatory diseases, they are emerging as important biomarkers to establish the prognosis of the course and outcome of patients with sepsis or shock septic. However, it is necessary to clarify controversies of its predictive value in this scenario. General Objective: To establish the association between MMPs, TIMPs and mortality in septic patients. Methodology: a prospective cohort study of patients over 18 years of age was carried out, captured in the G-SEPSIS and MMACDyS projects in a group of hospitalized patients in the emergency department and adult Intensive Care Units of 4 clinics in the metropolitan area of ​​Bucaramanga , with a diagnosis of sepsis according to the definition of the third International Consensus for sepsis and septic shock (SEPSIS-3) of JAMA 2016. Descriptive, bivariate analysis, discriminative capacity (ROC curves) and multivariate logistic model were performed. Results: of 289 patients aged between 18 and 92 years, the incidence of death was 28.4 / 100,000. In the bivariate analysis, the plasma concentrations of TIMPs and MMP2 were higher in those who died, while those of MMP9 were higher in the survivors. The MMP / TIMPS indices, activities, and concentration-adjusted activities did not show statistically significant differences between patients who died and survivors. In the multivariate model, it was found that the factors associated with 30-day mortality were septic shock, age, BUN, and the Charlson score. Conclusion: the factors found associated with 30-day mortality were septic shock, age, BUN, and the Charlson score. No statistically significant association was found for MMP / TIMPS indices, activities of MMPs, and TIMPs, and activities adjusted for concentration and mortality in patients with sepsis and septic shock.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 ColombiaAsociación entre la mortalidad y las metaloproteinasas y sus inhibidores en pacientes sépticosAssociation between mortality and metalloproteinases and their inhibitors in septic patientsEspecialista en Medicina Crítica y Cuidado Intensivo del AdultoBucaramanga (Santander, Colombia)UNAB Campus BucaramangaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Crítica y Cuidado Intensivo del Adultoinfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMSeptic syndromePublic healthMortalityMetalloproteinasesMedicineCritical medicineAdult intensive careInvestigationsRelationship with patientsMetalloproteinases (MMPs)Tissue metalloproteinase inhibitors (TIMPs)Síndrome sépticoSalud públicaMortalidadMetaloproteinasasMedicinaMedicina críticaCuidado intensivo del adultoInvestigacionesRelación con los pacientesSepsisMetaloproteinasas (MMPs)Inhibidores tisulares de metaloproteinasas (TIMPs)Sanabria Reyes, Marelbi Stella, Puerto Chaparro, Ricardo Giovanni (2017). 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Niño M, Serrano S,Pazin-Filho A,Jaimes F,Cunha F,Schulz,Torres-Dueñas TIMP1 and MMP9 are predictors of mortalitiy in septic patients in the Emergency department and intensive care unit unlike MMP9/TIMP1 ratio: Multivariate model. One PLOS.2017 feb 13.ORIGINAL2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdf2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdfTesisapplication/pdf845537https://repository.unab.edu.co/bitstream/20.500.12749/1723/1/2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdf5be77584c993cda33bb9b574cd9bf0abMD51open access2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdf2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdfLicenciaapplication/pdf1439910https://repository.unab.edu.co/bitstream/20.500.12749/1723/2/2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdf61936f235cde1caae184bfde8a24ebdaMD52metadata only accessTHUMBNAIL2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdf.jpg2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdf.jpgIM Thumbnailimage/jpeg6199https://repository.unab.edu.co/bitstream/20.500.12749/1723/3/2017_Tesis_Marelbi_Stella_Sanabria_Reyes.pdf.jpgd68c7b3b5714c26ac16e0d499f9af0b2MD53open access2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdf.jpg2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdf.jpgIM Thumbnailimage/jpeg11941https://repository.unab.edu.co/bitstream/20.500.12749/1723/4/2017_Licencia_Marelbi_Stella_Sanabria_Reyes.pdf.jpg7ab6ab1c2f8ee07a9a4015203f0c4c20MD54open access20.500.12749/1723oai:repository.unab.edu.co:20.500.12749/17232024-01-21 10:27:24.637open accessRepositorio Institucional | Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.co

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