Análisis de los pacientes cirróticos ingresados en las unidades de cuidados intensivos.
Objetivos En los últimos años el número de pacientes cirróticos que ingresan en las unidades de cuidados intensivos está aumentando. En los últimos años se ha publicado mucho sobre este hecho, dado que este tipo de enfermos presentan una elevada mortalidad no solamente en la UCI, sino hospitalaria. Los artículos publicados lo que más se destaca es el papel que pueden adoptar los índices de gravedad para para predecir la mortalidad de estos enfermos. Nuestra hipótesis de trabajo se basa en encontrar el índice de gravedad, que puede predecir, de manera más precisa la mortalidad de los pacientes cirróticos ingresado en a las unidades de cuidados intensivos, tanto hospitalaria como al año.
Los objetivos planteados en este trabajo serían: - Establecer la prevalencia de los pacientes cirróticos que ingresan en la UCI.
- Analizar las características demográficas, clínicas y analíticas del paciente cirrótico ingresado en UCI - Describir la evolución clínica, morbimortalidad, del paciente cirróticos crítico.
- Comparar los diferentes índices de gravedad para predecir la evolución de los pacientes.
Analizar los factores de riesgo de mortalidad hospitalaria y al año de los pacientes ingresados en UCI.
Metodología El estudio, observacional y prospectivo, ha sido realizado en la Unidad de Cuidados Intensivos del Hospital Universitario José María Morales Meseguer de Murcia en el periodo comprendido entre el 1 de enero de 2005 y 31 de diciembre del 2014. La UCI de este centro hospitalario, adscrito al Servicio Murciano de Salud, tiene capacidad para 18 camas donde se atiende a pacientes críticos en el ámbito de la patología médico-quirúrgica, coronaria y traumatológica.
Se incluyeron en el estudio todos los pacientes que de forma consecutiva ingresaron en UCI con el diagnóstico de cirrosis hepática independientemente del diagnóstico de ingreso.
Criterios de Inclusión " Pacientes que en el momento de ingreso estuvieran diagnosticado de cirrosis.
" Se incluyeron todos aquellos pacientes que ingresaron en la unidad de cuidados intensivos con diagnóstico de cirrosis hepática o fueron diagnosticados durante el ingreso. Se incluyeron todos los pacientes que ingresaron en la UCI con diagnóstico primario o secundario de cirrosis.
Criterios de exclusión La presencia de las siguientes situaciones supuso la exclusión de los pacientes en el estudio: " Pacientes que se ingresan en la UCI de forma transitoria para realización de técnicas diagnostica invasivas o colocación de catéter venoso central.
" Pacientes que una vez ingresados en UCI son dados a otros centros con estancia menor 24 horas por necesidad de atención especializada.
Conclusiones ¢ La prevalencia de la enfermedad cirrótica en los pacientes ingresados en la Unidad de Cuidados Intensivos es baja. Sin embargo, en os últimos años está aumentando el número de pacientes admitidos.
¢ La presencia de limitación de esfuerzo terapéutico, tanto la orden de no intubación como la orden de no reingreso en UCI son frecuentes en los pacientes con cirrosis hepática.
¢ Los pacientes cirróticos ingresados en cuidados intensivos presentan una muy elevada mortalidad, muy por encima de la mortalidad de pacientes no cirróticos con el mismo nivel de gravedad inicial.
¢ Múltiples variables se asocian con una peor evolución de los pacientes cirróticos. Mediante análisis multivariante, la gravedad inicial, medida mediante el índice SAPS II, la puntuación de la afectación hepática mediante el sistema MELD y la disfunción orgánica desarrollada durante la estancia en UCI, medida mediante el índice SOFA, son los factores predictivos independientes que se asocian a mayor mortalidad hospitalaria.
Analysis of cirrhotic patients admitted to the intensive care units.
Goals In recent years the number of cirrhotic patients admitted to intensive care units is increasing. In recent years much has been published on this fact, given that this type of patients has a high mortality not only in the ICU, but hospital. A published article what stands out most is the role that severity indexes can play in predicting the mortality of these patients. Our work hypothesis is based on finding the severity index, which can predict, in a more precise way, the mortality of cirrhotic patients admitted to the intensive care units, both hospital and one year.
The objectives proposed in this work would be:
- Establish the prevalence of cirrhotic patients admitted to the ICU.
- Analyze the demographic, clinical and analytical characteristics of the cirrhotic patient admitted to the ICU.
- Describe the clinical evolution, morbidity and mortality, of the critical cirrhotic patient.
- Compare the different severity indexes to predict the evolution of patients.
