• Factores asociados al estado neurológico al alta hospitalaria en pacientes con traumatismo craneoencefálico sometidos a tratamiento quirúrgico, en un hospital de Lima Metropolitana, entre los años 2008 – 2015.

      Soto Tarazona, Alonso; Chipana Sotomayor, Marco; Peña Yeckle, María de Fátima; Mercado Bastiand, Giuliana Alessandra (Universidad Peruana de Ciencias Aplicadas (UPC), 22/02/2017)
      Objective: To determine the prognostic factors of unfavorable outcomes at hospital discharge or up to 28 days of hospital stay assessed by the Glasgow Outcome Scale (GOS) in patients with Traumatic Brain Injury (TBI) undergoing surgical treatment. Methods: An observational, retrospective cohort study was conducted. The medical records of 179 patients from 2008 - 2015 were reviewed. The primary outcome was the presence of an unfavorable outcome defined as a result of GOS disability at hospital discharge. The possible prognostic factors evaluated were clinical, laboratory and tomographic data obtained at emergency admission, in addition to intraoperative time and type of surgery. For the statistical analysis of the crude association, Chi Square tests and Fisher's exact test were used for the categorical variables, and Student's t for the numerical variables. For the adjusted analysis, a model of Poisson Regression with robust variances was used. Results: Of the 290 patients included in the study, 179 were found with favorable outcomes and 111 with unfavorable outcomes. Most (86.21%) were male and with a median age of 40 years. The most common cause of TBI were falls (45.33%), considering the epidural hematoma (34.87%) as the most prevalent type of TBI. The predominant category of the Marshall computed tomography classification was type II diffuse lesion (36.21%). The severity of TBI at admission measured by the Glasgow Coma Scale (ECG) was classified as mild with 153 patients (52.76%), moderate with 84 (28.97%) and severe with 53 (18.28%). In the bivariate model, we found an association between unfavorable outcomes and the variables age, time of disease, Intraoperative time, the severity of TBI at admission, cause of TBI, type of surgery, extracranial injury, pupillary reactivity, Marshall classification, the type of TBI (epidural hematoma, acute subdural hemorrhage and subarachnoid hemorrhage), hemoglobin, glycemia, blood transfusion and mechanical ventilation. In the final multivariate analysis, there was only association with the severity of TBI at admission and Marshall's tomographic classification. Conclusions: Increased severity of TCE at admission and a higher grade in the Marshall computed tomography classification are associated with a high frequency of unfavorable outcomes in patients with surgically treated TBI.
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    • Factores de riesgo asociados a la sobrevida renal en pacientes con nefritis lúpica clase III y IV en Lima

      Canelo Aybar, Carlos Gilberto; Valdivia Vega, Renzo Pavel; Choque Chávez, Fernando Diego; Huamaní Fuente, Francisco Javier (Universidad Peruana de Ciencias Aplicadas (UPC), 2017-02-01)
      INTRODUCCIÓN: Se ha reportado que la nefritis lúpica (NL) en pacientes latinos tiene una mayor incidencia y un peor pronóstico que en pacientes de origen caucásico. Sin embargo, existe poca información en lo que respecta a poblaciones de alto mestizaje. El objetivo principal de este estudio fue determinar la sobrevida renal y los factores de riesgo para el desarrollo de enfermedad renal crónica estadio 5D (ERC-5D) en una población de pacientes mestizos con diagnóstico de nefritis lúpica clase III (NLIII) y clase IV (NLIV) en un hospital de Perú. MATERIALES Y MÉTODOS: Se evaluó una cohorte retrospectiva de pacientes con diagnóstico de lupus eritematoso sistémico (LES) y diagnóstico histopatológico de NLIII y NLIV de acuerdo a la clasificación de la Organización Mundial de la Salud (OMS) entre enero del 2000 y julio del 2014. Se recolectaron datos demográficos, clínicos, laboratoriales e histopatológicos, así como el índice de actividad e índice de cronicidad de las biopsias. Además, se estimó el índice de Actividad de Enfermedad de Lupus Eritematoso Sistémico (Systemic Lupus Erythematosus Disease Activity Index, SLEDAI). Se realizó un análisis de sobrevida para determinar la sobrevida renal, definida como el tiempo transcurrido desde el diagnóstico histopatológico de NLIII o NLIV hasta la aparición de ERC-5D, en los pacientes estudiados y se hallaron los factores de riesgo para desarrollar ERC-5D en la cohorte con razones de hazard mediante regresión de Cox. RESULTADOS: Se incluyeron 140 pacientes. A los 5 años de seguimiento, la sobrevida renal de la población estudiada fue de 72,51%. No se encontraron diferencias entre el tipo de nefropatía lúpica. En al análisis multivariado, se encontró que un mayor índice de actividad (HR 1,10; IC 95%: 1,01-1,19; p=0,027) y un valor aumentado de creatinina al diagnóstico (HR 1,23; IC 95%: 1,07-1,41; p=0,004) son predictores de desarrollo de ERC-5D. CONCLUSIONES: En una población, en su mayoría mestiza, la sobrevida renal fue menor a la reportada en poblaciones caucásicas y no guardó relación con el tipo de nefropatía lúpica. Además, un mayor índice de actividad y una función renal deteriorada al momento del diagnóstico representan factores de riesgo independientes para el desarrollo de ERC-5D.
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    • Factores de Riesgo asociados a Mortalidad Intrahospitalaria en pacientes con Injuria Renal Aguda en Hemodiálisis en Lima, Perú

