OriginalValor pronóstico del aclaramiento de procalcitonina, PCR y leucocitos en el shock sépticoPrognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock☆
Section snippets
Introducción
La sepsis y las secuelas derivadas de ella constituyen una de las principales causas de muerte en las unidades de cuidados intensivos (UCI)1,2. Su prevalencia creciente y su elevada mortalidad la convierten en un problema sociosanitario de primer orden. En nuestro país, Esteban et al., en un estudio realizado en tres hospitales del área sur de Madrid, observaron una incidencia de 333 casos de sepsis por 100.000 habitantes y año, la mortalidad hospitalaria fue del 13% para la sepsis, 28% para la
Población
Se trata de un estudio prospectivo de cohortes observacional en el que se incluyeron a todos los pacientes mayores de 14 años hospitalizados en la UCI del hospital universitario Marqués de Valdecilla de Santander con un cuadro de shock séptico según las definiciones propuestas por la Conferencia de Consenso SCCM/ESICM/ACCP/ATS/SIS1, es decir, la presencia de sepsis grave con hipotensión arterial y/o signos de hipoperfusión tisular persistentes que no responde a la administración intravenosa de
Resultados
Entre el 1 de enero y el 31 de diciembre de 2009 ingresaron en la UCI un total de 122 pacientes en shock séptico (tabla 1). De ellos, hubo 5 pacientes en que se realizó limitación del esfuerzo terapéutico, 26 en que no se llevó a cabo la determinación seriada de los marcadores y tres que fallecieron antes de transcurridas las 72 horas de ingreso en la UCI fueron excluidos. De este modo, la muestra finalmente incluyó un total de 88 pacientes de los cuales 54 (61%) fueron varones, con unos
Discusión
El aclaramiento de la PCT a las 72 horas del ingreso en la UCI predijo mejor que la determinación única al ingreso el pronóstico de los pacientes en shock séptico. El descenso en los valores de la PCT se comportó como un marcador independiente de supervivencia hospitalaria. En contraste, la variación en los niveles de PCR y leucocitos no guardó ninguna relación con el pronóstico final de este tipo de pacientes.
En determinación única la fiabilidad diagnóstica y pronóstica de la PCT puede verse
Conflicto de intereses
El Dr. Suberviola ha colaborado como consultor y en eventos patrocinados por BRAHMS Iberia; el resto de los firmantes declaran no tener ningún conflicto de intereses.
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Este trabajo ha sido galardonado con el premio BRAHMS 2010 concedido por la SEMICYUC.