Scientific letter
Frequency and clinical evolution of acute renal failure in obstetric patients treated in the Intensive Care Unit of a high-specialty hospital in Mexico City
Frecuencia y evolución clínica de la insuficiencia renal aguda en pacientes obstétricas tratadas en la unidad de cuidados intensivos de un hospital de alta especialidad en la ciudad de México
J.G. Vázquez-Rodríguez
, L.A. Solís-Castillo, F.J. Cruz-Martínez
Corresponding author
Unidad de Cuidados Intensivos, Unidad Médica de Alta Especialidad, Hospital Ginecología y Obstetricia N.° 3, Centro Médico Nacional «La Raza», Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Vázquez-Rodríguez, L.A. Solís-Castillo, F.J. Cruz-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.G." "apellidos" => "Vázquez-Rodríguez" "email" => array:1 [ 0 => "juangustavovazquez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.A." "apellidos" => "Solís-Castillo" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Cruz-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos, Unidad Médica de Alta Especialidad, Hospital Ginecología y Obstetricia N.° 3, Centro Médico Nacional «La Raza», Instituto Mexicano del Seguro Social, Mexico City, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Frecuencia y evolución clínica de la insuficiencia renal aguda en pacientes obstétricas tratadas en la unidad de cuidados intensivos de un hospital de alta especialidad en la ciudad de México" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute renal failure (ARF) is a syndrome defined by sudden impairment of filtration and an increase of nitrogenated compounds in blood with or without decreased urinary output. In Mexico, its prevalence is 79.7 per cent in pregnant women with high-risk factors,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and 75 per cent in pre-eclamptic patients hospitalized in intensive care units (ICU).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Critically ill obstetric patients are especially susceptible to develop ARF. Both the clinical manifestations and the complications are related to renal failure and fetoplacental repercussion.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Early diagnosis and timely treatment solve the problem in most patients except for when severity is extreme which is when admission in the ICU is recommended.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> When required, early hemodialysis to reduce complications and serious sequelae should be initiated.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The goal of this research was to determine the frequency and clinical progression of ARF in obstetric patients treated in the ICU of a high-specialty hospital in the City of Mexico.</p><p id="par0015" class="elsevierStylePara elsevierViewall">1305 medical records of women admitted at the ICU of the High-Specialty Medical Unit of the Hospital of Gynecology and Obstetrics #3 of the “La Raza” National Medical Centre at the Mexican Institute of Social Security were reviewed between January 1, 2012 and June 30, 2014. Pregnant patients or patients in the puerperium phase with ARF defined as the acute impairment (<48<span class="elsevierStyleHsp" style=""></span>h) of filtration based on the following Acute Kidney Injury Network (AKIN) criteria were included: (a) increase of serum creatinine (Cr) levels ≥0.3<span class="elsevierStyleHsp" style=""></span>mg/dl; (b) increase of serum Cr levels ≥50 per cent (1.5 times above the basal level) and (c) uresis <0.5<span class="elsevierStyleHsp" style=""></span>ml/K/h during a ≤6<span class="elsevierStyleHsp" style=""></span>h period of time.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Patients with chronic nephropathy, peritoneal dialysis, hemodialysis or carriers of renal grafts were excluded. No cases were precluded because all medical records and lab reports were complete and fully available.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The frequency of obstetric patients with ARF in relation to the total number of admissions was estimated. Three (3) measurements of the serum Cr levels and glomerular filtration rate were taken: at the moment of ICU admission, during the ARF nadir and at ICU discharge. The volume of total uresis in intensive care was studied as well. In order to estimate the glomerular filtration rate, the levels of creatinine clearance (CrCl) were estimated using the Cockroft-Gault equation (CrCl<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>square meters of body surface<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[(140<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>age)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>weight (kg)/serum Cr levels (mg/dl)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>72] (0.85 for being a female) (1.73 body surface [square meters]/body surface [square meters]). Clinical progression included: arterial hypotension (systolic pressure <90<span class="elsevierStyleHsp" style=""></span>mmHg), surgical reinterventions, hemodialysis, outcomes, mortality and stay at the ICU. The study was authorized by the local committee of investigations (CLIS 2013-3504-29). For the statistical analysis, descriptive and inferential statistic methods (Student <span class="elsevierStyleItalic">t</span> test) were used. <span class="elsevierStyleItalic">P</span> values <0.05 were considered significant values.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Sixty-three obstetric patients with ARF were identified—some 4.82 per cent of all ICU admissions whose general data are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were no losses of patients due to lack of data in the files, or any biases for this reason. The causes for ARF were: severe preeclampsia 65.07 per cent (41 cases), eclampsia 6.34 per cent (4 cases), obstetric hemorrhage with hypovolemic shock 4.76 per cent (3 cases), sepsis 4.76 per cent (3 cases) and various diagnoses 19.07 per cent (12 cases).