Variables predictoras de mortalidad precoz en pacientes hospitalizados con trauma hemorrágico / Predictors of Early Mortality in Hospitalized Patients with Hemorrhagic Trauma

Introducción: La enfermedad traumática grave es la sexta causa de muerte a nivel mundial, un elevado porcentaje de fallecidos se atribuye a hemorragias no controladas. En Cuba se carece de estudios sobre variables predictoras de mortalidad precoz en pacientes hospitalizados con trauma hemorrágico. Objetivo: Identificar variables predictoras de mortalidad precoz en pacientes hospitalizados con trauma hemorrágico. Métodos: Se realizó un estudio observacional, analítico, transversal, que incluyó 207 pacientes con trauma hemorrágico, en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, En el período comprendido entre los años 2012 y 2017. Las variables se agruparon en sociodemográficas, enfermedades crónicas, mecanismo lesional, tipo de trauma, localización topográfica, complicaciones precoces, tratamiento médico-quirúrgico y mortalidad precoz. Se elaboró un modelo de regresión logística binaria mediante el método hacia delante de Wald. Resultados: El porcentaje global del modelo de regresión logística mostró la relación entre lo pronosticado respecto a lo observado en un 94,6 por ciento. Los predictores explicaron el 83,8 por ciento de la variabilidad de la variable dependiente. Se determinaron cinco variables predictoras de mortalidad precoz, hipertensión arterial, enfermedad pulmonar obstructiva crónica, hepatopatía crónica, coagulopatía aguda e hipotermia. Conclusiones: Se concluye que las enfermedades crónicas como la hipertensión arterial, la enfermedad pulmonar obstructiva crónica y las hepatopatías crónicas, asociadas a la coagulopatía aguda e hipotermia fueron identificadas como variables predictoras de muerte precoz en pacientes hospitalizados por trauma hemorrágico(AU)

Introduction: Severe traumatic disease is the sixth leading cause of death worldwide, high percentage of deaths is ascribed to uncontrolled bleeding. There are no studies in Cuba on predictive variables of early mortality in hospitalized patients with hemorrhagic trauma. Objective: To identify predictive variables of early mortality in hospitalized patients with hemorrhagic trauma. Methods: An observational, analytical, cross-sectional study was carried out, which included 207 patients with hemorrhagic trauma, at Camilo Cienfuegos Provincial General Hospital in Sancti Spíritus, from 2012 to 2017. The variables were grouped into sociodemographic, diseases chronic, lesion mechanism, type of trauma, topographic location, early complications, medical-surgical treatment and early mortality. A binary logistic regression model was developed using the Wald forward method. Results: The global percentage of the logistic regression model showed the relationship between what was predicted with respect to what was observed in 94.6 por ciento. The predictors explained 83.8 por ciento of the variability of the dependent variable. Five predictors of early mortality, arterial hypertension, chronic obstructive pulmonary disease, chronic liver disease, acute coagulopathy, and hypothermia were determined. Conclusions: It is concluded that chronic diseases such as arterial hypertension, chronic obstructive pulmonary disease and chronic liver disease, associated with acute coagulopathy and hypothermia, were identified as predictors of early death in patients hospitalized for hemorrhagic trauma(AU).

Hemostatic dysfunction associated with endocrine disorders as a major risk factor and cause of human morbidity and mortality: a comprehensive meta-review.

We review the association between disorders of endocrine function and hemostasis. The content of more than 570 review articles were appraised to provide the core of 81 key articles referenced in this chapter. The search method used MEDLINE and EMBASE electronic databases and the key words e NDOCRINE DYSFUNCTION, DIABETES, GRAVES' DISEASE, HYPOTHYROIDISM, HYPERTHYROIDISM, THYROTOXICOSIS, VON WILLEBRAND DISEASE, VON WILLEBRAND FACTOR, BLEEDING DISORDERS, PLATELETS DYSFUNCTION, HEMOSTASIS DYSFUNCTION, and REVIEW. Abnormalities of hemostasis, platelets, and endothelium and the presence of microparticles, abnormal expression of adhesion molecules, and elevated von Willebrand factor are all associated with cardiovascular disease and are also features of various endocrine disorders, including diabetes and its complications, insulin resistance, polycystic ovary syndrome, and various thyroid disorders. Related causes and associated factors, including obesity, alcohol, hyperlipidemia, omega fatty acids, vitamin D, serotonin, insulin-like growth factors, angiotensin-converting enzyme, and C-reactive protein, are also discussed in this review.

[Critical analysis of hemostasis disorders in the course of eclampsia. Report of 106 cases]. / Analyse critique des troubles de l'hémostase au cours de l'éclampsie. A propos de 106 cas.

OBJECTIVE: Study of hemostatic disorders during eclampsia, their risk factors, maternal complications and associated mortality. METHODS: Retrospective study concerning 106 cases of severe eclampsia treated in intensive care between September 1992 and December 96. Patients with or without hemostatic disorders were compared for laboratory findings, maternal complications and mortality. RESULTS: Forty patients had hemostasis disorders as follows: isolated thrombopenia in 19 cases, disseminated intravascular coagulation (DIC) in 5 cases, Hellp syndrome associated to DIC in 7 cases and Hellp syndrome in 9 cases. Hemostasis disorders were associated to maternal advanced age, but not with gestational age or blood pressure in admission or time of convulsions. Complications and mortality associated with hemostasis disorders were more frequent compared to patients without hemostasis disorders. Among the 17 deaths of our series, 10 had hemostasis disorders. CONCLUSION: Hemostasis disorders were prognosis factors in eclampsia requiring systematic laboratory tests at admission and immediate delivery.