Diseño y validación de una herramienta para la predicción de desenlaces adversos en pacientes con obstrucción intestinal por bridas: La escala HALVIC
DOI:
https://doi.org/10.30944/20117582.2288Palabras clave:
obstrucción intestinal, adherencias tisulares, isquemia, mortalidad, valor predictivo, cirugíaResumen
Introducción. La obstrucción intestinal por bridas representa una causa común de consulta a los servicios de urgencias, pero hay poca claridad sobre qué pacientes tienen mayor riesgo de desarrollar complicaciones. El objetivo de este estudio fue diseñar y validar una escala de predicción de riesgo de desenlaces adversos en pacientes con obstrucción intestinal por bridas.
Métodos. Estudio de cohorte retrospectivo realizado a partir de la base de datos MIMIC-IV. Se incluyeron pacientes adultos admitidos al servicio de urgencias entre 2008 y 2019, con diagnóstico de obstrucción intestinal por bridas. El desenlace principal fue el compuesto de resección intestinal, ingreso a unidad de cuidados intensivos y mortalidad por cualquier causa. Se diseñó una escala de predicción de riesgo asignando un puntaje a cada variable.
Resultados. Se incluyeron 513 pacientes, 63,7 % hombres. El desenlace compuesto se presentó en el 25,7 % de los casos. La edad, historia de insuficiencia cardiaca y enfermedad arterial periférica, nivel de hemoglobina, recuento de leucocitos e INR constituyeron el mejor modelo de predicción de estos desenlaces (AUC 0,75). A partir de este modelo, se creó la escala simplificada HALVIC, clasificando el riesgo del desenlace compuesto en bajo (0-2 puntos), medio (3-4 puntos) y alto (5-7 puntos).
Conclusión. La escala HALVIC es una herramienta de predicción simple y fácilmente aplicable. Puede identificar de manera precisa los pacientes con obstrucción intestinal por bridas con alto riesgo de complicaciones, permitiendo el ajuste individualizado de las estrategias de manejo para mejorar los desenlaces.
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Referencias bibliográficas
Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, et al. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl. 4):S362-9. https://doi.org/10.1097/TA.0b013e31827019de
Vercruysse G, Busch R, Dimcheff D, Al-Hawary M, Saad R, Seagull FJ, et al. Evaluation and management of mechanical small bowel obstruction in adults. Ann Arbor (MI): Michigan Medicine University of Michigan. 2021. Fecha de consulta: 10 de septiembre de 2022. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK572336/
Behman R, Nathens AB, Haas B, Look-Hong N, Pechlivanoglou P, Karanicolas P. Surgery for adhesive small-bowel obstruction is associated with improved long-term survival mediated through recurrence prevention: A population-based, propensity-matched analysis. J Trauma Acute Care Surg. 2019;87:636-44. https://doi.org/10.1097/TA.0000000000002366
Ten Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24. https://doi.org/10.1186/s13017-018-0185-2
Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni L. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019;14:20. https://doi.org/10.1186/s13017-019-0240-7
Tong JWV, Lingam P, Shelat VG. Adhesive small bowel obstruction - an update. Acute Med Surg. 2020;7:e587. https://doi.org/10.1002/ams2.587
Aquina CT, Fleming FJ. Who should manage patients with adhesive small bowel obstruction? Adv Surg. 2017;51:125-40. https://doi.org/10.1016/j.yasu.2017.03.010
Tanaka S, Yamamoto T, Kubota D, Matsuyama M, Uenishi T, Kubo S, Ono K. Predictive factors for surgical indication in adhesive small bowel obstruction. Am J Surg. 2008;196:23-7. https://doi.org/10.1016/j.amjsurg.2007.05.048
Karamanos E, Dulchavsky S, Beale E, Inaba K, Demetriades D. Diabetes mellitus in patients presenting with adhesive small bowel obstruction: Delaying surgical intervention results in worse outcomes. World J Surg. 2016;40:863-9. https://doi.org/10.1007/s00268-015-3338-4
Bower KL, Lollar DI, Williams SL, Adkins FC, Luyimbazi DT, Bower CE. Small bowel obstruction. Surg Clin North Am. 2018;98:945-71. https://doi.org/10.1016/j.suc.2018.05.007
Musiienko AM, Shakerian R, Gorelik A, Thomson BNJ, Skandarajah AR. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction. ANZ J Surg. 2016;86:831-5. https://doi.org/10.1111/ans.13238
