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Factores predictores de hiperglucemia en pacientes con nutrición parenteral
Predictive factors of hyperglycaemia in patients with parenteral nutrition
Cristina Sangrador Pelluza,
Autor para correspondencia
csangrador@mutuaterrassa.cat

Autora para correspondencia.
, Júlia Pardo Pastora, Elisabeth Navas Moyab, Jordi Nicolás Picóa, Salvador Quintanac
a Servicio de Farmacia, Hospital Universitario Mútua Terrassa, Terrasa, Barcelona, España
b Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrasa, Barcelona, España
c Comité de Ética de la Investigación con Medicamentos, Hospital Universitario Mútua Terrassa, Terrasa, Barcelona, España
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Sin embargo&#44; estudios m&#225;s recientes basados en las recomendaciones actuales nos muestran un intervalo de prevalencia de hiperglucemia m&#225;s ajustado entorno al 27-57&#37;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; En estudios recientes&#44; la aparici&#243;n de hiperglucemia durante la NP se relaciona con un mayor riesgo de complicaciones card&#237;acas&#44; infecci&#243;n&#44; sepsis sist&#233;mica&#44; insuficiencia renal aguda&#44; insuficiencia respiratoria y muerte<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2&#44;8&#44;9</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Las causas de dicha complicaci&#243;n pueden ser independientes de la composici&#243;n de la NP&#44; o pueden estar relacionadas con esta&#46; El exceso de glucosa infundida es sin duda un factor determinante en la aparici&#243;n de la hiperglucemia&#44; sobre todo en los primeros tiempos de la nutrici&#243;n artificial&#59; sin embargo&#44; desde hace a&#241;os los requerimientos cal&#243;ricos han disminuido en comparaci&#243;n con las gu&#237;as anteriores y se han implementado estrictos controles gluc&#233;micos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#44;10</span></a>&#46; Adem&#225;s&#44; en la intolerancia a la glucosa tambi&#233;n participan otros factores entre los que destacan ciertos medicamentos&#44; como los corticoides&#44; los an&#225;logos de la somatostatina y los inmunosupresores entre otros&#46; De otro lado&#44; la gravedad y la presencia de fiebre en el paciente cr&#237;tico tambi&#233;n se han relacionado con intolerancia metab&#243;lica a la glucosa&#44; y por tanto con la aparici&#243;n de hiperglucemias en este perfil de pacientes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Asimismo&#44; algunos pacientes no cr&#237;ticos&#44; incluso sin tener antecedentes de diabetes mellitus &#40;DM&#41; ni intolerancia a la glucosa&#44; responden a la NP con hiperglucemias muy graves&#59; esto implica posteriormente la correcci&#243;n con insulina r&#225;pida y la modificaci&#243;n de la f&#243;rmula de NP lo antes posible<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">De acuerdo a las recomendaciones de las sociedades cient&#237;ficas&#44; el aporte de glucosa en la f&#243;rmula de NP se ajustar&#225; para mantener los valores de glucemia por debajo de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; con aporte ex&#243;geno de insulina si fuera necesario<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Adem&#225;s se ha evidenciado que los valores superiores a 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl est&#225;n relacionados con peores resultados cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Todo ello refuerza la necesidad de conseguir un control estricto de la glucemia ya que est&#225; asociado a un menor riesgo de complicaciones en pacientes hospitalizados<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los estudios de hiperglucemia con NP se refieren a pacientes cr&#237;ticos o a pacientes con antecedentes de DM&#44; sin embargo&#44; hay pocos estudios que incluyan tambi&#233;n a pacientes no cr&#237;ticamente enfermos con trastornos del tracto gastrointestinal y&#44; por tanto&#44; candidatos a recibir NP y susceptibles de poder padecer episodios de hiperglucemias&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo del estudio es identificar los factores predictivos de hiperglucemia en pacientes que reciben NP&#44; de forma que permitan orientar el dise&#241;o de una f&#243;rmula de NP de inicio&#44; as&#237; como implementar futuras estrategias para el manejo precoz de esta complicaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Estudio observacional retrospectivo de 12 meses de duraci&#243;n &#40;enero 2016-diciembre 2016&#41; realizado en un hospital universitario