Albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria / Seric albumin as prediction factor of multiple failures of organs in patients with secondary diffuse peritonitis

Introducción: La albúmina sérica constituye uno de los parámetros utilizados para predecir el riesgo de complicaciones en pacientes intervenidos quirúrgicamente. Objetivo: Evaluar la utilidad de la albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria. Método: Se realizó un estudio observacional, analítico, de cohortes de 54 pacientes con peritonitis difusa secundaria atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, de la provincia de Granma, durante el 2016. La variable marcadora del pronóstico fue el fallo múltiple de órganos, que se evaluó con la escala Secuencial Organ Failure Assessment. Resultados: En 37,7 % de los pacientes se desarrolló fallo múltiple de órganos; asimismo, el valor promedio de la albúmina sérica al ingreso (desviación estándar) fue 30,3 g/L (+ 3,4) en pacientes con dicha afectación y 33,2 g/L (+ 4,1) sin esta (p=0,012). El riesgo relativo de fallo múltiple de órganos resultó ser de 1,9 (IC: 95 % 1,1-3,2) con albúmina de 30 g/L o menos. En el análisis multivariado la albúmina sérica constituyó un factor independiente de fallo múltiple de órganos junto al índice de APACHE II; mientras que el área bajo la curva receptor operador presentó un valor de 0,7 cuando se estimó la capacidad discriminativa de la albúmina para predecir la no aparición de fallo múltiple de órganos y de 0,2 para predecir su desarrollo. Conclusiones: La albúmina sérica es útil como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria.

Introduction: Seric albumin constitutes one of the parameters used to predict the risk of complications in patients surgically intervened. Objective: To evaluate the utility of seric albumin as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis. Method: An observational, cohorts analytic study of 54 patients with secondary diffuse peritonitis was carried out, they were assisted in the Intensive Cares Unit of Carlos Manuel de Céspedes University General Hospital in Bayamo, Granma, during 2016. The marker variable of prediction was the multiple failures of organs that was evaluated with the Sequential scale Organ Failure Assessment. Results: In the 37.7 % of patients multiple failure of organs was developed; also, the average value of seric albumin at admission (standard deviation) was 30.3 g/L (+ 3.4) in patients with this disorder and 33.2 g/L (+ 4.1) without this disorder (p=0.012). The relative risk of multiple failure of organs was 1.9 (CI: 95 % 1.1-3.2) with albumin of 30 g/L or less. In the multivariate analysis seric albumin constituted an independent factor of multiple failure of organs along with APACHE II index; while the area under the curve receiving operator presented a value of 0.7 when the discriminative capacity of the albumin was considered to predict if the multiple failure of organs was not present and 0.2 to predict its development. Conclusions: Seric albumin is useful as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis.

Hypoalbuminemia in critically sick children

Background: Hypoalbuminemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and may predict morbidity and mortality.Methods: Patients of age more than 1 year and less than 12 years diagnosed with hypoalbuminemia on the grounds of the inclusion criteria who were admitted in the Paediatric Intensive Care Unit (PICU) were enrolled in the study as 'cases' and patients with normal levels of serum albumin and otherwise similar characteristics to cases were included in the study as 'controls'. Detailed clinical examination and required investigations were done. Above collected information was utilized to select two groups for the study i.e., those with hypoalbuminemia and others with no hypoalbuminemia. Both these groups were further followed up till discharge or death and the outcome in terms of morbidity and mortality was noted.Results: Incidences of MODS and degree of severity of illness as judged by PRISM III score in cases and control showed that, a lower serum albumin concentration correlated well with higher rates of complications such as ventilator dependence and development of new infections leading longer stay in the critical care unit. The mean length of PICU stay in cases group was statistically longer than in the control group. Although we did not observe a difference in fatal outcome in patients managed with either Human Albumin or Fresh Frozen Plasma compared to those managed conservatively in this study, we did observe a decreased mean length of PICU stay and rate of complications in the patients treated with either Human Albumin or Fresh Frozen Plasma, thus achieving a faster rate of recovery with lesser rate of complications and thus alleviating the morbidity, though still not being able to affect the overall mortality.Conclusions: Hypoalbuminemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.

Análisis estadístico implicativo para la identificación de factores pronósticos de la mortalidad por cáncer de mama / Statistical analysis involving the identification of mortality prediction factors due to breast cancer

Se realizó un estudio observacional y analítico para evaluar la utilidad de una nueva técnica de análisis estadístico implicativo en la identificación de los factores pronósticos de la mortalidad por cáncer de mama en la provincia de Santiago de Cuba, desde septiembre de 2013 hasta igual mes de 2014. Según la regresión logística, los factores de mal pronóstico fueron la invasión neural y la radioterapia; según el análisis estadístico implicativo, la invasión neural, la radioterapia, la invasión vascular y el grado III de diferenciación histológica. El análisis estadístico implicativo resultó ser una técnica apropiada que complementa a la regresión logística en la identificación de factores pronósticos, con lo cual se logra una mejor comprensión de la causalidad y se eleva la calidad de las investigaciones de este tipo

An analytical observational study was carried out to evaluate the usefulness of a new technique of statistical analysis involving the identification of mortality prediction factors due to breast cancer in Santiago de Cuba, from September, 2013 to the same month in 2014. According to the logistical regression, the poor prediction factors were the neural invasion, radiotherapy; according to statistical involving analysis, neural invasion, radiotherapy, vascular invasion and histological differentiation stage III. The statistical involving analysis was a suitable technique that complements the logistical regression in the identification of prediction factors, with which a better understanding of causation is achieved and the quality of this type of investigations increases