Predicción de lesión renal aguda asociada a cirugía cardíaca: la escala crate
- Autores: Pablo Jorge Monjas
- Directores de la Tesis: Eduardo Tamayo Gómez (dir. tes.), José Ignacio Gómez Herreras (codir. tes.)
- Lectura: En la Universidad de Valladolid ( España ) en 2015
- Idioma: español
- Tribunal Calificador de la Tesis: José María Eiros Bouza (presid.), Francisco Javier Álvarez González (secret.), Francisco José López Hernández (voc.), Rafael Uña Orejón (voc.), Juan Bustamante (voc.)
- Materias:
- Enlaces
- Tesis en acceso abierto en: UVADOC
- Resumen
Introducción La injuria o lesión renal aguda (LRA) es una complicación frecuente en el post-operatorio de cirugía cardíaca y se asocia a un incremento de la morbimortalidad.
El diagnostico precoz es fundamental en el abordaje de esta entidad para iniciar tempranamente medidas preventivas. El objetivo de este estudio fue diseñar una escala de predicción postoperatoria de LRA no dialítica, en pacientes con función renal previa normal operados de cirugía cardiaca con circulación extracorpórea.
Material y métodos Se diseñó una recogida de datos de forma prospectiva en 909 pacientes intervenidos de cirugía cardíaca con circulación extracorpórea entre los años 2011 y 2013. De todos ellos, un total de 810 pacientes cumplieron los criterios de inclusión.
Los pacientes fueron clasificados de acuerdo a la aparición de LRA siguiendo los criterios RIFLE (acrónimo de Risk, Injury, Failure, Loss, End-stage; riesgo, daño, fallo, pérdida, terminal). Utilizamos como nivel de creatinina basal la obtenida en el análisis de laboratorio al ingreso del paciente en el hospital. Recogimos diversos parámetros pre e intraoperatorios, y al ingreso del paciente en la unidad de cuidados intensivos, buscando una asociación con el riesgo de desarrollar LRA. Las variables que se asociaron de forma significativa con el riesgo de LRA fueron testadas para precisión mediante el análisis de curvas COR (característica operativa del receptor).
Las variables con mejor área bajo la curva fueron analizadas en un modelo de regresión logística multivariante por pasos hacia delante.
Resultados Un total de 137 pacientes (16,9%) presentaron LRA en el postoperatorio. Tras realizar el análisis estadístico incluimos cuatro factores de riesgo independiente en la escala CRATE: creatinina (odds ratio [OR] 9,66; 95% intervalo de confianza [IC] 4,77-19,56; p < 0.001), ácido láctico (OR 1,03; IC 1,01-1,04; p < 0,001), tiempo de circulación extracorpórea (OR 1,01; IC 1,01-1,02; p < 0,001), y EuroSCORE (OR 1,40; IC 1,29-1,52; p < 0,001). La escala de riesgo de lesión renal fue realizada en 24 base al peso de cada variable significativa. La precisión del modelo fue moderadamente buena, con un área bajo la curva de 0,89; IC 0,85-0,92. Calculamos la probabilidad de padecer lesión renal según diferentes rangos de riesgo, lo que resultó en la obtención de cinco categorías de riesgo: muy bajo (2%), bajo (8,5%), moderado (33.8%), alto (57,5%), y muy alto (84,7%). Además realizamos un análisis de supervivencia en función de la aparición de lesión renal asociada a cirugía cardíaca que demostró que existen diferencias significativas entre ambos grupos. Los pacientes que desarrollaron lesión renal aguda en nuestra población tienen menor supervivencia tanto a los 30, como a los 90 días.
Conclusiones CRATE (acrónimo de Creatinina, Ácido láctico, Tiempo de circulación extracorpórea, y Euroscore) es una escala de riesgo precisa y fácil de calcular que emplea variables fáciles de obtener en cualquier centro donde se lleven a cabo procedimientos quirúrgicos cardíacos rutinariamente.
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