[Mortality risk factors in critical surgical patients]. / Factores de riesgo de mortalidad de los pacientes quirúrgicos graves.

OBJECTIVE: To determine mortality risk factors for critically ill postoperative patients. PATIENTS: Two hundred eleven patients undergoing any type of surgery admitted to the intensive care unit (ICU) over a period of one year were enrolled. METHOD: We performed a cross-sectional study that was retrospective for pre- and intraoperative observations and prospective for ICU observations. A univariate analysis was performed and relative risk (95% CI) was calculated. Multivariate analysis was also performed and the adjusted odds ratio calculated (95% CI). The end point of measurement was death in the ICU. RESULTS: The independent risk factors for mortality were age 60 years (OR: 2.8; 95% CI 1.36-5.09), physical status ASA-V (OR: 9.66; 95% CI 5.62-14.31), intracranial surgery to treat severe head injury (OR: 5.33; 95% CI 3.08-9.47), hemorrhagic shock during surgery (OR: 5.20; 95% CI 4.16-8.29), arterial hypotension during surgery (OR: 4.0; 95% CI 2.78-11.65), APACHE III score upon admission to the ICU (OR: 9.29; 95% CI 3.62-21.38), multiple organ dysfunction syndrome (OR: 7.96; 95% CI 3.73-13.92), and cardiopulmonary arrest in the ICU (OR: 5.85; 95% CI 2.21-10.43). The APACHE III score demonstrated high sensitivity (87%) and positive predictive value (96%). CONCLUSIONS: Surgical patients in critical condition continue to account for a large number of admissions to and death in the ICU. The variables analyzed were sufficient to explain patient outcome, such that risk factors for mortality in surgical patients admitted to the ICU could be determined.

Factores de riesgo de mortalidad de los pacientes quirúrgicos graves / Mortality risk factors in critically ill postoperative patients

Objetivo. Determinar los factores de riesgo de la mortalidad de los pacientes quirúrgicos graves.Material y métodos. Se incluyó a los 211 pacientes operados, independientemente del tipo de intervención quirúrgica practicada, que ingresaron durante el período de tiempo de un año en la unidad de cuidados intensivos (UCI). Se realizó un estudio de corte transversal, ambispectivo (retrospectivo en cuanto a las observaciones pre e intraoperatorias y prospectivo en cuanto a las observaciones en la UCI). Se analizaron variables correspondientes a las etapas pre, intra y postoperatoria. Se realizó un análisis univariado y se calculó el riesgo relativo con un intervalo de confianza (IC) del 95 por ciento. También se realizó un análisis multivariado calculándose la odds ratio (OR) ajustada, así como los intervalos de confianza del 95 por ciento. El punto final de la medición fue la mortalidad en la UCI. Resultados. Las variables que constituyeron factores de riesgo independientes para la mortalidad fueron: edad igual o mayor de 60 años (OR: 2,8; IC del 95 por ciento: 1,36-5,09), estado físico 5, según la clasificación de la American Society of Anesthesiologists (OR: 9,66; IC del 95 por ciento: 5,62-14,31), cirugía intracraneal para tratamiento del trauma craneoencefálico grave (OR: 5,33; IC del 95 por ciento: 3,089,47), shock hemorrágico intraoperatorio (OR: 5,20; IC del 95 por ciento: 4,16-8,29), hipotensión arterial intraoperatoria (OR: 4,0; IC del 95 por ciento: 2,78-11,65), índice APACHE III en el momento del ingreso en UCI (OR: 9,29; IC del 95 por ciento: 3,6221,38), síndrome de disfunción orgánica múltiple (OR: 7,96; IC del 95 por ciento: 3,73-13,92), y paro cardiorrespiratorio en la UCI (OR: 5,85; IC del 95 por ciento: 2,21-10,43). El índice APACHE III evidenció una elevada sensibilidad (87 por ciento) y valor predictivo positivo (96 por ciento).Conclusiones. Los pacientes quirúrgicos graves continúan siendo una causa importante de ingreso y mortalidad en la UCI. Las variables consideradas en el estudio fueron suficientes para explicar el desenlace final de los pacientes, por lo que se pudieron determinar los factores de riesgo para la mortalidad de los pacientes quirúrgicos admitidos en la UCI (AU)

Estudio clínico-patológico en 460 fallecidos con infarto miocardio agudo. Informe de dos series (1985-1987 y 1991-1993) / Clinico-pathologic study in 460 patients died wth acute myocardial infarction. Report of two series (1985-1987 and 1991-1993)