      Carreazo Parsiaca, Nilton Yhuri; Valdivia Vega, Renzo Pavel; Cerna, Renato; Figueroa Tarrillo, Jorge Arturo (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-15)
      Introduction: The worldwide incidence of acute kidney injury (AKI) is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis (HD) patients. Objectives: To identify risk factors associated to hospital mortality of AKI in HD patients. Methods: This is a retrospective cohort of patients with AKI in HD patients on HNERM gathered between January 2013 and December 2015. The sample size was 154 patients. ICD-10 codes were used to identify medical records of patients with AKI (N.17) and HD (Z.49). The independent variable was oliguria and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. Results: Medical records of 212 patients were analyzed, from which 44 were excluded and 73 were not found, despite they belonged to living patients. Out of 168 medical records, 129 belonged to living patients and 39 to deceased ones. The principal etiologies of AKI in HD were sepsis (39,2%) and severe dehydration (10,8%). In the adjusted multivariate, the risk factors associated to hospital mortality were lactate RR 1.09 (IC 95% 1.04-1.15), potassium RR 0.93 (IC 95% 0.87-0.99), and mean arterial pressure RR 0.97 (IC 95% 0.96-0.98). Conclusions: Lactate is an objective parameter que can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.
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    • Mortalidad en pacientes con hemorragia digestiva alta variceal y no variceal: Estudio de cohorte retrospectivo en una unidad especializada de un hospital de la seguridad social en Lima, Perú, 2012-2013

      Segura Paucar, Eddy Roberto; Patiño Valderrama, Lía Aliosha; Tello Velásquez, Ana Claudia; Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-30)
      Background and aim: In Peru, mortality due to Upper Gastrointestinal Bleeding (UGB) is still high. Our aim was to determine the risk factors for mortality after 30 days of UBG episode and its prediction using the Rockall score, according to type of UGB (variceal and non-variceal). Methods: A retrospective cohort study was performed from pre-existing data from 339 patients with clinical and endoscopic diagnosis of UGB admitted to the UHD from HNERM between June 2012 and December 2013. Clinical features and endoscopic findings were evaluated as risk factors associated with mortality using: chi square tests and Poisson regression analysis. We plot the ROC curve and calculate the area under the curve to analyze the Rockall scale as a mortality predictor. Results: A total of 339 patients were divided in two groups: variceal UGB (33%) and nonvariceal UGB (67%%). Mortality was greater in the first group (10.8% vs 7.9%), although without statistically significant difference. The factors associated with mortality in the non-variceal HDA were: heart rate, blood pressure, hematocrit, erosive esophagitis and treatment with argon plasma and clips. While in the HDA variceal were: heart rate, urea and treatment with variceal sclerotherapy. The ROC curve for non-variceal HDA mortality showed an area under the curve of 0.64 (95% CI 0.49-0.79), similar to the group with variceal HDA 0.43 (95% CI 0.27-0.59). Conclusions: In both UGB groups, different factors associated with mortality were found. In addition, the full Rockall scale does not predict mortality in either of the two subgroups with UGIB
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    • Prevalencia de mortalidad intrahospitalaria en pacientes con injuria renal Aguda en hemodiálisis en Lima, Perú

      Carreazo Parsiaca, Nilton Yhuri; Valdivia Vega, Renzo Pavel; Linares Linares, Mariela Alejandra (Universidad Peruana de Ciencias Aplicadas (UPC), 2018-01-15)
      Introduction: The worldwide incidence of acute kidney injury is 18% and the overall mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. Objectives: To identify the hospital mortality prevalence of acute kidney injury in hemodialysis patients. Methods: This is a cross-sectional study of patients with acute kidney injury in hemodialysis of Hospital Edgardo Rebagliati Martins gathered between January 2013 and December 2016. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). Results: There were 285 medical records. 73 of them weren’t available. 212 medical records were analyzed and 44 were excluded. 168 medical records were taken into consideration for the analysis and 59 of the alive patients whose medical records were unavailable were added only for the prevalence calculation. The overall hospital mortality prevalence found was 17.2%. The principal etiologies of acute kidney injury that required hemodialysis were sepsis (39.2%) and severe dehydration (10.8%). Conclusions: The mortality prevalence was 17.2% in patients with acute kidney injury that required hemodialysis.
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