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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 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.
RESUMO
Introducción y objetivo: Construir y validar una escala de factores de riesgo que sea útil en la predicción de complicaciones de preeclampsia en la población del Hospital de Ginecología y Obstetricia (HGO) del Instituto Materno Infantil del Estado de México (IMIEM). Pacientes y método: Se realizó un estudio de casos y controles, entre el 1 de enero de 2012 y el 31 de marzo de 2013, en pacientes con diagnóstico de preeclampsia y que cursaron o no con complicaciones. Se realizó análisis bivariado y multivariado con los factores de riesgo obtenidos para crear y validar un instrumento capaz de predecir complicaciones de preeclampsia en el Servicio de Urgencias y en la Unidad de Cuidados Intensivos del HGO del IMIEM. Se analizaron los expedientes de 345 pacientes con diagnóstico de preeclampsia: 115 pacientes con complicaciones y 230 pacientes que no las tuvieron. Variables de interés principales: Muerte materna, síndrome HELLP, eclampsia, lesión renal aguda, trombocitopenia, coagulopatía, hemorragia, edema pulmonar, tromboembolismo pulmonar, evento vascular cerebral. Resultados: Se obtuvieron 12 variables capaces de predecir complicaciones de preeclampsia: edad materna <20 años; edad gestacional a la que se realizó el diagnóstico de preeclampsia, cefalea, disnea, oliguria; trombocitopenia, volumen plaquetario medio, índice normalizado internacional (INR), creatinina sérica, ácido úrico, transaminasa glutámico oxalacética y deshidrogenasa láctica. Se construyó una escala con esos factores de riesgo cuya sensibilidad fue del 93%, especificidad de 80%, LR+ 4,65 y LR-0,09. Conclusión: La aplicación de esta escala de factores de riesgo puede predecir complicaciones de preeclampsia
Introduction and objective: To construct and validate a risk factor scale to help predict the complications of preeclampsia in the population attended by the Obstetrics and Gynecology Hospital (HGO) of the Maternity Institute of Mexico (IMIEM). Patients and method :A case-control study was conducted between January 1, 2012 and March 31, 2013 in patients with pre-eclampsia with or without complications. We performed a bivariate analysis and a multivariate analysis with the risk factors obtained to create and validate a tool able to predict the complications of pre-eclampsia. Emergency department and intensive care unit of the Obstetrics and Gynecology Hospital. We reviewed 345 records. There were 115 patients with complications and 230 with uncomplicated pre-eclampsia. Primary endpoints: Maternal death, HELLP syndrome, eclampsia, acute kidney injury, thrombocytopenia, coagulopathy, hemorrhage, pulmonary edema, pulmonary embolism, and cerebral vascular events. Results: The following 12 variables able to predict complications of preeclampsia were obtained: maternal age <20 years, gestational age at diagnosis of preeclampsia, headache, dyspnea, oliguria, thrombocytopenia, mean platelet volume, international normalized ratio (INR), serum creatinine, uric acid, glutamic oxaloacetic transaminase and lactic dehydrogenase. These risk factors were used to construct the scale. Sensitivity was 93% and specificity was 80%. LR+ was 4.65 and the LR- 0,09. Conclusion: The application of this risk factor scale can predict the complications of preeclampsia (AU)