Fundamento: La concordancia clínico-patológica (CCP), en fallecidos con Infarto Miocárdico Agudo (IMA), continúa siendo tema de máxima actualidad.Objetivos: 1. Estimar el grado de CCP en fallecidos con IMA. 2. Identificar factores asociados a una CCP correcta o no.Métodos: Se estudió la CCP en 460 pacientes fallecidos en nuestro hospital con diagnóstico anatomopatológico de IMA, en 1985-1987 (n=257) y en 1991-19.93 (n=203). Se precisaron: edad, sexo, color de la piel, infarto miocárdico previo, hábito de fumar, antecedentes patológicos personales, formas clínicas de presentación, cambios en el electrocardiograma (ECG) y su localización, enzimas séricas y servicio donde ocurrió el fallecimiento.Resultados: La CCP total fue de 63.7 por ciento (57.6 por ciento y 71.4 por ciento). En ambas series, las siguientes variables presentaron significativamente mayores porcentajes, entre los que tuvieron CCP total: forma dolorosa precordial, cambios inequívocos y localización anterior en el ECG, valores elevados de enzimas séricas y fallecidos en Unidad de Cuidados Intensivos. Los que murieron en salas convencionales presentaron con mayor frecuencia no CCP. Al unirse todos los casos, se comprobó, además, una mayor no CCP entre los diabéticos y los fallecidos en la Unidad de Cuidados Intermedios.Conclusiones: El IMA constituyó un hallazgo necrópsico en la tercera parte de los fallecidos estudiados. Se identificaron un grupo de factores asociados a la CCP. La práctica de la necropsia y el estudio de la CCP mantienen su vigencia en la evaluación de la calidad de la atención que se brinda en los servicios hospitalarios y su perfeccionamiento (AU)

[Risk markers and high blood pressure. The Cienfuegos global project. Longitudinal study 1992-1994]. / Marcadores de riesgo e hipertensión arterial. Proyecto global de Cienfuegos. Estudio longitudinal 1992-1994.

OBJECTIVE: To determine the significance of the selected risk markers in the development of high blood pressure in a relatively short period of time. DESIGN: Longitudinal or cohort study of a sample of a population from the municipality of Cienfuegos, as a second measurement of the Cienfuegos Global Project. CONTEXT: Community. Municipality of Cienfuegos; geographic area of the subject-object intervention-investigation of the Cienfuegos Global Project. SUBJECT: 1,369 adults aged 15 years of more (619 men and 750 women; 1,294 alive and 75 dead) were followed from January 1992 to February 1994, which constitutes an alleatory, stratified, equiprobabilistic sample by age and sex. Persons diagnosed as hypertensive in the initial evaluation of Cienfuegos Global Project were excluded, so that the new series for hypertensive patients was constituted by 731 individuals with 125 new patients when the risk markers age, sex, color of skin, family history of high blood pressure, salt consumption, sedentarism, alcoholism and tobaccoism were studied. The association of the risk markers hypercholesterolemia or risky cholesterolemia and obesity was studied with another series formed by a second sample of 417 individuals, this sample introduced 74 new cases of high blood pressure. MAIN OUTCOME: It was intended to estimate the odds ratio for high blood pressure for the different risk markers studied, in those patients exposed or not to them. RESULTS: The odds ratio for each of the risk markers was determined. The odds related to age increased from 1.37, to 1.86 in males and decreased to 0.64 in white individuals. These 3 results were statistically significant as risk markers for high blood pressure. The odds ratio for the remaining risk markers had no statistical significance. CONCLUSION: The age, male sex, and black race, in the comparatively short term--slightly over two years--are the main risk markers that will markedly favor the appearance of high blood pressure.

[The epidemiology of cerebrovascular disease in Cuba]. / Epidemiología de la enfermedad cerebrovascular en Cuba.

OBJECTIVE AND DEVELOPMENT: We present a synopsis of some of the main achievements of the Cuban Public Health Service in the past 39 years. We emphasize the importance of cerebrovascular disease as a cause of mortality, both in Cuba and in certain selected provinces, together with its relationship with some parameters such as age group. In the second part, we show the main results of a longitudinal or cohort study carried out in the town of Cienfuegos in Cuba. In this the importance of age as a statistically significant risk marker for the development of cerebrovascular disease is clearly seen. We also present the rate of incidence depending on exposure to risk markers, and the estimated number of new cases annually of cerebrovascular disease according to age group and gender in the town of Cienfuegos. We emphasize the need for our Public Health System to continue to deal with this disorder in an integrated manner.

[Risk markers and cerebrovascular diseases. The Cienfuegos Global Project. A longitudinal study 1992-1994]. / Marcadores de riesgo y enfermedades cerebrovasculares. Proyecto Global de Cienfuegos. Estudio longitudinal 1992-1994.

OBJECTIVE: To find the value of different risk markers (RM) used for the development of cerebrovascular disease (CVD) in the relatively short term. MATERIAL AND METHODS: We carried out a longitudinal or cohort study in a sample of the population of Cienfuegos as part of the second series of measurements of the Global Project of Cienfuegos (GPC). We followed up 1,369 adults aged 15 years and over (619 men and 750 women: 1,294 alive and 75 posthumously) between January 1992 and February 1994. They formed an equiprobable randomized sample, stratified in groups of age and sex. Persons diagnosed as having CVD in the initial evaluation of the GPC were excluded. Thus the series of CVD for the study of RM was made up of 1,330 individuals requiring a medical interview and 14 new cases. The Odds Ratio (OR) of having CVD was estimated for the different RM studied: Age, sex, colour of skin, smoking, alcoholism, sedentary life, arterial hypertension and the combination of smoking and arterial hypertension. RESULTS: The OR corresponding to age rose to 2.89, which is statistically significant as RM for CVD. The OR of the other RM markers was not found to be statistically significant. CONCLUSIONS: Age, in the comparatively short term--slightly over two years--is the main RM markedly predisposing to the appearance of CVD.