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[Utilidad del índice de choque para predecir la mortalidad en pacientes pediátricos con sepsis grave o choque séptico].

INTRODUCCIÓN: La sepsis en pediatría es la principal causa de muerte hospitalaria. Se han intentado crear herramientas que faciliten su identificación, como el índice de choque (IC), definido como el cociente entre frecuencia cardíaca y tensión arterial sistólica. El objetivo de este trabajo fue identificar el mejor momento del IC para predecir la mortalidad en pacientes pediátricos con sepsis grave y choque séptico.

MÉTODOS: Cohorte retrospectiva con 165 pacientes pediátricos que desarrollaron sepsis grave y choque séptico en la Unidad de Terapia Intensiva Pediatrica. Se calculó el IC al diagnóstico (IC0), a las dos, cuatro y seis horas posteriores al mismo (IC2, IC4 e IC6). Se crearon dos grupos según el desenlace (sobrevivientes/muertos). La comparación estadística se realizó con prueba U-Mann Whitney y χ2 . Se compararon los factores de riesgo entre los sobrevivientes y muertos, calculando la razón de momios (RM).

RESULTADOS: Se comparó el valor del IC entre grupos; en el grupo de choque séptico, el IC se encontró más elevado en IC4 e IC6 (p = 0.010 y p = 0.005). Se encontró que, en los pacientes muertos, el IC incrementó progresivamente su valor en IC4 e IC6 (p < 0.05). Los valores de IC4 e IC6 elevados incrementaron el riesgo de muerte en los pacientes (IC4, RM: 442.1; IC 95% [intervalo de confianza al 95%]: 54.2-3,601.7; p < 0.001; e IC6, RM: 81,951.3; IC 95%: 427.1-15,700,000; p < 0.001).

CONCLUSIONES: La elevación del valor del IC se asocia con mayor mortalidad de la sepsis. El valor de IC6 es el más útil para predecir mortalidad.

BACKGROUND: Pediatric sepsis is considered the main cause of hospital death around the world. Many groups have tried to create tools that facilitate its early identification, as the shock index (SI) defined as the ratio between cardiac frequency and systolic blood pressure. The objective of this study was to determine the utility of SI to predict mortality in pediatric patients with severe sepsis and septic shock.

METHODS: Retrospective cohort with 165 pediatric patients with severe sepsis or septic shock in the Pediatric Intensive Care Unit. SI was calculated at diagnosis, 2, 4 and 6 hours after (SI2, SI4 and SI6). We divided the population in two groups depending their outcome: survivors and non-survivors. The statistical analysis was performed with U Mann-Whitney and chi squared tests. The risk factors were compared between the survivors and the dead, and we calculated the odds ratio (OR).

RESULTS: The median value of SI was compared between groups; in the group of septic shock, SI showed a tendency to remain high in SI4 and SI6 (p = 0.010 and p = 0.005, respectively). Among the survivors and the non-survivors, we found that in the latter, SI was progressively increased in SI4 and SI6 (p < 0.05). High values of SI4 and SI6 increased the risk of death in patients (SI4: OR: 442.1; CI 95% [confidence interval 95%]: 54.2-3,601.7; p < 0.001 and SI6: OR: 81,951.3; CI 95%: 427.1-15,700,000]; p < 0.001).

CONCLUSIONS: High values of SI are associated with increased mortality. The IS6 value is the most useful to predict mortality.

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