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Comportamiento, factores clínicos, complicaciones y supervivencia en niños críticos con infección respiratoria severa por Adenovirus frente a otras causas respiratorias infecciosas con soporte ECMO
| dc.contributor.advisor | Bareño Silva, José | |
| dc.contributor.advisor | Mullet Hoyos, Hernando Rafael | |
| dc.contributor.other | Gonzalez Pardo, Otto Mauricio | |
| dc.contributor.other | Casalett, Gabriel | |
| dc.contributor.other | Barrera, Pedro | |
| dc.contributor.other | Chacon tapias, Shayl zamira | |
| dc.contributor.other | Piñeres Olave, Byron Enrique | |
| dc.contributor.other | Ruz, Miguel | |
| dc.contributor.other | Lasso Palomino, Rubén Eduardo | |
| dc.creator | Acevedo Sedano, Gizeth Lorena | |
| dc.creator.degree | Magíster en Epidemiología | |
| dc.creator.degreeLevel | Maestría | |
| dc.date.accessioned | 2024-12-06T21:48:20Z | |
| dc.date.available | 2024-12-06T21:48:20Z | |
| dc.date.created | 2024-11-30 | |
| dc.date.embargoEnd | info:eu-repo/date/embargoEnd/2026-12-07 | |
| dc.description | Introducción: Infección por Adenovirus suele ser rápidamente progresiva y potencialmente fatal en inmunocomprometidos. Se han descrito casos muy severos en pacientes inmunocompetentes, requiriendo soporte ECMO. La mortalidad descrita en estos casos de adenovirus severo en ECMO es superior a la por otras causas infecciosas. El objetivo es Estimar los diferentes desenlaces, complicaciones, duración de la terapia y supervivencia de los pacientes pediátricos con soporte ECMO por adenovirus vs otras etiologías infecciosas. Así como identificar factores de riesgo asociados a mortalidad y complicaciones en las cohortes. Metodología: estudio observacional analítico tipo cohortes retrospectivo multicéntrico en niños de 1 mes a 18 años que ingresaron a terapia ECMO. Cohorte expuesta, niños con infección por adenovirus y cohorte no expuesta pacientes con ingreso a ECMO por otra causa infecciosa respiratoria. Resultados Un total de 205 pacientes, cohorte adenovirus 80 y no adenovirus 125. La supervivencia de la cohorte adenovirus de 67.5% y la no expuesta 71.2% (p 0.59; 95%IC 0.87-1.74), complicaciones hemorrágicas la cohorte adenovirus 37/80 (46.3%) vs no adenovirus 44/125 (35.2%) p=014. Mayor duración de la VM en pacientes adenovirus 21 días de mediana (RIC=14-32.5) vs no adenovirus 18 dias de mediana (RIC=12-29) p 0.04 y días totales de ECMO mediana en adenovirus 12.5 días (RIC=7-19.3) vs no adenovirus 8 días (RIC 5-15) p=0.003. Regresión multivariada identificó que VIS preECMO mayor a 15 (OR=3.18; 95%. IC=1.08-7.45) PH preECMO menor a 7.2 (OR=3.79; 95%IC 1.75-5.52; p=0.004) y hrs entre diagnóstico de refractariedad y canulación mayor a 13 horas (OR=4.04; 95% IC 1.7-7.21; p=0.002). Conclusiones: pacientes con adenovirus soportados en ECMO tienen sobrevida de 67.5%, sin diferencia significativa frente a otras etiologías infecciosas. Se identificaron factores de riesgo asociados a mayor mortalidad como el PH, VIS score preECMO y el tiempo entre el diagnóstico de refractaridad y la canulación. No hubo diferencia significativa en las complicaciones hemorrágicas ni infecciosas. Pero la cohorte expuesta a adenovirus requirió mayor duración de soporte ventilatorio invasivo y terapia ECMO | |
| dc.description.abstract | Introduction: Adenovirus infection is often rapidly progressive and potentially fatal in immunocompromised patients. Severe cases have also been described in immunocompetent individuals, requiring ECMO support. Mortality associated with severe adenovirus infections on ECMO has been reported to be higher than that of other infectious causes. This study aims to estimate outcomes, complications, therapy duration, and survival rates in pediatric patients receiving ECMO support for adenovirus compared to other infectious etiologies, as well as to identify risk factors associated with mortality and complications in these