Asociación entre los niveles de déficit de base y la aparición de disfunción orgánica múltiple en pacientes con preeclampsia severa admitidas en la clínica gestión salud s.a.s (Cartagena) entre el 1 de enero de 2014 hasta 31 diciembre 2016
DOI:
https://doi.org/10.18041/2390-0512/bioc..2.2290Palabras clave:
preeclampsia, embarazo, disfunción orgánicaResumen
Objetivo: Determinar la asociación entre los niveles de déficit de base y la aparición de disfunción orgánica en pacientes con preeclampsia severa admitidas en la Clínica Gestión salud S.A.S (Cartagena) entre el 1 de enero de 2014 hasta 31 Dic 2016. Método: La Pseudomonas Aerugiosa es una bacilo gramnegativos, con diámetros de 1 - 3 mm de longitud, aerobio obligado, oxidasa positiva que crece a 37-42 °C, de habita variable (tierra, agua, plantas y animales). Se caracteriza por formar colonias redondeadas, lisas con olor a uvas y de variable color según el pimento producidos por la cepa color verde-azulado (piocinina y pioverdina), rojo oscuro (piorrubina) y negro (piomelanina). Resultados: Mediante un análisis de regresión logística se exploró la fuerza de asociación entre tener un déficit de base menor o igual a -5 y el desarrollo de DOM encontrándose una asociación estadísticamente significativa. Tener un déficit de base menor o igual a -5 aumentaba la probabilidad de desarrollar DOM con una OR de 3,73 (IC 95% 1,28 a 12,05 p=0,0197). Conclusión: Valores de DB menores a -5, es decir, tener un mayor DB se asocia a un aumento en la probabilidad de tener DOM. En este grupo de pacientes también son más frecuentes la disfunción hepática, la disfunción de la coagulación y el síndrome de HELLP.
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Referencias
Health Canada. Special report on maternal mortality and severe morbidity in Canada – enhanced surveillance: the path to prevention. Ottawa: Minister of Public Works and Government Services Canada; 2004. - 2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005; 365: 785–99.
Emily Bartsch, Karyn E Medcalf, Alison L Park, Joel G Ray. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016;353:i1753
Chen CY, Chen YH, Lin HC, Chen SF, Lin HC. Increased risk of adverse pregnancy outcomes for hospitalisation of women with lupus during pregnancy: a nationwide population-based study. Clin Exp Rheumatol. 2010 Jan-Feb. 28(1):49-55.
Hagmann H, Thadhani R, Benzing T, Karumanchi SA, Stepan H. The promise of angiogenic markers for the early diagnosis and prediction of preeclampsia. Clin Chem 2012;58(5):837–45.
Benton SJ, HuY, XieF, KupferK, LeeSW, MageeLA, et al. Angiogenic factors as diagnostic tests for preeclampsia: a performance comparison between two commercial immunoassays. Am J Obstet Gynecol 2011;205(5):469.e1– 8.
Chen CW, Jaffe IZ, Karumanchi SA. Pre-eclampsia and cardiovascular disease. Cardiovascular research. 2014;101(4):579-86. Epub 2014/02/18.
• Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta- analysis. BMJ (Clinical research ed). 2007;335(7627):974. Epub 2007/11/03.
Bello N, Rendon IS, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013 Oct 29;62(18):1715-23.
Cheryl Bushnell. and Monique Chireau. Preeclampsia and Stroke: Risks during and after Pregnancy. Stroke Research and Treatment Volume 2011, Article ID 858134, 9 pages
Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Trastornos hipertensivos. Williams. Obstetricia, 24e New York, NY: McGraw-Hill; 2015.
Melania Maria Ramos de Amorim. Luiz Carlos Santos. Ana Maria Feitosa Porto. Leila Katz Dias Martins. Risk factors for maternal death in patients with severe preeclampsia and eclampsia. Rev. bras. saúde matern. infant., Recife, 1 (3): 237-247, set. - dez., 2001
Baha M. Sibai, MD. Imitators of Severe Pre-eclampsia. Semin Perinatol 33:196-205 © 2009 Elsevier Inc.
Lopez-Mendez MA, Martinez-Gaytan V, Cortes-Flores R, et al. Doppler ultrasound evaluation in preeclampsia. BMC Research Notes. 2013;6:477.
Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964; 143 (3613): 1457-9.
Weil MH, Afifi A. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970; 41: 9891001.
Giguère Y, Charland M, Bujold E, Bernard N, Grenier S, Rousseau F, et al. Combining biochemical and ultrasonographic markers in predicting preeclampsia: a systematic review. Clin Chem 2010; 56(3):361–75.
Nichol A, Bailey M, Egi M, et al. Dynamic lactate indices as predictors of outcome in critically ill patients. Critical Care. 2011; 15 (5): R242.
