Anemia crónica como factor de riesgo de muerte por choque hipovolémico en población peruana. 2021-2022
Palabras clave:
anemia, choque, registros de mortalidad, análisis multivariante, oportunidad relativa
Resumen
Objetivo: determinar si la anemia crónica es un factor de riesgo asociado a la muerte por choque hipovolémico en adultos peruanos.
Métodos: estudio observacional, de casos y controles, basado en datos del Sistema Nacional de Defunciones del Ministerio de Salud peruano entre enero de 2021 a septiembre de 2022. La población estudiada fue de 281.456 adultos cuando se analizó según sexo, y 281.416 adultos cuando se dividió según grupo etario con una diferencia de 40 datos perdidos durante el procesamiento de la información. Se incluyó a pacientes con y sin anemia (variable independiente), cuyas causas de muerte inmediata fueron divididas en muertes por choque hipovolémico (variable dependiente) y muertes por otras causas inmediatas. Se realizó la prueba de Chi-cuadrado y el coeficiente V de Cramer, así como el análisis multivariado considerando variables como la edad y el sexo. Se consideró un valor de p significativo menor a 0,05 con un intervalo de confianza al 95%.
Resultados: 1627 hombres fallecieron por choque hipovolémico de los cuales 18,20% tuvo anemia crónica (p<0,001). De 1540 mujeres fallecidas, 21,30% tuvo anemia crónica (p<0,001) y en ambos grupos (3167) el 19,70% tuvo anemia crónica (p<0,001). Con la prueba V de Cramer se halló una asociación positiva y baja entre las variables estudiadas (p<0,001). Los pacientes con anemia crónica tuvieron mayor probabilidad de morir por choque hipovolémico que los fallecidos sin anemia crónica, siendo mayor en adultos a partir de los 40 años, datos reafirmados en el modelo de regresión logística binaria.
Conclusiones: la anemia crónica es una comorbilidad que supone un aumento del riesgo de muerte en pacientes con choque hipovolémico. Independientemente de la etiología del choque, el control y corrección de la anemia crónica podría tener un impacto en la reducción de la mortalidad de la hipovolemia aguda en adultos peruanos.
Citas
1. Stucchi M, Cantoni S, Piccinelli E, Savonitto S, Morici N. Anemia and acute coronary syndrome: current perspectives. Vasc Health Risk Manag [Internet]. 2018 [cited 2023 Feb 10]; 14:109–18. Available from: https://www.dovepress.com/anemia-and-acute-coronary-syndrome-current-perspectives-peer-reviewed-fulltext-article-VHRM. doi: http://dx.doi.org/10.2147/vhrm.s140951
2. Brian Lanier J, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician [Internet]. 2018 [cited 2023 Jun 26];98(7):437–42. Available from : https://www.aafp.org/pubs/afp/issues/2018/1001/p437.html
3. Abdelhaleim AF, Amer AY, Abdo Soliman JS. Corrected: Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study. Cureus [Internet]. 2019 [cited 2023 Jun 26];11(1):e3811. Available from: https://assets.cureus.com/uploads/original_article/pdf/16553/20211206-18451-we1xfp.pdf. doi: 10.7759/cureus.3811
4. Begum S, Latunde-Dada GO. Anemia of inflammation with an emphasis on chronic kidney disease. Nutrients [Internet]. 2019 [cited 2023 Jun 26];11(10):2424. Available from: https://www.mdpi.com/2072-6643/11/10/2424. doi: https://doi.org/10.3390/nu11102424
5. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Ann NY Acad Sci [Internet]. 2019[cited 2023 Jun 26]; 1450(1):15-31. Available from: https://pubmed.ncbi.nlm.nih.gov/31008520. doi: http://dx.doi.org/10.1111/nyas.14092
6. Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol [Internet]. 2021 [cited 2023 Jun 26]; 14:17562848211038771. Available from: https://pubmed.ncbi.nlm.nih.gov/34484423. doi: http://dx.doi.org/10.1177/17562848211038771
