Factores asociados al surgimiento de desenlaces clínicos graves en pacientes críticos con dengue en una unidad de cuidados intensivos durante el año 2022
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2024
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
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Introducción: Debido a su falta de tratamiento específico, la infección por el virus del dengue en casos graves se presenta con espectros clínicos que van desde la hemorragia interna grave, hepatitis fulminante, encefalitis, síndrome dificultad respiratoria aguda, linfohistiocitosis hemofagocítica y el shock con insuficiencia multiorgánica; aumentando las tasas de mortalidad en pacientes que poseen factores sociales o clínicos que facilitan el desarrollo de desenlaces fatales de la enfermedad, hecho el cual justifica la denominación del dengue grave como evento de interés en salud pública totalmente prevenible, cobrando esto gran importancia para las autoridades sanitarias quienes han aunado esfuerzos enfocados a prevenir casos nuevos de dengue, dado que anualmente se incrementa de forma ostensible su prevalecía según fuentes de la OMS afectando áreas tropicales de países de América, África, Europa, Asia; evidenciándose así mismo un aumento porcentual de casos graves que condicionan de forma importante un aumento en los índices de mortalidad, por esta razón consideramos necesaria la realización de nuestro trabajo para conocer los factores que se asocian a la presencia de desenlaces clínicos graves en pacientes con dengue que requieren manejo en la Unidad de Cuidado Intensivo. Objetivo: Evaluar los factores asociados al surgimiento de desenlaces clínicos graves en pacientes adultos críticos con dengue admitidos a una unidad de cuidados intensivos en Barranquilla (Colombia) desde el 1 de enero del 2022 al 31 de diciembre del 2022. Materiales y métodos: Estudio retrospectivo, descriptivo y de corte transversal de pacientes con dengue que ingresaron a unidad de cuidados intensivos de la red hospitalaria publica de Barranquilla. A todas las variables se aplicó la prueba de Shapiro Wilk y en el análisis univariado todas las variables cuantitativas se analizaron mediante la prueba de Mann-Whitney U. Se realizó un modelo de regresión logística binaria para ajustar las variables de confusión y se calcularon las medianas de asociación OR con sus intervalos de confianza al 95%, posteriormente se realizó un análisis de los predictores de desenlaces clínicos graves. Se realizó una regresión lineal para determinar la correlación entre las variables analizadas con la presencia de desenlaces clínicos graves, con su respectivo coeficiente y sus intervalos de confianza al 95%. Resultados: La prevalencia de pacientes críticos con dengue fue del 8.99% (n = 102/1134). La mediana de edad fue de 21.5 años (percentil 25 de 19.3 y un percentil 75 de 27). Los pacientes con desenlaces graves tenían niveles más bajo de recuento de plaquetas, niveles más altos de creatinina sérica y bilirrubina total durante la admisión y la hospitalización (p = < 0.05). Encontramos que la evaluación del SOFA score en la admisión (OR: 2.75; IC 95%: 1.41 – 5.34; p = 0.003), los días de estancia hospitalaria (OR: 1.74; IC 95%: 1.16 – 2.59; p = 0.007) y la detección del derrame pleural (OR: 4.42; IC 95%: 1.23 – 15.7; p = 0.022) otorga una mayor probabilidad de presentar desenlaces graves. Conclusiones: Nuestra investigación identifico asociaciones significativas entre la evaluación de score SOFA durante la admisión y la presencia de derrame pleural y la estancia hospitalaria prolongada.
