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excepto en las situaciones donde el pron&#243;stico no est&#225; directamente relacionado con la funci&#243;n hep&#225;tica&#44; excepciones al MELD&#44; siendo el carcinoma hepatocelular &#40;CHC&#41; el paradigma<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Aunque la puntuaci&#243;n MELD est&#225; bien establecida como predictor de mortalidad antes del trasplante y es utilizada como criterio de distribuci&#243;n de &#243;rganos&#44; ha sido ampliamente estudiada y debatida para su mejora<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#8211;11</span></a>&#44; y recientemente ha sido revisada<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46; As&#237; pues desde enero de 2016 la UNOS incluye la tasa de sodio s&#233;rico para el c&#225;lculo del MELD&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha estudiado el papel del MELD como predictor de la mortalidad postrasplante&#44; aunque sigue siendo motivo de debate<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Por ello&#44; se han estudiado otros factores de riesgo&#44; como la hospitalizaci&#243;n previa en UCI<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#44; necesidad de tratamiento de depuraci&#243;n extrarrenal<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; antecedentes de cirug&#237;a abdominal<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#44; u otras comorbilidades que a&#241;adidas al MELD pudieran construir modelos espec&#237;ficos que mejoren la capacidad predictiva de mortalidad postoperatoria precoz<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los especialistas en Medicina Intensiva deben participar en los comit&#233;s de selecci&#243;n de los candidatos para trasplante hep&#225;tico y deben conocer los factores de riesgo que pueden incrementar la mortalidad postoperatoria&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo principal del estudio fue identificar otras caracter&#237;sticas cl&#237;nicas de los candidatos en lista de espera&#44; y por tanto previas al trasplante&#44; que junto al MELD-Na se comporten como predictores independientes de mortalidad precoz &#40;primeros 90 d&#237;as&#41; tras el trasplante hep&#225;tico en los receptores adultos electivos&#46; Y como objetivo secundario&#44; valorar la capacidad de predicci&#243;n o discriminaci&#243;n de las variables incluidas en el modelo obtenido&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pacientes y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio retrospectivo&#44; observacional&#44; de casos y controles anidados sobre una cohorte consecutiva de RTH adultos&#44; en una &#250;nica instituci&#243;n de &#225;mbito universitario&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fueron elegibles para su inclusi&#243;n todos los receptores adultos de trasplante hep&#225;tico desde enero de 2003 hasta diciembre de 2016&#46; Se consideraron criterios de exclusi&#243;n&#58; pacientes con fallo hep&#225;tico agudo&#44; los pacientes sometidos a trasplante simult&#225;neo de m&#250;ltiples &#243;rganos&#44; los receptores de trasplante hep&#225;tico de donantes vivos o de donantes en asistolia&#44; los receptores electivos de segundos trasplantes por disfunci&#243;n cr&#243;nica de un injerto previo y aquellos receptores con necesidad de retrasplante urgente durante el periodo de estudio&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se consideraron casos a los pacientes que cumplieron el criterio de mortalidad dentro de los 90 d&#237;as despu&#233;s del trasplante&#44; el resto de los receptores de trasplante fueron considerados controles&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se registraron variables antropom&#233;tricas de los receptores &#40;edad&#44; g&#233;nero&#44; peso&#44; talla e &#237;ndice de masa corporal&#41;&#44; la etiolog&#237;a de la enfermedad hep&#225;tica y puntuaciones pretrasplante relacionadas con el pron&#243;stico de la enfermedad hep&#225;tica &#40;Child-Pugh&#44; MELD&#41;&#46; La puntuaci&#243;n MELD-Na fue calculada &#40;<a href="http://www.rccc.eu/calculadoras/MELD.html">http&#58;&#47;&#47;www&#46;rccc&#46;eu&#47;calculadoras&#47;MELD&#46;html</a>&#41; con los datos de laboratorio obtenidos en el momento del ingreso hospitalario para realizar el trasplante&#44; momento en que tambi&#233;n se registraron urea y creatinina en sangre&#46; Y de la historia cl&#237;nica se obtuvieron los antecedentes de otras comorbilidades pretrasplante que pudieran incidir sobre la mortalidad postoperatoria&#44; como diabetes mellitus&#44; implantaci&#243;n de <span class="elsevierStyleItalic">transjugular portosystemic shunt</span> &#40;TIPS&#41; o cirug&#237;a supramesoc&#243;lica&#44; y tambi&#233;n los antecedentes durante el mes previo al trasplante de criterios de s&#237;ndrome hepatorrenal&#44; tratamiento con terlipresina&#44; necesidad de soporte renal &#40;di&#225;lisis en cualquiera de sus modalidades&#41; e ingresos hospitalarios &#40;tanto en planta como en UCI&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El estudio cumple todos los requerimientos contenidos en el c&#243;digo &#233;tico de la OMS &#40;Declaraci&#243;n de Helsinki&#41;&#44; fue aprobado por el Comit&#233; de Investigaci&#243;n Cl&#237;nica del hospital&#44; y el Comit&#233; de &#201;tica eximi&#243; a los investigadores de la necesidad de solicitar el consentimiento informado&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Estudio estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los pacientes fueron agrupados de acuerdo a la variable dependiente &#40;mortalidad a los 90 d&#237;as del trasplante&#41;&#46; Las variables de estudio cuantitativas de la cohorte fueron analizadas para contrastar su ajuste a la distribuci&#243;n normal &#40;test de Kolmogorov-Smirnov&#41; y se describen como mediana y percentiles 25-75 cuando es apropiado&#46; Para el estudio de casos y controles&#44; todos los factores excepto la puntuaci&#243;n MELD-Na se categorizaron para una mejor comprensi&#243;n de los resultados desde el punto de vista cl&#237;nico&#44; y se individualizaron en variables <span class="elsevierStyleItalic">dummy</span> cuando estaba indicado&#46; El punto de corte para la categorizaci&#243;n de los factores cuantitativos fue elegido de forma arbitraria seg&#250;n un criterio cl&#237;nico basado en el valor del cuartil de mayor riesgo&#46; En la variable <span class="elsevierStyleItalic">descompensaci&#243;n de la cirrosis</span> se agruparon las etiolog&#237;as hepatocelular&#44; biliar y miscel&#225;nea&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariante se realiz&#243; mediante regresi&#243;n log&#237;stica binaria simple&#46; Se obtuvo la tasa de riesgo como <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y su intervalo de confianza al 95&#37; &#40;IC95&#37;&#41; como medida de asociaci&#243;n&#46; Se consider&#243; significativa la probabilidad p-valor &#60; 0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se realiz&#243; an&#225;lisis multivariante mediante regresi&#243;n log&#237;stica binaria incluyendo en el modelo inicial todos los factores con p-valor &#8804; 0&#44;10&#46; Los posibles factores de confusi&#243;n e interacciones &#40;estatura y g&#233;nero&#41; fueron controlados mediante an&#225;lisis estratificado y regresi&#243;n log&#237;stica&#46; Se obtuvo un modelo intermedio considerando significativos los factores con p-valor &#8804; 0&#44;15 y que se ajust&#243; mediante regresi&#243;n log&#237;stica binaria atr&#225;s por pasos con salida manual de predictores &#40;raz&#243;n de verosimilitud&#41; y m&#225;xima parsimonia considerando significativos los predictores con p-valor &#8804; 0&#44;05 para obtener el modelo final&#46; Se construyeron las curvas <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41; de los modelos y se compar&#243; la probabilidad discriminante de estos seg&#250;n los motivos de trasplante mediante el test de DeLong&#46; El an&#225;lisis estad&#237;stico fue realizado utilizando los paquetes inform&#225;ticos PASW versi&#243;n 18 &#40;SPSS Inc&#46; Chicago&#44; IL&#41;&#44; y MedCalc statistical software versi&#243;n 18 &#40;Ostend&#44; Belgium&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Un total de 533 trasplantes hep&#225;ticos fueron realizados en RTH durante el periodo de estudio&#46; Todos ellos fueron elegibles&#46; Se excluyeron 62 RTH que cumpl&#237;an alguno o varios de los criterios de exclusi&#243;n&#46; En total fueron incluidos 471 pacientes para el an&#225;lisis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas pretrasplante de los grupos de estudio se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La mediana de edad de los RTH fue de 55 a&#241;os &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span> &#61; 49-60 a&#241;os&#41;&#44; existi&#243; predominio de varones &#40;77&#44;1&#37;&#41;&#44; y la mediana del IMC fue de 26&#44;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span> &#61; 24&#44;0-30&#44;1&#41;&#46; Las indicaciones para el trasplante fueron las descompensaciones de la cirrosis &#40;62&#37;&#41; y los tumores hep&#225;ticos &#40;38&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Una proporci&#243;n elevada de los RTH ten&#237;an otras comorbilidades&#59; diabetes mellitus &#40;28&#44;4&#37;&#41;&#44; criterios de s&#237;ndrome hepatorrenal o necesidad de tratamiento con terlipresina en el &#250;ltimo mes &#40;13&#44;4&#37;&#41; o hab&#237;an sido sometidos a terapia de soporte renal en cualquiera de sus modalidades al menos una vez &#40;1&#44;3&#37;&#41;&#44; hab&#237;an sufrido cirug&#237;a supramesoc&#243;lica previa &#40;14&#44;7&#37;&#41;&#44; o hab&#237;an sido ingresados en el hospital en el &#250;ltimo mes o estaban ingresados cuando se acept&#243; la donaci&#243;n del &#243;rgano para el trasplante &#40;n&#61;61&#44; 13&#44;0&#37;&#41;&#44; y 10 de ellos estaban ingresados en UCI en el momento del trasplante &#40;2&#44;1&#37; del total&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Un total de 49 pacientes &#40;10&#44;4&#37;&#41; cumpl&#237;an el criterio de la variable principal del estudio &#40;mortalidad antes de 90 d&#237;as despu&#233;s del trasplante&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los factores de riesgo potencial de mortalidad considerados se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; La mortalidad fue mayor en las mujeres &#40;OR&#61;2&#44;618&#44; IC95&#37;&#61;1&#44;413-4&#44;847&#41;&#44; en los RTH mayores de 60 a&#241;os de edad &#40;OR&#61;2&#44;039&#44; IC95&#37;&#61;1&#44;100-3&#44;779&#41; y en los receptores de estatura menor de 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR&#61;4&#44;260&#44; IC95&#37;&#61;2&#44;292-7&#44;917&#41;&#46; La interacci&#243;n de la estatura con el g&#233;nero no fue significativa&#44; OR &#61; 0&#44;908 &#40;IC95&#37;&#61;0&#44;820-1&#44;005&#41;&#46; En RTH por causa de descompensaci&#243;n de la cirrosis la mortalidad precoz postrasplante es mayor que en los trasplantados por causa tumoral &#40;CHC&#41; &#40;OR&#61;2&#44;998&#44; IC95&#37;&#61;1&#44;418-6&#44;340&#41;&#46; La mortalidad tambi&#233;n se relaciona con la gravedad de la enfermedad &#40;MELD-Na&#44; OR&#61;1&#44;064 por cada punto de incremento con IC95&#37;&#61;1&#44;020-1&#44;111&#41;&#44; pero no solamente por afectaci&#243;n de la funci&#243;n hep&#225;tica &#40;grado C de Child-Pugh&#44; p-valor &#61; ns&#41;&#46; Los RTH que fallecieron presentaban cifras m&#225;s elevadas de creatinemia &#40;OR&#61;2&#44;027&#44; IC95&#37;&#61;1&#44;076-3&#44;821&#41; y uremia &#40;OR&#61;2&#44;096&#44; IC95&#37;&#61;1&#44;130-3&#44;888&#41;&#93;&#44; mayor frecuencia de s&#237;ndrome hepatorrenal previo &#40;OR&#61;2&#44;353&#44; IC95&#37;&#61;1&#44;152-4&#44;805&#41; y de di&#225;lisis pretrasplante &#40;p-valor &#61; 0&#44;615&#41;&#46; Tambi&#233;n hab&#237;an precisado ingreso hospitalario en el mes previo al trasplante en mayor proporci&#243;n &#40;OR&#61;2&#44;469&#44; IC95&#37;&#61;1&#44;207-5&#44;052&#41; o estaban ingresados en UCI en el momento del trasplante &#40;OR&#61;3&#44;866&#44; IC95&#37;&#61;0&#44;0967-15&#44;467&#41;&#46; La diabetes no se comport&#243; como factor de riesgo de mortalidad precoz &#40;p-valor &#61; ns&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariante identific&#243; 10 variables explicativas predictoras de mortalidad precoz &#40;p-valor &#8804; 0&#44;10&#41; que fueron incluidas en el an&#225;lisis multivariante&#46; Se excluy&#243; la creatinina por colinealidad y se incluy&#243; la cirug&#237;a previa por criterio cl&#237;nico&#46; Este modelo inicial explica entre el 10&#44;0-20&#44;7&#37; de la varianza total&#44; con un porcentaje global de acierto del 90&#44;3&#37;&#46; Tiene muy elevada especificidad &#40;99&#44;7&#37;&#41; aunque muy baja sensibilidad &#40;6&#44;5&#37;&#41;&#46; Mediante un proceso de regresi&#243;n log&#237;stica atr&#225;s por pasos se obtuvo el modelo final que identific&#243; 3 predictores independientes de mortalidad precoz y un factor de confusi&#243;n &#40;motivo del trasplante&#41; que incrementa en un 27&#37; el coeficiente de regresi&#243;n &#223; de la puntuaci&#243;n MELD-Na&#44; por lo que queda en la ecuaci&#243;n final &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En esta tabla se muestran los predictores independientes tanto globales como para ambos motivos de trasplante&#44; por causa tumoral y por descompensaci&#243;n de la cirrosis&#46; Se obtuvieron las curvas ROC de ambos en comparaci&#243;n con la curva ROC del MELD-Na &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; y la capacidad predictiva de los modelos finales fue comparada con respecto al MELD-Na mediante el test de DeLong &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41; confirm&#225;ndose que el modelo obtenido en los RTH por motivo de descompensaci&#243;n de la cirrosis predice mejor la supervivencia que el MELD-Na de forma significativa &#40;p-valor &#61; 0&#44;003&#41;&#44; mientras que el modelo en RTH trasplantados por CHC no mejora la predicci&#243;n del MELD-Na&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Es conocido que las complicaciones del acto quir&#250;rgico son las que tienen mayor impacto sobre la mortalidad precoz de los RTH<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17&#44;19&#44;20</span></a>&#44; pero generalmente no pueden ser previstas ni controladas antes del trasplante&#46; Por ello&#44; precisamos encontrar predictores pretrasplante que puedan ayudarnos a valorar el riesgo de los candidatos en lista de espera y predecir la mortalidad tras el trasplante&#46; Aunque se han realizado m&#250;ltiples estudios al respecto&#44; los resultados no han sido concluyentes<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#8211;25</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio demuestran la diferente asociaci&#243;n de factores de riesgo de mortalidad y motivo del trasplante &#40;CHC vs&#46; descompensaci&#243;n de la cirrosis&#41; e incluyen a la puntuaci&#243;n MELD-Na como predictor independiente de mortalidad precoz en los RTH por cirrosis descompensada&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Tambi&#233;n confirman los resultados de otros estudios<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">26&#8211;28</span></a> que incluyen la edad mayor de 60 a&#241;os como un factor de riesgo independiente de mortalidad&#44; pero este predictor no tiene valor en los RTH por causa tumoral y solo debiera ser tenido en cuenta en los RTH por descompensaci&#243;n de la cirrosis&#44; lo cual podr&#237;a estar en relaci&#243;n con una mayor comorbilidad en estos pacientes&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hasta donde nuestro conocimiento alcanza&#44; el presente trabajo es pionero en relacionar la estatura del receptor como factor de riesgo independiente de mortalidad&#46; La causa no puede ser conocida por los datos del estudio&#44; pero ser&#237;a razonable asociarlo con una mayor tasa de complicaciones quir&#250;rgicas en relaci&#243;n tanto al menor tama&#241;o del campo quir&#250;rgico como a la mayor probabilidad de disparidad de tama&#241;os donante&#47;receptor del h&#237;gado<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46; En nuestro estudio tambi&#233;n se aprecia esa asociaci&#243;n&#44; mayor proporci&#243;n de donantes varones &#40;60&#44;5&#37;&#41; y mayor mortalidad en mujeres &#40;OR&#61;2&#44;618 con IC95&#37;&#61; 1&#44;413-4&#44;847&#41;&#44; por lo que el g&#233;nero puede comportarse como factor de confusi&#243;n&#46; Sin embargo&#44; en nuestros resultados la estatura sigue siendo significativa cuando fue controlada por el g&#233;nero&#46; Estos resultados no coinciden con los de otros autores<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> y deber&#225; ser validado&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Y finalmente&#44; nuestro estudio demuestra que incluso considerando una importante cantidad de factores pretrasplante &#40;18 variables&#41; no somos capaces de diferenciar de forma significativa a los pacientes que fallecer&#225;n tras el trasplante hep&#225;tico&#44; dado que nuestros modelos muestran escasa sensibilidad&#46; Esto tiene una muy importante implicaci&#243;n en las evaluaciones pretrasplante de los posibles candidatos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Desde el punto de vista cl&#237;nico&#44; es l&#243;gico pensar que aquellos pacientes con mayor disfunci&#243;n hep&#225;tica&#44; mayor grado de hipertensi&#243;n portal y mayor disfunci&#243;n renal &#40;mayor puntuaci&#243;n MELD-Na&#41; tendr&#225;n mayor riesgo perioperatorio&#46; En nuestros pacientes cada incremento de 10 puntos en el MELD-Na increment&#243; la mortalidad un 10&#37; aproximadamente&#46; Pero aunque la puntuaci&#243;n MELD-Na pretrasplante sea un predictor independiente de mortalidad postrasplante precoz&#44; su capacidad predictiva es pobre<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">20&#44;30&#44;31</span></a>&#46; Esto coincide con nuestros resultados&#44; ya que el MELD-Na explica solo entre el 1&#44;7-3&#44;5&#37; de la varianza de la mortalidad precoz &#40;R2 de Cox-Snell y Nagelkerke&#41;&#46; Y