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determinar la frecuencia y el tipo de dichas decisiones&#44; as&#237; como analizar los factores asociados a la mortalidad hospitalaria de dichos pacientes&#44; realizando el seguimiento de los enfermos hasta los 90 d&#237;as de hospitalizaci&#243;n&#44; el momento del alta hospitalaria o el fallecimiento de este&#44; aquello que ocurriese primero&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Material y m&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Dise&#241;o del estudio</span><p id="par0020" class="elsevierStylePara elsevierViewall">ADENI-UCI es un estudio prospectivo&#44; observacional y multic&#233;ntrico&#46; El registro de enfermos se abri&#243; en febrero de 2018&#59; el primer paciente fue reclutado el 07 de febrero&#44; el &#250;ltimo lo hizo el 18 de marzo de 2019&#46; El periodo de seguimiento concluy&#243; 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Se entendi&#243; como medida de LTSV aquella decisi&#243;n de no ingreso tomada por el intensivita que valoraba al paciente&#44; apoyada en uno&#44; o combinaci&#243;n de algunos&#44; de las siguientes opciones&#58; la edad avanzada del enfermo&#44; la presencia de una enfermedad cr&#243;nica grave&#44; la limitaci&#243;n funcional previa del paciente&#44; una pobre calidad de vida estimada&#44; la futilidad de los tratamientos&#44; la existencia de un testamento vial o unas voluntades anticipadas que as&#237; lo justificasen o la propia negativa del enfermo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Asimismo&#44; se reclutaron las paradas cardiacas intrahospitalarias en las que se decidi&#243; finalizar la reanimaci&#243;n como medida de LTSV&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Recogida de datos y variables de estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">Para la recogida de los datos se elabor&#243; una hoja de registro en papel que inclu&#237;a las variables del estudio&#46; Dicho formulario posteriormente se transcrib&#237;a a un formato electr&#243;nico para la elaboraci&#243;n de un registro &#250;nico de todos los centros&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables analizadas inclu&#237;an datos cl&#237;nico-demogr&#225;ficos de los pacientes valorados &#40;edad&#44; sexo&#44; residencia habitual&#44; comorbilidades asociadas &#91;material electr&#243;nico suplementario&#93;&#44; situaci&#243;n funcional previa medida por la escala KNAUS<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> y Karnosfky<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a>&#44; motivo de ingreso hospitalario&#44; ingresos hospitalarios previos e ingresos en UCI&#41;&#59; variables relacionadas con la consulta efectuada &#40;horario&#44; ubicaci&#243;n del enfermo en el momento de realizar la consulta&#44; consultor&#44; motivo de consulta &#91;material electr&#243;nico suplementario&#93; y tiempo transcurrido desde el ingreso hasta el momento de la consulta&#44; escalas pronosticas de Lee<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> y Charlson<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#41;&#59; variables relacionadas con la decisi&#243;n de no ingreso adoptada &#40;gravedad del enfermo medida por las escalas APACHE II<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> y SOFA<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#44; facultativo que toma la decisi&#243;n y a&#241;os de experiencia laboral&#44; momento y motivo que justifica la toma de la decisi&#243;n&#44; persona a la cual es trasmitida la informaci&#243;n &#91;familiar o paciente&#93;&#44; grado de acuerdo y registro de la misma en la historia cl&#237;nica&#41;&#59; y variables evolutivas &#40;fecha de alta o fallecimiento intrahospitalario&#44; destino al alta hospitalaria&#44; si se produjo cambio en la decisi&#243;n de no ingreso y motivo de este&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Seguimiento de los enfermos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; el seguimiento de los enfermos hasta los 90 d&#237;as de hospitalizaci&#243;n&#44; el momento del alta hospitalaria o el fallecimiento de este&#44; aquello que ocurriese primero&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio recibi&#243; la aprobaci&#243;n del Comit&#233; de &#201;tico de Investigaci&#243;n Cl&#237;nica &#40;CEIC&#41; del centro promotor&#46; Posteriormente se facilit&#243; la documentaci&#243;n necesaria para que cada centro participante hiciese lo propio en sus respectivos CEIC&#44; garantizando que todos los centros participantes tuviesen la aprobaci&#243;n de los mismos antes de su iniciaci&#243;n en el estudio&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se obtuvo el aval del Comit&#233; Cient&#237;fico de la Sociedad Espa&#241;ola de Medicina Intensiva y Unidades Coronarias &#40;SEMICYUC&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Estudio estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la muestra&#46; Los resultados se presentan en forma de porcentaje para las variables categ&#243;ricas&#44; y como media y desviaci&#243;n est&#225;ndar para las variables cuantitativas continuas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis de asociaci&#243;n de las diferentes variables recogidas y la mortalidad intrahospitaria con un m&#225;ximo de seguimiento de 90 d&#237;as&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para llevar a cabo dicho an&#225;lisis se realiz&#243; una regresi&#243;n log&#237;stica multinivel anidada en tres niveles&#46; Como los pacientes ingresados en el mismo hospital y los hospitales de la misma provincia suelen compartir procedimientos y protocolos similares respectivamente&#44; no pudimos asumir la independencia entre pacientes&#44; por lo tanto&#44; el an&#225;lisis se realiz&#243; utilizando regresi&#243;n log&#237;stica multinivel con tres niveles anidados&#58; provincia&#44; hospital y paciente&#46; En resumen&#44; la regresi&#243;n log&#237;stica habitual modela la relaci&#243;n entre una exposici&#243;n variable&#44; por ejemplo&#44; la puntuaci&#243;n APACHE y la probabilidad de morir como&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0080" class="elsevierStylePara elsevierViewall">donde P&#40;y<span class="elsevierStyleInf">i</span>&#41; es la probabilidad de morir por el paciente <span class="elsevierStyleInf">i</span>&#59; edad&#44; sexo y SOFA toman valores para cada paciente y es un error aleatorio&#46; En esta f&#243;rmula&#44; el logaritmo natural de la relaci&#243;n de probabilidades de morir por cada punto adicional en la puntuaci&#243;n APACHE&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sin embargo&#44; la regresi&#243;n log&#237;stica requiere independencia entre observaciones&#46; Como no se puede suponer en nuestro estudio&#44; realizamos un an&#225;lisis de regresi&#243;n log&#237;stica multinivel con tres niveles anidados&#58; provincia&#44; hospital y paciente&#46; En este caso&#44; la relaci&#243;n entre APACHE y la probabilidad de morir incluye tres errores aleatorios&#44; uno para cada nivel de an&#225;lisis&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0090" class="elsevierStylePara elsevierViewall">donde u<span class="elsevierStyleInf">j</span> es el error aleatorio para la interceptaci&#243;n debido a provincia y v<span class="elsevierStyleInf">k</span> es el error aleatorio para la interceptaci&#243;n debido al hospital&#46; La interpretaci&#243;n de &#946; par&#225;metros es la misma que antes&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados de dicho an&#225;lisis de asociaci&#243;n se presentan como <span class="elsevierStyleItalic">Odds Ratios</span> con IC 95&#37; ajustados por edad&#44; sexo&#44; APACHE II y escala SOFA&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">El programa estad&#237;stico utilizado fue stata en su versi&#243;n 15&#46;1&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Durante el mismo estudio fueron recogidas 2&#46;312 decisiones de no ingreso en UCI como medida de LTSV&#44; de 62 centros participantes&#46; Las caracter&#237;sticas de los centros y servicios participantes &#40;cinco de ellos no facilitaron dichos datos&#41; se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Despu&#233;s de la revisi&#243;n de las mismas&#44; fueron eliminadas 28 de ellas por errores en la recogida de datos&#46; Finalmente se analizaron un total de 2&#46;284 registros&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Las principales variables cl&#237;nico-epidemiol&#243;gicas de la muestra de pacientes analizados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Variables relacionadas con la consulta al SMI</span><p id="par0115" class="elsevierStylePara elsevierViewall">La consulta al SMI se realiz&#243; en 1&#46;064 ocasiones en la franja horaria comprendida entre las 15&#58;00 y las 23&#58;59 horas &#40;47&#37;&#41;&#44; realiz&#225;ndose 1&#46;124 veces desde las urgencias hospitalarias &#40;49&#37;&#41; por el m&#233;dico de guardia en 1&#46;117 &#40;49&#37;&#41;&#46; El principal motivo de consulta fue la insuficiencia respiratoria &#40;n &#61; 1&#46;080 &#91;47&#37;&#93;&#41;&#44; seguido de la alteraci&#243;n del nivel de conciencia &#40;n &#61; 911 &#91;40&#37;&#93;&#41; y la inestabilidad hemodin&#225;mica &#40;n &#61; 741 &#91;32&#37;&#93;&#41;&#46; La valoraci&#243;n por el servicio de medicina intensiva se realiz&#243; en la mayor&#237;a de las ocasiones por el m&#233;dico de guardia &#40;n &#61; 1&#46;825 &#91;81&#37;&#93;&#41;&#44; con una experiencia laboral entre los seis y los 15 a&#241;os &#40;n &#61; 1&#46;040 &#91;46&#37;&#93;&#41;&#46; En el momento de la valoraci&#243;n&#44; el APACHE II medio fue de 20&#44;38 &#40;&#177; 8&#44;52&#41; y el SOFA medio de 5&#44;99 &#40;&#177; 3&#44;97&#41;&#46; El &#237;ndice de Lee medio fue de 12&#44;73 &#40;&#177; 4&#44;07&#41; y el &#237;ndice de Charlson de 6&#44;69 &#40;&#177; 2&#44;63&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Motivos de decisi&#243;n de no-ingreso en UCI</span><p id="par0120" class="elsevierStylePara elsevierViewall">La decisi&#243;n de no ingreso en UCI se tom&#243; en una primera valoraci&#243;n casi en la totalidad de las ocasiones &#40;n &#61; 2&#46;127 &#91;93&#37;&#93;&#41;&#46; Fueron la pobre calidad de vida estimada de los enfermos &#40;n &#61; 1417 &#91;62&#37;&#93;&#41;&#44; la presencia de una enfermedad cr&#243;nica grave &#40;n &#61; 1&#46;367 &#91;60&#37;&#93;&#41; y la limitaci&#243;n funcional previa de los pacientes &#40;n &#61; 1&#46;270 &#91;56&#37;&#93;&#41;&#44; los principales motivos empleados en la toma de la decisi&#243;n de no ingreso como medida de LTSV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Variables relacionadas con la evoluci&#243;n posterior a la negaci&#243;n de ingreso en UCI&#58;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se inici&#243; sedaci&#243;n terminal en 484 &#40;21&#37;&#41; de las ocasiones una vez tomada la decisi&#243;n de no ingresar en UCI&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El paciente fue informado de la decisi&#243;n en 368 ocasiones &#40;16&#37;&#41;&#44; mientras que la familia fue informada en 1&#46;716 &#40;75&#37;&#41;&#46; La decisi&#243;n fue registrada en la historia cl&#237;nica del enfermo en la mayor&#237;a de las ocasiones &#40;n &#61; 2&#46;046 &#91;90&#37;&#93;&#41;&#46; De los pacientes que no fueron informados de la decisi&#243;n de no ingreso en UCI como LTSV &#40;n &#61; 1&#46;700 &#91;81&#37;&#93;&#41;&#44; tan solo en un 46&#37; &#40;n &#61; 780&#41; el motivo de consulta era la alteraci&#243;n del nivel de conciencia&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se evidenci&#243; desacuerdo con la decisi&#243;n adoptada por parte de la familia en 54 &#40;2&#37;&#41; de las ocasiones y con el m&#233;dico consultor en 138 &#40;6&#37;&#41;&#46; &#218;nicamente en 71 &#40;3&#37;&#41; ocasiones se produjo un posterior ingreso en UCI una vez tomada la decisi&#243;n&#46; De estos&#44; el 40&#37; fueron pacientes con criterio de ingreso para cuidados orientados a la donaci&#243;n de &#243;rganos&#46; Seguidos por aquellos ingresos motivados por presi&#243;n de servicios externos&#44; en un 18&#37;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">El destino al alta hospitalaria fue al domicilio en un 65&#37; de las ocasiones y en el 20&#37; los pacientes fueron dados de alta a un hospital de cr&#243;nicos&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lisis de mortalidad</span><p id="par0150" class="elsevierStylePara