Perfil cario-reno-metabólico en primera hospitalización por insuficiencia cardíaca. Evaluación de 541 pacientes
DOI:
https://doi.org/10.47196/diab.v59i2.1191Palabras clave:
diabetes mellitus, insuficiencia cardíaca, factores de riesgo cardiovascularResumen
Introducción: la insuficiencia cardíaca (IC) y la diabetes mellitus (DM) ocurren en muchos casos de manera concomitante y cada enfermedad aumenta el riesgo independiente de desarrollar la otra.
Objetivos: evaluar los factores cardio-reno-metabólicos en la primera hospitalización por IC y estimar los predictores de mortalidad.
Materiales y métodos: estudio retrospectivo. Se analizaron las historias clínicas digitalizadas de pacientes hospitalizados por primer evento de IC entre 2013 y 2019. Se recabaron antecedentes personales, hábitos, medicación habitual, examen físico, laboratorio y estudios complementarios. Se dividió la muestra en pacientes con y sin DM. Para la comparación de las variables numéricas se utilizó test de Student o Mann-Whitney, y para la comparación de frecuencias chi-cuadrado o test exacto de Fisher; p significativa <0,05. Se construyó un modelo predictor de mortalidad a través de una regresión logística con selección automática
Resultados: se incluyeron 541 pacientes, 297 sin DM y 244 con DM. Los pacientes con DM eran más jóvenes, con mayor prevalencia de dislipidemia e infarto agudo de miocardio (IAM), y mayor presión arterial sistólica (PAS) al egreso. En el laboratorio se registró mayor glucemia HbA1c, albuminuria y creatinina, y menor filtrado glomerular. En el ecocardiograma, la fracción de eyección del VI fue menor en los pacientes con DM. El modelo multivariable predictor de mortalidad incluyó edad, PAS al egreso, creatinina y HbA1c con una de sensibilidad del 96,88%, una especificidad del 34,04%, y una curva ROC con un área bajo la curva (area under the curve, AUC) de 0,82.
Conclusiones: acorde con la literatura, los pacientes con DM presentaron mayor severidad y cantidad de factores de riesgo cardio-reno-metabólicos, los cuales se comportaron de forma independiente como predictores de mortalidad.
Citas
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