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Papel dos biomarcadores inflamatórios como preditores de complicações após cirurgia de reparação de aneurisma da aorta abdominal
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Orientador(es)
Resumo(s)
A cirurgia de reparação de Aneurisma da Aorta Abdominal (AAA) por laparotomia está associada a isquémia abdominal (IA) em cerca de 9% dos pacientes submetidos a este procedimento. Paralelamente, estas cirurgias estão associadas a uma resposta inflamatória sistémica e elevados níveis de marcadores inflamatórios. Assim, este estudo procurou estabelecer uma relação entre a resposta inflamatória sistémica, o desenvolvimento de IA e a subida dos níveis séricos de marcadores inflamatórios.
Métodos
Foi conduzido um estudo retrospetivo com pacientes admitidos na unidade de cuidados intensivos (UCI) do Centro hospitalar Lisboa Norte após cirurgia major de reparação de AAA. Foram incluídos pacientes com pelo menos 2 valores de PCR medidos nas 48 horas após cirurgia, assim como outras variáveis. A Isquémia abdominal foi considerada o outcome primário, a qual foi diagnosticada por TC abdominal ou por laparotomia exploradora. Também foi avaliada a presença de bacteriemia, isquémia de membro inferior e mortalidade na UCI. Para identificar uma associação entre as variáveis medidas e o desenvolvimento IA utilizou-se análise univariada com regressão logística.
Resultados
Incluiu-se 88 pacientes admitidos na UCI após cirurgia de reparação de AAA. 21 pacientes (24%) desenvolveram IA. O desenvolvimento de complicações isquémicas associou-se a um valor de PCR mais elevado nas primeiras 48 horas (20.8 vs 32.02 mg/dL) comparativamente ao grupo sem IA. Verificou-se ainda uma associação estatisticamente significativa entre os valores de PCR no dia 1 (OR = 1.07) e 2 (OR = 1.13) e o desenvolvimento de IA. De salientar ainda que valores mais elevados de creatinina medidos no dia 1 e no dia 2, SAPSII e SOFA na admissão na unidade se associaram ao desenvolvimento de IA numa análise univariada. Os valores de PCR não se correlacionaram com a mortalidade neste estudo.
Discussão/conclusão
Neste estudo observou-se uma associação entre os valores de PCR nas primeiras 48 horas e o desenvolvimento de IA após reparação de AAA. No futuro, a medição de PCR após cirurgias vasculares major poderá ser integrada na avaliação clínica dos pacientes, com o intuito de ajudar a prever o desenvolvimento de complicações isquémicas no período pós-operatório, contribuindo para um diagnóstico mais precoce das mesmas, o que se poderá associar a um melhor prognóstico.
Background Abdominal aortic aneurysm repair via laparotomy is frequently complicated by abdominal ischemia, which occurs in 9% of patients undergoing this type of surgery. Major aortic vascular surgery is linked with a systemic inflammatory response and very high levels of inflammatory biomarkers. We hypothesized that there is an association between inflammatory response and organ ischemia, and that an early increase in CPR levels might help predicting abdominal ischemia. Methods We performed a retrospective study of patients admitted to the ICU of Universitary Hospital of Lisbon after major vascular surgery due to aorta aneurism during a period of two years. We included patients with at least two CRP levels in a 48 hour-period. Our primary outcome was abdominal ischemia assessed by abdominal CT-scan or exploratory laparotomy. We also evaluated the presence of bacteremia, lower limb ischemia and ICU mortality. To identify an association between inflammatory parameters and ischemia we used univariate logistic regression. Results We included 88 patients admitted to the ICU immediately after major abdominal vascular surgery. 21 patients (24%) developed abdominal ischemia which was associated with higher increase in CRP in the first 48 hours after surgery (20.8 vs 32.02 mg/dL). There was a statistically significant relation between mean CRP at day 1 (OR = 1.07) and 2 (OR = 1.13) and the development of abdominal ischemia. A positive association between abdominal ischemia and SAPSII, SOFA at day 1 and levels of creatinine at day 1 and 2 was also found. Levels of CRP were not associated with mortality. Discussion/Conclusion We found a positive association between CRP kinetics and abdominal ischemic complications. In the future, CRP measurement after major vascular surgery might be used to complement clinical assessment as a readily available test and help to predict ischemic complications. This earlier detection might be linked with a better prognosis.
Background Abdominal aortic aneurysm repair via laparotomy is frequently complicated by abdominal ischemia, which occurs in 9% of patients undergoing this type of surgery. Major aortic vascular surgery is linked with a systemic inflammatory response and very high levels of inflammatory biomarkers. We hypothesized that there is an association between inflammatory response and organ ischemia, and that an early increase in CPR levels might help predicting abdominal ischemia. Methods We performed a retrospective study of patients admitted to the ICU of Universitary Hospital of Lisbon after major vascular surgery due to aorta aneurism during a period of two years. We included patients with at least two CRP levels in a 48 hour-period. Our primary outcome was abdominal ischemia assessed by abdominal CT-scan or exploratory laparotomy. We also evaluated the presence of bacteremia, lower limb ischemia and ICU mortality. To identify an association between inflammatory parameters and ischemia we used univariate logistic regression. Results We included 88 patients admitted to the ICU immediately after major abdominal vascular surgery. 21 patients (24%) developed abdominal ischemia which was associated with higher increase in CRP in the first 48 hours after surgery (20.8 vs 32.02 mg/dL). There was a statistically significant relation between mean CRP at day 1 (OR = 1.07) and 2 (OR = 1.13) and the development of abdominal ischemia. A positive association between abdominal ischemia and SAPSII, SOFA at day 1 and levels of creatinine at day 1 and 2 was also found. Levels of CRP were not associated with mortality. Discussion/Conclusion We found a positive association between CRP kinetics and abdominal ischemic complications. In the future, CRP measurement after major vascular surgery might be used to complement clinical assessment as a readily available test and help to predict ischemic complications. This earlier detection might be linked with a better prognosis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Aneurisma da aorta abdominal Isquémia intestinal Proteína C reativa Medicina intensiva