de 450 camas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n fueron todos los pacientes adultos hospitalizados mayores de 18 a&#241;os que recibieron NP total por v&#237;a central durante al menos 48<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los criterios de exclusi&#243;n fueron pacientes menores de 18 a&#241;os&#44; con NP por v&#237;a perif&#233;rica o por v&#237;a central de menos de 48<span class="elsevierStyleHsp" style=""></span>h de duraci&#243;n&#46; Tambi&#233;n se excluyeron aquellos pacientes de los que no se dispon&#237;a de informaci&#243;n completa en la historia cl&#237;nica para poder llevar a cabo el an&#225;lisis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A trav&#233;s de la historia cl&#237;nica y el programa de seguimiento del soporte nutricional Nutridata&#174; se recogieron las variables necesarias para caracterizar a los pacientes&#44; y aquellas referentes a la NP recibida&#46; Las variables fueron recogidas durante el per&#237;odo de seguimiento nutricional de los pacientes&#44; cuya duraci&#243;n fue correspondiente al per&#237;odo de tiempo que recibieron NP&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los datos recogidos fueron&#58;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Variables demogr&#225;ficas&#58;</span> edad&#44; sexo e &#237;ndice de masa corporal &#40;IMC&#41; calculado con la f&#243;rmula &#91;peso&#40;kg&#41;&#93;&#47;&#91;altura &#40;m&#41;&#93;<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Variables cl&#237;nicas</span><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Comorbilidades&#58;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8728;</span><p id="par0075" class="elsevierStylePara elsevierViewall">DM&#58; definida como glucemia en ayuno<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; glucemia a las 2<span class="elsevierStyleHsp" style=""></span>h postingesta<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o hemoglobina glucosilada<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#37;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8728;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Dislipidemia&#58; definida como triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y&#47;o colesterol LDL<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>115<span class="elsevierStyleHsp" style=""></span>mg&#47;dl<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8728;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Hipertensi&#243;n arterial&#58; definida como presi&#243;n arterial sist&#243;lica<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mmHg o presi&#243;n arterial diast&#243;lica<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8728;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Insuficiencia renal&#58; definida como tasa de filtrado glomerular<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o anomal&#237;as funcionales o estructurales del ri&#241;&#243;n durante al menos 3 meses<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8728;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Insuficiencia card&#237;aca&#58; definida por s&#237;ntomas y signos caracter&#237;sticos&#44; y posibilidad de alteraci&#243;n de la fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo y de los valores de p&#233;ptidos natriur&#233;ticos elevados<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8728;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Insuficiencia hep&#225;tica&#58; definida por la aparici&#243;n de signos y s&#237;ntomas caracter&#237;sticos as&#237; como elevaci&#243;n por encima de l&#237;mite superior de normalidad de bilirrubina y&#47;o enzimas hep&#225;ticas seg&#250;n patr&#243;n hepatocelular &#40;aminotransferasa&#41; o colest&#225;sico &#40;fosfatasa alcalina&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8728;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Sobrepeso u obesidad&#58; definidos como IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 e IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30 respectivamente<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8211;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Servicio m&#233;dico&#58; unidad de cuidados intensivos&#44; servicio quir&#250;rgico&#44; servicio m&#233;dico&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8211;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Indicaci&#243;n de la NP&#46; Para el an&#225;lisis de los datos&#44; los motivos de indicaci&#243;n de NP fueron agrupados de la siguiente