por ello&#44; los estudios realizados en pacientes con MELD mayores de 40 puntos no pueden demostrar la futilidad del trasplante en estos pacientes en base solamente a este predictor<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">24&#44;32</span></a>&#46; Por tanto&#44; no podr&#237;amos rechazar la opci&#243;n del trasplante a pacientes con elevada puntuaci&#243;n MELD-Na en base a este par&#225;metro solamente&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Hay que considerar que en nuestro caso la puntuaci&#243;n MELD-Na es obtenida de los datos de laboratorio en el momento del ingreso para el trasplante del paciente y&#44; m&#225;s importante&#44; que se refiere a la capacidad predictiva de mortalidad postrasplante y no de pacientes en lista de espera sin trasplante&#44; por ello la capacidad predictiva del MELD-Na es menor que las cifras publicadas por estos autores<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Adem&#225;s la capacidad predictiva de la mortalidad postrasplante tambi&#233;n disminuye al disgregar el modelo global &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestros datos tienen una debilidad&#44; de la cual somos conscientes tras los resultados del estudio&#44; y es que un predictor tan significativo desde el punto de vista estad&#237;stico &#40;la estatura del receptor&#41; no suele ser medido de forma directa sino que es referido por los pacientes y podr&#237;a tener un sesgo<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#44; aunque este sesgo disminuye al categorizar la variable estatura del receptor en una variable dicot&#243;mica&#46; De todas formas&#44; la pregunta cl&#237;nica es si una diferencia de medianas de 8<span class="elsevierStyleHsp" style=""></span>cm en la estatura de ambos grupos es cl&#237;nicamente relevante o solo estad&#237;sticamente significativa&#46; Para resolverlo precisar&#237;amos corroborar nuestros resultados en otras poblaciones diferentes o haber estudiado a una cohorte de validaci&#243;n&#46; Esta &#250;ltima opci&#243;n no pudo ser realizada dada la baja frecuencia de mortalidad y el consiguiente tama&#241;o muestral&#44; por lo que debe considerarse una limitaci&#243;n de nuestro estudio&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nuestros modelos son simples&#44; homog&#233;neos en sus criterios y est&#225;n centrados en los receptores en lista de espera sin contraindicaciones evidentes &#40;cardiopat&#237;a grave&#44; sepsis activa&#41; para el trasplante&#46; Presentan muy elevada especificidad y valores predictivos negativos&#44; pero tienen muy escasa sensibilidad para diferenciar a los pacientes que no sobreviven al trasplante&#46; Otros estudios que incluyen datos del donante y del proceso quir&#250;rgico tampoco demuestran una mejor predicci&#243;n de mortalidad<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">36&#44;37</span></a>&#46; Por todo ello&#44; pensamos que podr&#237;an ser considerados por los Comit&#233;s de Evaluaci&#243;n de Candidatos como herramientas de valoraci&#243;n del riesgo en pacientes individualizados&#44; aunque teniendo siempre en cuenta que la predicci&#243;n de la mortalidad basada en factores pretrasplante es muy pobre en los casos individuales&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; los modelos obtenidos con los factores pretrasplante estudiados tienen muy bajo valor predictivo positivo y baja capacidad discriminante &#40;AUROC inferior a 0&#44;8&#41;&#44; y por tanto no pueden excluir la posibilidad del trasplante a ninguno de los candidatos&#44; dado que no son capaces de clasificar con seguridad a los pacientes que fallecer&#225;n en el periodo postrasplante precoz&#46; Pero estos predictores pueden ayudar a los Comit&#233;s de Evaluaci&#243;n de Candidatos a valorar el riesgo de mortalidad de los candidatos en base al motivo del trasplante &#40;CHC o no-CHC&#41; y en consecuencia intentar minimizar otros factores de riesgo&#46; Los RTH por causa tumoral &#40;CHC&#41; tienen mayor riesgo de mortalidad precoz si su estatura es inferior a 163<span class="elsevierStyleHsp" style=""></span>cm&#46; Los RTH por causa de cirrosis descompensada tienen mayor riesgo de mortalidad precoz cuanto m&#225;s elevada sea su puntuaci&#243;n MELD-Na&#44; si su edad es mayor de 60 a&#241;os y si su estatura es inferior a 163<span class="elsevierStyleHsp" style=""></span>cm&#44; y este modelo predice la supervivencia significativamente mejor que el MELD-Na de forma aislada&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Autor&#237;a&#47;colaboradores</span><p id="par0160" class="elsevierStylePara elsevierViewall">JCPL y MRP han contribuido al dise&#241;o del estudio y la selecci&#243;n de los criterios de inclusi&#243;n y exclusi&#243;n&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">MCMV&#44; JCPL y MRP han contribuido a la realizaci&#243;n del estudio estad&#237;stico&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">JCPL&#44; FRE&#44; JMT e IDG han contribuido en el registro de datos&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">JCPL es responsable del manuscrito&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Todos los autores son responsables de la revisi&#243;n final&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar predictores pretrasplante de mortalidad precoz &#40;90 d&#237;as postrasplante&#41; y evaluar su capacidad discriminante en receptores adultos de trasplante hep&#225;tico &#40;RTH&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; retrospectivo&#44; de casos y controles anidados sobre una cohorte consecutiva de RTH&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hospital Universitario&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2003 a diciembre de 2016&#44; todos los receptores adultos de trasplante hep&#225;tico fueron elegibles para inclusi&#243;n&#46; Fueron excluidos los RTH por fallo hep&#225;tico agudo&#44; disfunci&#243;n de un injerto previo&#44; trasplante simult&#225;neo de &#243;rganos&#44; de donantes en asistolia&#44; y aquellos que precisaron retrasplante durante el periodo de estudio&#46; Para el an&#225;lisis se incluyeron 471 pacientes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Principales variables de inter&#233;s</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas pretrasplante fueron las variables de inter&#233;s&#46; Los RTH fueron agrupados de acuerdo con la variable dependiente &#40;mortalidad precoz&#41;&#46; Los predictores se obtuvieron mediante an&#225;lisis multivariante de regresi&#243;n log&#237;stica&#46; La capacidad discriminante de los modelos obtenidos se evalu&#243; mediante comparaci&#243;n de curvas ROC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se identificaron como predictores independientes de mortalidad precoz&#58; la puntuaci&#243;n MELD-Na &#40;OR&#61;1&#44;069&#59; IC95&#37;&#61;1&#44;014-1&#44;127&#41;&#44; la edad mayor de 60 a&#241;os &#40;OR&#61;2&#44;479&#59; IC95&#37;&#61; 1&#44;226-5&#44;015&#41;&#44; y la estatura del RTH inferior a 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR&#61;4&#44;092&#59; IC95&#37;&#61;2&#44;115-7&#44;917&#41;&#44; consider&#225;ndose el motivo del trasplante &#40;carcinoma hepatocelular o cirrosis descompensada&#41; como variable de confusi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En los RTH por cirrosis descompensada&#44; la puntuaci&#243;n MELD-Na&#44; la edad mayor de 60 a&#241;os y la estatura del receptor inferior a 163<span class="elsevierStyleHsp" style=""></span>cm son predictores independientes de mortalidad precoz&#46; Esos predictores producen un modelo que clasifica a los pacientes significativamente mejor que el MELD-Na en relaci&#243;n con la mortalidad precoz&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Aims</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To identify pretransplant predictors of early mortality &#40;90 days after transplantation&#41; and evaluate their discriminating capacity in adult liver transplant recipients &#40;LTR&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; retrospective&#44; nested cases-controls study from a consecutive cohort of LTRs was carried out&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">University hospital&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All consecutive LTR between January 2003 and December 2016 were eligible for inclusion&#46; Patients with acute liver failure&#44; previous graft dysfunction&#44; simultaneous multiple organ transplantation&#44; non-heart beating donors&#44; and those needing urgent retransplantation during the study period were excluded&#46; The analysis comprised 471 patients&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Main variables of interest</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pretransplant characteristics were the main variables of interest&#46; The LTR were grouped according to the dependent variable &#40;early mortality&#41;&#46; Multivariate logistic regression analysis was conducted to identify predictors of early mortality&#46; The discriminating capacity of the models obtained was evaluated