To analyze the risk factors of hospital mortality and one year of patients admitted to the ICU.
Methodology The observational and prospective study was carried out in the Intensive Care Unit of the José María Morales Meseguer University Hospital of Murcia in the period between January 1, 2005 and December 31, 2014. The ICU of this hospital center, assigned to the Murciano Health Service, has capacity for 18 beds where critical patients are attended in the field of medical-surgical, coronary and trauma pathology.
All the patients who consecutively entered the ICU with the diagnosis of liver cirrhosis independently of the admission diagnosis were included in the study.
Inclusion criteria o Patients who, at the time of admission, were diagnosed with cirrhosis.
o All patients admitted to the intensive care unit diagnosed with liver cirrhosis or were diagnosed during admission were included. All patients admitted to the ICU with primary or secondary diagnosis of cirrhosis were included.
Exclusion criteria The presence of the following situations involved the exclusion of patients in the study:
o Patients admitted to the ICU temporarily to perform invasive diagnostic techniques or placement of a central venous catheter.
o Patients who, once admitted to the ICU, are given to other centers with a stay of less than 24 hours due to the need for specialized care.
Conclusions - The prevalence of cirrhotic disease in patients admitted to the Intensive Care Unit is low. However, in recent years the number of admitted patients is increasing.
- The presence of limitation of therapeutic effort, both the order of not intubation and the order of non-re-entry in the ICU are frequent in patients with liver cirrhosis.
-Cirrhotic patients admitted to intensive care have a very high mortality, well above the mortality of non-cirrhotic patients with the same initial severity level.
-Multiple variables are associated with a worse evolution of cirrhotic patients. By means of multivariate analysis, the initial severity, measured using the SAPS II index, the score of the hepatic involvement through the MELD system and the organic dysfunction developed during the stay in the ICU, measured by the SOFA index, are the independent predictors that are associated to higher hospital mortality.
Analysis of cirrhotic patients admitted to the intensive care units.
Goals In recent years the number of cirrhotic patients admitted to intensive care units is increasing. In recent years much has been published on this fact, given that this type of patients has a high mortality not only in the ICU, but hospital. A published article what stands out most is the role that severity indexes can play in predicting the mortality of these patients. Our work hypothesis is based on finding the severity index, which can predict, in a more precise way, the mortality of cirrhotic patients admitted to the intensive care units, both hospital and one year.
The objectives proposed in this work would be:
- Establish the prevalence of cirrhotic patients admitted to the ICU.
- Analyze the demographic, clinical and analytical characteristics of the cirrhotic patient admitted to the ICU.
- Describe the clinical evolution, morbidity and mortality, of the critical cirrhotic patient.
- Compare the different severity indexes to predict the evolution of patients.
To analyze the risk factors of hospital mortality and one year of patients admitted to the ICU.
Methodology The observational and prospective study was carried out in the Intensive Care Unit of the José María Morales Meseguer University Hospital of Murcia in the period between January 1, 2005 and December 31, 2014. The ICU of this hospital center, assigned to the Murciano Health Service, has capacity for 18 beds where critical patients are attended in the field of medical-surgical, coronary and trauma pathology.
All the patients who consecutively entered the ICU with the diagnosis of liver cirrhosis independently of the admission diagnosis were included in the study.
Inclusion criteria o Patients who, at the time of admission, were diagnosed with cirrhosis.
o All patients admitted to the intensive care unit diagnosed with liver cirrhosis or were diagnosed during admission were included. All patients admitted to the ICU with primary or secondary diagnosis of cirrhosis were included.
Exclusion criteria The presence of the following situations involved the exclusion of patients in the study:
o Patients admitted to the ICU temporarily to perform invasive diagnostic techniques or placement of a central venous catheter.
o Patients who, once admitted to the ICU, are given to other centers with a stay of less than 24 hours due to the need for specialized care.
Conclusions - The prevalence of cirrhotic disease in patients admitted to the Intensive Care Unit is low. However, in recent years the number of admitted patients is increasing.
- The presence of limitation of therapeutic effort, both the order of not intubation and the order of non-re-entry in the ICU are frequent in patients with liver cirrhosis.
-Cirrhotic patients admitted to intensive care have a very high mortality, well above the mortality of non-cirrhotic patients with the same initial severity level.
-Multiple variables are associated with a worse evolution of cirrhotic patients. By means of multivariate analysis, the initial severity, measured using the SAPS II index, the score of the hepatic involvement through the MELD system and the organic dysfunction developed during the stay in the ICU, measured by the SOFA index, are the independent predictors that are associated to higher hospital mortality.
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