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Predicción de desenlaces maternos adversos en pacientes obstétricas con infección mediante el índice de choque diastólico

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datacite.rightshttp://purl.org/coar/access_right/c_16ec
dc.contributor.advisorRojas Suarez, José Antonio
dc.contributor.advisorTorres Anaya, Maricela
dc.contributor.authorCórdoba Torres, Genesis Jhoanna
dc.contributor.authorArias Ibarra, Kenny Yurexi
dc.date.accessioned2025-07-08T22:07:28Z
dc.date.available2025-07-08T22:07:28Z
dc.date.issued2025
dc.description.abstractIntroducción: La sepsis obstétrica constituye una causa significativa de mortalidad materna global (10.7%), ocupando el tercer lugar en Colombia (2023). Las herramientas diagnósticas actuales muestran limitaciones en población obstétrica debido a los cambios fisiológicos del embarazo que pueden enmascarar signos tempranos de deterioro. El estudio evaluó el valor predictivo del Índice de Choque e Índice de Choque Diastólico para predecir desenlaces maternos adversos en pacientes obstétricas con infección, basándose en investigaciones previas que demostraron su utilidad en población general. Metodología: Estudio analítico observacional de cohorte retrospectivo mediante análisis secundario de la base de datos COLLOSSAL, incluyendo 2198 mujeres embarazadas o puérperas (≤42 días) entre 14-49 años con diagnóstico de infección atendidas en 12 instituciones colombianas (2018-2022). Se calcularon y analizaron los índices de choque e índice de choque diastólico, junto con variables sociodemográficas, clínicas y paraclínicas. El desenlace primario fueron los desenlaces maternos adversos (ingreso a la unidad de cuidados intensivos, uso de vasopresores o ventilación mecánica invasiva) y los secundarios incluyeron desenlaces neonatales adversos. Se realizó análisis de componentes principales para controlar la multicolinealidad entre con estratificación por terciles y regresión logística multivariada. Resultados: Se identificó una correlación moderadamente fuerte entre índice de choque e índice de choque diastólico (R=0.7314, p<0.001), con el primer componente principal explicando 53.5% de la varianza total. Las pacientes del tercil superior (T3) presentaron edad significativamente menor (22 vs 24 años, p<0.001), mayor frecuencia cardíaca (108 vs 82 vs 78 lpm, p<0.001) y leucocitosis más marcada (14.1 vs 11.47 x10³/mm³, p<0.001), mientras que el peso e índice de masa corporal fueron mayores en el tercil inferior. Los desenlaces maternos adversos fueron significativamente más frecuentes en T3 (12% vs 4.1% y 4.2%, p<0.001). El análisis de regresión logística identificó al primer componente principal como predictor significativo (OR ajustado 1.68, IC 95% 1.51-1.87, p<0.001), con T3 representando un riesgo significativo (OR ajustado 3.16, IC 95% 2.22-4.48, p<0.001), mientras T1 y T2 actuaron como factores protectores (reducción del 53% y 48% respectivamente). Respecto a los desenlaces neonatales adversos, se observó una tendencia paradójica no significativa a menor proporción de eventos en T3 (36.7% vs 55.6% en T1, p=0.092). Conclusiones: El análisis por terciles del índice de choque e índice de choque diastólico proporciona una estratificación útil del riesgo para identificar pacientes obstétricas con infección en riesgo de desarrollar desenlaces maternos adversos. Hallazgos como la edad más joven en pacientes de mayor riesgo contradicen perfiles tradicionales de riesgo obstétrico, sugiriendo que estos índices capturan aspectos de la respuesta hemodinámica a la infección no reflejados en factores convencionales. La simplicidad de cálculo del índice de choque e índice de choque diastólico facilita su implementación incluso en entornos con recursos limitados, representando una herramienta potencialmente valiosa para mejorar el triaje y la atención temprana en pacientes obstétricas con sospecha de infección, contribuyendo potencialmente a reducir la morbimortalidad materna asociada a sepsisspa