forma&#58;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8728;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Postoperatorio de diferentes tipos de cirug&#237;as&#58; hepatobiliar&#44; colorrectal&#44; intestinal&#44; esofagog&#225;strica&#44; ginecol&#243;gica y urol&#243;gica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8728;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Reposo del tubo digestivo&#58; pancreatitis&#44; mucositis&#44; diverticulitis&#44; ingesta de productos c&#225;usticos&#44; enfermedad inflamatoria intestinal&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8728;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Complicaciones posquir&#250;rgicas&#58; &#237;leo paral&#237;tico&#44; dehiscencia de sutura&#44; f&#237;stulas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8211;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Presencia de sepsis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8211;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Patolog&#237;a con afectaci&#243;n del p&#225;ncreas&#58; duodenopancreatectom&#237;a y pancreatitis&#46;</p></li></ul></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Variables referentes a la nutrici&#243;n y farmacoterapia</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8211;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Tratamientos concomitantes potencialmente hiperglucemiantes&#58; corticoides&#44; an&#225;logos de la somatostatina e inmunosupresores&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8211;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Tratamiento antidiab&#233;tico ambulatorio en pacientes con DM&#46; De acuerdo a las gu&#237;as espa&#241;olas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> se clasific&#243; en&#58;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8728;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Tratamiento antidiab&#233;tico de primera l&#237;nea&#58; antidiab&#233;ticos orales &#40;ADO&#41; como metformina&#44; sulfonilureas o repaglinida en monoterapia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8728;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Tratamiento antidiab&#233;tico de segunda l&#237;nea&#58; combinaciones de metformina y sulfonilureas&#44; repaglinida o inhibidores de la dipeptidil-peptidasa 4&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8728;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Tratamiento antidiab&#233;tico de tercera l&#237;nea&#58; combinaciones de f&#225;rmacos de segunda l&#237;nea e insulina o inhibidores de la dipeptidil-peptidasa 4&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8728;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Tratamiento en pacientes con descompensaci&#243;n hipergluc&#233;mica o dependientes de insulina&#58; insulina en monoterapia o combinada con metformina&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8211;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Duraci&#243;n de la NP &#40;d&#237;as&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8211;</span><p id="par0185" class="elsevierStylePara elsevierViewall">HC por peso del paciente aportados en la NP &#40;g&#47;kg&#47;d&#237;a&#41;&#44; calculado como la media de HC recibidos durante el total de d&#237;as con NP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8211;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Ritmo de infusi&#243;n de la glucosa &#40;mg&#47;kg&#47;min&#41;&#46;</p></li></ul></p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Variables anal&#237;ticas</span><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8211;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Glucemia previa al inicio de la NP &#40;mg&#47;dl&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8211;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Glucemia m&#225;xima alcanzada durante la NP &#40;mg&#47;dl&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8211;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Glucemia m&#237;nima durante la NP &#40;mg&#47;dl&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8211;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Aclaramiento renal al inicio de la NP &#40;ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; calculado seg&#250;n ecuaci&#243;n CKD-EPI creatinina &#40;2009&#41;&#46;</p></li></ul></p><p id="par0220" class="elsevierStylePara elsevierViewall">El protocolo de control gluc&#233;mico del hospital se estableci&#243; en base a las recomendaciones de las gu&#237;as del soporte