7. Piccin A, O’Connor-Byrne N, Daves M, Lynch K, Farshbaf AD, Martin-Loeches I. Autoimmune disease and sickle cell anaemia: “Intersecting pathways and differential diagnosis”. Br J Haematol [Internet]. 2022 [cited 2023 Jun 26];197(5):518–28. Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.18109. doi: http://dx.doi.org/10.1111/bjh.18109
8. Muñoz M, Gómez-Ramírez S, Bhandari S. The safety of available treatment options for iron-deficiency anemia. Expert Opin Drug Saf. 2018;17(2):149–59. doi: http://dx.doi.org/10.1080/14740338.2018.1400009
9. Castro Bedriñana JI, Chirinos Peinado DM. Prevalencia de anemia infantil y su asociación con factores socioeconómicos y productivos en una comunidad altoandina del Perú. Rev Esp Nutr Comunitaria [Internet]. 2019 [citado 26 Jun 2023];25(3):1. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7137728
10. Suresh MR, Chung KK, Schiller AM, Holley AB, Howard JT, Convertino VA. Unmasking the hypovolemic shock continuum: The compensatory reserve. J Intensive Care Med. 2019;34(9):696–706. doi: http://dx.doi.org/10.1177/0885066618790537
11. Ozakin E, Yazlamaz NO, Kaya FB, Karakilic EM, Bilgin M. Perfusion index measurement in predicting hypovolemic shock in trauma patients. J Emerg Med [Internet]. 2020 [cited 2023 Jun 26];59(2):238–45. Available from: https://www.sciencedirect.com/science/article/pii/S0736467920303413
12. Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. The nomenclature, definition and distinction of types of shock. Dtsch Arztebl Int [Internet]. 2018 [cited 2023 Jun 26];115(45):757-68. Available from: https://pubmed.ncbi.nlm.nih.gov/30573009. doi: http://dx.doi.org/10.3238/arztebl.2018.0757
13. Malin SW, Lutfi R, Friedman ML, Teagarden AM. Food protein-induced enterocolitis syndrome causing hypovolemic shock and methemoglobinemia. Case Rep Crit Care [Internet]. 2018 [cited 2023 Jun 26]; 2018: 1903787. Available from: https://pubmed.ncbi.nlm.nih.gov/29854475. doi: 10.1155/2018/1903787
14. Pavani P, Naveena E, Subhashini P, Srikanth S, Thirumala Naik K, Kishore Babu M. A review on non-steroidal anti-inflammatory drugs induced kidney diseases. Res J Pharmacol Pharmacodyn [Internet]. 2022 [cited 2023 Jun 26];14(4):268–72. Available from: https://rjppd.org/HTMLPaper.aspx?Journal=Research%20Journal%20of%20Pharmacology%20and%20Pharmacodynamics;PID=2022-14-4-12. doi: 10.52711/2321-5836.2022.00046
15. Shen ZA. Preliminary discussion on the prevention and treatment of shock after severe burns. Zhonghua Shao Shang Za Zhi [Internet]. 2022 [cited 2023 Jun 26];38(1):9–12. Available from: https://europepmc.org/article/med/35012266. Doi: 10.3760/cma.j.cn501120-20211130-00402
16. Jones TJ, Bhattacharya B, Davis KA. Hypovolemic shock. En: Textbook of emergency general surgery [Internet]. Cham: Springer International Publishing; 2023. p. 137–46. [cited 2023 Jun 26]. Available from: http://dx.doi.org/10.1007/978-3-031-22599-4_11
17. Khalil OA, Sakr MM, Selim FO, Mohammed Salem IM. Prevalence, pattern and clinical outcome of circulatory shock in critically ill patients in medical ICU. Zagazig univ med j [Internet]. 2018 [cited 2023 Jun 26];24(4):329–37. Available from: https://zumj.journals.ekb.eg/article_13226.html. doi: 10.21608/ZUMJ.2018.13226
18. Elbaih AH, Housseini AM, Khalifa MEM. Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients. Chin J Traumatol [Internet]. 2018 [cited 2023 Jun 26];21(3):156–62. Available from: https://www.sciencedirect.com/science/article/pii/S1008127517301037. doi: https://doi.org/10.1016/j.cjtee.2017.06.009
19. Taghavi S, Nassar Ak, Askari R. Hypovolemic shock. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Jun 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513297/