Husain FA, Martin MJ, Mullenix PS, Steele ST, Elliot DC. Serum lactate and e base deficit as predictors of mortality and morbidity. Am J Surg. 2003; 185 (5): 455-91.
Soliman HM, Vincent JL. Prognostic value of admission serum lactate concentrations in intensive care unit patients. Acta Clin Belg. 2010; 65 (3): 176-81.
Belfort MA, Anthony J, Saade GR, et al. The oxygen consumption/oxygen delivery curve in severe preeclampsia: Evidence for a fixed oxygen extraction state. Am J Obstet Gynecol 1993;169:1448- 55.
Bakker J, Vincent JL. The oxygen supply dependency phenomenon is associated with increased blood lactate levels. J Crit Care 1991;6:152-9.
Magee L, Helewa M, Moutquin JM. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol. 2008;30:S1- S48.
Baxter JK, Weinstein L. HELLP syndrome: the state of the art. Obstet Gynecol Surv. 2004;59:838-45.
Centro Latinoamericano de Perinatología Salud de la Mujer y Reproductiva (CLAP/SMR). Guías para la atención de las principales emergencias obstétricas. CLAP/SMR No 1594, 2012.
Meza R, Pareja M, Navas F. HELLP syndrome: a critical care condition,
Review article. Acta Colomb Cuidado Intens. 2010;10:111-20.
Colombia, Ministerio de Salud. Guía de práctica clínica para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio. Bogotá: Ministerio de Salud; 2013.
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E. and Tomlanovich, M. (2001). Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. New England Journal of Medicine, 345(19), pp.1368-1377.
Wheeler TC, Graves CR, Troiano NH, Reed GW. Base deficit and oxygen transport in severe preeclampsia. Obstet Gynecol. 1996 Mar;87(3):375-9.
Sibai B, Dekker G, Kupferminc M. Preeclampsia. Lancet 2005;365:785-99.
Patrick J. Neligan y Clifford S. Deutschman. Equilibrio acidobásico durante el período perioperatorio. Miller. Anestesia, Octava edición. 2016. Capítulo 60, 1811-1829
http://www.who.int/maternal_child_adolescent/topics/maternal/mdg/es/
http-//www.ins.gov.co/lineas-de-accion/SubdireccionVigilancia/sivigila/ Fichas%20de%20Notificacion%20SIVIGILA/Morbilidad%20materna%20extr ema%20549 5.
Rojas-Suarez J, Almanza A, López C, Llamas A Dueñas C. Niveles de deficit de base como marcador de hipoperfusion en la paciente con preeclampsia severa en cuidados intensivos. X Congreso nacional de medicina crítica y cuidado intensivo: 2015-05-27 Presentación de trabajo – Ponencia.
Curran CA. Multiple organ dysfunction syndrome (MODS) in the obstetric population. J Perinat Neonatal Nurs. 2002;15(4):37-55. (n.d.).
Miranda JE. Disfunción orgánica en la paciente con morbilidad materna extrema: un estudio multicéntrico [tesis]. Cartagena: Universidad de Cartagena; 2012. 32 p. (n.d.).
Rojas-Suarez J, Vigil-De Gracia P. Pre-eclampsia-eclampsia admitted to critical care unit. J Matern Fetal Neonatal Med. 2012;25(10):2051-4. (n.d.).
Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41(5):769-74. (n.d.).
Kincaid EH, Miller PR, Meredith JW, Rahman N, Chang MC. Elevated arterial base deficit in trauma patients: a marker of impaired oxygen utilization. J Am Coll Surg. 1998;187(4):384-92. (n.d.).
Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E; Arbeitsgemeinschaft "Polytrauma" of the Deutsche Gesellschaft fur Unfallchirurgie. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma re. (n.d.).
Cheddie S, Muckart DJ, Hardcastle TC. Base deficit as an early marker of coagulopathy in trauma. S Afr J Surg. 2013;51(3):88-90. (n.d.).
Surbatovic M, Radakovic S, Jevtic M, Filipovic N, Romic P, Popovic N et al. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients. Gen Physiol Biophys. 2009;28 Spec No:271-6.
Daskalopoulou SS, Khan NA, Quinn RR, et al. The 2012 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol 2012;28: 270–87.
Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia. Semin Nephrol 2011;31(1):33–46.
Menzies J, Magee LA, Macnab YC, et al. Current CHS and NHBPEP criteria for severe preeclampsia do not uniformly predict adverse maternal or perinatal outcomes. Hypertens Pregnancy 2007; 26: 447–62
CnossenJS, terRietG, MolBW, vanderPostJA, LeeflangMM, Meads CA, et al. Are tests for predicting pre-eclampsia good enough to make screening viable? A review of reviews and critical appraisal. Acta Obstet Gynecol Scand 2009;88(7):758–65
Ortner, C. M., Combrinck, B., Allie, S., Story, D., Landau, R., Cain, K., & Dyer, R. A. (2015). Strong ion and weak acid analysis in severe preeclampsia: potential clinical significance. British journal of anaesthesia, 115(2), 275-284..