elsevierViewall">Una vez rechazado el ingreso en UCI como medida de LTSV&#44; la mortalidad hospitalaria a los 90 d&#237;as&#44; de la poblaci&#243;n estudiada fue del 60&#44;33&#37;&#46; La asociaci&#243;n a mortalidad de las principales variables cl&#237;nico-epidemiol&#243;gicas de los enfermos se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Las peticiones de valoraci&#243;n realizada desde los servicios de urgencias se asociaron a una menor mortalidad &#40;OR&#58; 0&#44;63&#59; IC 95&#37;&#58; 0&#44;52-0&#44;76&#41;&#44; teniendo como referencia las consultas realizadas desde las plantas de hospitalizaci&#243;n convencional&#46; Al margen de las paradas cardiorespiratorias interrumpidas considerando el cese una maniobra de LTSV&#44; la consulta por alteraci&#243;n del nivel de conciencia fue el motivo que present&#243; una mayor asociaci&#243;n a mortalidad &#40;OR&#58; 1&#44;76&#59; IC 95&#37;&#58; 1&#44;44-2&#44;15&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">La gravedad de los pacientes en el momento de la consulta&#44; valorada por la escala APACHE II y SOFA&#44; se asoci&#243; a mayor mortalidad &#40;OR&#58;1&#44;07 &#91;1&#44;05-1&#44;08&#93; p 0&#44;000 y OR&#58; 1&#44;28 &#91;1&#44;24-1&#44;33&#93; p 0&#44;000&#44; respectivamente&#41; por cada punto de incremento&#46; Como se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; la futilidad del tratamiento fue el motivo de no ingreso en UCI que present&#243; mayor fuerza de asociaci&#243;n a mortalidad intrahospitalaria &#40;OR&#58; 3&#44;23&#59; IC 95&#37;&#58; 2&#44;62-3&#44;99&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en supervivencia al analizar el facultativo que realizaba la valoraci&#243;n&#44; atendiendo a la localizaci&#243;n f&#237;sica del mismo &#40;unidad de destino&#44; Servicio Extendido de Cuidados Intensivos &#91;SECI&#93; o m&#233;dico de guardia&#41; ni atendiendo a los a&#241;os de experiencia&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El tiempo transcurrido desde el ingreso hospitalario del enfermo hasta la valoraci&#243;n por parte del servicio de medicina intensiva fue significativamente mayor en los enfermos que posteriormente fallecieron &#40;7&#44;04 &#91;0&#44;54&#93; frente a 3&#44;58 &#91;0&#44;67&#93; d&#237;as p &#60; 0&#44;000&#59; OR&#58;1&#44;02 &#91;1&#44;01-1&#44;03&#93; p &#60; 0&#44;001&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nuestro trabajo analiza las decisiones de rechazar el ingreso en UCI como medida de LTSV&#44; a trav&#233;s de m&#225;s de 2000 registros en 62 UCI de nuestro pa&#237;s&#46; Se trata del primer trabajo en tener un enfoque sistem&#225;tico y exclusivo en este campo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En los resultados del trabajo destaca la baja tasa de mortalidad intrahospitalaria encontrada a 90 d&#237;as&#44; pr&#243;xima al 60&#37;&#44; entre aquellos pacientes para quienes el ingreso en la UCI se denegaba como medida de LTSV&#46; Resulta dif&#237;cil la comparaci&#243;n con estudios previos que analizaron las decisiones de no ingreso en UCI en aquellos pacientes que se encontraban en una situaci&#243;n demasiado grave como para beneficiarse del mismo&#44; pero en estos se hallaron tasas de mortalidad entre el 80&#37; y el 100&#37;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">16&#8211;19</span></a>&#46; No obstante&#44; nuestra alta supervivencia no puede descartar que estos enfermos que sobreviven sean pacientes libres de discapacidad o que presenten una progresi&#243;n de su limitaci&#243;n funcional&#46; De hecho&#44; hasta un 20&#37; de los pacientes que fueron dados de alta hospitalaria&#44; lo hicieron con destino a un hospital de cr&#243;nicos&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Por otro lado&#44; nuestra poblaci&#243;n presenta una edad media mayor que otros trabajos de similares caracter&#237;sticas<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20&#8211;23</span></a> y s&#243;lo 7&#44;4&#37; no ten&#237;an limitaci&#243;n alguna por enfermedad&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">En este sentido&#44; los resultados obtenidos al estudiar el beneficio de ingresar o rechazar al paciente anciano cr&#237;ticamente enfermo en una UCI son discordantes<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a>&#46; Aunque&#44; como reflejan nuestros datos&#44; la edad es un factor asociado a mayor mortalidad intrahospitalaria despu&#233;s de rechazar el ingreso&#59; se ha supuesto que la fragilidad puede resultar un predictor m&#225;s robusto de vulnerabilidad y &#171;recuperabilidad&#187; que la edad cronol&#243;gica por s&#237; misma&#44; sobre todo en el contexto de una enfermedad grave<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">El estudio FRAIL-ICU remarc&#243; la asociaci&#243;n entre mortalidad y fragilidad en los pacientes cr&#237;ticos&#46; Estos enfermos presentaron un mayor n&#250;mero de decisiones de LTSV dentro de la UCI<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a>&#46; Este dato podr&#237;a sugerir que estos enfermos fr&#225;giles&#44; menos expuestos que presentan menor riesgo de mortalidad&#44; pudiera deberse simplemente&#44; por evitar factores intr&#237;nsecos de la UCI que pudieran empeorar su pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Asimismo&#44; y aunque no hay publicaciones que permitan comparar estos resultados&#44; en el presente trabajo el porcentaje de pacientes propuestos desde urgencias para su ingreso en UCI y limitados&#44; presenta una mortalidad significativamente menor que los propuestos para ingreso en UCI y limitados desde planta&#46; Este porcentaje de pacientes de urgencias con posibilidad de mejor&#237;a cl&#237;nica al ser la valoraci&#243;n inicial puede explicar&#44; en parte&#44; la baja mortalidad&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Atendiendo a nuestros resultados&#44; los motivos adoptados por el intensivista para negar el ingreso en UCI como medida de LTSV&#44; no difieren significativamente a las decisiones de LTSV descritas al ingreso en UCI en nuestro entorno&#44; donde los m&#225;s frecuentes son&#58; la presencia de una enfermedad cr&#243;nica severa previa&#44; el respeto a las voluntades anticipadas del paciente&#44; la limitaci&#243;n funcional previa y la futilidad cualitativa<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a>&#46; Del mismo modo&#44; recientemente el estudio INSTINCT evidenci&#243; que la imposibilidad de recuperar la autonom&#237;a&#44; la presencia de una enfermedad cr&#243;nica en estado avanzado y la pobre calidad de vida&#44; eran las principales razones esgrimidas para considerar un ingreso en UCI como no beneficioso<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">&#218;nicamente el 16&#37; de los enfermos reclutados fueron informados de la toma de dicha decisi&#243;n&#46; Es cierto que en el enfermo grave se dan con frecuencia situaciones que dificultan o impiden una participaci&#243;n completa del paciente en el proceso<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>&#46; Pero hay que valorar que la calidad de vida percibida en los supervivientes a&#241;osos de un ingreso en UCI&#44; como es el caso de nuestra cohorte de pacientes&#44; no es diferente a la de los grupos de edad m&#225;s j&#243;venes&#59; y que esta aumenta con el tiempo a pesar de una disminuci&#243;n en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">En tres de cada cuatro ocasiones la decisi&#243;n se consensu&#243; con los familiares o representantes&#46; Sin embargo&#44; se han realizado estudios que demuestran que la opini&#243;n de los familiares no es un fiel reflejo de los deseos del paciente<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#44; e incluso que aqu&#233;llos llegan a desconocer c&#243;mo desear&#237;a este que se tomara la decisi&#243;n<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#46; De hecho&#44; el grado de concordancia entre la decisi&#243;n del paciente y la de sus familiares en un caso hipot&#233;tico es cercano al 70&#37;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#46; Asimismo&#44; el pron&#243;stico que los familiares consideran no se basa solo en la informaci&#243;n recibida del equipo m&#233;dico&#44; sino tambi&#233;n en otros imponderables como la fortaleza del paciente&#44; su historia de sobreponerse a las enfermedades&#44; la impresi&#243;n que les ocasiona el aspecto del paciente&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Este estudio tiene varias limitaciones&#46; En primer lugar&#44; las UCI no fueron seleccionadas al azar&#44; sino que eran voluntarias&#46; En segundo lugar&#44; existe una variabilidad de criterios entre los profesionales en cuanto a la decisi&#243;n de admitir un paciente UCI&#46; En tercer lugar&#44; el per&#237;odo de estudio de seis meses puede no ser representativo de los procedimientos de triaje a lo largo de cada UCI&#44; causando potencialmente sesgo derivado de la estacionalidad de ciertas patolog&#237;as&#46; Sin embargo&#44; creemos que el gran n&#250;mero de centros participantes y la duraci&#243;n total del estudio reflejan adecuadamente la pr&#225;ctica diaria en las UCI espa&#241;olas&#46; En cuarto lugar&#44; es posible que se haya producido alguna p&#233;rdida de registro de decisiones no recogidas como tales &#40;fines de semana&#44; periodos vacacionales&#8230;&#41;&#46; Otros posibles sesgos del estudio como el registro variable de casos&#44; la ausencia de protocolos homog&#233;neos&#44; la diferencia en el seguimiento proactivo o a demanda de los enfermos&#44; as&#237; como el diferente nivel de implicaci&#243;n de los distintos hospitales&#44; pueden considerarse parcial o totalmente resueltos con el an&#225;lisis estad&#237;stico efectuado&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Podemos concluir que una de las mayores fortalezas del estudio actual es el gran n&#250;mero de decisiones que se han registrado&#46; Esto permite destacar que las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos criterios que las decisiones tomadas dentro de la UCI y que en la mayor&#237;a de los casos este rechazo no conduce a la muerte de los pacientes&#46; Esto lleva a la hip&#243;tesis de que el factor decisivo para negar el ingreso no era la gravedad de la enfermedad por s&#237; sola&#44; sino que pudiese estar influenciado por el procedimiento y las comorbilidades en el momento de la valoraci&#243;n&#46; Por otro lado&#44; nos gustar&#237;a subrayar la viabilidad de las evaluaciones realizadas por los m&#233;dicos de cuidados intensivos en t&#233;rminos de futilidad terap&#233;utica y la asociaci&#243;n con la muerte posterior&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Contribuci&#243;n de los autores</span><p id="par0230" class="elsevierStylePara elsevierViewall">Concepci&#243;n y el dise&#241;o del estudio&#44; la adquisici&#243;n de datos&#58; Patricia Escudero Acha&#44; Alejandro Gonzalez Castro&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">An&#225;lisis estad&#237;stico&#58; Ines Gomez Acebo</p><p id="par0240" class="elsevierStylePara elsevierViewall">Adquisici&#243;n de datos&#58; Patricia Escudero Acha&#44; Oihana Leizaola&#44; Noelia L&#225;zaro&#44; M&#243;nica Cordero&#44; Ana Mar&#237;a Coss&#237;o&#44; Daniel Ballesteros&#44; Paula Recena&#44; Ana Isabel Tiz&#243;n&#44; Manuel Palomo&#44; Maite Misis del Campo&#44; Santiago Freita&#44; Jorge Duerto&#44; Naia Mas Bilbao&#44; Barbara Vidal&#44; Domingo Gonz&#225;lez Romero&#44; Francisco Diaz Dominguez&#44; Jaume Revuelto&#44; Maria Luisa Blasco&#44; Monica Domezain&#44; M&#170; de la Concepci&#243;n Pav&#237;a Pesquera&#44; Olga Rubio&#44; Angel Estella&#44; Angel Pobo&#44; Alejandro Gonz&#225;lez-Castro&#59; ADENI Study Group</p><p id="par0245" class="elsevierStylePara elsevierViewall">Borrador del art&#237;culo o la revisi&#243;n cr&#237;tica del contenido intelectual y la aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#58; Alejandro Gonzalez Castro&#44; Patricia Escudero Acha&#44; Angel Estela&#44; Angel Pobo&#44; Olga Rubio&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Financiaci&#243;n</span><p id="par0250" class="elsevierStylePara elsevierViewall">El presente manuscrito no ha recibido financiaci&#243;n alguna&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicto de intereses</span><p id="par0255" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos &#40;UCI&#41; como medida de limitaci&#243;n de tratamiento de soporte