Marcadores inflamatorios y clínicos predictores de mortalidad en neonatos menores de 1500 g / Inflammatory and clinical markers predicting mortality in neonates under 1500 g

Resumen

Resumen

Introducción: la mortalidad neonatal temprana sucede dentro de los 7 días de vida.  Las variables clínicas, los marcadores inflamatorios y el CRIB (Clinical Risk Index for Babies) podrían ser útiles para identificar riesgo de mortalidad.

Objetivo: analizar la utilidad de marcadores inflamatorios y clínicos para predecir mortalidad temprana en recién nacidos prematuros (RNPT) < 1500 g.

Material y métodos: estudio analítico, retroprospectivo, observacional y transversal. Se incluyeron RNPT con peso al nacimiento < 1500 g. Se evaluaron características clínicas, CRIB, marcadores inflamatorios y proteína C reactiva (PCR) a las 12 horas de vida.

Resultados: se estudiaron 248 RNPT, con edad gestacional de 32 semanas (RIC 30-34) y peso 1285 g (RIC 1070-1400); fallecieron 20 (8.06%). Los factores de riesgo para mortalidad fueron peso ≤ 1000 g, RM = 24 (7.69-77.96), p < 0.0001; edad gestacional ≤ 28 semanas, RM = 42 (13.71-128.61), p < 0.0001; ventilación invasiva, RM = 44.7 (5.85-340), p < 0.0001. Los factores protectores fueron los corticoesteroides antenatales, RM = 0.15 (0.05-0.39), p = 0.0001 y la preeclampsia materna, RM = 0.13 (0.01-1.02), p = 0.01. La PCR, el déficit de base y el peso al nacer se asociaron a mortalidad en el análisis multivariado (intercepto = 6.62; EE = 1.85; R2 = 0.60; p = 0.0003). La PCR ≥ 2.30 µg/dL mostró una sensibilidad de 26.32% y una especificidad de 97.50% para mortalidad, AUC = 0.69, p = 0.005. 

Conclusiones: los predictores de mortalidad temprana fueron el peso ≤ 1000 g, la edad gestacional ≤ 28 semanas y la PCR ≥ 2.30 μg/dL.

Abstract  

Background: Early neonatal mortality occurs within 7 days of life. Clinical variables, inflammatory markers and CRIB (Clinical Risk Index for Babies) could be useful to identify mortality risk.

Objective: To assess the predictive value of inflammatory and clinical markers for early mortality in preterm newborns (PTNB) < 1500 g.

Material and methods: Analytical, retroprospective, observational and cross-sectional study. PTNBs with birth weight < 1500 g were included. Clinical characteristics, CRIB, inflammatory markers and C-reactive protein (CRP) were evaluated at 12 hours of life.

Results: 248 PTNBs were studied, with a gestational age of 32 weeks (IQR 30-34), weight 1285 g (IQR 1070-1400); 20 died (8.06%). Risk factors for mortality were weight ≤ 1000 g, OR = 24 (7.69-77.96), p < 0.0001; gestational age ≤ 28 weeks, OR = 42 (13.71-128.61), p < 0.0001; invasive ventilation, OR = 44.7 (5.85-340), p < 0.0001. Protective factors were antenatal corticosteroids, OR = 0.15 (0.05-0.39), p = 0.0001, and maternal preeclampsia, OR = 0.13 (0.01-1.02), p = 0.01. CRP, base deficit and birth weight were associated with mortality in the multivariate analysis (intercept = 6.62; SE = 1.85; R2 = 0.60; p = 0.0003). CRP ≥ 2.30 µg/dL showed a sensitivity of 26.32% and a specificity of 97.50% for mortality, AUC = 0.69, p = 0.005.

Conclusions: Predictors of early mortality were weight ≤ 1000 g, gestational age ≤ 28 weeks and CRP ≥ 2.30 μg/dL.