Hodgman EI, Morse BC, Dente CJ, Mina MJ, et al. Base deficit as a marker of survival after traumatic injury: Consistent across changing patient populations and resuscitation paradigma. J Trauma Acute Care Surg 2012; 72: 844-51.
Dellinger P, Okorie ON. Lactate: biomarker and potential therapeutic target. Crit Care Clin 2011; 27: 299-326.
Parks JK, Elliott C, Gentilello LM, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36 (1): 296–327.
Emily Bartsch, Karyn E Medcalf, Alison L Park, Joel G Ray. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016;353:i1753
Chen CY, Chen YH, Lin HC, Chen SF, Lin HC. Increased risk of adverse pregnancy outcomes for hospitalisation of women with lupus during pregnancy: a nationwide population-based study. Clin Exp Rheumatol. 2010 Jan-Feb. 28(1):49-55.
Hagmann H, Thadhani R, Benzing T, Karumanchi SA, Stepan H. The promise of angiogenic markers for the early diagnosis and prediction of preeclampsia. Clin Chem 2012;58(5):837–45.
Benton SJ, HuY, XieF, KupferK, LeeSW, MageeLA, et al. Angiogenic factors as diagnostic tests for preeclampsia: a performance comparison between two commercial immunoassays. Am J Obstet Gynecol 2011;205(5):469.e1– 8.
Chen CW, Jaffe IZ, Karumanchi SA. Pre-eclampsia and cardiovascular disease. Cardiovascular research. 2014;101(4):579-86. Epub 2014/02/18.
• Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta- analysis. BMJ (Clinical research ed). 2007;335(7627):974. Epub 2007/11/03.
Bello N, Rendon IS, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013 Oct 29;62(18):1715-23.
Cheryl Bushnell. and Monique Chireau. Preeclampsia and Stroke: Risks during and after Pregnancy. Stroke Research and Treatment Volume 2011, Article ID 858134, 9 pages
Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Trastornos hipertensivos. Williams. Obstetricia, 24e New York, NY: McGraw-Hill; 2015.
Melania Maria Ramos de Amorim. Luiz Carlos Santos. Ana Maria Feitosa Porto. Leila Katz Dias Martins. Risk factors for maternal death in patients with severe preeclampsia and eclampsia. Rev. bras. saúde matern. infant., Recife, 1 (3): 237-247, set. - dez., 2001
Baha M. Sibai, MD. Imitators of Severe Pre-eclampsia. Semin Perinatol 33:196-205 © 2009 Elsevier Inc.
Lopez-Mendez MA, Martinez-Gaytan V, Cortes-Flores R, et al. Doppler ultrasound evaluation in preeclampsia. BMC Research Notes. 2013;6:477.
Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964; 143 (3613): 1457-9.
Weil MH, Afifi A. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970; 41: 9891001.
Giguère Y, Charland M, Bujold E, Bernard N, Grenier S, Rousseau F, et al. Combining biochemical and ultrasonographic markers in predicting preeclampsia: a systematic review. Clin Chem 2010; 56(3):361–75.
Nichol A, Bailey M, Egi M, et al. Dynamic lactate indices as predictors of outcome in critically ill patients. Critical Care. 2011; 15 (5): R242.
Husain FA, Martin MJ, Mullenix PS, Steele ST, Elliot DC. Serum lactate and e base deficit as predictors of mortality and morbidity. Am J Surg. 2003; 185 (5): 455-91.
Soliman HM, Vincent JL. Prognostic value of admission serum lactate concentrations in intensive care unit patients. Acta Clin Belg. 2010; 65 (3): 176-81.
Belfort MA, Anthony J, Saade GR, et al. The oxygen consumption/oxygen delivery curve in severe preeclampsia: Evidence for a fixed oxygen extraction state. Am J Obstet Gynecol 1993;169:1448- 55.
Bakker J, Vincent JL. The oxygen supply dependency phenomenon is associated with increased blood lactate levels. J Crit Care 1991;6:152-9.
Magee L, Helewa M, Moutquin JM. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol. 2008;30:S1- S48.
Baxter JK, Weinstein L. HELLP syndrome: the state of the art. Obstet Gynecol Surv. 2004;59:838-45.
Centro Latinoamericano de Perinatología Salud de la Mujer y Reproductiva (CLAP/SMR). Guías para la atención de las principales emergencias obstétricas. CLAP/SMR No 1594, 2012.
Meza R, Pareja M, Navas F. HELLP syndrome: a critical care condition,
Review article. Acta Colomb Cuidado Intens. 2010;10:111-20.