nutricional parenteral en pacientes adultos con hiperglucemia de la <span class="elsevierStyleItalic">American Society for Parenteral and Enteral Nutrition</span><a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a>&#46; De acuerdo a esto&#44; se defini&#243; hiperglucemia como 3 glucemias consecutivas superiores a 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o 2 superiores a 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl durante el per&#237;odo de administraci&#243;n de la NP&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Los datos se analizaron mediante el programa estad&#237;stico SPSS&#46;v&#46;24&#46; Se realiz&#243; un an&#225;lisis estad&#237;stico descriptivo incluyendo medidas de tendencia central y dispersi&#243;n&#44; y frecuencias absolutas y relativas&#46; En cuanto al an&#225;lisis comparativo bivariante&#44; se emple&#243; el test Ji cuadrado para comparar las variables categ&#243;ricas y la t de Student para comparar medias&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Finalmente se realiz&#243; un an&#225;lisis estad&#237;stico multivariante mediante regresi&#243;n log&#237;stica binaria empleando como variable dependiente la aparici&#243;n de hiperglucemia&#44; y como variables independientes las que hab&#237;an resultado significativas en el an&#225;lisis bivariable&#46; Se consider&#243; que exist&#237;an diferencias estad&#237;sticamente significativas cuando p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">El estudio se aprob&#243; por el Comit&#233; de &#201;tica de la Investigaci&#243;n con medicamentos de nuestro hospital&#44; y se llev&#243; a cabo de acuerdo con la Declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0240" class="elsevierStylePara elsevierViewall">Se incluyeron 234 pacientes&#44; el 65&#44;8&#37; varones y una edad media de 65&#44;3 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;6&#41;&#46; El 100&#37; de las NP se administraron por v&#237;a central mediante perfusi&#243;n continua de 24<span class="elsevierStyleHsp" style=""></span>h&#44; no emple&#225;ndose la administraci&#243;n de tipo c&#237;clica en ning&#250;n caso&#46; La prevalencia de hiperglucemia en la poblaci&#243;n a estudio fue del 44&#44;0&#37;&#46; Las variables demogr&#225;ficas y cl&#237;nicas se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La principal comorbilidad observada en la poblaci&#243;n fue la DM &#40;20&#44;1&#37;&#41;&#46; Respecto al tipo de paciente&#44; principalmente eran pacientes quir&#250;rgicos &#40;66&#44;7&#37;&#41; siendo los postoperatorios la principal indicaci&#243;n de la NP &#40;67&#44;5&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran las variables relacionadas con la nutrici&#243;n y la farmacoterapia&#44; as&#237; como las variables anal&#237;ticas&#46; En cuanto a la NP&#44; cabe destacar que su duraci&#243;n media fue de 9&#44;3 d&#237;as &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;5&#41; con un aporte medio de HC de 3<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;7&#41;&#46; Respecto al tratamiento antidiab&#233;tico cr&#243;nico ambulatorio de los pacientes con DM &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;&#44; el 46&#44;8&#37; &#40;22&#47;47&#41; empleaban tratamiento de primera l&#237;nea con ADO en monoterapia&#44; el 21&#44;3&#37; &#40;10&#47;47&#41; tratamiento de segunda l&#237;nea con combinaci&#243;n de 2 ADO&#44; el 14&#44;9&#37; &#40;7&#47;47&#41; tratamiento con insulina en monoterapia&#44; el 14&#44;9&#37; &#40;7&#47;47&#41; tratamiento de insulina combinada con metformina y el 2&#44;1&#37;&#40;1&#47;47&#41; tratamiento de tercera l&#237;nea con combinaci&#243;n con 3 ADO&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">Las principales diferencias observadas entre los pacientes hipergluc&#233;micos y normogluc&#233;micos se relacionaron con edad&#44; comorbilidades previas &#40;principalmente DM&#41;&#44; servicio m&#233;dico&#44; presencia de sepsis&#44; duraci&#243;n y aporte de glucosa en la NP&#44; as&#237; como los valores anal&#237;ticos de glucemia y el tratamiento con corticoides&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se muestran los factores predictores de hiperglucemia obtenidos tras el an&#225;lisis multivariante&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0255" class="elsevierStylePara elsevierViewall">La NP se asocia a una mayor frecuencia de hiperglucemia y de necesidades de insulina<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> debido a que la glucosa en la NP accede directamente a