Correlación de la concentración sérica de ácido úrico en pacientes con preeclampsia severa en la unidad de cuidados intensivos / Correlation of serum uric acid concentration in patients with severe preeclampsia in the intensive care unit

RESUMEN

Resumen OBJETIVOS: determinar si las concentraciones séricas de ácido úrico se correlacionan con la preeclampsia severa, exponer la presentación clínica, morbilidad y mortalidad materno y fetal en pacientes hospitalizadas en la unidad de cuidados intensivos. MATERIAL Y MÉTODOS: estudio transversal, retrolectivo y descriptivo al que se incluyeron pacientes con embarazo mayor de 20 semanas de gestación, con reporte de concentraciones séricas de ácido úrico al ingreso al hospital, con diagnóstico establecido de preeclampsia severa e ingresadas a la unidad de cuidados intensivos. Los datos se reunieron en una hoja de Excel 2010 y el análisis estadístico se efectuó en el programa SPSS para Windows, V19.0. RESULTADOS: se consultaron los registros de 72 pacientes; las embarazadas normotensas tuvieron concentraciones significativamente más bajas de ácido úrico: 3.6 ± 0.4 mg/dL que las mujres con preeclmpsia severa: 6.3 ± 1.4 mg/dL (p<0.001). Con respecto a la manifestación clínica, el vasoespasmo y la epigastralgia se relacionaron con la hiperuricemia y los datos de severidad estudiados, como el daño renal agudo con la consecuente correspondencia directa con la mortalidad materna. En el pronóstico fetal se observó una correlación negativa en la calificación APGAR de mayor importancia a los 5 minutos. CONCLUSIONES: se identificó una relación estadísticamente significativa de las concentraciones elevadas de ácido úrico con la preeclampsia severa; esto demuestra que la hiperuricemia en embarazos con hipertensión se relaciona con pobres resultados perinatales y maternos. Por lo tanto, la elevación del ácido úrico puede ser una herramienta pronóstica de fácil determinación que permite identificar a las pacientes con preeclampsia asociada con mayores complicaciones materno-fetales.

ABSTRACT

Abstract BACKGROUND: Severe preeclampsia as a public health problem is a multifactorial and several events that result in highly lethal episodes of obstetric emergencies. In Mexico according to data reported by the INEGI, preeclampsia had a frequency until 35.6%. Maternal death is an indicator of impact and quality of obstetric care and is associated with failures in the health care and preventable deaths are up 80%. Prevention is most important to prevent complications, as well biochemical markers as risk factors like uric acid to known is modified levels in this obstetric complication. OBJECTIVES: To determine whether serum uric acid levels correlate with the presence of severe preeclampsia, as well as their clinical presentation, and maternal morbidity and fetal mortality in patients hospitalized in the intensive care unit. MATERIALS AND METHODS A cross-sectional study, retrolective, descriptive was carried-out. Were included pregnancies higher than 20 weeks with reports of serum measurement of uric acid at hospitalization, with an established diagnosis of severe preeclampsia were admitted to the service of intensive care unit. Statistical analysis was performed using Microsoft Excel 2010 and the Statistical program SPSS for Windows version 19.0. RESULTS: Were included 72 patients in the present study, pregnant normotensive patients had significantly lower uric acid 3.6±0.4 mg/dL compared with the study group with severe preeclampsia 6.3±1.4 mg/dL (p <0.001). With regard to the clinical manifestation the vasospasm and the epigastralgia were related with the hyperuricemia; as well as the studied data of severity, as the acute renal damage with the consequent direct correspondence in the maternal mortality. In relation to the fetal pronostic a negative correlation is observed in the qualification APGAR with more importance to the 5 minutes. CONCLUSIONS: In this study, a statistically significant relationship between high levels of uric acid in the presence of preeclampsia was identified. With respect to the clinical presentation of data presentation and epigastralgia vasospasm they are related to hyperuricemia, and is associated with poor perinatal and maternal outcomes. Thus, the elevation of uric acid could be a prognostic tool for easy determination that would identify a group of patients with severe preeclampsia associated with higher damage.