Colombia, Ministerio de Salud. Guía de práctica clínica para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio. Bogotá: Ministerio de Salud; 2013.
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E. and Tomlanovich, M. (2001). Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. New England Journal of Medicine, 345(19), pp.1368-1377.
Wheeler TC, Graves CR, Troiano NH, Reed GW. Base deficit and oxygen transport in severe preeclampsia. Obstet Gynecol. 1996 Mar;87(3):375-9.
Sibai B, Dekker G, Kupferminc M. Preeclampsia. Lancet 2005;365:785-99.
Patrick J. Neligan y Clifford S. Deutschman. Equilibrio acidobásico durante el período perioperatorio. Miller. Anestesia, Octava edición. 2016. Capítulo 60, 1811-1829
http://www.who.int/maternal_child_adolescent/topics/maternal/mdg/es/
http-//www.ins.gov.co/lineas-de-accion/SubdireccionVigilancia/sivigila/ Fichas%20de%20Notificacion%20SIVIGILA/Morbilidad%20materna%20extr ema%20549 5.
Rojas-Suarez J, Almanza A, López C, Llamas A Dueñas C. Niveles de deficit de base como marcador de hipoperfusion en la paciente con preeclampsia severa en cuidados intensivos. X Congreso nacional de medicina crítica y cuidado intensivo: 2015-05-27 Presentación de trabajo – Ponencia.
Curran CA. Multiple organ dysfunction syndrome (MODS) in the obstetric population. J Perinat Neonatal Nurs. 2002;15(4):37-55. (n.d.).
Miranda JE. Disfunción orgánica en la paciente con morbilidad materna extrema: un estudio multicéntrico [tesis]. Cartagena: Universidad de Cartagena; 2012. 32 p. (n.d.).
Rojas-Suarez J, Vigil-De Gracia P. Pre-eclampsia-eclampsia admitted to critical care unit. J Matern Fetal Neonatal Med. 2012;25(10):2051-4. (n.d.).
Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41(5):769-74. (n.d.).
Kincaid EH, Miller PR, Meredith JW, Rahman N, Chang MC. Elevated arterial base deficit in trauma patients: a marker of impaired oxygen utilization. J Am Coll Surg. 1998;187(4):384-92. (n.d.).
Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E; Arbeitsgemeinschaft "Polytrauma" of the Deutsche Gesellschaft fur Unfallchirurgie. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma re. (n.d.).
Cheddie S, Muckart DJ, Hardcastle TC. Base deficit as an early marker of coagulopathy in trauma. S Afr J Surg. 2013;51(3):88-90. (n.d.).
Surbatovic M, Radakovic S, Jevtic M, Filipovic N, Romic P, Popovic N et al. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients. Gen Physiol Biophys. 2009;28 Spec No:271-6.
Daskalopoulou SS, Khan NA, Quinn RR, et al. The 2012 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol 2012;28: 270–87.
Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia. Semin Nephrol 2011;31(1):33–46.
Menzies J, Magee LA, Macnab YC, et al. Current CHS and NHBPEP criteria for severe preeclampsia do not uniformly predict adverse maternal or perinatal outcomes. Hypertens Pregnancy 2007; 26: 447–62
CnossenJS, terRietG, MolBW, vanderPostJA, LeeflangMM, Meads CA, et al. Are tests for predicting pre-eclampsia good enough to make screening viable? A review of reviews and critical appraisal. Acta Obstet Gynecol Scand 2009;88(7):758–65
Ortner, C. M., Combrinck, B., Allie, S., Story, D., Landau, R., Cain, K., & Dyer, R. A. (2015). Strong ion and weak acid analysis in severe preeclampsia: potential clinical significance. British journal of anaesthesia, 115(2), 275-284..
Hodgman EI, Morse BC, Dente CJ, Mina MJ, et al. Base deficit as a marker of survival after traumatic injury: Consistent across changing patient populations and resuscitation paradigma. J Trauma Acute Care Surg 2012; 72: 844-51.
Dellinger P, Okorie ON. Lactate: biomarker and potential therapeutic target. Crit Care Clin 2011; 27: 299-326.
Parks JK, Elliott C, Gentilello LM, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36 (1): 296–327.
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Publicado
2017-06-25
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ARTÍCULOS DE INVESTIGACIÓN CIENTÍFICA Y TECNOLÓGICA
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Cómo citar
Buelvas Villalba, M., & Jaraba Coronado, R. (2017). Asociación entre los niveles de déficit de base y la aparición de disfunción orgánica múltiple en pacientes con preeclampsia severa admitidas en la clínica gestión salud s.a.s (Cartagena) entre el 1 de enero de 2014 hasta 31 diciembre 2016. Biociencias, 12(2), 59-70. https://doi.org/10.18041/2390-0512/bioc..2.2290
