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| Format: | Artículo científico |
| Language: | en |
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Medical Education Cooperation with Cuba
2017
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| Online Access: | https://www.redalyc.org/articulo.oa?id=437553387005 |
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Table of Contents:
- Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure Caridad de Dios Soler-Morejón Tomás A. Lombardo-Vaillant Teddy O. Tamargo-Barbeito Manu L.N.G. Malbrain Medicina Cuba intra evidence APACHE II mortality INTRODUCTIONEarly assessment of prognosis following majorabdominal surgery is associated with decreased risk of complicationsand death. While scoring systems are useful in this regard, there is noindex that enables comprehensive individual patient assessment andis also applicable in ICUs with limited resources.OBJECTIVESDemonstrate that a model based on intra-abdominalpressure is effective in predicting death after major abdominalsurgery.METHODSA prospective observational study was done of 300 post–abdominal-surgery patients admitted to the ICU of a university hospitalaffiliated with the General Calixto García Medical Faculty, in January2008 through January 2010. Patients were randomly assigned (2:1)to two groups: test and validation. The independent variable was vitalstatus at discharge (alive or deceased); independent variables wereage, sex, malignancy, APACHE II score and intra-abdominal pressure.In the test group, three mathematical models werefit to predict death(APACHE II, intra-abdominal pressure, and APACHE II plus intra-abdominal pressure), which were later validated in the second group.Each model’s capacity to discriminate between living and deceasedwas evaluated according to sensitivity and specificity of receiveroperating characteristic curves. Calibration was assessed with theHosmer–Lemeshow goodness-of-fit test and comparison of receiveroperating characteristic curves by chi-square test of homogeneity.Each patient was followed until hospital discharge or death.RESULTSThe three mortality prediction models displayed excellentcalibration and discrimination, very similar predictive power, and nodifferences among their respective areas under the curve (chi square2.802, p = 0.094). Variables with the most influence on probability ofdeath were age, APACHE II score and intra-abdominal pressure.CONCLUSIONSThe three models show good capacity and similareffectiveness to predict death after major abdominal surgery. Themodel based on intra-abdominal pressure is the most feasible inlimited-resource settings. 2017 artículo científico 1555-7960 https://www.redalyc.org/articulo.oa?id=437553387005 en http://www.redalyc.org/revista.oa?id=4375 MEDICC Review application/pdf Medical Education Cooperation with Cuba MEDICC Review (Estados Unidos de América) Num.4 Vol.19