Niveles de creatinina sérica como factor pronóstico de mortalidad en pacientes entre 18-65 años con shock hipovolémico en Hospital Teodoro Maldonado Carbo, 2015-2018.

Abstract

Hypovolemic shock is a relatively frequent clinical condition in the emergency department whose symptoms may vary but, if not resolved, may result, prematurely, in death. The risk is triggered as a result of hypoperfusion of tissues whose oxygen supply constitutes a fundamental element, such as heart, brain and kidney. The last one, can trigger acute renal failure, if it is not resolved early and properly. For this, it is important to determine creatinine levels, because of its direct relationship with renal function. Methodology. This is an observational, retrospective cohort study. The information was used according to the established inclusion criteria, being: diagnosis of hypovolemic shock, patients between 18 and 65 years admitted to the emergency service of the HTMC, patients with serum creatinine measurement on the day of diagnosis of shock. Patients with insufficient laboratory data, diagnosis of chronic renal failure, liver cirrhosis, diagnosis of septic shock and SOFA index >7 points were excluded. To establish a relationship between mortality and creatinine levels, the first measurement of creatinine was taken at admission, and another at 48H. Thus, obtaining the exchange value (Δ) creatinine. Results In the positive Δ group, the average number of hospitalization days was 53.66 while in the negative Δ group it was 68.44. Also, there is an inverse relationship between creatinine levels and days of hospital stay (r = -0.17). In the delta Δ negative group, the mortality rate was 19.0% (n = 15). In those patients whose Δ creatinine is positive, a mortality of n = 30 (65.2%) was found. A positive correlation was found between the increase in creatinine and mortality. Finally, the survival analysis showed a statistically significant difference between the mortality curves of the patients according to their Δ creatinine. Conclusions. There was a strong relationship between increased creatinine and mortality in patients with hypovolemic shock, regardless of the diagnosis of admission. There is also an inverse relationship between the increase in creatinine and the hospital stay. The most frequent cause of shock was hemorrhagic, followed by non-hemorrhagic. Finally, it was not possible to show a relationship between the increase in creatinine and the type of shock presented.