cohorts. Methods: This is a multicenter retrospective cohort observational study involving children aged 1 month to 18 years who required ECMO support. The exposed cohort included children with adenovirus infection, while the non-exposed cohort consisted of patients requiring ECMO for other infectious respiratory causes. Results: A total of 205 patients were included, with 80 in the adenovirus cohort and 125 in the non-adenovirus cohort. Survival in the adenovirus cohort was 67.5%, compared to 71.2% in the non-adenovirus group (p = 0.59; 95% CI 0.87–1.74). Hemorrhagic complications occurred in 46.3% of adenovirus cases (37/80) versus 35.2% in the non-adenovirus group (44/125, p = 0.14). Patients in the adenovirus cohort had a longer median duration of mechanical ventilation (21 days, IQR 14–32.5) compared to the non-adenovirus cohort (18 days, IQR 12–29, p = 0.04). The total median ECMO duration was also longer for adenovirus patients (12.5 days, IQR 7–19.3) versus non-adenovirus patients (8 days, IQR 5–15, p = 0.003). Multivariate regression analysis identified pre-ECMO VIS > 15 (OR = 3.18; 95% CI 1.08–7.45), pre-ECMO pH < 7.2 (OR = 3.79; 95% CI 1.75–5.52; p = 0.004), and time between refractory diagnosis and cannulation > 13 hours (OR = 4.04; 95% CI 1.7–7.21; p = 0.002) as significant risk factors for mortality. Conclusions: Pediatric patients with adenovirus infection requiring ECMO support have a survival rate of 67.5%, with no significant difference compared to other infectious etiologies. Risk factors associated with higher mortality include low pre-ECMO pH, high pre-ECMO VIS score, and prolonged time between refractory diagnosis and cannulation. While there were no significant differences in hemorrhagic or infectious complications, the adenovirus cohort required longer durations of invasive ventilation and ECMO therapy. | |
| dc.format.extent | 83 pp | |
| dc.format.mimetype | application/pdf | |
| dc.identifier.doi | https://doi.org/10.48713/10336_44475 | |
| dc.identifier.uri | https://repository.urosario.edu.co/handle/10336/44475 | |
| dc.language.iso | spa | |
| dc.publisher | Universidad del Rosario | spa |
| dc.publisher | Universidad CES. Facultad de Medicina | |
| dc.publisher.department | Escuela de Medicina y Ciencias de la Salud | spa |
| dc.publisher.program | Maestría en Epidemiología | spa |
| dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | * |
| dc.rights.accesRights | info:eu-repo/semantics/embargoedAccess | |
| dc.rights.acceso | Restringido (Temporalmente bloqueado) | |
| dc.rights.licencia | EL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos. | spa |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
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| dc.source.instname | instname:Universidad del Rosario | |
| dc.source.reponame | reponame:Repositorio Institucional EdocUR | |
| dc.subject | Adenovirus | |
| dc.subject | Membrana de oxigenación extracorporea | |
| dc.subject | Hipoxemia refractaria pediátrico | |
| dc.subject | Supervivencia | |
| dc.subject.keyword | Adenovirus | |
| dc.subject.keyword | Extracorporeal membrane oxigenation | |
| dc.subject.keyword | Refractory hypoxemia | |
| dc.subject.keyword | Pediatric | |
| dc.subject.keyword | Survival | |
| dc.title | Comportamiento, factores clínicos, complicaciones y supervivencia en niños críticos con infección respiratoria severa por Adenovirus frente a otras causas respiratorias infecciosas con soporte ECMO | |
| dc.title.TranslatedTitle | Behavior, clinical factors, complications, and survival in critically ill children with severe respiratory infection due to adenovirus compared to other infectious respiratory causes with ECMO Support | |
| dc.type | masterThesis | |
| dc.type.hasVersion | info:eu-repo/semantics/acceptedVersion | |
| dc.type.spa | Trabajo de grado | |
| local.department.report | Escuela de Medicina y Ciencias de la Salud | |
| local.regiones | Bogotá |
