RESUMEN
Objetivos. Analizar y comparar el poder predictivo de mortalidad a 30 días de varios biomarcadores (proteína C reactiva, procalcitonina, lactato y suPAR) en los pacientes que acuden al servicio de urgencias (SU) por un episodio de infección. Y, secundariamente, si estos mejoran la capacidad pronóstica de los criterios de sepsis (síndrome de respuesta inflamatoria sistémica-SRIS- y del quick Sepsis-related Organ Failure Assessment qSOFA-). Métodos. Estudio observacional, prospectivo y analítico. Se incluyó consecutivamente a pacientes atendidos en un SU por un proceso infeccioso. Se analizaron 32 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Resultados. Se incluyó a 347 pacientes, de los que 54 (15,6%) habían fallecido a los 30 días tras su consulta en el SU. El suPAR es el biomarcador que consigue la mayor área bajo la curva (ABC)-ROC para predecir mortalidad a los 30 días de 0,836 [IC 95%: 0,765-0,907; p< 0,001] con sensibilidad de 53% y especificidad de 89%. El modelo combinado (suPAR > 10 ng/ml con qSOFA ≥ 2) mejora el ABC-ROC a 0,853 [IC 95%: 0,790-0,916; p<0,001] y ofrece el mejor rendimiento pronóstico con una sensibilidad de 39%, especificidad del 97% y un valor predictivo negativo de 90%. Conclusiones. En los pacientes que acuden al SU por un episodio de infección, suPAR presenta una capacidad pronóstica de mortalidad a los 30 días superior al resto de biomarcadores, la qSOFA obtiene mayor rendimiento que los criterios de SRIS, y el modelo combinado qSOFA ≥ 2 con suPAR > 10 ng/ mL mejora el poder predictivo de qSOFA. (AU)
Objectives. To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). Methods. A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Results. The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P < .001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. Conclusions. suPAR showed better performance for 30- day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA. (AU)
Asunto(s)
Humanos , Biomarcadores , Mortalidad , Pronóstico , Plasminógeno , Atención Ambulatoria , Estudios Prospectivos , Activador de Plasminógeno de Tipo Uroquinasa , SepsisRESUMEN
Tenoxicam, a piroxicam analogue, is an NSAID (Non-Steroid Antinflamatory Drug). It is used in the symptomatic management of musculoskeletal and joint disorders such as osteoarthritis and rheumatoid arthritis, and also in the short-term management of soft-tissue injury. Its quantitative determination in pharmaceutical formulations is important to guarantee the desired therapeutic effects. The objective of this research was to develop, validate and compare spectrophotometric and chromatographic methods in the quantitative determination of tenoxicam in tablet preparations. In this work, tablets containing 20.0 mg of tenoxicam from different origins were analyzed. The spectrophotometric method was validated using 0.1 mol/L NaOH as solvent and a signal at 368 nm was taken. The HPLC method was validated using Synergi Hydro-RP® C18 column (250x4.6 mm, 4 µm). The mobile phase was constituted of methanol-water (61:39 v/v) with pH adjusted to 2.5 with formic acid, at a flow rate of 1.0 mL/min. UV detection was made at 375 nm. All analyses were performed with a column temperature of 25 ºC ± 1. The calibration curves were linear over a concentration range from 4.0-24.0 µg/mL with a correlation coefficient better than 0.9999. The detection limit (DL) and quantitation limit (QL) were 0.25 µg/mL and 0.90 µg/mL for UV method and 0.35 µg/mL and 1.20 µg/mL for HPLC method respectively. The intra-day and inter-day precision expressed as RSD were below 2 percent for both methods. The mean recovery of tenoxicam was found to be in the range of 98.5-101.25 percent for UV method and 99.01-101.93 percent for HPLC method. The UV and HPLC methods were found to be rapid, precise and accurate. Statistically there was no significant difference between proposed UV spectrophotometric and HPLC methods.
Tenoxicam, um análogo de piroxicam, é um AINE (Antiinflamatório Não-Esteróide). ë usado no tratamento sintomático de doenças musculoesqueléticas das juntas, tais como osteoartrite e artrite reumatóide, e, também, no tratamento de danos dos tecidos moles. Sua determinação quantitativa em formulações farmacêuticas é importante para garantir os efeitos terapêuticos desejados. O objetivo dessa pesquisa foi desenvolver, validar e comparar métodos espectrofotométrico e cromatográfico na determinação quantitativa de tenoxicam em comprimidos. Neste trabalho, comprimidos contendo 20,0 mg de tenoxicam de diferentes procedências foram analisados. O método espectrofotométrico foi validado utilizando-se 0,1 mol/L de NaOH como solvente e se obteve sinal a 368 nm. O método por CLAE foi validado utilizando-se coluna Synergi Hydri-RP® C18 (250x4,6 nm, 4µm). A fase móvel constitui-se de metanol-água (61:39 v/v), com pH ajustado para 2,5 com ácido fórmico, e velocidade de fluxo de 1,0 mL/minuto. A detecção por UV foi efetuada a 375 nm. Todas as análises foram realizadas com temperatura de coluna a 25 ºC ± 1. As curvas de calibração foram lineares na faixa de concentração de 4,0 a 24,0 µg/mL, comcoeficiente de correlação melhor que 0,9999. O limite de detecção (LD) e o limite de quantificação (LQ) foram 0,25 µg/mL e 0,90 µg/mL e 1,20 µg/mL por CLAE, respectivamente. A precisão intra e inter-dia, expressa como RSD, foi abaixo de 2 por cento para ambos os métodos. A média de recuperação do tenoxicam ficou na faixa de 98,5 a 101,25 por cento para o método de UV, e 99,01 a 101,93, para a CLAE. Os métodos de UV e de CLAE mostraram-se rápidos, precisos e exatos. Estatisticamente, não se observou diferença significativa entre os métodos espectrofotométricos (UV) e CLAE.