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">ARF was diagnosed at admission in 85.71 per cent (54 cases) and in the ICU in 14.29 per cent (9 cases). Based on the AKIN criteria,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> distributions were: stage 1, 71.43 per cent (45 cases); stage 2, 19.05 per cent (12 cases) and stage 3, 9.52 per cent (6 cases). The serum Cr levels at ICU admission were 1.59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.99<span class="elsevierStyleHsp" style=""></span>mg/dl (range: 0.7–6), the ARF nadir was 1.67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.77<span class="elsevierStyleHsp" style=""></span>mg/dl (range: 1.8–6.4), and the Cr levels at ICU discharge were 1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.61<span class="elsevierStyleHsp" style=""></span>mg/dl (range: 0.4–3.9). The CrCl levels at ICU admission were 54.36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.81 (range: 8.87–95.04), the ARF nadir was 43.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.13 (range: 9.95–85.73), and the CrCl levels at ICU discharge were 87.60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>37.07<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> of body surface (range: 14.14–124.3) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The mean of total volume of uresis was 1.61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.21<span class="elsevierStyleHsp" style=""></span>ml/kg/h (range: 0–5.7).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Arterial hypotension was diagnosed in 1.58 per cent (1 case), surgical reinterventions on one (1) occasion, in 11.11 per cent (7 cases), and on two (2) occasions in 4.76 per cent (3 cases), and hemodialysis in 1.58 per cent (1 case). These were the outcomes: referrals to the general ward of patients with ARF recovery in 95.26 per cent (60 cases), referrals to an infectology hospital for the management of sepsis with ARF but without hemodialysis in 1.58 per cent (1 case), referrals to the hemodialysis unit in 1.58 per cent (1 case), and mortality due to hemorrhage with ARF in 1.58 per cent (1 case). Thus, at ICU discharge, ARF progressed satisfactorily in 95.26 per cent (60 cases) and in 4.76 per cent (3 cases) the AKIN-stage 3 was maintained. Stays at the ICU were 4.30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.72 days (range: 1–19).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the actual investigation, the critically ill obstetric patients with ARF were 4.82 per cent – lower numbers than in previous reports in Mexico.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Guerrero et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> studied 333 women managed in the ICU, among which 86.18 per cent (287 cases) were pregnant women whose main causes for ARF were similar: preeclampsia, eclampsia, hemorrhage, and sepsis. Findings are consistent with the studies conducted in industrialized countries<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and in developing countries like India,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Morocco<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and Saudi Arabia.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Arterial hypotension was scarce even though some patients underwent reinterventions one or more times. The ARF was not seriously possible because they were young women with an intact pregestational condition, and possibly because they were identified early. Following the indications of hemodialysis and pregnancy,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> the method was implemented in 1.58 per cent (1 case) only. Mortality rates were low (1.58 per cent), and similar to the 1.74 per cent reported by Guerrero et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> but lower than the 20 per cent reported by Prakash et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and the 28.3 per cent reported by the study conducted by Bentata et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and the 12 per cent reported by Aggarwal et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The ARF in critically ill obstetric patients is a challenge for the multidisciplinary medical team. Intensive care can play a decisive role when trying to achieve successful results.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0045" class="elsevierStylePara elsevierViewall">This paper has not received any financial support.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">We the authors declare that while conducting this paper there were no conflicts of interests linked whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vázquez-Rodríguez JG, Solís-Castillo LA, Cruz-Martínez FJ. Frecuencia y evolución clínica de la insuficiencia renal aguda en pacientes obstétricas tratadas en la unidad de cuidados intensivos de un hospital de alta especialidad en la ciudad de México. Med Intensiva. 2017;41:255–257.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AKIN: Acute Kidney Injury Network.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Data \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Values \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Number of patients</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">AKIN classification</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stage 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.43 per cent (45 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stage 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.05 per cent (12 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stage 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.52 per cent (6 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Maternal age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17–44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Parity (median)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1–4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gestational