Mu JF, Wang Q, Wang SD, Wang C, Song JX, Jiang J, Cao XY. Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction: A retrospective study of 288 cases. Medicine (Baltimore). 2018;97:e12011. https://doi.org/10.1097/MD.0000000000012011
Asuzu D, Pei KY, Davis KA. A simple predictor of post-operative complications after open surgical adhesiolysis for small bowel obstruction. Am J Surg. 2018;216:67-72. https://doi.org/10.1016/j.amjsurg.2018.02.031
Morris RS, Murphy P, Boyle K, Somberg L, Webb T, Milia D, et al. Bowel ischemia score predicts early operation in patients with adhesive small bowel obstruction. Am Surg. 2022;88:205-11. https://doi.org/10.1177/0003134820988820
Hernandez MC, Haddad NN, Cullinane DC, Yeh DD, Wydo S, Inaba K, et al. The American Association for the Surgery of Trauma Severity Grade is valid and generalizable in adhesive small bowel obstruction. J Trauma Acute Care Surg. 2018;84:372-8. https://doi.org/10.1097/ta.0000000000001736
Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, Bannon MP. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg. 2011;212:1068-76. https://doi.org/10.1016/j.jamcollsurg.2011.02.023
Deng Y, Wang Y, Guo C. Prediction of surgical management for operated adhesive postoperative small bowel obstruction in a pediatric population. Medicine (Baltimore). 2019;98:e14919. https://doi.org/10.1097/MD.0000000000014919
Sullivan LM, Massaro JM, D’Agostino RB. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med. 2004;23:1631-60. https://doi.org/10.1002/sim.1742
Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg. 2018;13:48. https://doi.org/10.1186/s13017-018-0208-z
Quero G, Covino M, Laterza V, Fiorillo C, Rosa F, Menghi R, et al. Adhesive small bowel obstruction in elderly patients: a single-center analysis of treatment strategies and clinical outcomes. Scand J Gastroenterol. 2021;56:784-90. https://doi.org/10.1080/00365521.2021.1921256
Krause WR, Webb TP. Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort. Am J Surg. 2015;209:347-51. https://doi.org/10.1016/j.amjsurg.2014.04.008
Liang SY. Sepsis and other infectious disease emergencies in the elderly. Emerg Med Clin North Am. 2016;34:501-22. https://doi.org/10.1016/j.emc.2016.04.005
Springer JE, Bailey JG, Davis PJB, Johnson PM. Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study. Can J Surg. 2014;57:379-84. https://doi.org/10.1503/cjs.029513
Sincavage J, Robinson B, Msosa VJ, Katete C, Purcell LN, Charles A. Preoperative anemia and surgical outcomes following laparotomy in a resource-limited setting. Am J Surg. 2021;222:424-30. https://doi.org/10.1016/j.amjsurg.2020.12.032
Michailidou M, Nfonsam VN. Preoperative anemia and outcomes in patients undergoing surgery for inflammatory bowel disease. Am J Surg. 2018;215:78-81. https://doi.org/10.1016/j.amjsurg.2017.02.016
Wang H, Zhang JR, Chen S, Hou P, Chen QF, Weng ZQ, et al. Who would avoid severe adverse events from nasointestinal tube in small bowel obstruction? A matched case-control study. BMC Gastroenterol. 2022;22:332. https://doi.org/10.1186/s12876-022-02405-8
Kärkkäinen JM. Acute mesenteric ischemia: A challenge for the acute care surgeon. Scand J Surg. 2021;110:150- 8. https://doi.org/10.1177/14574969211007590
Lin YM, Li F, Shi XZ. Mechanical stress is a pro-inflammatory stimulus in the gut: in vitro, in vivo and ex vivo evidence. PLoS One. 2014;9:e106242. https://doi.org/10.1371/journal.pone.0106242
Vaishnavi C. Translocation of gut flora and its role in sepsis. Indian J Med Microbiol. 2013;31:334-42. https://doi.org/10.4103/0255-0857.118870
Lipinska-Gediga M. Coagulopathy in sepsis - a new look at an old problem. Anaesthesiol Intensive Ther. 2016;48:352-9. https://doi.org/10.5603/AIT.a2016.0051
Semeraro N, Ammollo CT, Semeraro F, Colucci M. Coagulopathy of acute sepsis. Semin Thromb Hemost. 2015;41:650-8. https://doi.org/10.1055/s-0035-1556730
Iba T, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Anesthesiology. 2020;132:1238-45. https://doi.org/10.1097/ALN.0000000000003122
Dorgalaleh A, Daneshi M, Rashidpanah J, Yasaghi ER. An overview of hemostasis. En: Dorgalaleh A, ed. Congenital bleeding disorders. Diagnosis and management. Cham: Springer International Publishing; 2018. p. 3-26.