vital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospectivo&#44; multic&#233;ntrico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sesenta y dos UCI de Espa&#241;a entre febrero de 2018 y marzo de 2019&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mayores de 18 a&#241;os a los que se les neg&#243; el ingreso a una UCI como medida de limitaci&#243;n de tratamiento de soporte vital&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Intervenciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables de inter&#233;s principals</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comorbilidades de los pacientes&#44; situaci&#243;n funcional previa medida por la escala KNAUS y Karnosfky&#59; escalas pron&#243;sticas de Lee y Charlson&#59; gravedad del enfermo medida por las escalas APACHE II y SOFA&#44; motivo que justifica la toma de la decisi&#243;n&#44; persona a la cual es trasmitida la informaci&#243;n&#59; fecha de alta o fallecimiento intrahospitalario&#44; destino al alta hospitalaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se registraron un total de 2&#46;312 decisiones de no ingreso como medida de limitaci&#243;n del tratamiento de soporte vital &#40;LTSV&#41;&#44; de las cuales se analizaron 2&#46;284&#46; El principal motivo de consulta fue la insuficiencia respiratoria &#40;1&#46;080 &#91;47&#44;29&#37;&#93;&#41;&#46; La pobre calidad de vida estimada de los enfermos &#40;1&#46;417 &#91;62&#44;04&#37;&#93;&#41;&#44; la presencia de una enfermedad cr&#243;nica grave &#40;1&#46;367 &#91;59&#44;85&#37;&#93;&#41; y la limitaci&#243;n funcional previa de los pacientes &#40;1&#46;270 &#91;55&#44;60&#37;&#93;&#41; fueron los principales motivos esgrimidos para denegar el ingreso&#46; La tasa de mortalidad intrahospitalaria fue del 60&#44;33&#37;&#46; La futilidad del tratamiento se constat&#243; como factor de riesgo asociado a mortalidad &#40;OR&#58; 3&#44;23&#59; IC 95&#37;&#58; 2&#44;62-3&#44;99&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI&#46; La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; multicentrico</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Scope</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">62 ICU from Spain between February 2018 and March 2019&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Main interest variables</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient comorities&#44; functional situation as measured by the KNAUS and Karnosfky scale&#59; predicted scales of Lee and Charlson&#59; severity of the sick person measured by the APACHE II and SOFA scales&#44; which justifies the decision-making&#44; a person to whom the information is transmitted&#59; date of discharge or in-hospital death&#44; destination for hospital discharge&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed&#46; The main reason for consultation was respiratory failure &#40;1080 &#91;47&#46;29&#37;&#93;&#41;&#46; The poor estimated quality of life of the sick &#40;1417 &#91;62&#46;04&#37;&#93;&#41;&#44; the presence of a severe chronic disease &#40;1367 &#91;59&#46;85&#37;&#93;&#41; and the prior functional limitation of patients &#40;1270 &#91;55&#46;60&#37;&#93;&#41; were the main reasons for denying admission&#46; The in-hospital mortality rate was 60&#46;33&#37;&#46; The futility of treatment was found as a risk factor associated with mortality &#40;OR&#58; 3&#46;23&#59; IC95&#37;&#58; 2&#46;62-3&#46;99&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU&#46; The futility valued by the intensivist is adequately related to the final result of death&#46;</p></span>"
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                  \t\t\t\t">52 &#40;91&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gasto sanitario por habitante &#40;media &#91;DE&#93;&#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&#46;394&#44;35 &#40;166&#44;71&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospital universitario&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">43 &#40;75&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de camas hospitalarias &#40;media &#91;DE&#93;&#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">568 &#40;878&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas &#61; &#60; 200&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;12&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas 200-500&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">23 &#40;40&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas 501-1000&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">20 &#40;35&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas &#61; &#62;1000&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 &#40;10&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de camas en UCI &#40;media &#91;DE&#93;&#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">19 &#40;11&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de ingresos anuales en UCI &#40;media &#91;DE&#93;&#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">998 &#40;453&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de UCI abierta en horarios de visita&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">30 &#40;53&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de UCI mixta seg&#250;n patolog&#237;a tratada&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">45 &#40;79&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dotaci&#243;n de UCIM en el SMI&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;21&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de SECI en el SMI&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">15 &#40;26&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de protocolo de LTSV en SMI&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">43 &#40;75&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de tratamiento con VMNI fuera del SMI&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">48 &#40;84&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de escala de detecci&#243;n de enfermo grave&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">10 &#40;17&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Registro de PCR&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">13 &#40;23&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Registro de decisiones de negaci&#243;n de ingreso en UCI&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">10 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC&#58; insuficiencia cardiaca&#46;</p>"
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                  \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">Caracter&#237;sticas&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" scope="col" style="border-bottom: 2px solid black">Valor&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="elsevierStyleBold">Edad &#40;media &#91;DE&#93;&#41;</span>&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">75 &#40;12&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \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>Var&#243;n n &#40;&#37;&#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">1&#46;355 &#40;59&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Origen</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Domicilio familiar n &#40;&#37;&#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&#46;962 &#40;86&#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
                  \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>Institucionalizado n &#40;&#37;&#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">275 &#40;12&#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
                  \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>Otros n &#40;&#37;&#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">27 &#40;1&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Motivo de Ingreso hospitalario</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico&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&#46;965 &#40;86&#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
                  \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>Quir&#250;rgico&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">271 &#40;12&#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
                  \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>Otro&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">43 &#40;2&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Escala KNAUS</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a></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>A n &#40;&#37;&#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">166 &#40;7&#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
                  \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>B n &#40;&#37;&#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">725 &#40;32&#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
                  \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>C n &#40;&#37;&#41;&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">877 &#40;39&#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\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D n &#40;&#37;&#41;&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Escala Karnofski</span></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\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Puntuaci&#243;n &#8804; 50&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&#46;022 &#40;44&#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
                  \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>Puntuaci&#243;n &#62; 50&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&#46;262 &#40;55&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades</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>IC n &#40;&#37;&#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">744 &#40;32&#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
                  \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>IC Clase III -IV NYHA n &#40;&#37;&#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">263 &#40;11&#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"><span class="elsevierStyleHsp" style=""></span>Enfermedad neuromuscular n &#40;&#37;&#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">145 &#40;6&#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
                  \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>Enfermedad neurodegenerativa n &#40;&#37;&#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">299 &#40;13&#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
                  \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>EPOC n &#40;&#37;&#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</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>EPOC GOLD III-IV n &#40;&#37;&#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</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 mellitus n &#40;&#37;&#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</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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Cirrosis CHILD C n &#40;&#37;&#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\ttop\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunosupresi&#243;n n &#40;&#37;&#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">333 &#40;15&#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
