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Inicio temprano de norepinefrina y mortalidad en pacientes con sepsis tratados en urgencias

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dc.contributor.advisorDevia Jaramillo, Germán Alberto
dc.contributor.otherRoncancio Melgarejo, Claudia Patricia
dc.creatorDonoso Zapata, William Gerardo
dc.creatorMotta Hernández, José Wdroo
dc.creator.degreeEspecialista en Medicina de Emergencias
dc.creator.degreeLevelMaestría
dc.date.accessioned2025-10-22T16:34:18Z
dc.date.available2025-10-22T16:34:18Z
dc.date.created2025-09-12
dc.descriptionLa sepsis, y en particular el choque séptico, es una afección potencialmente mortal asociada con altas tasas de mortalidad en urgencias. Las intervenciones oportunas pueden reducir significativamente estas tasas de mortalidad inaceptablemente altas. Si bien algunos estudios han demostrado una reducción de la mortalidad con el inicio temprano del tratamiento con norepinefrina, la investigación sobre esta intervención, específicamente en urgencias, es limitada. El objetivo de este estudio fue determinar la asociación entre el tiempo transcurrido hasta el inicio del tratamiento con norepinefrina en urgencias y la mortalidad hospitalaria en pacientes adultos con diagnóstico de choque séptico. Métodos: Este estudio de cohorte retrospectivo incluyó pacientes adultos con diagnóstico de choque séptico en urgencias. Se evaluaron las variables demográficas, paraclínicas y el tiempo transcurrido hasta el inicio del tratamiento con norepinefrina. La mortalidad hospitalaria se definió como el resultado principal. Finalmente, se realizó un análisis multivariable para desarrollar un nomograma que predijera la mortalidad por choque séptico en urgencias. Resultados: Se incluyó a 176 pacientes. Se documentó una diferencia significativa entre el tiempo transcurrido hasta el inicio del tratamiento con noradrenalina (en minutos) y las tasas de supervivencia: mediana (RIC) de 12 (2-29) minutos para los supervivientes frente a 104 (68-181) minutos para los no supervivientes (p < 0,001). De igual manera, al dividir el tiempo transcurrido hasta el inicio en tres grupos (<60, 61-179, >179 min), se observó una asociación diferencial con la mortalidad: OR 0,16 (IC del 95 %: 0,08-0,32), OR 5,59 (IC del 95 %: 2,67-11,6) y OR 353 (IC del 95 %: 20,8-5978,9), respectivamente. Además, las variables asociadas con la mortalidad incluyeron la presión arterial media, el lactato arterial y los niveles de creatinina. Conclusiones: El inicio temprano de noradrenalina en urgencias podría reducir la mortalidad hospitalaria por shock séptico sin aumentar las tasas de arritmia. Se necesitan más estudios de alta calidad para confirmarlo e identificar a los pacientes que se beneficiarían más.
dc.description.abstractSepsis, and particularly septic shock, is a life-threatening condition associated with high mortality rates in the emergency department. Timely interventions can significantly reduce these unacceptably high mortality rates. While some studies have demonstrated reduced mortality with early norepinephrine initiation, there is limited research on this intervention specifically within the emergency department setting. The objective of this study was to determine the association between the time to norepinephrine initiation in the emergency department and in-hospital mortality in adult patients diagnosed with septic shock. Methods: This retrospective cohort study included adult patients diagnosed with septic shock in the emergency department. Demographics, paraclinical variables, and the time to norepinephrine initiation were evaluated. In-hospital mortality was defined as the primary outcome. Finally, a multivariate analysis was performed to develop a nomogram for predicting septic shock mortality from the emergency department. Results: A total of 176 patients were included. A significant difference was documented between the time to norepinephrine initiation (in minutes) and survival rates: median (IQR) 12 (2–29) min for survivors versus 104 (68–181) min for non-survivors (p < 0.001). Similarly, when the time to initiation was divided into three groups (<60, 61–179, >179 min), a differential association with mortality was observed: OR 0.16 (95% CI; 0.08–0.32), OR 5.59 (95% CI; 2.67–11.6), and OR 353 (95% CI; 20.8–5978.9), respectively. Additionally, variables associated with mortality included mean arterial pressure, arterial lactate, and creatinine levels. Conclusions: Early initiation of norepinephrine in the emergency department may lower in-hospital mortality from septic shock without raising arrhythmia rates. Further high-quality studies are needed to confirm this and identify the patients who would benefit most.
dc.format.extent62 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_46815
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/46815
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Medicina de Emergencias
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectSepsis
dc.subjectChoque séptico
dc.subjectServicio de urgencias
dc.subjectMortalidad
dc.subject.keywordSepsis
dc.subject.keywordSeptic shock
dc.subject.keywordEmergency department
dc.subject.keywordMortality
dc.titleInicio temprano de norepinefrina y mortalidad en pacientes con sepsis tratados en urgencias
dc.title.TranslatedTitleNorepinephrine onset time and mortality in patients with septic shock treated in the emergency department
dc.typemasterThesis
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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