by comparing ROC curves &#40;models versus MELD-Na&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The MELD-Na score &#40;OR &#61; 1&#46;069&#44; 95&#37; <span class="elsevierStyleSmallCaps">C</span>I &#61; 1&#46;014-1&#46;127&#41;&#44; age &#62; 60 years &#40;OR &#61; 2&#46;479&#44; 95&#37; CI &#61; 1&#46;226-5&#46;015&#41;&#44; and LTR height &#60; 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR &#61; 4&#46;092&#44; 95&#37; CI &#61; 2&#46;115-7&#46;917&#41; were identified as independent predictors of early mortality&#46; The cause of transplantation &#40;hepatocellular carcinoma or decompensated cirrhosis&#41; was identified as a confounding factor&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In LTR due to decompensated cirrhosis&#44; the MELD-Na score&#44; age &#62; 60 years&#44; and height &#60; 163<span class="elsevierStyleHsp" style=""></span>cm are independent predictors of early mortality&#46; These factors provide a better classification model than the MELD-Na score for early post-transplant mortality&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Etiolog&#237;a de la hepatopat&#237;a</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gravedad de la enfermedad hep&#225;tica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Motivo del trasplante hep&#225;tico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Descompensaci&#243;n de la cirrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades previas al trasplante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinemia &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uremia &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;25-48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;26-88&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIPS previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome hepatorrenal o terlipresina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ingreso previo en UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">S&#237;ndrome hepatorrenal o terlipresina&#44; ingreso hospitalario o en UCI previos&#44; se refieren al mes previo al trasplante&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Excepto la puntuaci&#243;n MELD-Na&#44; variable cuantitativa que se expresa como media &#40;desviaci&#243;n est&#225;ndar&#41;&#44; todas las variables fueron categorizadas de acuerdo al punto de corte del cuartil de mayor riesgo&#44; y se describen como frecuencia y porcentajes&#44; y el contraste de hip&#243;tesis se realiz&#243; mediante regresi&#243;n log&#237;stica binaria simple&#44; expres&#225;ndose la significaci&#243;n de probabilidad p&#44; tasa de riesgo OR odds ratio e IC95&#37; intervalos de confianza al 95&#37;&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">CHC carcinoma hepatocelular&#59; IMC&#58; &#237;ndice de masa corporal&#59; ns&#58; no signficativo&#46;TIPS&#58; acr&#243;nimo ingl&#233;s de shunt portosist&#233;mico transyugular&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>G&#233;nero mujer &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88 &#40;20&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;40&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad &#62; 60 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;039&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;100-3&#44;779&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peso &#62; 86 kg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Talla &#60; 163 cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;292-7&#44;917&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#62; 30 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Motivo del trasplante hep&#225;tico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CHC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">170 &#40;40&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;18&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Descompensaciones de la cirrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gravedad de la enfermedad hep&#225;tica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Child-Pugh estadio C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MELD-Na&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades previas al trasplante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">119 &#40;28&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinemia &#62; 1&#44;1 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uremia &#62; 48 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;130-3&#44;888&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIPS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome hepatorrenal o terlipresina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;152-4&#44;805&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Di&#225;lisis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a supramesoc&#243;lica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ingreso hospitalario previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;469&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;207-5&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ingreso en UCI previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049108.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Evaluaci&#243;n de los predictores pretrasplante de mortalidad precoz postrasplante hep&#225;tico&#46; An&#225;lisis bivariante &#40;N&#61;471&#41;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">CHC&#58; carcinoma hepatocelular&#59; IC95&#37;&#58; intervalo de confianza al 95&#37;&#59; MELD-Na&#58; Mayo End-Liver Disease score&#59; OR&#58; odds ratio&#59; RTH&#58; receptores de trasplante hep&#225;tico&#46;</p>"
          "tablatextoimagen" => array:3 [
            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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final global &#40;N &#61; 456&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad mayor de 60 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirrosis descompensada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049106.png"
              ]
            ]
            1 => 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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final para pacientes RTH por causa de CHC &#40;N &#61; 171&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049109.png"
              ]
            ]
            2 => 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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final para pacientes RTH por causa de cirrosis descompensada &#40;N &#61; 285&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;581&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;711&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad mayor de 60 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2049104.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Predictores pretrasplante independientes de mortalidad precoz postrasplante hep&#225;tico&#46; An&#225;lisis de regresi&#243;n log&#237;stica multivariante&#58; Modelos finales</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">AUC &#225;rea bajo la curva&#59; CHC&#58; carcinoma hepatocelular&#59; IC95&#37; intervalo de confianza al 95&#37;&#59; N&#58; tama&#241;o de la muestra&#59; P&#58; probabilidad&#59; &#37; porcentaje&#46;</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo de pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comparaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fallecidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Supervivientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diferencia entre &#225;reas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cohorte</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">456</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#40;10&#44;09&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">410&#40;89&#44;91&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;767&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;726 - 0&#44;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;158</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;068 &#8211; 0&#44;246</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0005</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;563 - 0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHC</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#40;4&#44;68&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&#40;95&#44;32&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;640 - 0&#44;781&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;161</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#44;109 &#8211; 0&#44;430</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;243</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;554&nbsp;\t\t\t\t\t\t\n
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ORIGINAL
Predictores pretrasplante de mortalidad precoz en receptores adultos de trasplante hepático en la era MELD-Na
Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era
J.C. Pozo-Laderasa,b,
Autor para correspondencia
drjcpozo@hotmail.com

Autor para correspondencia.