                  \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>Alcoholismo n &#40;&#37;&#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">214 &#40;9&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Lee &#40;media &#91;DE&#93;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;69 &#40;2&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Charlson &#40;media &#91;DE&#93;&#41;</span>&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="elsevierStyleBold">Ingreso en el &#250;ltimo a&#241;</span>o<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a><span class="elsevierStyleBold">n &#40;&#37;&#41;</span>&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">1 &#40;2&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Ingreso previo en UCI n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \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="elsevierStyleBold">Desenlace &#233;xitus n &#40;&#37;&#41;</span>&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&#46;378 &#40;60&#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" scope="col" style="border-bottom: 2px solid black">Fallecidos1&#46;372 &#40;60&#37;&#41;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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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"><span class="elsevierStyleBold">Edad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;01 &#40;1&#44;00-1&#44;02&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo Var&#243;n n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">519 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">828 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Origen</span></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>Domicilio familiar n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">755 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;195 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;90 &#40;0&#44;39-2&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;807&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Institucionalizado n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">153 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;ref&#46;&#41;&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>Otros n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;79 &#40;0&#44;59-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;108&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Motivo de Ingreso hospitalario</span></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>M&#233;dico n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">809 &#40;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;145 &#40;84&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;ref&#46;&#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>Quir&#250;rgico n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">184 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;43 &#40;1&#44;05-1&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otro n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;02 &#40;1&#44;67-15&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Escala KNAUS</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>A n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">125 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;ref&#46;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">267 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">450 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;43 &#40;0&#44;28-0&#44;66&#41;&nbsp;\t\t\t\t\t\t\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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\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="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Escala Karnofski</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>Puntuaci&#243;n &#8804; 50 n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">353 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">661 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;ref&#46;&#41;&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
                  \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>Puntuaci&#243;n &#62; 50 n &#40;&#37;&#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
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                  \t\t\t\t">547 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">711 &#40;52&#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">0&#44;70 &#40;0&#44;58-0&#44;85&#41;&nbsp;\t\t\t\t\t\t\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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" 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="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca n &#40;&#37;&#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
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                  \t\t\t\t">314 &#40;35&#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">424 &#40;31&#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;75 &#40;0&#44;62-0&#44;93&#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;007&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>Clase III -IV NYHA n &#40;&#37;&#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">106 &#40;12&#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">156 &#40;11&#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;96 &#40;0&#44;72-1&#44;29&#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;781&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>Enfermedad neuromuscular n &#40;&#37;&#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">70 &#40;8&#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">74 &#40;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;66 &#40;0&#44;45-0&#44;97&#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;036&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>Enfermedad neurodegenerativa n &#40;&#37;&#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">136 &#40;15&#41;&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">163 &#40;12&#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;84 &#40;0&#44;64-1&#44;11&#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;217&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>EPOC n &#40;&#37;&#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">269&#40;30&#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">323&#40;23&#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;66 &#40;0&#44;53-0&#44;82&#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;000&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>GOLD III-IV n &#40;&#37;&#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">105 &#40;12&#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">96 &#40;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">0&#44;56 &#40;0&#44;41-0&#44;78&#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;001&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>Diabetes mellitus n &#40;&#37;&#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">278 &#40;31&#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">468 &#40;34&#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&#44;10 &#40;0&#44;90-1&#44;35&#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;347&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>C&#225;ncer n &#40;&#37;&#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">226 &#40;25&#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">410 &#40;30&#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">No-data&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">No-data&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>Insuficiencia renal n &#40;&#37;&#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">210 &#40;23&#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">350 &#40;25&#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;87 &#40;0&#44;69-1&#44;09&#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;216&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>Cirrosis hep&#225;tica n &#40;&#37;&#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">62 &#40;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">111 &#40;8&#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">No-data&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">No-data&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>CHILD C n &#40;&#37;&#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">20 &#40;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">54 &#40;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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quir&#243;fano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;84 &#40;0&#44;34-2&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;715&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;69 &#40;0&#44;31-1&#44;55&#41;&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="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Consultor</span></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>Residente&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">84 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">133 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#40;ref&#46;&#41;&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">&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>Adjunto&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">370 &#40;41&#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">528 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;84 &#40;0&#44;60-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;330&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>M&#233;dico de guardia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">436 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">679 &#40;49&#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">0&#44;90 &#40;0&#44;64-1&#44;27&#41;&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;547&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&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">9 &#40;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
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                  \t\t\t\t">32 &#40;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
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                  \t\t\t\t">1&#44;85 &#40;0&#44;77-4&#44;45&#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
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                  \t\t\t\t">0&#44;170&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  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Motivo de Consulta</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inestabilidad hemodin&#225;mica&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">263 &#40;29&#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">476 &#40;35&#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&#44;04 &#40;0&#44;85-1&#44;28&#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;690&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>Insuficiencia respiratoria&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">417 &#40;46&#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">657 &#40;48&#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;98 &#40;0&#44;81-1&#44;19&#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;846&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>Alteraci&#243;n del nivel de conciencia&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">274 &#40;30&#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">633 &#40;46&#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&#44;76 &#40;1&#44;44-2&#44;15&#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"><span class="elsevierStyleBold">0&#44;000</span>&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>Perfil de sepsis&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">139 &#40;15&#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">228 &#40;17&#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;93 &#40;0&#44;72-1&#44;21&#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;585&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>Alteraci&#243;n anal&#237;tica&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">254 &#40;28&#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">375 &#40;27&#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;90 &#40;0&#44;72-1&#44;11&#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;319&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>Petici&#243;n familiar&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 &#40;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">19 &#40;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">No-data&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">No-data&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>PCR interrumpida&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">11 &#40;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
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Original
Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital
ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments
P. Escudero-Achaa, O. Leizaolab, N. Lázaroc, M. Corderod, A.M. Cossíoe, D. Ballesterosf, P. Recenag, A.I. Tizónh, M. Palomoi, M.M. del Campoj, S. Freitak, J. Duertol, N.M. Bilbaom, B. Vidaln, D. González-Romeroo, F. Diaz-Dominguezp, J. Revueltoq, M.L. Blascor, M. Domezains, Mª. de la Concepción Pavía-Pesquerat..., O. Rubiou, A. Estellav, A. Pobow, I. Gomez-Acebox, A. González-Castroa,
Autor para correspondencia
jandro120475@hotmail.com
e409@humv.es

Autor para correspondencia.