20. Rudkin SE, Grogan TR, Treger RM. Relationship between the anion gap and serum lactate in hypovolemic shock. J Intensive Care Med [Internet]. 2022 [cited 2023 Jun 26];37(12):1563–8. Available from: https://pubmed.ncbi.nlm.nih.gov/35668631. doi: http://dx.doi.org/10.1177/08850666221106413
21. Bonanno FG. Management of hemorrhagic shock: Physiology approach, timing and strategies. J Clin Med [Internet]. 2022 [cited 2023 Jun 26];12(1):260. Available from: https://pubmed.ncbi.nlm.nih.gov/36615060. doi: 10.3390/jcm12010260
22. Ranjan AK, Gulati A. Controls of central and peripheral blood pressure and hemorrhagic/hypovolemic shock. J Clin Med [Internet]. 2023 [cited 2023 Jun 26];12(3):1108. Available from: https://www.mdpi.com/2077-0383/12/3/1108. doi: 10.3390/jcm12031108
23. Lier H, Bernhard M, Hossfeld B. Hypovolemic and hemorrhagic shock. Anaesthesist. 2018;67(3):225–44. doi: 10.1007/s00101-018-0411-z
24. Gulati A. Vascular endothelium and hypovolemic shock. Curr Vasc Pharmacol. 2016;14(2):187–95. doi: 10.2174/1570161114666151202210221
25. Doyle J, Cooper JS. Physiology, carbon dioxide transport. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 26]. Available from:: https://www.ncbi.nlm.nih.gov/books/NBK532988/
26. Premont RT, Reynolds JD, Zhang R, Stamler JS. Role of nitric oxide carried by hemoglobin in cardiovascular physiology: Developments on a three-gas respiratory cycle. Circ Res [Internet]. 2020 [cited 2023 Jun 26];126(1):129–58. Available from: https://pubmed.ncbi.nlm.nih.gov/31590598/. doi: 10.1161/CIRCRESAHA.119.315626
27. Su H, Liu X, Du J, Deng X, Fan Y. The role of hemoglobin in nitric oxide transport in vascular system. Med Nov Technol Devices [Internet]. 2020 [cited 2023 Jun 26];5(100034):1-6. Available from: https://www.sciencedirect.com/science/article/pii/S2590093520300084. doi: https://doi.org/10.1016/j.medntd.2020.100034
28. Benner A, Patel AK, Singh K, Dua A. Physiology, Bohr Effect In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526028
29. Malte H, Lykkeboe G, Wang T. The magnitude of the bohr effect profoundly influences the shape and position of the blood oxygen equilibrium curve. Comp Biochem Physiol A Mol Integr Physiol. 2021; 254:110880. doi: 10.1016/j.cbpa.2020.110880
30. Capone J, Gluncic V, Lukic A, Candido KD. Physiologically difficult airway in the patient with severe hypotension and metabolic acidosis. Case Rep Anesthesiol [Internet]. 2020 [cited 2023 Jun 26]; 2020:8821827. Available from: https://pubmed.ncbi.nlm.nih.gov/32953182. doi: 10.1155/2020/8821827
31. Guo SB, Chen YX, Yu XZ. Clinical characteristics and current interventions in shock patients in Chinese emergency departments: A multicenter prospective cohort study. Chin Med J (Engl) [Internet]. 2017 [cited 2023 Jun 26];130(10):1146–54. Available from: https://pubmed.ncbi.nlm.nih.gov/28485313. doi: 10.4103/0366-6999.205862
32. Delgado BJ, Lopez-Ojeda W. Estrogen In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538260/
2. Brian Lanier J, Park JJ, Callahan RC. Anemia in Older Adults. Am Fam Physician [Internet]. 2018 [cited 2023 Jun 26];98(7):437–42. Available from : https://www.aafp.org/pubs/afp/issues/2018/1001/p437.html
3. Abdelhaleim AF, Amer AY, Abdo Soliman JS. Corrected: Association of Zinc Deficiency with Iron Deficiency Anemia and its Symptoms: Results from a Case-control Study. Cureus [Internet]. 2019 [cited 2023 Jun 26];11(1):e3811. Available from: https://assets.cureus.com/uploads/original_article/pdf/16553/20211206-18451-we1xfp.pdf. doi: 10.7759/cureus.3811