Introduction: Due to its lack of specific treatment, dengue virus infection in severe cases presents with clinical spectrums ranging from severe internal bleeding, fulminant hepatitis, encephalitis, acute respiratory distress syndrome, hemophagocytic lymphohistiocytosis and shock with failure multi-organic; increasing mortality rates in patients who have social or clinical factors that facilitate the development of fatal outcomes of the disease, a fact which justifies the designation of severe dengue as a completely preventable event of interest in public health. This is of great importance to health authorities who have joined efforts focused on preventing new cases of dengue, given that its prevalence increases significantly annually according to WHO sources, affecting tropical areas of countries in America, Africa, Europe, Asia; Also showing a percentage increase in serious cases that significantly determines an increase in mortality rates, for this reason we consider it necessary to carry out our work to know the factors that are associated with the presence of serious clinical outcomes in patients with dengue. Requiring management in the Intensive Care Unit. Objectives: To evaluate the factors associated with the surgeon of serious clinical outcomes in critically ill adult patients with dengue admitted to an intensive care unit in Barranquilla (Colombia) from January 1, 2022 to December 31, 2022. Materials and Methods: Retrospective, descriptive and cross-sectional study of patients with dengue who were admitted to the ICU of the public hospital network of Barranquilla. The Shapiro Wilk test was applied to all variables and in the univariate analysis all quantitative variables were analyzed using the Mann-Whitney U test. A binary logistic regression model was performed to adjust the confounding variables and the medians were calculated. of OR association with their 95% confidence intervals, subsequently an analysis of the predictors of serious clinical outcomes was performed. A linear regression was performed to determine the evaluation between the variables analyzed with the presence of serious clinical outcomes, with their respective coefficient and 95% confidence intervals. Results: The prevalence of critically ill patients with dengue was 8.99% (n = 102/1134). The median age was 21.5 years (19.3 – 27). Patients with severe outcomes had lower levels of platelet count, higher levels of serum creatinine and total bilirubin during admission and hospitalization (p = < 0.05). We found that the evaluation of the SOFA score at admission (OR: 2.75; 95% CI: 1.41 – 5.34; p = 0.003), the days of hospital stay (OR: 1.74; 95% CI: 1.16 – 2.59; p = 0.007) and the detection of pleural effusion (OR: 4.42; 95% CI: 1.23 – 15.7; p = 0.022) gives a greater probability of presenting serious outcomes Conclusions: Our research identifies significant differences between the SOFA score evaluation during admission and the presence of pleural effusion and prolonged hospital stay.
Introduction: Due to its lack of specific treatment, dengue virus infection in severe cases presents with clinical spectrums ranging from severe internal bleeding, fulminant hepatitis, encephalitis, acute respiratory distress syndrome, hemophagocytic lymphohistiocytosis and shock with failure multi-organic; increasing mortality rates in patients who have social or clinical factors that facilitate the development of fatal outcomes of the disease, a fact which justifies the designation of severe dengue as a completely preventable event of interest in public health. This is of great importance to health authorities who have joined efforts focused on preventing new cases of dengue, given that its prevalence increases significantly annually according to WHO sources, affecting tropical areas of countries in America, Africa, Europe, Asia; Also showing a percentage increase in serious cases that significantly determines an increase in mortality rates, for this reason we consider it necessary to carry out our work to know the factors that are associated with the presence of serious clinical outcomes in patients with dengue. Requiring management in the Intensive Care Unit. Objectives: To evaluate the factors associated with the surgeon of serious clinical outcomes in critically ill adult patients with dengue admitted to an intensive care unit in Barranquilla (Colombia) from January 1, 2022 to December 31, 2022. Materials and Methods: Retrospective, descriptive and cross-sectional study of patients with dengue who were admitted to the ICU of the public hospital network of Barranquilla. The Shapiro Wilk test was applied to all variables and in the univariate analysis all quantitative variables were analyzed using the Mann-Whitney U test. A binary logistic regression model was performed to adjust the confounding variables and the medians were calculated. of OR association with their 95% confidence intervals, subsequently an analysis of the predictors of serious clinical outcomes was performed. A linear regression was performed to determine the evaluation between the variables analyzed with the presence of serious clinical outcomes, with their respective coefficient and 95% confidence intervals. Results: The prevalence of critically ill patients with dengue was 8.99% (n = 102/1134). The median age was 21.5 years (19.3 – 27). Patients with severe outcomes had lower levels of platelet count, higher levels of serum creatinine and total bilirubin during admission and hospitalization (p = < 0.05). We found that the evaluation of the SOFA score at admission (OR: 2.75; 95% CI: 1.41 – 5.34; p = 0.003), the days of hospital stay (OR: 1.74; 95% CI: 1.16 – 2.59; p = 0.007) and the detection of pleural effusion (OR: 4.42; 95% CI: 1.23 – 15.7; p = 0.022) gives a greater probability of presenting serious outcomes Conclusions: Our research identifies significant differences between the SOFA score evaluation during admission and the presence of pleural effusion and prolonged hospital stay.
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Unidad de cuidados intensivos, Dengue, Enfermedades tropicales, Mortalidad, Desenlaces graves, Intensive care unit, Dengue, Tropical diseases, Mortality, Serious outcomes