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Lozano Gómez H, Rodríguez García A, Rodríguez Esteban MÁ, López Ferraz C, Murcia Hernández MDP, Fernández Zapata A, Villarreal Tello E, Ruiz Ruiz J, Fraile Gutiérrez V, Socias Crespi L, Pallas Beneyto LA, Villanueva Anadón B, Porcar Rodado E, Araiz Burdio JJ. Design of a new mortality indicator in acute coronary syndrome on admission to the Intensive Care Unit. Med Intensiva 2023; 47:501-515. [PMID: 37076405 DOI: 10.1016/j.medine.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To design a mortality indicator in acute coronary syndrome (ACS) in the intensive care unit (ICU). DESIGN A multicenter, observational descriptive study was carried out. PARTICIPANTS Patients with ACS admitted to the ICUs included in the ARIAM-SEMICYUC registry between January 2013 and April 2019. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic parameters, time of access to the healthcare system, and clinical condition. Revascularization therapy, drugs and mortality were analyzed. Cox regression analysis was performed, followed by the design of a neural network. A receiver operating characteristic curve (ROC) was plotted to calculate the power of the new score. Lastly, the clinical utility or relevance of the ARIAM indicator (ARIAM's) was assessed using a Fagan test. RESULTS A total of 17,258 patients were included in the study, with a mortality rate of 3.5% (n = 605) at discharge from the ICU. The variables showing statistical significance (P < .001) were entered into the supervised predictive model, an artificial neural network. The new ARIAM's yielded a mean of 0.0257 (95%CI: 0.0245-0.0267) in patients discharged from the ICU versus 0.27085 (95%CI: 0.2533-0.2886) in those who died (P < .001). The area under the ROC curve of the model was 0.918 (95%CI: 0.907-0.930). Based on the Fagan test, the ARIAM's showed the mortality risk to be 19% (95%CI: 18%-20%) when positive and 0.9% (95%CI: 0.8%-1.01%) when negative. CONCLUSIONS A new mortality indicator for ACS in the ICU can be established that is more accurate and reproducible, and periodically updated.
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Affiliation(s)
- Herminia Lozano Gómez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - Adrián Rodríguez García
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Cristina López Ferraz
- Complejo Hospitalario Universitario Nuestra Sra. de la Candelaria (Sta. Cruz de Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | - Juan José Araiz Burdio
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Vidal-Cortés P, Santos ED, Alonso EA, Menéndez RA, Ballesteros MÁ, Bodí MA, Laguna MLB, Garnacho Montero J, Sánchez MG, Sánchez ML, Martín-Loeches I, Calvo AO, Galleymore PR, Carmona SA, Ojeda DA, Arébalo OB, González HB, Sa MB, Castellanos-Ortega Á, Estella Á, Roca RF, Gutiérrez VF, Cabanes MF, Vich CGE, Iglesias CG, Hernández-Tejedor A, Carlos Igeño Cano J, Posadilla DI, Rivera JJJ, Jorge CL, Llompart-Pou JA, Camps VL, Cárdenas CL, Neira PM, Delgado MCM, González MMM, Villén LM, Casals XN, Suñer AO, Díaz MQ, Sedes PR, Núñez MR, Carbajo LDR, Aguirregabiria MR, Oviedo AR, Betolaza IS, Cuesta CS, Cañas BS, Ching CV, González ÁV, Fenor LZ, Crespo RZ. [Recommendations for the management of critically ill patients with COVID-19 in Intensive Care Units]. Med Intensiva 2021; 46:81-89. [PMID: 34545260 PMCID: PMC8443328 DOI: 10.1016/j.medin.2021.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
La pandemia por COVID-19 ha provocado el ingreso de un elevado número de pacientes en UCI, generalmente por insuficiencia respiratoria severa. Desde la aparición de los primeros casos de infección por SARS-CoV-2, a finales de 2019, en China, se ha publicado una cantidad ingente de recomendaciones de tratamiento de esta entidad, no siempre respaldadas por evidencia científica suficiente ni con el rigor metodológico necesario. Gracias al esfuerzo de distintos grupos de investigadores, actualmente disponemos de resultados de ensayos clínicos, y otro tipo de estudios, de mayor calidad. Consideramos necesario realizar un documento que incluya recomendaciones que recojan estas evidencias en cuanto al diagnóstico y tratamiento de la COVID-19, pero también aspectos que otras guías no han contemplado y que consideramos fundamentales en el manejo del paciente crítico con COVID-19. Para ello se ha creado un comité redactor, conformado por miembros de los Grupos de Trabajo de SEMICYUC más directamente relacionados con diferentes aspectos específicos del manejo de estos pacientes.
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Affiliation(s)
- Pablo Vidal-Cortés
- Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Emili Díaz Santos
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain.,Departament de Medicina, Univ Autonoma de Barcelona, Spain
| | | | | | - María Ángeles Ballesteros
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - María A Bodí
- Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain.,Universitat Rovira i Virgili, Tarragona, Spain
| | | | | | | | - Marta López Sánchez
- Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ignacio Martín-Loeches
- Intensive Care Medicine, St James´s Hospital, Dublin, Spain.,Trinity College Dublin, School of Medicine, Dublin, Spain
| | - Ana Ochagavía Calvo
- Medicina Intensiva, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | | | | | | | | | | | - Marcio Borges Sa
- Medicina Intensiva, Hospital Universitario Son Llátzer, Palma de Mallorca, Spain
| | | | - Ángel Estella
- Medicina Intensiva, Hospital Universitario de Jerez, Jerez, Spain.,Departamento de Medicina, INIBICA, Universidad de Cádiz, Cádiz, Spain
| | - Ricard Ferrer Roca
- Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - MariPaz Fuset Cabanes
- Medicina Intensiva, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Juan Antonio Llompart-Pou
- Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain.,Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | | | - Pilar Marcos Neira
- Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - María Cruz Martín Delgado
- Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain.,Universidad Francisco de Vitoria, Spain
| | | | - Luis Martín Villén
- Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Andrea Ortiz Suñer
- Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain.,Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Valencia, Spain
| | - Manuel Quintana Díaz
- Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain.,Departamento de Medicina Universidad Autónoma de Madrid, Madrid, Spain
| | - Pedro Rascado Sedes
- Medicina Intensiva, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | - Claudia Vera Ching
- Medicina Intensiva, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | | | - Lluis Zapata Fenor
- Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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