4. Begum S, Latunde-Dada GO. Anemia of inflammation with an emphasis on chronic kidney disease. Nutrients [Internet]. 2019 [cited 2023 Jun 26];11(10):2424. Available from: https://www.mdpi.com/2072-6643/11/10/2424. doi: https://doi.org/10.3390/nu11102424
5. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Ann NY Acad Sci [Internet]. 2019[cited 2023 Jun 26]; 1450(1):15-31. Available from: https://pubmed.ncbi.nlm.nih.gov/31008520. doi: http://dx.doi.org/10.1111/nyas.14092
6. Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol [Internet]. 2021 [cited 2023 Jun 26]; 14:17562848211038771. Available from: https://pubmed.ncbi.nlm.nih.gov/34484423. doi: http://dx.doi.org/10.1177/17562848211038771
7. Piccin A, O’Connor-Byrne N, Daves M, Lynch K, Farshbaf AD, Martin-Loeches I. Autoimmune disease and sickle cell anaemia: “Intersecting pathways and differential diagnosis”. Br J Haematol [Internet]. 2022 [cited 2023 Jun 26];197(5):518–28. Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.18109. doi: http://dx.doi.org/10.1111/bjh.18109
8. Muñoz M, Gómez-Ramírez S, Bhandari S. The safety of available treatment options for iron-deficiency anemia. Expert Opin Drug Saf. 2018;17(2):149–59. doi: http://dx.doi.org/10.1080/14740338.2018.1400009
9. Castro Bedriñana JI, Chirinos Peinado DM. Prevalencia de anemia infantil y su asociación con factores socioeconómicos y productivos en una comunidad altoandina del Perú. Rev Esp Nutr Comunitaria [Internet]. 2019 [citado 26 Jun 2023];25(3):1. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=7137728
10. Suresh MR, Chung KK, Schiller AM, Holley AB, Howard JT, Convertino VA. Unmasking the hypovolemic shock continuum: The compensatory reserve. J Intensive Care Med. 2019;34(9):696–706. doi: http://dx.doi.org/10.1177/0885066618790537
11. Ozakin E, Yazlamaz NO, Kaya FB, Karakilic EM, Bilgin M. Perfusion index measurement in predicting hypovolemic shock in trauma patients. J Emerg Med [Internet]. 2020 [cited 2023 Jun 26];59(2):238–45. Available from: https://www.sciencedirect.com/science/article/pii/S0736467920303413
12. Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W. The nomenclature, definition and distinction of types of shock. Dtsch Arztebl Int [Internet]. 2018 [cited 2023 Jun 26];115(45):757-68. Available from: https://pubmed.ncbi.nlm.nih.gov/30573009. doi: http://dx.doi.org/10.3238/arztebl.2018.0757
13. Malin SW, Lutfi R, Friedman ML, Teagarden AM. Food protein-induced enterocolitis syndrome causing hypovolemic shock and methemoglobinemia. Case Rep Crit Care [Internet]. 2018 [cited 2023 Jun 26]; 2018: 1903787. Available from: https://pubmed.ncbi.nlm.nih.gov/29854475. doi: 10.1155/2018/1903787
14. Pavani P, Naveena E, Subhashini P, Srikanth S, Thirumala Naik K, Kishore Babu M. A review on non-steroidal anti-inflammatory drugs induced kidney diseases. Res J Pharmacol Pharmacodyn [Internet]. 2022 [cited 2023 Jun 26];14(4):268–72. Available from: https://rjppd.org/HTMLPaper.aspx?Journal=Research%20Journal%20of%20Pharmacology%20and%20Pharmacodynamics;PID=2022-14-4-12. doi: 10.52711/2321-5836.2022.00046
15. Shen ZA. Preliminary discussion on the prevention and treatment of shock after severe burns. Zhonghua Shao Shang Za Zhi [Internet]. 2022 [cited 2023 Jun 26];38(1):9–12. Available from: https://europepmc.org/article/med/35012266. Doi: 10.3760/cma.j.cn501120-20211130-00402
16. Jones TJ, Bhattacharya B, Davis KA. Hypovolemic shock. En: Textbook of emergency general surgery [Internet]. Cham: Springer International Publishing; 2023. p. 137–46. [cited 2023 Jun 26]. Available from: http://dx.doi.org/10.1007/978-3-031-22599-4_11
