Predicción de riesgo transfusional en cirugía cardiaca comparando las escalas TRUST versus TRACK, Clínica General del Norte, Barranquilla periodo 2023 -2024
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Fecha
2024
Autores
Redondo Martínez, Antony Michell
Bravo González, Carlos Andrés
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: A pesar de los avances en las estrategias perioperatorias para disminuir las necesidades transfusionales en cirugía cardiaca, aún hoy las cifras continúan siendo altas, donde la literatura reporta cifras que pueden alcanzar hasta 9 de cada 10 pacientes, inclusive algunas series describen que las cifras van en aumento, por lo que se han descrito diferentes factores de riesgo asociados, y a partir de estos se han diseñado escalas de riesgo como lo son las escalas TRACK y la TRUST, las cuales han evidenciado en población del Reino Unido, Mexicana y en Brasil tener una buena sensibilidad y una especificidad media, sin embargo, en el ámbito nacional y local no se conocen estudios.
Objetivos: Evaluar la predicción de riesgo transfusional en cirugía cardíaca comparando las escalas TRUST versus TRACK, en la Clínica General del Norte, Barranquilla, periodo enero de 2023 – diciembre de 2024.
Materiales y métodos: Estudio observacional descriptivo retrospectivo, la población estudiada está compuesta por pacientes mayor o igual a 18 años sometidos a cirugía cardíaca electiva en la Organización Clínica General del Norte en el periodo 1ro de enero de 2023 a 30 de junio de 2024. Se estudió el desempeño diagnóstico de las escalas mediante la sensibilidad, la especificidad, el valor predictivo positivo (VPP), el valor predictivo negativo (VPN).
Resultados: Para la escala TRACK el 59.8% de la población fue clasificada como bajo riesgo el 40.2% riesgo alto; para la escala TRUST ningún paciente fue clasificado como riesgo nulo, el 41.1% riesgo bajo, el 21.4% riesgo intermedio, el 28.6% riesgo alto y el restante 8.9% riesgo muy alto.
Conclusiones: La escala de predicción transfusional TRACK evidenció una sensibilidad del 88.5%, especificidad del 77.2%, valor predictivo positivo del 78.1%, valor predictivo negativo el 87.9% y un índice de exactitud del 82.6% frente a la escala de predicción TRUST que evidenció una sensibilidad del 90.3%, especificidad del 78.8%, valor predictivo positivo del 79.7%, valor predictivo negativo el 89.8% y un índice de exactitud del 84.3%, mostrándose en las dos escalas un buen y similar desempeño predictor, por lo que son aplicables en la población local.
Introduction: Despite advances in perioperative strategies to reduce transfusion needs in cardiac surgery, the numbers are still high today, with the literature reporting figures that can reach up to 9 out of 10 patients. Some series even describe that the numbers are increasing, which is why different associated risk factors have been described, and from these, risk scales such as the TRACK and TRUST scales have been designed, which have shown good sensitivity and average specificity in the population of the United Kingdom, Mexico and Brazil. However, there are no known studies at the national and local levels. Objectives: To evaluate the prediction of transfusion risk in cardiac surgery by comparing the TRUST versus TRACK scales, at the Clínica General del Norte, Barranquilla, period January 2023 – December 2024. Materials and methods: Retrospective descriptive observational study, the study population is composed of patients over or equal to 18 years of age who underwent elective cardiac surgery at the Organizacion Clinica general del Norte in the period January 1, 2023, to June 30, 2024. The diagnostic performance of the scales was studied using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Results: For the TRACK scale, 59.8% of the population was classified as low risk, 40.2% as high risk; for the TRUST scale, no patient was classified as null risk, 41.1% low risk, 21.4% intermediate risk, 28.6% high risk and the remaining 8.9% very high risk. Conclusions: The TRACK transfusion prediction scale showed a sensitivity of 88.5%, specificity of 77.2%, positive predictive value of 78.1%, negative predictive value of 87.9% and an accuracy index of 82.6% compared to the TRUST prediction scale that evidenced a sensitivity of 90.3%, specificity of 78.8%, positive predictive value of 79.7%, negative predictive value of 89.8% and an accuracy index of 84.3%. showing a good and similar predictive performance in both scales, so they are applicable in the local population.
Introduction: Despite advances in perioperative strategies to reduce transfusion needs in cardiac surgery, the numbers are still high today, with the literature reporting figures that can reach up to 9 out of 10 patients. Some series even describe that the numbers are increasing, which is why different associated risk factors have been described, and from these, risk scales such as the TRACK and TRUST scales have been designed, which have shown good sensitivity and average specificity in the population of the United Kingdom, Mexico and Brazil. However, there are no known studies at the national and local levels. Objectives: To evaluate the prediction of transfusion risk in cardiac surgery by comparing the TRUST versus TRACK scales, at the Clínica General del Norte, Barranquilla, period January 2023 – December 2024. Materials and methods: Retrospective descriptive observational study, the study population is composed of patients over or equal to 18 years of age who underwent elective cardiac surgery at the Organizacion Clinica general del Norte in the period January 1, 2023, to June 30, 2024. The diagnostic performance of the scales was studied using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Results: For the TRACK scale, 59.8% of the population was classified as low risk, 40.2% as high risk; for the TRUST scale, no patient was classified as null risk, 41.1% low risk, 21.4% intermediate risk, 28.6% high risk and the remaining 8.9% very high risk. Conclusions: The TRACK transfusion prediction scale showed a sensitivity of 88.5%, specificity of 77.2%, positive predictive value of 78.1%, negative predictive value of 87.9% and an accuracy index of 82.6% compared to the TRUST prediction scale that evidenced a sensitivity of 90.3%, specificity of 78.8%, positive predictive value of 79.7%, negative predictive value of 89.8% and an accuracy index of 84.3%. showing a good and similar predictive performance in both scales, so they are applicable in the local population.
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Palabras clave
Escala de predicción, Cirugía cardiaca, Transfusión
