Hiperglucemia al ingreso como predictor independiente de morbimortalidad en pacientes con hemorragia subaracnoidea aneurismática: estudio retrospectivo unicéntrico
DOI:
https://doi.org/10.59156/aa77dz15Palavras-chave:
Hemorragia subaracnoidea, Hiperglucemia, Mortalidad, PronósticoResumo
Introducción: la hemorragia subaracnoidea aneurismática (HSAa) se asocia a alta morbimortalidad. La hiperglucemia al ingreso ha sido propuesta como marcador pronóstico, aunque su rol independiente no está completamente establecido.
Objetivos: evaluar la asociación de la hiperglucemia al ingreso con la mortalidad intrahospitalaria y la incidencia de infecciones nosocomiales en pacientes con hemorragia subaracnoidea aneurismática (HSAa).
Materiales y métodos: se realizó un estudio observacional, analítico y retrospectivo en una cohorte de 79 pacientes con HSAa en un centro de alta complejidad durante 7 años. Se definió hiperglucemia como glucemia ≥140 mg/dL en sangre venosa. Se analizaron variables demográficas y clínicas. Se utilizaron pruebas de Chi-cuadrado y regresión logística multivariada para identificar predictores independientes de mortalidad.
Resultados: la hiperglucemia estuvo presente en el 54.43 % de los pacientes. Se asoció a mayor mortalidad (44 % vs. 16 %; p = 0.01) y mayor tasa de infecciones (41 % vs. 19 %; p = 0.03) en el subgrupo de hiperglucemia. La mortalidad también fue mayor en pacientes con alto grado de Hunt y Hess (50 % vs. 14 %; p <0.001) y Fisher modificado (44 % vs. 14 %; p = 0.003). En el análisis multivariado, la hiperglucemia se comportó como predictor independiente de mortalidad (OR 5.02; IC 95 % 1.58-15.97; p = 0.006).
Conclusiones: en pacientes con HSAa, la hiperglucemia al ingreso se asocia de forma independiente con un incremento en la mortalidad y en las complicaciones infecciosas. Dado su carácter potencialmente modificable, se perfila como un objetivo terapéutico clave y una valiosa herramienta de estratificación pronóstica.
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