, M. Rodríguez-Perálvarezc,b, M.C. Muñoz-Villanuevad, F. Rivera-Espinara, I. Durban-Garcíaa, J. Muñoz-Trujilloa, J.C. Robles-Aristaa,b, J. Briceño-Delgadoe,b
a UCG Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
b Instituto Maimónides de Investigación Biomédica IMIBIC, Córdoba, España
c UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
d Unidad de Bioestadística Médica, Instituto Maimónides de Investigación Biomédica IMIBIC, Córdoba, España
e UGC Cirugía General, Hospital Universitario Reina Sofía, Córdoba, España
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio de predictores pretrasplante de mortalidad precoz en receptores adultos de trasplante hep&#225;tico&#46; Criterios de inclusi&#243;n y exclusi&#243;n&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El trasplante hep&#225;tico es la &#250;nica terapia curativa para los pacientes con enfermedad hep&#225;tica terminal&#44; pero el riesgo inherente al procedimiento del trasplante es significativo y los receptores de trasplante hep&#225;tico &#40;RTH&#41; han de poder superarlo&#46; Aunque no existe consenso establecido&#44; se podr&#237;a considerar la mortalidad durante los primeros 90 d&#237;as despu&#233;s del trasplante &#40;mortalidad precoz&#41; inferior al 10&#37; como criterio est&#225;ndar de buena practica cl&#237;nica en pacientes sometidos a trasplantes electivos<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La desproporci&#243;n entre donantes y potenciales candidatos al trasplante hizo obligada la priorizaci&#243;n de los candidatos en lista de espera&#46; En el pasado&#44; las escalas de Child-Turcotte-Pugh o de la United Network for Organ Sharing &#40;UNOS score&#41; fueron el est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#44; pero los sistemas de distribuci&#243;n de &#243;rganos han evolucionado intentando aplicar los principios de justicia individual y m&#225;ximo rendimiento de la donaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La introducci&#243;n del Model for End-stage Liver Disease &#40;MELD&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a> score aport&#243; objetividad y transparencia a la priorizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a>&#44; y es actualmente utilizado en todo el mundo para la distribuci&#243;n de &#243;rganos por su balance entre utilidad y justicia distributiva<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#44; excepto en las situaciones donde el pron&#243;stico no est&#225; directamente relacionado con la funci&#243;n hep&#225;tica&#44; excepciones al MELD&#44; siendo el carcinoma hepatocelular &#40;CHC&#41; el paradigma<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Aunque la puntuaci&#243;n MELD est&#225; bien establecida como predictor de mortalidad antes del trasplante y es utilizada como criterio de distribuci&#243;n de &#243;rganos&#44; ha sido ampliamente estudiada y debatida para su mejora<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">9&#8211;11</span></a>&#44; y recientemente ha sido revisada<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46; As&#237; pues desde enero de 2016 la UNOS incluye la tasa de sodio s&#233;rico para el c&#225;lculo del MELD&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha estudiado el papel del MELD como predictor de la mortalidad postrasplante&#44; aunque sigue siendo motivo de debate<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Por ello&#44; se han estudiado otros factores de riesgo&#44; como la hospitalizaci&#243;n previa en UCI<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#44; necesidad de tratamiento de depuraci&#243;n extrarrenal<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a>&#44; antecedentes de cirug&#237;a abdominal<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#44; u otras comorbilidades que a&#241;adidas al MELD pudieran construir modelos espec&#237;ficos que mejoren la capacidad predictiva de mortalidad postoperatoria precoz<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los especialistas en Medicina Intensiva deben participar en los comit&#233;s de selecci&#243;n de los candidatos para trasplante hep&#225;tico y deben conocer los factores de riesgo que pueden incrementar la mortalidad postoperatoria&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El objetivo principal del estudio fue identificar otras caracter&#237;sticas cl&#237;nicas de los candidatos en lista de espera&#44; y por tanto previas al trasplante&#44; que junto al MELD-Na se comporten como predictores independientes de mortalidad precoz &#40;primeros 90 d&#237;as&#41; tras el trasplante hep&#225;tico en los receptores adultos electivos&#46; Y como objetivo secundario&#44; valorar la capacidad de predicci&#243;n o discriminaci&#243;n de las variables incluidas en el modelo obtenido&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pacientes y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio retrospectivo&#44; observacional&#44; de casos y controles anidados sobre una cohorte consecutiva de RTH adultos&#44; en una &#250;nica instituci&#243;n de &#225;mbito universitario&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fueron elegibles para su inclusi&#243;n todos los receptores adultos de trasplante hep&#225;tico desde enero de 2003 hasta diciembre de 2016&#46; Se consideraron criterios de exclusi&#243;n&#58; pacientes con fallo hep&#225;tico agudo&#44; los pacientes sometidos a trasplante simult&#225;neo de m&#250;ltiples &#243;rganos&#44; los receptores de trasplante hep&#225;tico de donantes vivos o de donantes en asistolia&#44; los receptores electivos de segundos trasplantes por disfunci&#243;n cr&#243;nica de un injerto previo y aquellos receptores con necesidad de retrasplante urgente durante el periodo de estudio&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se consideraron casos a los pacientes que cumplieron el criterio de mortalidad dentro de los 90 d&#237;as despu&#233;s del trasplante&#44; el resto de los receptores de trasplante fueron considerados controles&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se registraron variables antropom&#233;tricas de los receptores &#40;edad&#44; g&#233;nero&#44; peso&#44; talla e &#237;ndice de masa corporal&#41;&#44; la etiolog&#237;a de la enfermedad hep&#225;tica y puntuaciones pretrasplante relacionadas con el pron&#243;stico de la enfermedad hep&#225;tica &#40;Child-Pugh&#44; MELD&#41;&#46; La puntuaci&#243;n MELD-Na fue calculada &#40;<a href="http://www.rccc.eu/calculadoras/MELD.html">http&#58;&#47;&#47;www&#46;rccc&#46;eu&#47;calculadoras&#47;MELD&#46;html</a>&#41; con los datos de laboratorio obtenidos en el momento del ingreso hospitalario para realizar el trasplante&#44; momento en que tambi&#233;n se registraron urea y creatinina en sangre&#46; Y de la historia cl&#237;nica se obtuvieron los antecedentes de otras comorbilidades pretrasplante que pudieran incidir sobre la mortalidad postoperatoria&#44; como diabetes mellitus&#44; implantaci&#243;n de <span class="elsevierStyleItalic">transjugular portosystemic shunt</span> &#40;TIPS&#41; o cirug&#237;a supramesoc&#243;lica&#44; y tambi&#233;n los antecedentes durante el mes previo al trasplante de criterios de s&#237;ndrome hepatorrenal&#44; tratamiento con terlipresina&#44; necesidad de soporte renal &#40;di&#225;lisis en cualquiera de sus modalidades&#41; e ingresos hospitalarios &#40;tanto en planta como en UCI&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El estudio cumple todos los requerimientos contenidos en el c&#243;digo &#233;tico de la OMS &#40;Declaraci&#243;n de Helsinki&#41;&#44; fue aprobado por el Comit&#233; de Investigaci&#243;n Cl&#237;nica del hospital&#44; y el Comit&#233; de &#201;tica eximi&#243; a los investigadores de la necesidad de solicitar el consentimiento informado&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Estudio estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los pacientes fueron agrupados de acuerdo a la variable dependiente &#40;mortalidad a los 90 d&#237;as del trasplante&#41;&#46; Las variables de estudio cuantitativas de la cohorte fueron analizadas para contrastar su ajuste a la distribuci&#243;n normal &#40;test de Kolmogorov-Smirnov&#41; y se describen como mediana y percentiles 25-75 cuando es apropiado&#46; Para el estudio de casos y controles&#44; todos los factores excepto la puntuaci&#243;n MELD-Na se categorizaron para una mejor comprensi&#243;n de los resultados desde el punto de vista cl&#237;nico&#44; y se individualizaron en variables <span class="elsevierStyleItalic">dummy</span> cuando estaba indicado&#46; El punto de corte para la categorizaci&#243;n de los factores cuantitativos fue elegido de forma arbitraria seg&#250;n un criterio cl&#237;nico basado en el valor del cuartil de mayor riesgo&#46; En la variable <span class="elsevierStyleItalic">descompensaci&#243;n de la cirrosis</span> se agruparon las etiolog&#237;as hepatocelular&#44; biliar y miscel&#225;nea&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariante se realiz&#243; mediante regresi&#243;n log&#237;stica binaria simple&#46; Se obtuvo la tasa de riesgo como <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; y su intervalo de confianza al 95&#37; &#40;IC95&#37;&#41; como medida de asociaci&#243;n&#46; Se consider&#243; significativa la probabilidad p-valor &#60; 0&#44;05&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se realiz&#243; an&#225;lisis multivariante mediante regresi&#243;n log&#237;stica binaria incluyendo en el modelo inicial todos los factores con p-valor &#8804; 0&#44;10&#46; Los posibles factores de confusi&#243;n e interacciones &#40;estatura y g&#233;nero&#41; fueron controlados mediante an&#225;lisis estratificado y regresi&#243;n log&#237;stica&#46; Se obtuvo un modelo intermedio considerando significativos los factores con p-valor &#8804; 0&#44;15 y que se ajust&#243; mediante regresi&#243;n log&#237;stica binaria atr&#225;s por pasos con salida manual de predictores &#40;raz&#243;n de verosimilitud&#41; y m&#225;xima parsimonia considerando significativos los predictores con p-valor &#8804; 0&#44;05 para obtener el modelo final&#46; Se construyeron las curvas <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41; de los modelos y se compar&#243; la probabilidad discriminante de estos seg&#250;n los motivos de trasplante mediante el test de DeLong&#46; El an&#225;lisis estad&#237;stico fue realizado utilizando los paquetes inform&#225;ticos PASW versi&#243;n 18 &#40;SPSS Inc&#46; Chicago&#44; IL&#41;&#44; y MedCalc statistical software versi&#243;n 18 &#40;Ostend&#44; Belgium&#41;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Un total de 533 trasplantes hep&#225;ticos fueron realizados en RTH durante el periodo de estudio&#46; Todos ellos fueron elegibles&#46; Se excluyeron 62 RTH que cumpl&#237;an alguno o varios de los criterios de exclusi&#243;n&#46; En total fueron incluidos 471 pacientes para el an&#225;lisis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas pretrasplante de los grupos de estudio se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La mediana de edad de los RTH fue de 55 a&#241;os &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span> &#61; 49-60 a&#241;os&#41;&#44; existi&#243; predominio de varones &#40;77&#44;1&#37;&#41;&#44; y la mediana del IMC fue de 26&#44;7<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span> &#61; 24&#44;0-30&#44;1&#41;&#46; Las indicaciones para el trasplante fueron las descompensaciones de la cirrosis &#40;62&#37;&#41; y los tumores hep&#225;ticos &#40;38&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Una proporci&#243;n elevada de los RTH ten&#237;an otras comorbilidades&#59; diabetes mellitus &#40;28&#44;4&#37;&#41;&#44; criterios de s&#237;ndrome hepatorrenal o necesidad de tratamiento con terlipresina en el &#250;ltimo mes &#40;13&#44;4&#37;&#41; o hab&#237;an sido sometidos a terapia de soporte renal en cualquiera de sus modalidades al menos una vez &#40;1&#44;3&#37;&#41;&#44; hab&#237;an sufrido cirug&#237;a supramesoc&#243;lica previa &#40;14&#44;7&#37;&#41;&#44; o hab&#237;an sido ingresados en el hospital en el &#250;ltimo mes o estaban ingresados cuando se acept&#243; la donaci&#243;n del &#243;rgano para el trasplante &#40;n&#61;61&#44; 13&#44;0&#37;&#41;&#44; y 10 de ellos estaban ingresados en UCI en el momento del trasplante &#40;2&#44;1&#37; del total&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Un total de 49 pacientes &#40;10&#44;4&#37;&#41; cumpl&#237;an el criterio de la variable principal del estudio &#40;mortalidad antes de 90 d&#237;as despu&#233;s del trasplante&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los factores de riesgo potencial de mortalidad considerados se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; La mortalidad fue mayor en las mujeres &#40;OR&#61;2&#44;618&#44; IC95&#37;&#61;1&#44;413-4&#44;847&#41;&#44; en los RTH mayores de 60 a&#241;os de edad &#40;OR&#61;2&#44;039&#44; IC95&#37;&#61;1&#44;100-3&#44;779&#41; y en los receptores de estatura menor de 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR&#61;4&#44;260&#44; IC95&#37;&#61;2&#44;292-7&#44;917&#41;&#46; La interacci&#243;n de la estatura con el g&#233;nero no fue significativa&#44; OR &#61; 0&#44;908 &#40;IC95&#37;&#61;0&#44;820-1&#44;005&#41;&#46; En RTH por causa de descompensaci&#243;n de la cirrosis la mortalidad precoz postrasplante es mayor que en los trasplantados por causa tumoral &#40;CHC&#41; &#40;OR&#61;2&#44;998&#44; IC95&#37;&#61;1&#44;418-6&#44;340&#41;&#46; La mortalidad tambi&#233;n se relaciona con la gravedad de la enfermedad &#40;MELD-Na&#44; OR&#61;1&#44;064 por cada punto de incremento con IC95&#37;&#61;1&#44;020-1&#44;111&#41;&#44; pero no solamente por afectaci&#243;n de la funci&#243;n hep&#225;tica &#40;grado C de Child-Pugh&#44; p-valor &#61; ns&#41;&#46; Los RTH que fallecieron presentaban cifras m&#225;s elevadas de creatinemia &#40;OR&#61;2&#44;027&#44; IC95&#37;&#61;1&#44;076-3&#44;821&#41; y uremia &#40;OR&#61;2&#44;096&#44; IC95&#37;&#61;1&#44;130-3&#44;888&#41;&#93;&#44; mayor frecuencia de s&#237;ndrome hepatorrenal previo &#40;OR&#61;2&#44;353&#44; IC95&#37;&#61;1&#44;152-4&#44;805&#41; y de di&#225;lisis pretrasplante &#40;p-valor &#61; 0&#44;615&#41;&#46; Tambi&#233;n hab&#237;an precisado ingreso hospitalario en el mes previo al trasplante en mayor proporci&#243;n &#40;OR&#61;2&#44;469&#44; IC95&#37;&#61;1&#44;207-5&#44;052&#41; o estaban ingresados en UCI en el momento del trasplante &#40;OR&#61;3&#44;866&#44; IC95&#37;&#61;0&#44;0967-15&#44;467&#41;&#46; La diabetes no se comport&#243; como factor de riesgo de mortalidad precoz &#40;p-valor &#61; ns&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El an&#225;lisis bivariante identific&#243; 10 variables explicativas predictoras de mortalidad precoz &#40;p-valor &#8804; 0&#44;10&#41; que fueron incluidas en el an&#225;lisis multivariante&#46; Se excluy&#243; la creatinina por colinealidad y se incluy&#243; la cirug&#237;a previa por criterio cl&#237;nico&#46; Este modelo inicial explica entre el 10&#44;0-20&#44;7&#37; de la varianza total&#44; con un porcentaje global de acierto del 90&#44;3&#37;&#46; Tiene muy elevada especificidad &#40;99&#44;7&#37;&#41; aunque muy baja sensibilidad &#40;6&#44;5&#37;&#41;&#46; Mediante un proceso de regresi&#243;n log&#237;stica atr&#225;s por pasos se obtuvo el modelo final que identific&#243; 3 predictores independientes de mortalidad precoz y un factor de confusi&#243;n &#40;motivo del trasplante&#41; que incrementa en un 27&#37; el coeficiente de regresi&#243;n &#223; de la puntuaci&#243;n MELD-Na&#44; por lo que queda en la ecuaci&#243;n final &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En esta tabla se muestran los predictores independientes tanto globales como para ambos motivos de trasplante&#44; por causa tumoral y por descompensaci&#243;n de la cirrosis&#46; Se obtuvieron las curvas ROC de ambos en comparaci&#243;n con la curva ROC del MELD-Na &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; y la capacidad predictiva de los modelos finales fue comparada con respecto al MELD-Na mediante el test de DeLong &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41; confirm&#225;ndose que el modelo obtenido en los RTH por motivo de descompensaci&#243;n de la cirrosis predice mejor la supervivencia que el MELD-Na de forma significativa &#40;p-valor &#61; 0&#44;003&#41;&#44; mientras que el modelo en RTH trasplantados por CHC no mejora la predicci&#243;n del MELD-Na&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0110" class="elsevierStylePara elsevierViewall">Es conocido que las complicaciones del acto quir&#250;rgico son las que tienen mayor impacto sobre la mortalidad precoz de los RTH<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17&#44;19&#44;20</span></a>&#44; pero generalmente no pueden ser previstas ni controladas antes del trasplante&#46; Por ello&#44; precisamos encontrar predictores pretrasplante que puedan ayudarnos a valorar el riesgo de los candidatos en lista de espera y predecir la mortalidad tras el trasplante&#46; Aunque se han realizado m&#250;ltiples estudios al respecto&#44; los resultados no han sido concluyentes<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#8211;25</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio demuestran la diferente asociaci&#243;n de factores de riesgo de mortalidad y motivo del trasplante &#40;CHC vs&#46; descompensaci&#243;n de la cirrosis&#41; e incluyen a la puntuaci&#243;n MELD-Na como predictor independiente de mortalidad precoz en los RTH por cirrosis descompensada&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Tambi&#233;n confirman los resultados de otros estudios<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">26&#8211;28</span></a> que incluyen la edad mayor de 60 a&#241;os como un factor de riesgo independiente de mortalidad&#44; pero este predictor no tiene valor en los RTH por causa tumoral y solo debiera ser tenido en cuenta en los RTH por descompensaci&#243;n de la cirrosis&#44; lo cual podr&#237;a estar en relaci&#243;n con una mayor comorbilidad en estos pacientes&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hasta donde nuestro conocimiento alcanza&#44; el presente trabajo es pionero en relacionar la estatura del receptor como factor de riesgo independiente de mortalidad&#46; La causa no puede ser conocida por los datos del estudio&#44; pero ser&#237;a razonable asociarlo con una mayor tasa de complicaciones quir&#250;rgicas en relaci&#243;n tanto al menor tama&#241;o del campo quir&#250;rgico como a la mayor probabilidad de disparidad de tama&#241;os donante&#47;receptor del h&#237;gado<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46; En nuestro estudio tambi&#233;n se aprecia esa asociaci&#243;n&#44; mayor proporci&#243;n de donantes varones &#40;60&#44;5&#37;&#41; y mayor mortalidad en mujeres &#40;OR&#61;2&#44;618 con IC95&#37;&#61; 1&#44;413-4&#44;847&#41;&#44; por lo que el g&#233;nero puede comportarse como factor de confusi&#243;n&#46; Sin embargo&#44; en nuestros resultados la estatura sigue siendo significativa cuando fue controlada por el g&#233;nero&#46; Estos resultados no coinciden con los de otros autores<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> y deber&#225; ser validado&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Y finalmente&#44; nuestro estudio demuestra que incluso considerando una importante cantidad de factores pretrasplante &#40;18 variables&#41; no somos capaces de diferenciar de forma significativa a los pacientes que fallecer&#225;n tras el trasplante hep&#225;tico&#44; dado que nuestros modelos muestran escasa sensibilidad&#46; Esto tiene una muy importante implicaci&#243;n en las evaluaciones pretrasplante de los posibles candidatos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Desde el punto de vista cl&#237;nico&#44; es l&#243;gico pensar que aquellos pacientes con mayor disfunci&#243;n hep&#225;tica&#44; mayor grado de hipertensi&#243;n portal y mayor disfunci&#243;n renal &#40;mayor puntuaci&#243;n MELD-Na&#41; tendr&#225;n mayor riesgo perioperatorio&#46; En nuestros pacientes cada incremento de 10 puntos en el MELD-Na increment&#243; la mortalidad un 10&#37; aproximadamente&#46; Pero aunque la puntuaci&#243;n MELD-Na pretrasplante sea un predictor independiente de mortalidad postrasplante precoz&#44; su capacidad predictiva es pobre<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">20&#44;30&#44;31</span></a>&#46; Esto coincide con nuestros resultados&#44; ya que el MELD-Na explica solo entre el 1&#44;7-3&#44;5&#37; de la varianza de la mortalidad precoz &#40;R2 de Cox-Snell y Nagelkerke&#41;&#46; Y por ello&#44; los estudios realizados en pacientes con MELD mayores de 40 puntos no pueden demostrar la futilidad del trasplante en estos pacientes en base solamente a este predictor<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">24&#44;32</span></a>&#46; Por tanto&#44; no podr&#237;amos rechazar la opci&#243;n del trasplante a pacientes con elevada puntuaci&#243;n MELD-Na en base a este par&#225;metro solamente&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Hay que considerar que en nuestro caso la puntuaci&#243;n MELD-Na es obtenida de los datos de laboratorio en el momento del ingreso para el trasplante del paciente y&#44; m&#225;s importante&#44; que se refiere a la capacidad predictiva de mortalidad postrasplante y no de pacientes en lista de espera sin trasplante&#44; por ello la capacidad predictiva del MELD-Na es menor que las cifras publicadas por estos autores<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Adem&#225;s la capacidad predictiva de la mortalidad postrasplante tambi&#233;n disminuye al disgregar el modelo global &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestros datos tienen una debilidad&#44; de la cual somos conscientes tras los resultados del estudio&#44; y es que un