la circulaci&#243;n perif&#233;rica&#44; alcanzando niveles sist&#233;micos elevados y manteni&#233;ndose bajos en la circulaci&#243;n portal<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a>&#46; Por otro lado&#44; se incrementan las rutas metab&#243;licas mediadas por regulaci&#243;n hormonal y citocinas proinflamatorias<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#44;26</span></a>&#44; dando lugar a una hiperglucemia mantenida junto a una hiperinsulinemia<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Los niveles elevados de glucemia se han asociado con un mayor riesgo de complicaciones<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> y&#44; por tanto&#44; es importante identificar a aquellos pacientes en potencial riesgo de desencadenar hiperglucemia asociada a la NP y prevenir las complicaciones que podr&#237;an aparecer durante el per&#237;odo de administraci&#243;n&#46; El beneficio del control gluc&#233;mico es especialmente importante en pacientes sin diagn&#243;stico previo de DM ya que se ha observado que la mortalidad asociada a la hiperglucemia en estos pacientes es muy superior a la de los pacientes diab&#233;ticos ya conocidos<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">27&#44;28</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">En nuestro estudio la incidencia de hiperglucemia observada en pacientes con NP fue del 44&#37;&#44; dato que se sit&#250;a dentro del intervalo recogido en la literatura &#40;27-57&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46;Las pautas actuales para el soporte nutricional parenteral recomiendan infusiones de glucosa de no m&#225;s de 5-7<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;min porque el hipercatabolismo inducido por estr&#233;s reduce la capacidad de oxidar la glucosa y potencialmente induce lipog&#233;nesis&#44; h&#237;gado graso e hiperglucemia<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; El aporte medio de HC en nuestra poblaci&#243;n fue consistente con las directrices actuales de soporte nutricional&#44; y en ning&#250;n caso se superaron las tasas m&#225;ximas de infusi&#243;n recomendadas<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">29&#44;30</span></a>&#46; No obstante&#44; se observa un aporte medio de HC&#47;kg en la NP inferior en aquellos pacientes que desarrollaron hiperglucemia respecto a pacientes que se mantuvieron normogluc&#233;micos&#46; Esto es debido a que en numerosas ocasiones se realizaron restricciones del aporte de HC durante el soporte nutricional para mejorar el control gluc&#233;mico de estos pacientes&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en el estudio muestran como factores predictores de hiperglucemias en pacientes con NP el aclaramiento renal disminuido&#44; la glucemia previa al inicio de NP elevada&#44; antecedentes de DM&#44; la utilizaci&#243;n de corticoides y el paciente cr&#237;tico&#46; Estos resultados son similares a los obtenidos en otros trabajos previamente publicados<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;11&#44;31&#8211;33</span></a>&#46; Si bien es cierto que la glucemia previa elevada result&#243; factor predictor&#44; es conveniente tener en cuenta que su efecto result&#243; discreto&#44; siendo los IC superiores a la unidad e inferiores a 2&#46; En el caso del aclaramiento renal &#40;OR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; aquellos pacientes cuya tasa de filtraci&#243;n glomerular sea elevada tendr&#225;n menor riesgo de presentar hiperglucemia durante la administraci&#243;n del soporte nutricional parenteral&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Otros autores han establecido que la edad&#44; la cirug&#237;a en los 7 d&#237;as previos al inicio de la NP y el IMC se asocian con hiperglucemias relacionadas con la utilizaci&#243;n de NP<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;31&#44;33</span></a>&#46; En nuestro estudio se observ&#243; cierta tendencia en el caso de la edad y el IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#44; si bien finalmente no fue confirmada en el an&#225;lisis multivariante&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Al contrario de lo que se&#241;alan las gu&#237;as cl&#237;nicas&#44; en la poblaci&#243;n estudiada no se observ&#243; asociaci&#243;n estad&#237;stica entre la aparici&#243;n de hiperglucemias y la presencia de patolog&#237;a con afectaci&#243;n del p&#225;ncreas o la utilizaci&#243;n de an&#225;logos de somatostatina&#46; Este hecho&#44; al igual que ocurre en otros