dc.description.abstractIntroduction: Obstetric sepsis represents a significant cause of global maternal mortality (10.7%), ranking third in Colombia (2023). Current diagnostic tools show limitations in the obstetric population due to pregnancy-related physiological changes that may mask early signs of deterioration. This study evaluated the predictive value of the Shock Index and Diastolic Shock Index for adverse maternal outcomes in obstetric patients with infection, based on previous research demonstrating their utility in the general population. Methodology: Retrospective observational cohort study through secondary analysis of the COLLOSSAL database, including 2198 pregnant or postpartum women (≤42 days) aged 14-49 years with diagnosed infection treated in 12 Colombian institutions (2018-2022). Shock Index and Diastolic Shock Index were calculated and analyzed alongside sociodemographic, clinical, and paraclinical variables. The primary outcome was adverse maternal outcomes (the intensive care unit admission, vasopressor use, or invasive mechanical ventilation), and secondary outcomes included adverse neonatal outcomes. Principal component analysis was performed to control for multicollinearity between SI and DSI, with tertile stratification and multivariate logistic regression. Results: A moderately strong correlation between Shock Index and Diastolic Shock Index was identified (R=0.7314, p<0.001), with the first principal component explaining 53.5% of the total variance. Patients in the upper tertile (T3) had significantly lower age (22 vs. 24 years, p<0.001), higher heart rate (108 vs. 82 vs. 78 bpm, p<0.001), and more pronounced leukocytosis (14.1 vs. 11.47 x10³/mm³, p<0.001), while weight and BMI were higher in the lower tertile. Adverse maternal outcomes were significantly more frequent in T3 (12% vs. 4.1% and 4.2%, p<0.001). Logistic regression analysis identified the first principal component as a significant predictor (adjusted OR 1.68, 95% CI 1.51-1.87, p<0.001), with T3 representing a significant risk (adjusted OR 3.16, 95% CI 2.22-4.48, p<0.001), while T1 and T2 acted as protective factors (reduction of 53% and 48%, respectively). Regarding adverse neonatal outcomes, a non-significant paradoxical trend toward a lower proportion of events in T3 was observed (36.7% vs. 55.6% in T1, p=0.092). Discussion and Conclusions: Tertile analysis of Shock Index and Diastolic Shock Index provides useful risk stratification to identify obstetric patients with infection at risk of developing adverse maternal outcomes. Findings such as younger age in higher-risk patients contradict traditional obstetric risk profiles, suggesting that these indices capture aspects of the hemodynamic response to infection not reflected in conventional factors. The simplicity of calculating Shock Index and Diastolic Shock Index facilitates their implementation even in resource-limited settings, representing a potentially valuable tool to improve triage and early care in obstetric patients with suspected infection, potentially contributing to reducing maternal morbidity and mortality associated with sepsis.eng
dc.format.mimetypepdf
dc.identifier.urihttps://hdl.handle.net/20.500.12442/16811
dc.language.isospa
dc.publisherEdiciones Universidad Simón Bolívarspa
dc.publisherFacultad de Ciencias de la Saludspa
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationaleng
dc.rights.accessrightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectInfecciónspa
dc.subjectÍndice de choquespa
dc.subjectÍndice de choque diastólicospa
dc.subjectDesenlaces maternos adversosspa
dc.subjectDesenlaces neonatales adversosspa
dc.subject.keywordsInfectioneng
dc.subject.keywordsShock indexeng
dc.subject.keywordsDiastolic shock indexeng
dc.subject.keywordsAdverse maternal outcomeseng
dc.subject.keywordsAdverse neonatal outcomeseng
dc.titlePredicción de desenlaces maternos adversos en pacientes obstétricas con infección mediante el índice de choque diastólicospa
dc.type.driverinfo:eu-repo/semantics/other
dc.type.spaOtros
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sb.programaEspecialización en Medicina Crítica y Cuidados Intensivosspa
sb.sedeSede Barranquillaspa

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