17. Khalil OA, Sakr MM, Selim FO, Mohammed Salem IM. Prevalence, pattern and clinical outcome of circulatory shock in critically ill patients in medical ICU. Zagazig univ med j [Internet]. 2018 [cited 2023 Jun 26];24(4):329–37. Available from: https://zumj.journals.ekb.eg/article_13226.html. doi: 10.21608/ZUMJ.2018.13226
18. Elbaih AH, Housseini AM, Khalifa MEM. Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients. Chin J Traumatol [Internet]. 2018 [cited 2023 Jun 26];21(3):156–62. Available from: https://www.sciencedirect.com/science/article/pii/S1008127517301037. doi: https://doi.org/10.1016/j.cjtee.2017.06.009
19. Taghavi S, Nassar Ak, Askari R. Hypovolemic shock. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Jun 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513297/
20. Rudkin SE, Grogan TR, Treger RM. Relationship between the anion gap and serum lactate in hypovolemic shock. J Intensive Care Med [Internet]. 2022 [cited 2023 Jun 26];37(12):1563–8. Available from: https://pubmed.ncbi.nlm.nih.gov/35668631. doi: http://dx.doi.org/10.1177/08850666221106413
21. Bonanno FG. Management of hemorrhagic shock: Physiology approach, timing and strategies. J Clin Med [Internet]. 2022 [cited 2023 Jun 26];12(1):260. Available from: https://pubmed.ncbi.nlm.nih.gov/36615060. doi: 10.3390/jcm12010260
22. Ranjan AK, Gulati A. Controls of central and peripheral blood pressure and hemorrhagic/hypovolemic shock. J Clin Med [Internet]. 2023 [cited 2023 Jun 26];12(3):1108. Available from: https://www.mdpi.com/2077-0383/12/3/1108. doi: 10.3390/jcm12031108
23. Lier H, Bernhard M, Hossfeld B. Hypovolemic and hemorrhagic shock. Anaesthesist. 2018;67(3):225–44. doi: 10.1007/s00101-018-0411-z
24. Gulati A. Vascular endothelium and hypovolemic shock. Curr Vasc Pharmacol. 2016;14(2):187–95. doi: 10.2174/1570161114666151202210221
25. Doyle J, Cooper JS. Physiology, carbon dioxide transport. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 26]. Available from:: https://www.ncbi.nlm.nih.gov/books/NBK532988/
26. Premont RT, Reynolds JD, Zhang R, Stamler JS. Role of nitric oxide carried by hemoglobin in cardiovascular physiology: Developments on a three-gas respiratory cycle. Circ Res [Internet]. 2020 [cited 2023 Jun 26];126(1):129–58. Available from: https://pubmed.ncbi.nlm.nih.gov/31590598/. doi: 10.1161/CIRCRESAHA.119.315626
27. Su H, Liu X, Du J, Deng X, Fan Y. The role of hemoglobin in nitric oxide transport in vascular system. Med Nov Technol Devices [Internet]. 2020 [cited 2023 Jun 26];5(100034):1-6. Available from: https://www.sciencedirect.com/science/article/pii/S2590093520300084. doi: https://doi.org/10.1016/j.medntd.2020.100034
28. Benner A, Patel AK, Singh K, Dua A. Physiology, Bohr Effect In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526028
29. Malte H, Lykkeboe G, Wang T. The magnitude of the bohr effect profoundly influences the shape and position of the blood oxygen equilibrium curve. Comp Biochem Physiol A Mol Integr Physiol. 2021; 254:110880. doi: 10.1016/j.cbpa.2020.110880
30. Capone J, Gluncic V, Lukic A, Candido KD. Physiologically difficult airway in the patient with severe hypotension and metabolic acidosis. Case Rep Anesthesiol [Internet]. 2020 [cited 2023 Jun 26]; 2020:8821827. Available from: https://pubmed.ncbi.nlm.nih.gov/32953182. doi: 10.1155/2020/8821827
31. Guo SB, Chen YX, Yu XZ. Clinical characteristics and current interventions in shock patients in Chinese emergency departments: A multicenter prospective cohort study. Chin Med J (Engl) [Internet]. 2017 [cited 2023 Jun 26];130(10):1146–54. Available from: https://pubmed.ncbi.nlm.nih.gov/28485313. doi: 10.4103/0366-6999.205862
32. Delgado BJ, Lopez-Ojeda W. Estrogen In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Ago 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538260/