, ADENI Study Group. Grupo de trabajo de BIOETICA de la SEMICYUC Ver más
a Hospital Universitario Marqués de Valdecilla, Santander, España
b Hospital Universitario Central de Asturias, Asturias, España
c Hospital 12 de Octubre, Madrid, España
d Hospital Universitario de Álava, Vitoria, España
e Hospital Universitario Virgen Macarena, Sevilla, España
f Hospital Puerta de Hierro, Madrid, España
g Hospital Universitario de Cabueñes, Gijón, España
h Complexo Hospitalario Universitario de Ourense, Ourense, España
i Hospital de Sagunto, Valencia, España
j Hospital Universitario Germans Trias i Pujol, Badalona, España
k Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, España
l Hospital Clínico San Carlos, Madrid, España
m Hospital Galdakao-Usansolo, Bizkaia, España
n Hospital Universitario de Castellón, Castellón, España
o Complejo Universitario Insular Materno Infantil, Las Palmas, España
p Complejo Asistencial Universitario de León, León, España
q Hospital Universitario Puerta del Mar, Cádiz, España
r Hospital Clínico de Valencia, Valencia, España
s Hospital Universitario de Cruces, Bilbao, España
t Hospital San Pedro, Logroño, España
u Fundació Althaia Xarxa Universitaria Assistencial de Manresa, Manresa, España
v Hospital de Jerez, Jerez, España
w Hospital Joan XXIII de Tarragona, Tarragona, España
x Departamento de Preventiva y Salud Pública. Facultad de Medicina. Universidad de Cantabria, Santander, España
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            "entidad" => "Departamento de Preventiva y Salud P&#250;blica&#46; Facultad de Medicina&#46; Universidad de Cantabria&#44; Santander&#44; Espa&#241;a"
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        "titulo" => "ADENI-UCI Study&#58; Analysis of non-income decisions in ICU as a measure of limitation of life support treatments"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Asociaci&#243;n con la mortalidad intrahospitalaria&#44; mediante an&#225;lisis de regresi&#243;n log&#237;stica multinivel anidado&#44; ajustado por edad&#44; sexo&#44; APACHE II y SOFA&#44; de los motivos utilizados para denegar el ingreso en UCI como medida de LTSV&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La limitaci&#243;n del tratamiento de soporte vital &#40;LTSV&#41; ocurre cada vez con m&#225;s frecuencia en los pa&#237;ses de nuestro entorno<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a>&#46; Est&#225; considerada como una buena pr&#225;ctica m&#233;dica puesto que la obstinaci&#243;n terap&#233;utica y el mantenimiento de tratamientos f&#250;tiles no tiene justificaci&#243;n &#233;tica ni cient&#237;fica<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En ocasiones las decisiones de no ingreso en unidades de cuidados intensivos &#40;UCI&#41; son consideradas una forma de LTSV&#44; que pueden obedecer a m&#250;ltiples consideraciones<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; Sin embargo&#44; a pesar del trabajo en desarrollar documentos de consenso y de gu&#237;as cl&#237;nicas con el objetivo de unificar criterios&#44; en cuanto a la admisi&#243;n de los pacientes en la UCI<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a>&#44; algunos autores han lamentado la falta de datos sobre los procesos de aceptaci&#243;n y negaci&#243;n de ingreso en UCI<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Son pocos los trabajos que se centran en recoger cu&#225;les son las principales variables que influyen en la mortalidad intrahospitalaria posterior de estos enfermos<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio multic&#233;ntrico fue observar y describir las variables que intervienen en la decisi&#243;n de rechazo de ingreso en una UCI como medida de LTSV&#44; determinar la frecuencia y el tipo de dichas decisiones&#44; as&#237; como analizar los factores asociados a la mortalidad hospitalaria de dichos pacientes&#44; realizando el seguimiento de los enfermos hasta los 90 d&#237;as de hospitalizaci&#243;n&#44; el momento del alta hospitalaria o el fallecimiento de este&#44; aquello que ocurriese primero&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Material y m&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Dise&#241;o del estudio</span><p id="par0020" class="elsevierStylePara elsevierViewall">ADENI-UCI es un estudio prospectivo&#44; observacional y multic&#233;ntrico&#46; El registro de enfermos se abri&#243; en febrero de 2018&#59; el primer paciente fue reclutado el 07 de febrero&#44; el &#250;ltimo lo hizo el 18 de marzo de 2019&#46; El periodo de seguimiento concluy&#243; el 12 de mayo de 2019&#46; Los enfermos fueron reclutados de 62 servicios de medicina intensiva &#40;SMI&#41; de forma consecutiva durante un periodo de seis meses&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Con relaci&#243;n al c&#225;lculo de un tama&#241;o muestral&#44; la escasez de bibliograf&#237;a previa respecto a la negaci&#243;n de ingreso en UCI como medida de LTSV&#44; dificult&#243; la realizaci&#243;n de un c&#225;lculo de tama&#241;o muestral previo&#46; Extrapolando los resultados del estudio franc&#233;s ADMISSIONREA<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a>&#44; que registra en 11 UCI francesas&#44; durante un mes a 51 pacientes considerados &#171;demasiado enfermos&#187; para beneficiarse de un ingreso en UCI&#44; podr&#237;amos estimar un c&#225;lculo aproximado de 1&#46;700 pacientes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Fueron criterios de inclusi&#243;n ser mayor de 18 a&#241;os y valorado por un m&#233;dico intensivista siendo considerado no subsidiario de ingreso en UCI como medida de LTSV&#46; Se entendi&#243; como medida de LTSV aquella decisi&#243;n de no ingreso tomada por el intensivita que valoraba al paciente&#44; apoyada en uno&#44; o combinaci&#243;n de algunos&#44; de las siguientes opciones&#58; la edad avanzada del enfermo&#44; la presencia de una enfermedad cr&#243;nica grave&#44; la limitaci&#243;n funcional previa del paciente&#44; una pobre calidad de vida estimada&#44; la futilidad de los tratamientos&#44; la existencia de un testamento vial o unas voluntades anticipadas que as&#237; lo justificasen o la propia negativa del enfermo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Asimismo&#44; se reclutaron las paradas cardiacas intrahospitalarias en las que se decidi&#243; finalizar la reanimaci&#243;n como medida de LTSV&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Recogida de datos y variables de estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">Para la recogida de los datos se elabor&#243; una hoja de registro en papel que inclu&#237;a las variables del estudio&#46; Dicho formulario posteriormente se transcrib&#237;a a un formato electr&#243;nico para la elaboraci&#243;n de un registro &#250;nico de todos los centros&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables analizadas inclu&#237;an datos cl&#237;nico-demogr&#225;ficos de los pacientes valorados &#40;edad&#44; sexo&#44; residencia habitual&#44; comorbilidades asociadas &#91;material electr&#243;nico suplementario&#93;&#44; situaci&#243;n funcional previa medida por la escala KNAUS<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> y Karnosfky<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a>&#44; motivo de ingreso hospitalario&#44; ingresos hospitalarios previos e ingresos en UCI&#41;&#59; variables relacionadas con la consulta efectuada &#40;horario&#44; ubicaci&#243;n del enfermo en el momento de realizar la consulta&#44; consultor&#44; motivo de consulta &#91;material electr&#243;nico suplementario&#93; y tiempo transcurrido desde el ingreso hasta el momento de la consulta&#44; escalas pronosticas de Lee<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> y Charlson<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#41;&#59; variables relacionadas con la decisi&#243;n de no ingreso adoptada &#40;gravedad del enfermo medida por las escalas APACHE II<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> y SOFA<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#44; facultativo que toma la decisi&#243;n y a&#241;os de experiencia laboral&#44; momento y motivo que justifica la toma de la decisi&#243;n&#44; persona a la cual es trasmitida la informaci&#243;n &#91;familiar o paciente&#93;&#44; grado de acuerdo y registro de la misma en la historia cl&#237;nica&#41;&#59; y variables evolutivas &#40;fecha de alta o fallecimiento intrahospitalario&#44; destino al alta hospitalaria&#44; si se produjo cambio en la decisi&#243;n de no ingreso y motivo de este&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Seguimiento de los enfermos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; el seguimiento de los enfermos hasta los 90 d&#237;as de hospitalizaci&#243;n&#44; el momento del alta hospitalaria o el fallecimiento de este&#44; aquello que ocurriese primero&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio recibi&#243; la aprobaci&#243;n del Comit&#233; de &#201;tico de Investigaci&#243;n Cl&#237;nica &#40;CEIC&#41; del centro promotor&#46; Posteriormente se facilit&#243; la documentaci&#243;n necesaria para que cada centro participante hiciese lo propio en sus respectivos CEIC&#44; garantizando que todos los centros participantes tuviesen la aprobaci&#243;n de los mismos antes de su iniciaci&#243;n en el estudio&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se obtuvo el aval del Comit&#233; Cient&#237;fico de la Sociedad Espa&#241;ola de Medicina Intensiva y Unidades Coronarias &#40;SEMICYUC&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Estudio estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la muestra&#46; Los resultados se presentan en forma de porcentaje para las variables categ&#243;ricas&#44; y como media y desviaci&#243;n est&#225;ndar para las variables cuantitativas continuas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis de asociaci&#243;n de las diferentes variables recogidas y la mortalidad intrahospitaria con un m&#225;ximo de seguimiento de 90 d&#237;as&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para llevar a cabo dicho an&#225;lisis se realiz&#243; una regresi&#243;n log&#237;stica multinivel anidada en tres niveles&#46; Como los pacientes ingresados en el mismo hospital y los hospitales de la misma provincia suelen compartir procedimientos y protocolos similares respectivamente&#44; no pudimos asumir la independencia entre pacientes&#44; por lo tanto&#44; el an&#225;lisis se realiz&#243; utilizando regresi&#243;n log&#237;stica multinivel con tres niveles anidados&#58; provincia&#44; hospital y paciente&#46; En resumen&#44; la regresi&#243;n log&#237;stica habitual modela la relaci&#243;n entre una exposici&#243;n variable&#44; por ejemplo&#44; la puntuaci&#243;n APACHE y la probabilidad de morir como&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0080" class="elsevierStylePara elsevierViewall">donde P&#40;y<span class="elsevierStyleInf">i</span>&#41; es la probabilidad de morir por el paciente <span class="elsevierStyleInf">i</span>&#59; edad&#44; sexo y SOFA toman valores para cada paciente y es un error aleatorio&#46; En esta f&#243;rmula&#44; el logaritmo natural de la relaci&#243;n de probabilidades de morir por cada punto adicional en la puntuaci&#243;n APACHE&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Sin embargo&#44; la regresi&#243;n log&#237;stica requiere independencia entre observaciones&#46; Como no se puede suponer en nuestro estudio&#44; realizamos un an&#225;lisis de regresi&#243;n log&#237;stica multinivel con tres niveles anidados&#58; provincia&#44; hospital y paciente&#46; En este caso&#44; la relaci&#243;n entre APACHE y la probabilidad de morir incluye tres errores aleatorios&#44; uno para cada nivel de an&#225;lisis&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0090" class="elsevierStylePara elsevierViewall">donde u<span class="elsevierStyleInf">j</span> es el error aleatorio para la interceptaci&#243;n debido a provincia y v<span class="elsevierStyleInf">k</span> es