predictor tan significativo desde el punto de vista estad&#237;stico &#40;la estatura del receptor&#41; no suele ser medido de forma directa sino que es referido por los pacientes y podr&#237;a tener un sesgo<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#44; aunque este sesgo disminuye al categorizar la variable estatura del receptor en una variable dicot&#243;mica&#46; De todas formas&#44; la pregunta cl&#237;nica es si una diferencia de medianas de 8<span class="elsevierStyleHsp" style=""></span>cm en la estatura de ambos grupos es cl&#237;nicamente relevante o solo estad&#237;sticamente significativa&#46; Para resolverlo precisar&#237;amos corroborar nuestros resultados en otras poblaciones diferentes o haber estudiado a una cohorte de validaci&#243;n&#46; Esta &#250;ltima opci&#243;n no pudo ser realizada dada la baja frecuencia de mortalidad y el consiguiente tama&#241;o muestral&#44; por lo que debe considerarse una limitaci&#243;n de nuestro estudio&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nuestros modelos son simples&#44; homog&#233;neos en sus criterios y est&#225;n centrados en los receptores en lista de espera sin contraindicaciones evidentes &#40;cardiopat&#237;a grave&#44; sepsis activa&#41; para el trasplante&#46; Presentan muy elevada especificidad y valores predictivos negativos&#44; pero tienen muy escasa sensibilidad para diferenciar a los pacientes que no sobreviven al trasplante&#46; Otros estudios que incluyen datos del donante y del proceso quir&#250;rgico tampoco demuestran una mejor predicci&#243;n de mortalidad<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">36&#44;37</span></a>&#46; Por todo ello&#44; pensamos que podr&#237;an ser considerados por los Comit&#233;s de Evaluaci&#243;n de Candidatos como herramientas de valoraci&#243;n del riesgo en pacientes individualizados&#44; aunque teniendo siempre en cuenta que la predicci&#243;n de la mortalidad basada en factores pretrasplante es muy pobre en los casos individuales&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; los modelos obtenidos con los factores pretrasplante estudiados tienen muy bajo valor predictivo positivo y baja capacidad discriminante &#40;AUROC inferior a 0&#44;8&#41;&#44; y por tanto no pueden excluir la posibilidad del trasplante a ninguno de los candidatos&#44; dado que no son capaces de clasificar con seguridad a los pacientes que fallecer&#225;n en el periodo postrasplante precoz&#46; Pero estos predictores pueden ayudar a los Comit&#233;s de Evaluaci&#243;n de Candidatos a valorar el riesgo de mortalidad de los candidatos en base al motivo del trasplante &#40;CHC o no-CHC&#41; y en consecuencia intentar minimizar otros factores de riesgo&#46; Los RTH por causa tumoral &#40;CHC&#41; tienen mayor riesgo de mortalidad precoz si su estatura es inferior a 163<span class="elsevierStyleHsp" style=""></span>cm&#46; Los RTH por causa de cirrosis descompensada tienen mayor riesgo de mortalidad precoz cuanto m&#225;s elevada sea su puntuaci&#243;n MELD-Na&#44; si su edad es mayor de 60 a&#241;os y si su estatura es inferior a 163<span class="elsevierStyleHsp" style=""></span>cm&#44; y este modelo predice la supervivencia significativamente mejor que el MELD-Na de forma aislada&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Autor&#237;a&#47;colaboradores</span><p id="par0160" class="elsevierStylePara elsevierViewall">JCPL y MRP han contribuido al dise&#241;o del estudio y la selecci&#243;n de los criterios de inclusi&#243;n y exclusi&#243;n&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">MCMV&#44; JCPL y MRP han contribuido a la realizaci&#243;n del estudio estad&#237;stico&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">JCPL&#44; FRE&#44; JMT e IDG han contribuido en el registro de datos&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">JCPL es responsable del manuscrito&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Todos los autores son responsables de la revisi&#243;n final&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar predictores pretrasplante de mortalidad precoz &#40;90 d&#237;as postrasplante&#41; y evaluar su capacidad discriminante en receptores adultos de trasplante hep&#225;tico &#40;RTH&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; retrospectivo&#44; de casos y controles anidados sobre una cohorte consecutiva de RTH&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hospital Universitario&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2003 a diciembre de 2016&#44; todos los receptores adultos de trasplante hep&#225;tico fueron elegibles para inclusi&#243;n&#46; Fueron excluidos los RTH por fallo hep&#225;tico agudo&#44; disfunci&#243;n de un injerto previo&#44; trasplante simult&#225;neo de &#243;rganos&#44; de donantes en asistolia&#44; y aquellos que precisaron retrasplante durante el periodo de estudio&#46; Para el an&#225;lisis se incluyeron 471 pacientes&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Principales variables de inter&#233;s</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas pretrasplante fueron las variables de inter&#233;s&#46; Los RTH fueron agrupados de acuerdo con la variable dependiente &#40;mortalidad precoz&#41;&#46; Los predictores se obtuvieron mediante an&#225;lisis multivariante de regresi&#243;n log&#237;stica&#46; La capacidad discriminante de los modelos obtenidos se evalu&#243; mediante comparaci&#243;n de curvas ROC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se identificaron como predictores independientes de mortalidad precoz&#58; la puntuaci&#243;n MELD-Na &#40;OR&#61;1&#44;069&#59; IC95&#37;&#61;1&#44;014-1&#44;127&#41;&#44; la edad mayor de 60 a&#241;os &#40;OR&#61;2&#44;479&#59; IC95&#37;&#61; 1&#44;226-5&#44;015&#41;&#44; y la estatura del RTH inferior a 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR&#61;4&#44;092&#59; IC95&#37;&#61;2&#44;115-7&#44;917&#41;&#44; consider&#225;ndose el motivo del trasplante &#40;carcinoma hepatocelular o cirrosis descompensada&#41; como variable de confusi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En los RTH por cirrosis descompensada&#44; la puntuaci&#243;n MELD-Na&#44; la edad mayor de 60 a&#241;os y la estatura del receptor inferior a 163<span class="elsevierStyleHsp" style=""></span>cm son predictores independientes de mortalidad precoz&#46; Esos predictores producen un modelo que clasifica a los pacientes significativamente mejor que el MELD-Na en relaci&#243;n con la mortalidad precoz&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Aims</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To identify pretransplant predictors of early mortality &#40;90 days after transplantation&#41; and evaluate their discriminating capacity in adult liver transplant recipients &#40;LTR&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; retrospective&#44; nested cases-controls study from a consecutive cohort of LTRs was carried out&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">University hospital&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All consecutive LTR between January 2003 and December 2016 were eligible for inclusion&#46; Patients with acute liver failure&#44; previous graft dysfunction&#44; simultaneous multiple organ transplantation&#44; non-heart beating donors&#44; and those needing urgent retransplantation during the study period were excluded&#46; The analysis comprised 471 patients&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Main variables of interest</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pretransplant characteristics were the main variables of interest&#46; The LTR were grouped according to the dependent variable &#40;early mortality&#41;&#46; Multivariate logistic regression analysis was conducted to identify predictors of early mortality&#46; The discriminating capacity of the models obtained was evaluated by comparing ROC curves &#40;models versus MELD-Na&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The MELD-Na score &#40;OR &#61; 1&#46;069&#44; 95&#37; <span class="elsevierStyleSmallCaps">C</span>I &#61; 1&#46;014-1&#46;127&#41;&#44; age &#62; 60 years &#40;OR &#61; 2&#46;479&#44; 95&#37; CI &#61; 1&#46;226-5&#46;015&#41;&#44; and LTR height &#60; 163<span class="elsevierStyleHsp" style=""></span>cm &#40;OR &#61; 4&#46;092&#44; 95&#37; CI &#61; 2&#46;115-7&#46;917&#41; were identified as independent predictors of early mortality&#46; The cause of transplantation &#40;hepatocellular carcinoma or decompensated cirrhosis&#41; was identified as a confounding factor&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In LTR due to decompensated cirrhosis&#44; the MELD-Na score&#44; age &#62; 60 years&#44; and height &#60; 163<span class="elsevierStyleHsp" style=""></span>cm are independent predictors of early mortality&#46; These factors provide a better classification model than the MELD-Na score for early post-transplant mortality&#46;</p></span>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio de predictores pretrasplante de mortalidad precoz en receptores adultos de trasplante hep&#225;tico&#46; Criterios de inclusi&#243;n y exclusi&#243;n&#46;</p>"
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                  \t\t\t\t">252 &#40;59&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uremia &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>G&#233;nero mujer &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;40&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peso &#62; 86 kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;24&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Talla &#60; 163 cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93 &#40;22&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;55&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;260&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;292-7&#44;917&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#62; 30 kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">104 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;27&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Motivo del trasplante hep&#225;tico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CHC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">170 &#40;40&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;18&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Descompensaciones de la cirrosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">252 &#40;59&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;81&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;998&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;418-6&#44;340&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gravedad de la enfermedad hep&#225;tica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Child-Pugh estadio C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">173 &#40;41&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;48&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MELD-Na&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#44;0 