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Factores asociados a injuria renal aguda en pacientes con trasplante hepático en un hospital de cuarto nivel

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dc.contributor.advisorBarrera Garavito, Edgar Camilo
dc.creatorNaranjo-Millán, Julián
dc.creatorCastellanos-de la Hoz, Juan
dc.creator.degreeEspecialista en Medicina Interna
dc.date.accessioned2018-08-03T14:36:01Z
dc.date.available2018-08-03T14:36:01Z
dc.date.created2018-07-13
dc.date.issued2018
dc.descriptionObjetivo: Determinar factores clínicos asociados al desarrollo de lesión renal aguda (LRA) en el periodo posoperatorio de trasplante hepático en pacientes operados en la FCI-IC. Diseño: El presente será un estudio prospectivo, observacional, analítico de cohorte; incluyendo pacientes mayores de 18 años, receptores de trasplante hepático realizado en la Fundación Cardioinfantil (FCI). Se analizarán dentro de la cohorte disponible de pacientes trasplantados en la FCI entre los años 2005 a 2014, se establecerá mediante análisis multivariados que variables se encuentran asociadas al desarrollo de LRA. Resultados:198 pacientes cumplían con los criterios de inclusión y exclusión, descartándose 94 pacientes por no contar con datos intraoperatorios en la historia clínica. Se encontraron 54 (52%) casos de LRA, con una mediana de sobrevida libre de LRA de 83 días. El modelo de regresión incluyó la presencia de ascitis severa, MELD > 20 y uso de mas de 4 unidades de Crioprecipitado durante la cirugía. La presencia de ascitis severa confiere un HR 0.36 (IC 95%0.14-0.92) independiente del MELD y el uso de crioprecipitado durante la cirugía de trasplante. Discusión: La LRA es una complicación frecuente en el postrasplante hepático. Se ha considerado a la LRA multifactorial, donde influyen factores del recipiente, peri operatorios y posoperatorios. En nuestro estudio se ha encontrado después de ajustar por las probables variables de confusión, como la principal variable asociada la ascitis severa, esto probablemente asociado a fenómenos de precondicionamiento isquémico. Consideramos un hallazgo que se debe tener en consideración en los estudios que se realicen a posteriori.spa
dc.description.abstractObjective: To determine the clinical variables associated with the development of acute kidney injury (AKI) in the postoperative period of liver transplantation. Design: Prospective, observational, analytical cohort study. Frame of reference: The study was developed at the Fundación Cardioinfantil (FCI), a fourth level hospital. Patients: Patients older than 18 years, liver transplant recipients. Main measurements: Pre-surgical, post-surgical variables and creatinine evolution to determine the incidence of AKI. A Cox regression model was developed to determine which variables are associated with AKI. Results: 198 patients were found; 94 patients were discarded due to the lack of intraoperative data in the history chart. 54 (52%) cases of AKI were found, with a median survival time free of AKI of 83 days. No statistically significant differences in the univariate analyzes between the population with AKI and event-free patients. The regression model included the presence of severe ascites, MELD> 20 and the use of more than 4 units of cryoprecipitate during surgery. The presence of severe ascites confers a HR 0.36 (95% CI 0.14-0.92). Conclusions: In our study it was found after adjusting for the confounding variables, that severe ascites is associated with a decreased rate of AKI, a finding that could be understood studying the ischemic preconditioning phenomena that this population group can have. We consider a finding that should be taken into consideration in the studies that are carried out in the future.eng
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dc.identifier.doihttps://doi.org/10.48713/10336_18247
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/18247
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Medicina Internaspa
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
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dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectLesión renal agudaspa
dc.subjectTrasplante hepáticospa
dc.subjectTerapia de remplazo renalspa
dc.subject.ddcEnfermedades
dc.subject.keywordAcute renal failureeng
dc.subject.keywordLiver transplantationeng
dc.subject.lembEnfermedades renalesspa
dc.subject.lembTrasplantes de hígadospa
dc.titleFactores asociados a injuria renal aguda en pacientes con trasplante hepático en un hospital de cuarto nivelspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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