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Correlación entre el índice de choque y el índice anaerobio / Correlation between the shock index and the anaerobic index
Resumen
Resumen
Introducción: el choque se define como una insuficiencia circulatoria aguda que ocasiona disfunción celular. El índice de choque (ICh) y el índice anaerobio o relación entre el gradiente veno-arterial de dióxido de carbono y la diferencia entre el contenido arterial y venoso de O2 [∆P(v-a)CO2/ ΔC(a-v)O2] son marcadores de hipoperfusión sistémica.
Objetivo: determinar si existe correlación entre el ICh y el índice anaerobio en pacientes con choque circulatorio.
Material y métodos: estudio observacional y prospectivo en pacientes con choque circulatorio. Se calcularon el ICh y el índice anaerobio al ingreso a la unidad de cuidados intensivos (UCI) y durante su estancia. Se calculó el coeficiente de correlación de Pearson y se exploró la asociación del ICh con la mortalidad con una regresión logística bivariada.
Resultados: se analizaron 59 pacientes de 55.5 (± 16.5) años, 54.3% hombres. El tipo de choque más frecuente fue el hipovolémico (40.7%). Tuvieron puntaje SOFA: 8.4 (± 3.2) y APACHE II: 18.5 (± 6). El ICh fue: 0.93 (± 0.32) y el índice anaerobio: 2.3 (± 1.3). La correlación global fue r = 0.15; al ingreso: r = 0.29; a las 6 horas: r = 0.19; a las 24 horas: r = 0.18; a las 48 horas: r = 0.44, y a las 72 horas: r = 0.66. El ICh > 1 al ingreso a la UCI tuvo una RM 3.8 (IC 95%: 1.31-11.02), p = 0.01.
Conclusiones: el ICh y el índice anaerobio tienen una correlación positiva débil durante las primeras 48 horas del choque circulatorio. El ICh > 1 es un posible factor de riesgo de muerte en pacientes con choque circulatorio.
Abstract
Background: Shock is defined as an acute circulatory insufficiency that causes cellular dysfunction. The shock index (SI) and the anaerobic index or the relationship between the veno-arterial gradient of carbon dioxide and the difference between the arterial and venous content of O2 [∆P(v-a)CO2/ ΔC(a-v)O2] are markers of systemic hypoperfusion.
Objective: To determine if there is a correlation between the SI and the anaerobic index in patients with circulatory shock.
Material and methods: Observational and prospective study in patients with circulatory shock. The SI and the anaerobic index were calculated at admission to the intensive care unit (ICU) and during their stay. Pearson’s correlation coefficient was calculated and the association of SI with mortality was explored with bivariate logistic regression.
Results: 59 patients aged 55.5 (± 16.5) years, 54.3% men, were analyzed. The most frequent type of shock was hypovolemic (40.7%). They had SOFA score: 8.4 (± 3.2) and APACHE II: 18.5 (± 6). The SI was: 0.93 (± 0.32) and the anaerobic index: 2.3 (± 1.3). Global correlation was r = 0.15; at admission r = 0.29; after 6 hours: r = 0.19; after 24 hours: r = 0.18; after 48 hours: r = 0.44, and after 72 hours: r = 0.66. The SI > 1 at ICU admission had an OR 3.8 (95% CI: 1.31- 11.02), p = 0.01.
Conclusions: The SI and the anaerobic index have a weak positive correlation during the first 48 hours of circulatory shock. The SI > 1 is a possible risk factor for death in patients with circulatory shock
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