el error aleatorio para la interceptaci&#243;n debido al hospital&#46; La interpretaci&#243;n de &#946; par&#225;metros es la misma que antes&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados de dicho an&#225;lisis de asociaci&#243;n se presentan como <span class="elsevierStyleItalic">Odds Ratios</span> con IC 95&#37; ajustados por edad&#44; sexo&#44; APACHE II y escala SOFA&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">El programa estad&#237;stico utilizado fue stata en su versi&#243;n 15&#46;1&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Durante el mismo estudio fueron recogidas 2&#46;312 decisiones de no ingreso en UCI como medida de LTSV&#44; de 62 centros participantes&#46; Las caracter&#237;sticas de los centros y servicios participantes &#40;cinco de ellos no facilitaron dichos datos&#41; se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Despu&#233;s de la revisi&#243;n de las mismas&#44; fueron eliminadas 28 de ellas por errores en la recogida de datos&#46; Finalmente se analizaron un total de 2&#46;284 registros&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Las principales variables cl&#237;nico-epidemiol&#243;gicas de la muestra de pacientes analizados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Variables relacionadas con la consulta al SMI</span><p id="par0115" class="elsevierStylePara elsevierViewall">La consulta al SMI se realiz&#243; en 1&#46;064 ocasiones en la franja horaria comprendida entre las 15&#58;00 y las 23&#58;59 horas &#40;47&#37;&#41;&#44; realiz&#225;ndose 1&#46;124 veces desde las urgencias hospitalarias &#40;49&#37;&#41; por el m&#233;dico de guardia en 1&#46;117 &#40;49&#37;&#41;&#46; El principal motivo de consulta fue la insuficiencia respiratoria &#40;n &#61; 1&#46;080 &#91;47&#37;&#93;&#41;&#44; seguido de la alteraci&#243;n del nivel de conciencia &#40;n &#61; 911 &#91;40&#37;&#93;&#41; y la inestabilidad hemodin&#225;mica &#40;n &#61; 741 &#91;32&#37;&#93;&#41;&#46; La valoraci&#243;n por el servicio de medicina intensiva se realiz&#243; en la mayor&#237;a de las ocasiones por el m&#233;dico de guardia &#40;n &#61; 1&#46;825 &#91;81&#37;&#93;&#41;&#44; con una experiencia laboral entre los seis y los 15 a&#241;os &#40;n &#61; 1&#46;040 &#91;46&#37;&#93;&#41;&#46; En el momento de la valoraci&#243;n&#44; el APACHE II medio fue de 20&#44;38 &#40;&#177; 8&#44;52&#41; y el SOFA medio de 5&#44;99 &#40;&#177; 3&#44;97&#41;&#46; El &#237;ndice de Lee medio fue de 12&#44;73 &#40;&#177; 4&#44;07&#41; y el &#237;ndice de Charlson de 6&#44;69 &#40;&#177; 2&#44;63&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Motivos de decisi&#243;n de no-ingreso en UCI</span><p id="par0120" class="elsevierStylePara elsevierViewall">La decisi&#243;n de no ingreso en UCI se tom&#243; en una primera valoraci&#243;n casi en la totalidad de las ocasiones &#40;n &#61; 2&#46;127 &#91;93&#37;&#93;&#41;&#46; Fueron la pobre calidad de vida estimada de los enfermos &#40;n &#61; 1417 &#91;62&#37;&#93;&#41;&#44; la presencia de una enfermedad cr&#243;nica grave &#40;n &#61; 1&#46;367 &#91;60&#37;&#93;&#41; y la limitaci&#243;n funcional previa de los pacientes &#40;n &#61; 1&#46;270 &#91;56&#37;&#93;&#41;&#44; los principales motivos empleados en la toma de la decisi&#243;n de no ingreso como medida de LTSV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Variables relacionadas con la evoluci&#243;n posterior a la negaci&#243;n de ingreso en UCI&#58;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se inici&#243; sedaci&#243;n terminal en 484 &#40;21&#37;&#41; de las ocasiones una vez tomada la decisi&#243;n de no ingresar en UCI&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El paciente fue informado de la decisi&#243;n en 368 ocasiones &#40;16&#37;&#41;&#44; mientras que la familia fue informada en 1&#46;716 &#40;75&#37;&#41;&#46; La decisi&#243;n fue registrada en la historia cl&#237;nica del enfermo en la mayor&#237;a de las ocasiones &#40;n &#61; 2&#46;046 &#91;90&#37;&#93;&#41;&#46; De los pacientes que no fueron informados de la decisi&#243;n de no ingreso en UCI como LTSV &#40;n &#61; 1&#46;700 &#91;81&#37;&#93;&#41;&#44; tan solo en un 46&#37; &#40;n &#61; 780&#41; el motivo de consulta era la alteraci&#243;n del nivel de conciencia&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se evidenci&#243; desacuerdo con la decisi&#243;n adoptada por parte de la familia en 54 &#40;2&#37;&#41; de las ocasiones y con el m&#233;dico consultor en 138 &#40;6&#37;&#41;&#46; &#218;nicamente en 71 &#40;3&#37;&#41; ocasiones se produjo un posterior ingreso en UCI una vez tomada la decisi&#243;n&#46; De estos&#44; el 40&#37; fueron pacientes con criterio de ingreso para cuidados orientados a la donaci&#243;n de &#243;rganos&#46; Seguidos por aquellos ingresos motivados por presi&#243;n de servicios externos&#44; en un 18&#37;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">El destino al alta hospitalaria fue al domicilio en un 65&#37; de las ocasiones y en el 20&#37; los pacientes fueron dados de alta a un hospital de cr&#243;nicos&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lisis de mortalidad</span><p id="par0150" class="elsevierStylePara elsevierViewall">Una vez rechazado el ingreso en UCI como medida de LTSV&#44; la mortalidad hospitalaria a los 90 d&#237;as&#44; de la poblaci&#243;n estudiada fue del 60&#44;33&#37;&#46; La asociaci&#243;n a mortalidad de las principales variables cl&#237;nico-epidemiol&#243;gicas de los enfermos se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Las peticiones de valoraci&#243;n realizada desde los servicios de urgencias se asociaron a una menor mortalidad &#40;OR&#58; 0&#44;63&#59; IC 95&#37;&#58; 0&#44;52-0&#44;76&#41;&#44; teniendo como referencia las consultas realizadas desde las plantas de hospitalizaci&#243;n convencional&#46; Al margen de las paradas cardiorespiratorias interrumpidas considerando el cese una maniobra de LTSV&#44; la consulta por alteraci&#243;n del nivel de conciencia fue el motivo que present&#243; una mayor asociaci&#243;n a mortalidad &#40;OR&#58; 1&#44;76&#59; IC 95&#37;&#58; 1&#44;44-2&#44;15&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">La gravedad de los pacientes en el momento de la consulta&#44; valorada por la escala APACHE II y SOFA&#44; se asoci&#243; a mayor mortalidad &#40;OR&#58;1&#44;07 &#91;1&#44;05-1&#44;08&#93; p 0&#44;000 y OR&#58; 1&#44;28 &#91;1&#44;24-1&#44;33&#93; p 0&#44;000&#44; respectivamente&#41; por cada punto de incremento&#46; Como se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; la futilidad del tratamiento fue el motivo de no ingreso en UCI que present&#243; mayor fuerza de asociaci&#243;n a mortalidad intrahospitalaria &#40;OR&#58; 3&#44;23&#59; IC 95&#37;&#58; 2&#44;62-3&#44;99&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">No se encontraron diferencias en supervivencia al analizar el facultativo que realizaba la valoraci&#243;n&#44; atendiendo a la localizaci&#243;n f&#237;sica del mismo &#40;unidad de destino&#44; Servicio Extendido de Cuidados Intensivos &#91;SECI&#93; o m&#233;dico de guardia&#41; ni atendiendo a los a&#241;os de experiencia&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El tiempo transcurrido desde el ingreso hospitalario del enfermo hasta la valoraci&#243;n por parte del servicio de medicina intensiva fue significativamente mayor en los enfermos que posteriormente fallecieron &#40;7&#44;04 &#91;0&#44;54&#93; frente a 3&#44;58 &#91;0&#44;67&#93; d&#237;as p &#60; 0&#44;000&#59; OR&#58;1&#44;02 &#91;1&#44;01-1&#44;03&#93; p &#60; 0&#44;001&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nuestro trabajo analiza las decisiones de rechazar el ingreso en UCI como medida de LTSV&#44; a trav&#233;s de m&#225;s de 2000 registros en 62 UCI de nuestro pa&#237;s&#46; Se trata del primer trabajo en tener un enfoque sistem&#225;tico y exclusivo en este campo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En los resultados del trabajo destaca la baja tasa de mortalidad intrahospitalaria encontrada a 90 d&#237;as&#44; pr&#243;xima al 60&#37;&#44; entre aquellos pacientes para quienes el ingreso en la UCI se denegaba como medida de LTSV&#46; Resulta dif&#237;cil la comparaci&#243;n con estudios previos que analizaron las decisiones de no ingreso en UCI en aquellos pacientes que se encontraban en una situaci&#243;n demasiado grave como para beneficiarse del mismo&#44; pero en estos se hallaron tasas de mortalidad entre el 80&#37; y el 100&#37;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">16&#8211;19</span></a>&#46; No obstante&#44; nuestra alta supervivencia no puede descartar que estos enfermos que sobreviven sean pacientes libres de discapacidad o que presenten una progresi&#243;n de su limitaci&#243;n funcional&#46; De hecho&#44; hasta un 20&#37; de los pacientes que fueron dados de alta hospitalaria&#44; lo hicieron con destino a un hospital de cr&#243;nicos&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Por otro lado&#44; nuestra poblaci&#243;n presenta una edad media mayor que otros trabajos de similares caracter&#237;sticas<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20&#8211;23</span></a> y s&#243;lo 7&#44;4&#37; no ten&#237;an limitaci&#243;n alguna por enfermedad&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">En este sentido&#44; los resultados obtenidos al estudiar el beneficio de ingresar o rechazar al paciente anciano cr&#237;ticamente enfermo en una UCI son discordantes<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a>&#46; Aunque&#44; como reflejan nuestros datos&#44; la edad es un factor asociado a mayor mortalidad intrahospitalaria despu&#233;s de rechazar el ingreso&#59; se ha supuesto que la fragilidad puede resultar un predictor m&#225;s robusto de vulnerabilidad y &#171;recuperabilidad&#187; que la edad cronol&#243;gica por s&#237; misma&#44; sobre todo en el contexto de una enfermedad grave<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">El estudio FRAIL-ICU remarc&#243; la asociaci&#243;n entre mortalidad y fragilidad en los pacientes cr&#237;ticos&#46; Estos enfermos presentaron un mayor n&#250;mero de decisiones de LTSV dentro de la UCI<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a>&#46; Este dato podr&#237;a sugerir que estos enfermos fr&#225;giles&#44; menos expuestos que presentan menor riesgo de mortalidad&#44; pudiera deberse simplemente&#44; por evitar factores intr&#237;nsecos de la UCI que pudieran empeorar su pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Asimismo&#44; y aunque no hay publicaciones que permitan comparar estos resultados&#44; en el presente trabajo el porcentaje de pacientes propuestos desde urgencias para su ingreso en UCI y limitados&#44; presenta una mortalidad significativamente menor que los propuestos para ingreso en UCI y limitados desde planta&#46; Este porcentaje de pacientes de urgencias con posibilidad de mejor&#237;a cl&#237;nica al ser la valoraci&#243;n inicial puede explicar&#44; en parte&#44; la baja mortalidad&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Atendiendo a nuestros resultados&#44; los motivos adoptados por el intensivista para negar el ingreso en UCI como medida de LTSV&#44; no difieren significativamente a las decisiones de LTSV descritas al ingreso en UCI en nuestro entorno&#44; donde los m&#225;s frecuentes son&#58; la presencia de una enfermedad cr&#243;nica severa previa&#44; el respeto a las voluntades anticipadas del paciente&#44; la limitaci&#243;n funcional previa y la futilidad cualitativa<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a>&#46; Del mismo modo&#44; recientemente el estudio INSTINCT evidenci&#243; que la imposibilidad de recuperar la autonom&#237;a&#44; la presencia de una enfermedad cr&#243;nica en estado avanzado y la pobre calidad de vida&#44; eran las principales razones esgrimidas para considerar un ingreso en UCI como no beneficioso<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">&#218;nicamente el 16&#37; de los enfermos reclutados fueron informados de la