state</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>With pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.20 per cent (31 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical puerperium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.10 per cent (24 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Physiological puerperium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.7 per cent (8 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Gestational interruption</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C-section \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84.13 per cent (53 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vaginal delivery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.87 per cent (10 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Obstetric bleeding (ml)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.20 per cent (31 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1103.44<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>130.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100–6200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Surgical reinterventions</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.11 per cent (7 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Two \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.76 per cent (3 cases) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414500.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">General data.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CrCl: creatinine clearance (ml/min/1.73<span class="elsevierStyleHsp" style=""></span>square meters of body surface) corrected using the Cockroft-Gault equation; ARF: acute renal failure; ICU: intensive car unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Measurements</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col"><span class="elsevierStyleItalic">P</span> value</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICU admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ARF nadir \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICU discharge \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Admission vs discharge<br>Admission vs nadir<br>Nadir vs discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.09<br>0.06<br>0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CrCl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>37.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Admission vs discharge<br>Admission vs nadir<br>Nadir vs discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.16<br>0.09<br>0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uresis (ml/K/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="3" align="center" valign="top">1.61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.21</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414499.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Changes of renal function.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disfunción orgánica múltiple en obstetricia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 5 | 7 |
| 2024 October | 60 | 77 | 137 |
| 2024 September | 50 | 42 | 92 |
| 2024 August | 70 | 71 | 141 |
| 2024 July | 52 | 38 | 90 |
| 2024 June | 78 | 48 | 126 |
| 2024 May | 59 | 44 | 103 |
| 2024 April | 77 | 41 | 118 |
| 2024 March | 86 | 29 | 115 |
| 2024 February | 53 | 37 | 90 |
| 2024 January | 53 | 46 | 99 |
| 2023 December | 41 | 32 | 73 |
| 2023 November | 54 | 56 | 110 |
| 2023 October | 40 | 48 | 88 |
| 2023 September | 45 | 40 | 85 |
| 2023 August | 32 | 16 | 48 |
| 2023 July | 37 | 26 | 63 |
| 2023 June | 53 | 15 | 68 |
| 2023 May | 58 | 33 | 91 |
| 2023 April | 49 | 24 | 73 |
| 2023 March | 68 | 36 | 104 |
| 2023 February | 70 | 29 | 99 |
| 2023 January | 75 | 23 | 98 |
| 2022 December | 81 | 31 | 112 |
| 2022 November | 76 | 42 | 118 |
| 2022 October | 65 | 51 | 116 |
| 2022 September | 54 | 42 | 96 |
| 2022 August | 45 | 39 | 84 |
| 2022 July | 35 | 42 | 77 |
| 2022 June | 36 | 42 | 78 |
| 2022 May | 61 | 43 | 104 |
| 2022 April | 57 | 42 | 99 |
| 2022 March | 49 | 62 | 111 |
| 2022 February | 42 | 41 | 83 |
| 2022 January | 32 | 41 | 73 |
| 2021 December | 50 | 55 | 105 |
| 2021 November | 42 | 42 | 84 |
| 2021 October | 50 | 69 | 119 |
| 2021 September | 42 | 37 | 79 |
| 2021 August | 44 | 45 | 89 |
| 2021 July | 26 | 31 | 57 |
| 2021 June | 41 | 14 | 55 |
| 2021 May | 50 | 49 | 99 |
| 2021 April | 152 | 144 | 296 |
| 2021 March | 82 | 31 | 113 |
| 2021 February | 99 | 23 | 122 |
| 2021 January | 58 | 23 | 81 |
| 2020 December | 48 | 15 | 63 |
| 2020 November | 38 | 20 | 58 |
| 2020 October | 36 | 24 | 60 |
| 2020 September | 56 | 19 | 75 |
| 2020 August | 32 | 13 | 45 |
| 2020 July | 52 | 28 | 80 |
| 2020 June | 55 | 6 | 61 |
| 2020 May | 35 | 26 | 61 |
| 2020 April | 65 | 31 | 96 |
| 2020 March | 17 | 11 | 28 |
| 2020 February | 65 | 28 | 93 |
| 2020 January | 36 | 23 | 59 |
| 2019 December | 32 | 25 | 57 |
| 2019 November | 39 | 33 | 72 |
| 2019 October | 38 | 23 | 61 |
| 2019 September | 38 | 26 | 64 |
| 2019 August | 29 | 32 | 61 |
| 2019 July | 28 | 27 | 55 |
| 2019 June | 20 | 17 | 37 |
| 2019 May | 47 | 34 | 81 |
| 2019 April | 9 | 21 | 30 |
| 2019 March | 21 | 26 | 47 |
| 2019 February | 24 | 36 | 60 |
| 2019 January | 22 | 29 | 51 |
| 2018 December | 22 | 29 | 51 |
| 2018 November | 61 | 53 | 114 |
| 2018 October | 62 | 21 | 83 |
| 2018 September | 44 | 12 | 56 |
| 2018 August | 20 | 6 | 26 |
| 2018 July | 31 | 8 | 39 |
| 2018 June | 29 | 10 | 39 |
| 2018 May | 20 | 5 | 25 |
| 2018 April | 31 | 11 | 42 |
| 2018 March | 32 | 5 | 37 |
| 2018 February | 25 | 6 | 31 |
| 2018 January | 37 | 13 | 50 |
| 2017 December | 22 | 4 | 26 |
| 2017 November | 39 | 11 | 50 |
| 2017 October | 33 | 13 | 46 |
| 2017 September | 32 | 7 | 39 |
| 2017 July | 1 | 0 | 1 |
| 2017 May | 0 | 1 | 1 |
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