Comparación de los modelos pronósticos APACHE II y Score Salvador en sepsis abdominal / Comparison of APACHE II and Score Salvador models of prediction in abdominal sepsis

La evolución y pronóstico de la sepsis abdominal están determinados por la rapidez con que se efectúa el diagnóstico, intervención apropiada y la eficacia y oportunidad del tratamiento antibiótico. Los estudios clínicos han identificado algunos factores de mal pronóstico, entre los cuales se encuentran el puntaje APACHE II elevado. Nosotros realizamos un estudio retrospectivo en la Unidad de Cuidados Intensivos del Hospital del Salvador, comparando el Score Apache II con un Score local, denominado Score del Salvador, en los pacientes con diagnóstico de sepsis abdominal. Resultados: Hubo 2.158 ingresos en la UCI del Hospital del Salvador, correspondiendo a 7,6% (n =164) de los casos a sepsis abdominal. Las principales causas de infección abdominal fueron perforación intestinal, colangitis, obstrucción intestinal y pancreatitis aguda. La comparación de las curvas receptor-operador del Score del Salvador y el índice pronóstico Apache II, evidencia que no existen diferencias significativas en el área bajo la curva de ambos índices pronósticos en pacientes con sepsis abdominal. Conclusión: Ambos índices pronósticos fueron comparables plenamente. Dado el escaso número de pacientes enrolados y la gravedad de ellos el valor predictivo es limitado lo que sugiere necesario aumentar el tamaño de la muestra y diversificar la gravedad.

The evolution and presage of the abdominal sepsis are determined by the speed with which it is made the diagnosis, appropriate intervention and the effectiveness and opportunity of the antibiotic treatment. The clinical studies have identified some factors of bad presage, among which are the high score APACHE II. We carry out a retrospective study in the Intensive Care Unit of the Salvador’s Hospital, comparing the Apache Score II with a local score, denominated Score of the Salvador to the patients with the diagnose of abdominal sepsis. Results: There were 2.158 revenues in the ICU of the Salvador’s Hospital, corresponding 7,6% (n =164) of the cases to abdominal sepsis. The main causes of abdominal infection were intestinal perforation, colangitis, intestinal obstruction, and sharp pancreatitis. The comparison of the curves receiver-operator of the Salvador’s Score and the index Apache II, it evidences that significant differences don’t exist in the area under the curve of both index in patient with abdominal sepsis. Conclusion: Both scores were comparable fully. Given the scarce number of signed up patients and the graveness of them, the predictive value is limited what suggests necessary to increase the size of the sample and to diversify the graveness.

Lesión digestiva alta grave por ingestión de ácido muriático (ácido clorhídrico) / Gastrointestinal injury by hydrochloric acid

La lesión digestiva aguda por caústicos es una patología que con cierta frecuencia se observa como motivo de consulta a los servicios de urgencias. Tiene un pronóstico reservado dada la cantidad de complicaciones quirúrgicas, médicas e infecciosas a las que están expuestos estos pacientes. Las secuelas que el paciente debe enfrentar en diferentes etapas de su evolución requieren de cuidados intensivos durante un tiempo prolongado además de muchos controles posteriores al alta para evaluar y tratar proiblemas de consideración, estenosis y otras lesiones faringo-esofágicas. Presentamos el caso de un adulto masculino que debido a un síndrome depresivo mayor cursa un intento suicida ingiriendo ácido muriático por boca con severa lesiones digestivas muy poco sintomáticas durante su evolución precoz, pero con un resultado fatal debido a sangrado digestivo agudo masivo.

The acute gastrointestinal injury by caustics is a condition that frequently is observed as a cause of consultations to emergency department. These patients have reserved prognosis given the number of surgical complications, medical and infections. The aftermath that the patient must face at different stages of their development require intensive care for a long time and post-discharge many patients required assess and treat problems, primarily stenosis and other injuries pharynx-esophageal. We report the case of an adult male with depressive syndrome and by suicide attempt with ingesting muriatic acid by mouth, he developed very little injuries digestive during his early trends, but with a fatal outcome due to acute massive gastrointestinal bleeding.

Hepatitis isquémica. Caso clínico / Ischemic hepatitis. Case report

Ischemic hepatitis or shock liver is defined as an extensive hepatocellular necrosis associated with a decrease in hepatic perfusion due to systemic hypotension. Serum aminotransferase levels (ALAT and ASAT) increase rapidly after the ischemic episode and peak within 1 to 3 days to at least 20 times the upper normal limit. After recovery, aminotransferases return to near normal levels in 7-10 days of the initial insult. Histological it is characterized by centrolobular necrosis without inflammation. We report a 47 years old woman with a rheumatic mitral valve disease, atrial fibrillation on anticoagulation and congestive heart failure. She was admitted due to a rapid auricular arrhythmia and secondary severe hypotension. She developed rapidly progressive jaundice (bilirubin up to 8.9 mg/dl) and her aminotransferases (ALAT and ASAT) increased rapidly to levels near 100 times the upper normal limit. Other causes of liver disease were excluded. With hemodynamic support and after heart rate control she improved rapidly within the following 10 days with normalization of liver function tests and complete clinical recovery.