Levi M, Schultz MJ. What do sepsis-induced coagulation test result abnormalities mean to intensivists? Intensive Care Med. 2017;43:581-3. https://doi.org/10.1007/s00134-017-4725-0
Lyons PG, Micek ST, Hampton N, Kollef MH. Sepsis-associated coagulopathy severity predicts hospital mortality. Crit Care Med. 2018;46:736-42. https://doi.org/10.1097/CCM.0000000000002997
Zhang J, Du HM, Cheng MX, He FM, Niu BL. Role of international normalized ratio in nonpulmonary sepsis screening: An observational study. World J Clin Cases. 2021;9:7405-16. https://doi.org/10.12998/wjcc.v9.i25.7405
Winer LK, Salyer C, Beckmann N, Caldwell CC, Nomellini V. Enigmatic role of coagulopathy among sepsis survivors: a review of coagulation abnormalities and their possible link to chronic critical illness. Trauma Surg Acute Care Open. 2020;5:e000462. https://doi.org/10.1136/tsaco-2020-000462
Liu J, Bai C, Li B, Shan A, Shi F, Yao C, et al. Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units. Sci Rep. 2021;11:1275. https://doi.org/10.1038/s41598-020-79843-5
Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116:1509-26. https://doi.org/10.1161/CIRCRESAHA.116.303849
Emma LA. Chronic arterial occlusive disease. J Cardiovasc Nurs. 1992;7:14-24. https://doi.org/10.1097/00005082-199210000-00004
Moore KJ, Sheedy FJ, Fisher EA. Macrophages in atherosclerosis: a dynamic balance. Nat Rev Immunol. 2013;13:709-21. https://doi.org/10.1038/nri3520
Smilowitz NR, Banco D, Katz SD, Beckman JA, Berger JS. Association between heart failure and perioperative outcomes in patients undergoing non-cardiac surgery. Eur Heart J Qual Care Clin Outcomes. 2021;7:68-75. https://doi.org/10.1093/ehjqcco/qcz066
Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, et al. Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg. 2006;243:456-64. https://doi.org/10.1097/01.sla.0000205668.58519.76
Sharma R, Reddy S, Thoman D, Grotts J, Ferrigno L. Laparoscopic versus open bowel resection in emergency small bowel obstruction: Analysis of the National Surgical Quality Improvement Program Database. J Laparoendosc Adv Surg Tech A. 2015;25:625-30. https://doi.org/10.1089/lap.2014.0446
Chang E, Chung PJ, Smith MC, Lee MJ, Gross DJ, Kao E, Sugiyama G. Can the laparoscopic approach for adhesive small bowel obstruction be used in octogenarians? An observational study using ACS NSQIP. J Surg Res. 2019;233:345-50. https://doi.org/10.1016/j.jss.2018.07.064
Sandek A, Bauditz J, Swidsinski A, Buhner S, Weber-Eibel J, von Haehling S, et al. Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol. 2007;50:1561-9. https://doi.org/10.1016/j.jacc.2007.07.016
Romeiro FG, Okoshi K, Zornoff LAM, Okoshi MP. Gastrointestinal changes associated to heart failure. Arq Bras Cardiol. 2012;98:273-7. https://doi.org/10.1590/S0066-782X2012000300011
Sandek A, Swidsinski A, Schroedl W, Watson A, Valentova M, Herrmann R, et al. Intestinal blood flow in patients with chronic heart failure: A link with bacterial growth, gastrointestinal symptoms, and cachexia. J Am Coll Cardiol. 2014;64:1092-102. https://doi.org/10.1016/j.jacc.2014.06.1179
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