toma de dicha decisi&#243;n&#46; Es cierto que en el enfermo grave se dan con frecuencia situaciones que dificultan o impiden una participaci&#243;n completa del paciente en el proceso<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>&#46; Pero hay que valorar que la calidad de vida percibida en los supervivientes a&#241;osos de un ingreso en UCI&#44; como es el caso de nuestra cohorte de pacientes&#44; no es diferente a la de los grupos de edad m&#225;s j&#243;venes&#59; y que esta aumenta con el tiempo a pesar de una disminuci&#243;n en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">En tres de cada cuatro ocasiones la decisi&#243;n se consensu&#243; con los familiares o representantes&#46; Sin embargo&#44; se han realizado estudios que demuestran que la opini&#243;n de los familiares no es un fiel reflejo de los deseos del paciente<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#44; e incluso que aqu&#233;llos llegan a desconocer c&#243;mo desear&#237;a este que se tomara la decisi&#243;n<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#46; De hecho&#44; el grado de concordancia entre la decisi&#243;n del paciente y la de sus familiares en un caso hipot&#233;tico es cercano al 70&#37;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#46; Asimismo&#44; el pron&#243;stico que los familiares consideran no se basa solo en la informaci&#243;n recibida del equipo m&#233;dico&#44; sino tambi&#233;n en otros imponderables como la fortaleza del paciente&#44; su historia de sobreponerse a las enfermedades&#44; la impresi&#243;n que les ocasiona el aspecto del paciente&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Este estudio tiene varias limitaciones&#46; En primer lugar&#44; las UCI no fueron seleccionadas al azar&#44; sino que eran voluntarias&#46; En segundo lugar&#44; existe una variabilidad de criterios entre los profesionales en cuanto a la decisi&#243;n de admitir un paciente UCI&#46; En tercer lugar&#44; el per&#237;odo de estudio de seis meses puede no ser representativo de los procedimientos de triaje a lo largo de cada UCI&#44; causando potencialmente sesgo derivado de la estacionalidad de ciertas patolog&#237;as&#46; Sin embargo&#44; creemos que el gran n&#250;mero de centros participantes y la duraci&#243;n total del estudio reflejan adecuadamente la pr&#225;ctica diaria en las UCI espa&#241;olas&#46; En cuarto lugar&#44; es posible que se haya producido alguna p&#233;rdida de registro de decisiones no recogidas como tales &#40;fines de semana&#44; periodos vacacionales&#8230;&#41;&#46; Otros posibles sesgos del estudio como el registro variable de casos&#44; la ausencia de protocolos homog&#233;neos&#44; la diferencia en el seguimiento proactivo o a demanda de los enfermos&#44; as&#237; como el diferente nivel de implicaci&#243;n de los distintos hospitales&#44; pueden considerarse parcial o totalmente resueltos con el an&#225;lisis estad&#237;stico efectuado&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Podemos concluir que una de las mayores fortalezas del estudio actual es el gran n&#250;mero de decisiones que se han registrado&#46; Esto permite destacar que las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos criterios que las decisiones tomadas dentro de la UCI y que en la mayor&#237;a de los casos este rechazo no conduce a la muerte de los pacientes&#46; Esto lleva a la hip&#243;tesis de que el factor decisivo para negar el ingreso no era la gravedad de la enfermedad por s&#237; sola&#44; sino que pudiese estar influenciado por el procedimiento y las comorbilidades en el momento de la valoraci&#243;n&#46; Por otro lado&#44; nos gustar&#237;a subrayar la viabilidad de las evaluaciones realizadas por los m&#233;dicos de cuidados intensivos en t&#233;rminos de futilidad terap&#233;utica y la asociaci&#243;n con la muerte posterior&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Contribuci&#243;n de los autores</span><p id="par0230" class="elsevierStylePara elsevierViewall">Concepci&#243;n y el dise&#241;o del estudio&#44; la adquisici&#243;n de datos&#58; Patricia Escudero Acha&#44; Alejandro Gonzalez Castro&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">An&#225;lisis estad&#237;stico&#58; Ines Gomez Acebo</p><p id="par0240" class="elsevierStylePara elsevierViewall">Adquisici&#243;n de datos&#58; Patricia Escudero Acha&#44; Oihana Leizaola&#44; Noelia L&#225;zaro&#44; M&#243;nica Cordero&#44; Ana Mar&#237;a Coss&#237;o&#44; Daniel Ballesteros&#44; Paula Recena&#44; Ana Isabel Tiz&#243;n&#44; Manuel Palomo&#44; Maite Misis del Campo&#44; Santiago Freita&#44; Jorge Duerto&#44; Naia Mas Bilbao&#44; Barbara Vidal&#44; Domingo Gonz&#225;lez Romero&#44; Francisco Diaz Dominguez&#44; Jaume Revuelto&#44; Maria Luisa Blasco&#44; Monica Domezain&#44; M&#170; de la Concepci&#243;n Pav&#237;a Pesquera&#44; Olga Rubio&#44; Angel Estella&#44; Angel Pobo&#44; Alejandro Gonz&#225;lez-Castro&#59; ADENI Study Group</p><p id="par0245" class="elsevierStylePara elsevierViewall">Borrador del art&#237;culo o la revisi&#243;n cr&#237;tica del contenido intelectual y la aprobaci&#243;n definitiva de la versi&#243;n que se presenta&#58; Alejandro Gonzalez Castro&#44; Patricia Escudero Acha&#44; Angel Estela&#44; Angel Pobo&#44; Olga Rubio&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Financiaci&#243;n</span><p id="par0250" class="elsevierStylePara elsevierViewall">El presente manuscrito no ha recibido financiaci&#243;n alguna&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicto de intereses</span><p id="par0255" 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">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos &#40;UCI&#41; como medida de limitaci&#243;n de tratamiento de soporte vital&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospectivo&#44; multic&#233;ntrico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sesenta y dos UCI de Espa&#241;a entre febrero de 2018 y marzo de 2019&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mayores de 18 a&#241;os a los que se les neg&#243; el ingreso a una UCI como medida de limitaci&#243;n de tratamiento de soporte vital&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Intervenciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables de inter&#233;s principals</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comorbilidades de los pacientes&#44; situaci&#243;n funcional previa medida por la escala KNAUS y Karnosfky&#59; escalas pron&#243;sticas de Lee y Charlson&#59; gravedad del enfermo medida por las escalas APACHE II y SOFA&#44; motivo que justifica la toma de la decisi&#243;n&#44; persona a la cual es trasmitida la informaci&#243;n&#59; fecha de alta o fallecimiento intrahospitalario&#44; destino al alta hospitalaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se registraron un total de 2&#46;312 decisiones de no ingreso como medida de limitaci&#243;n del tratamiento de soporte vital &#40;LTSV&#41;&#44; de las cuales se analizaron 2&#46;284&#46; El principal motivo de consulta fue la insuficiencia respiratoria &#40;1&#46;080 &#91;47&#44;29&#37;&#93;&#41;&#46; La pobre calidad de vida estimada de los enfermos &#40;1&#46;417 &#91;62&#44;04&#37;&#93;&#41;&#44; la presencia de una enfermedad cr&#243;nica grave &#40;1&#46;367 &#91;59&#44;85&#37;&#93;&#41; y la limitaci&#243;n funcional previa de los pacientes &#40;1&#46;270 &#91;55&#44;60&#37;&#93;&#41; fueron los principales motivos esgrimidos para denegar el ingreso&#46; La tasa de mortalidad intrahospitalaria fue del 60&#44;33&#37;&#46; La futilidad del tratamiento se constat&#243; como factor de riesgo asociado a mortalidad &#40;OR&#58; 3&#44;23&#59; IC 95&#37;&#58; 2&#44;62-3&#44;99&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI&#46; La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; multicentrico</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Scope</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">62 ICU from Spain between February 2018 and March 2019&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Main interest variables</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient comorities&#44; functional situation as measured by the KNAUS and Karnosfky scale&#59; predicted scales of Lee and Charlson&#59; severity of the sick person measured by the APACHE II and SOFA scales&#44; which justifies the decision-making&#44; a person to whom the information is transmitted&#59; date of discharge or in-hospital death&#44; destination for hospital discharge&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed&#46; The main reason for consultation was respiratory failure &#40;1080 &#91;47&#46;29&#37;&#93;&#41;&#46; The poor estimated quality of life of the sick &#40;1417 &#91;62&#46;04&#37;&#93;&#41;&#44; the presence of a severe chronic disease &#40;1367 &#91;59&#46;85&#37;&#93;&#41; and the prior functional limitation of patients &#40;1270 &#91;55&#46;60&#37;&#93;&#41; were the main reasons for denying admission&#46; The in-hospital mortality rate was 60&#46;33&#37;&#46; The futility of treatment was found as a risk factor associated with mortality &#40;OR&#58; 3&#46;23&#59; IC95&#37;&#58; 2&#46;62-3&#46;99&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU&#46; The futility valued by the intensivist is adequately related to the final result of death&#46;</p></span>"
        "secciones" => array:8 [
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            "identificador" => "abst0045"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Design"
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          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Scope"
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          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Patients"
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          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Interventions"
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            "identificador" => "abst0070"
            "titulo" => "Main interest variables"
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          6 => array:2 [
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            "titulo" => "Results"
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          7 => array:2 [
            "identificador" => "abst0080"
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          ]
        ]
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          0 => array:4 [
            "apendice" => "<p id="par0265" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material adicional"
            "identificador" => "sec0080"
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        "etiqueta" => "Figura 1"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Asociaci&#243;n con la mortalidad intrahospitalaria&#44; mediante an&#225;lisis de regresi&#243;n log&#237;stica multinivel anidado&#44; ajustado por edad&#44; sexo&#44; APACHE II y SOFA&#44; de los motivos utilizados para denegar el ingreso en UCI como medida de LTSV&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n estandar&#59; UCI&#58; unidad de cuidados intensivos&#59; UCIM&#58; unidad de cuidados intermedios&#59; SECI&#58; servicio extendido de cuidados intensivos&#59; LTSV&#58; limitaci&#243;n del tratamiento de soporte vital&#59; SMI&#58; sevicio de medicina intensiva&#59; VMNI&#58; ventilaci&#243;n mec&#225;nica no invasiva&#59; PCR&#58; paradas cardiorespiratoria&#46;</p>"