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#44;5 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;064&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;020-1&#44;111&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades previas al trasplante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">119 &#40;28&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinemia &#62; 1&#44;1 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;20&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;34&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;027&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;076-3&#44;821&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Uremia &#62; 48 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">97 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;38&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;096&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;130-3&#44;888&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIPS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome hepatorrenal o terlipresina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;152-4&#44;805&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Di&#225;lisis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a supramesoc&#243;lica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ingreso hospitalario previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;469&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;207-5&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ingreso en UCI previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Evaluaci&#243;n de los predictores pretrasplante de mortalidad precoz postrasplante hep&#225;tico&#46; An&#225;lisis bivariante &#40;N&#61;471&#41;</p>"
        ]
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      4 => array:8 [
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">CHC&#58; carcinoma hepatocelular&#59; IC95&#37;&#58; intervalo de confianza al 95&#37;&#59; MELD-Na&#58; Mayo End-Liver Disease score&#59; OR&#58; odds ratio&#59; RTH&#58; receptores de trasplante hep&#225;tico&#46;</p>"
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            0 => array:2 [
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                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="\n
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                  \t\t\t\t  " colspan="5" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final global &#40;N &#61; 456&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;917&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad mayor de 60 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirrosis descompensada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049106.png"
              ]
            ]
            1 => 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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final para pacientes RTH por causa de CHC &#40;N &#61; 171&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049109.png"
              ]
            ]
            2 => 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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo final para pacientes RTH por causa de cirrosis descompensada &#40;N &#61; 285&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37; para OR</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatura menor de 163 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;581&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;711&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad mayor de 60 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;269&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;376&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049104.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Predictores pretrasplante independientes de mortalidad precoz postrasplante hep&#225;tico&#46; An&#225;lisis de regresi&#243;n log&#237;stica multivariante&#58; Modelos finales</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">AUC &#225;rea bajo la curva&#59; CHC&#58; carcinoma hepatocelular&#59; IC95&#37; intervalo de confianza al 95&#37;&#59; N&#58; tama&#241;o de la muestra&#59; P&#58; probabilidad&#59; &#37; porcentaje&#46;</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo de pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comparaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fallecidos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Supervivientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AUC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diferencia entre &#225;reas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cohorte</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modelo global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">456</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#40;10&#44;09&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">410&#40;89&#44;91&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;767&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;726 - 0&#44;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">0&#44;158</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">0&#44;068 &#8211; 0&#44;246</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">0&#44;0005</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">MELD-Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;563 - 0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">CHC</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Modelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">171</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">8&#40;4&#44;68&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">163&#40;95&#44;32&#37;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">0&#44;161</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de las curvas ROC mediante el test de DeLong</p>"
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                    0 => array:2 [
                      "titulo" => "3-month and 12-month mortality after first liver transplant in adults in Europe&#58; predictive models for outcome"
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                        0 => array:2 [
                          "etal" => true
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                            0 => "A&#46;K&#46; Burroughs"
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                            2 => "K&#46; Rolles"
                            3 => "V&#46; Delvart"
                            4 => "V&#46; Karam"
                            5 => "J&#46; Buckels"
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(06)68033-1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de consenso de la Sociedad Espa&#241;ola de Trasplante Hep&#225;tico"
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                        0 => array:2 [
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                        "link" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                        0 => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1016/j.mcna.2015.12.002"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Model for end-stage liver disease-sodium score&#58; The evolution in the prioritization of liver transplantation"
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                    0 => array:2 [
                      "titulo" => "A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            3 => "C&#46;J&#46; Peine"
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                    0 => array:2 [
                      "titulo" => "The new liver allocation system&#58; moving toward evidence-based transplantation policy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;B&#46; Freeman Jr&#46;"
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                            2 => "A&#46; Harper"
                            3 => "S&#46;V&#46; McDiarmid"
                            4 => "J&#46; Lake"
                            5 => "E&#46; Edwards"
                          ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1053/jlts.2002.35927"
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                        "fecha" => "2002"
                        "volumen" => "8"
                        "paginaInicial" => "851"
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                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "When the patient is sicker than his liver"
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                          "etal" => false
                          "autores" => array:5 [
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                            1 => "G&#46; Dhonneur"
                            2 => "C&#46; Feray"
                            3 => "C&#46; Lim"
                            4 => "D&#46; Azoulay"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0000000000000725"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Surg&#46;"
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                        "volumen" => "262"
                        "paginaInicial" => "e93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26559781"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing prioritization for transplantation&#58; MELD-Na&#44; hepatocellular carcinoma exceptions&#44; and more"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "J&#46;P&#46; Wedd"
                            2 => "S&#46;W&#46; Biggins"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOT.0000000000000281"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Organ Transplant&#46;"
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                        "volumen" => "21"
                        "paginaInicial" => "120"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            2 => "L&#46;L&#46; Chavez"
                            3 => "V&#46;I&#46; Descalzi"
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                            5 => "F&#46;G&#46; Villamil"
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                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Liver Transpl&#46;"
                        "fecha" => "2005"
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                        "paginaInicial" => "336"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
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                            2 => "W&#46;K&#46; Kremers"
                            3 => "R&#46;H&#46; Wiesner"
                            4 => "P&#46;S&#46; Kamath"
                            5 => "J&#46;T&#46; Benson"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0801209"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
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