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                  <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">Variable&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">Valor &#40;n &#61; 57&#41;&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">Hospital de gesti&#243;n publica&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">52 &#40;91&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gasto sanitario por habitante &#40;media &#91;DE&#93;&#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&#46;394&#44;35 &#40;166&#44;71&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospital universitario&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">43 &#40;75&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de camas hospitalarias &#40;media &#91;DE&#93;&#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">568 &#40;878&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas &#61; &#60; 200&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;12&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas 200-500&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">23 &#40;40&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas 501-1000&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">20 &#40;35&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitales con n&#250;mero de camas &#61; &#62;1000&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 &#40;10&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de camas en UCI &#40;media &#91;DE&#93;&#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">19 &#40;11&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de ingresos anuales en UCI &#40;media &#91;DE&#93;&#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">998 &#40;453&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de UCI abierta en horarios de visita&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">30 &#40;53&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de UCI mixta seg&#250;n patolog&#237;a tratada&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">45 &#40;79&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dotaci&#243;n de UCIM en el SMI&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;21&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de SECI en el SMI&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">15 &#40;26&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de protocolo de LTSV en SMI&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">43 &#40;75&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de tratamiento con VMNI fuera del SMI&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">48 &#40;84&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Existencia de escala de detecci&#243;n de enfermo grave&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">10 &#40;17&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Registro de PCR&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">13 &#40;23&#37;&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Registro de decisiones de negaci&#243;n de ingreso en UCI&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">10 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de 57 de los 62 hospitales y servicios de medicina intensiva participantes en el estudio</p>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IC&#58; insuficiencia cardiaca&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleBold">Edad &#40;media &#91;DE&#93;&#41;</span>&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">75 &#40;12&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sexo</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n n &#40;&#37;&#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&#46;355 &#40;59&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Origen</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Domicilio familiar n &#40;&#37;&#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&#46;962 &#40;86&#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
                  \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>Institucionalizado n &#40;&#37;&#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">275 &#40;12&#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
                  \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>Otros n &#40;&#37;&#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">27 &#40;1&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Motivo de Ingreso hospitalario</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico&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&#46;965 &#40;86&#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
                  \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>Quir&#250;rgico&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">271 &#40;12&#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
                  \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>Otro&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">43 &#40;2&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Escala KNAUS</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a></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>A n &#40;&#37;&#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">166 &#40;7&#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
                  \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>B n &#40;&#37;&#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">725 &#40;32&#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
                  \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>C n &#40;&#37;&#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">877 &#40;39&#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
                  \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>D n &#40;&#37;&#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">473 &#40;21&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Escala Karnofski</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Puntuaci&#243;n &#8804; 50&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&#46;022 &#40;44&#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
                  \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>Puntuaci&#243;n &#62; 50&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&#46;262 &#40;55&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades</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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC n &#40;&#37;&#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">744 &#40;32&#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
                  \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>IC Clase III -IV NYHA n &#40;&#37;&#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">263 &#40;11&#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
                  \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>Enfermedad neuromuscular n &#40;&#37;&#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">145 &#40;6&#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
                  \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>Enfermedad neurodegenerativa n &#40;&#37;&#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">299 &#40;13&#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
                  \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>EPOC n &#40;&#37;&#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">595 &#40;26&#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
                  \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>EPOC GOLD III-IV n &#40;&#37;&#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">203 &#40;9&#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
                  \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>Diabetes mellitus n &#40;&#37;&#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">750 &#40;33&#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
                  \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>C&#225;ncer n &#40;&#37;&#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">640 &#40;28&#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
                  \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>Insuficiencia renal n &#40;&#37;&#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">563 &#40;25&#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
                  \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>Cirrosis hep&#225;tica n &#40;&#37;&#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">174 &#40;8&#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
                  \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>Cirrosis CHILD C n &#40;&#37;&#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">75 &#40;3&#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
                  \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>Inmunosupresi&#243;n n &#40;&#37;&#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">333 &#40;15&#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
                  \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>Alcoholismo n &#40;&#37;&#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">214 &#40;9&#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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Escala KNAUS</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>A n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Escala Karnofski</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>Puntuaci&#243;n &#8804; 50 n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Puntuaci&#243;n &#62; 50 n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades</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>Insuficiencia cardiaca n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase III -IV NYHA n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;96 &#40;0&#44;72-1&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;781&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad neuromuscular n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">74 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;66 &#40;0&#44;45-0&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;036&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad neurodegenerativa n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;217&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">269&#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">323&#40;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;66 &#40;0&#44;53-0&#44;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;000&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>GOLD III-IV n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;56 &#40;0&#44;41-0&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">278 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Localizaci&#243;n del enfermo</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>Planta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urgencias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quir&#243;fano&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Consultor</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>Residente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adjunto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;84 &#40;0&#44;60-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico de guardia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">436 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">679 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;85 &#40;0&#44;77-4&#44;45&#41;&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="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Motivo de Consulta</span></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>Inestabilidad hemodin&#225;mica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">263 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">476 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;690&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">417 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">657 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;98 &#40;0&#44;81-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;846&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>Alteraci&#243;n del nivel de conciencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Información del artículo
ISSN: 02105691
Idioma original: Español
DOI:10.1016/j.medin.2020.11.003
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