trabajos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> para otras variables analizadas&#44; puede ser debido al reducido tama&#241;o muestral de pacientes que presentaban dichas condiciones &#40;un 21&#44;8&#37; padec&#237;an pancreatitis o duodenopancreatectom&#237;a y un 7&#44;3&#37; eran tratados con an&#225;logos de somatostatina&#41;&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">En los pacientes pertenecientes a servicios quir&#250;rgicos se observ&#243; una prevalencia de hiperglucemia inferior&#46; Este hecho puede explicarse por el hecho de que los pacientes sometidos a intervenciones quir&#250;rgicas de alto riesgo o con complicaciones posquir&#250;rgicas graves&#44; en los que en la literatura se describe una mayor probabilidad de presentar hiperglucemias&#44; pertenec&#237;an a la unidad de medicina intensiva&#46; En el caso de los pacientes cr&#237;ticos s&#237; se observ&#243; la mayor prevalencia de hiperglucemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Entre las limitaciones del estudio destacan que se trata de un estudio retrospectivo&#44; con datos obtenidos a trav&#233;s de la revisi&#243;n de la historia cl&#237;nica y de las historias de seguimiento nutricional de los pacientes&#46; Adem&#225;s&#44; el estudio englobaba a diferente tipo de pacientes &#40;cr&#237;tico&#44; m&#233;dico&#44; quir&#250;rgico&#41;&#44; a los que se les aplic&#243; distintos protocolos de control de hiperglucemias y adici&#243;n de insulina&#46; Por otro lado&#44; no se evalu&#243; la persistencia de la hiperglucemia sino que fue valorada por la aparici&#243;n de 2 o 3 glucemias por encima de 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl respectivamente&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Como ya indican otros autores<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a>&#44; conocer los factores predisponentes previos al inicio de la NP nos puede permitir adaptar la f&#243;rmula de NP inicial de manera individualizada a cada paciente&#44; minimizando el riesgo de hiperglucemia y sus consiguientes complicaciones&#46; De esta forma se podr&#225;n dise&#241;ar estrategias orientadas a este subgrupo de pacientes como podr&#225;n ser la limitaci&#243;n del aporte de HC&#47;kg&#44; un control gluc&#233;mico m&#225;s estricto&#44; la introducci&#243;n gradual del aporte de HC en la NP o la aditivaci&#243;n con insulina de la NP de forma protocolizada&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">La realizaci&#243;n de futuros estudios m&#225;s exhaustivos de acuerdo al tipo de paciente y su patolog&#237;a nos permitir&#225; identificar los factores predictores de hiperglucemia para cada grupo de poblaci&#243;n que recibe soporte nutricional parenteral de una forma m&#225;s individualizada&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la hiperglucemia en los pacientes con NP es una alteraci&#243;n muy frecuente y requiere un manejo exhaustivo&#46; El aclaramiento renal disminuido&#44; la glucemia previa elevada&#44; la DM&#44; la utilizaci&#243;n de corticoides y el paciente cr&#237;tico son factores predictores de hiperglucemia&#44; por lo que ser&#237;a conveniente considerarlos en el dise&#241;o de la f&#243;rmula de inicio de NP&#46; Conocer la asociaci&#243;n de estos factores con la hiperglucemia nos permitir&#225; implementar estrategias para realizar una temprana intervenci&#243;n para prevenir y corregir esta complicaci&#243;n metab&#243;lica&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0310" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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            1 => "Nutrici&#243;n parenteral"
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            0 => "Hyperglycaemia"
            1 => "Parenteral nutrition"
            2 => "Diabetes mellitus"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar los factores predictivos de hiperglucemia en pacientes que reciben nutrici&#243;n parenteral &#40;NP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo &#40;enero 2016-diciembre 2016&#41; realizado en un hospital universitario de 450 camas&#46; Se incluyeron los pacientes adultos hospitalizados que recibieron NP total por v&#237;a central durante al menos 48<span class="elsevierStyleHsp" style=""></span>h de duraci&#243;n&#46; Se recogieron las variables necesarias para caracterizar a los pacientes&#44; y aquellas referentes a la NP recibida y se defini&#243; hiperglucemia como 3 glucemias consecutivas superiores a 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o 2 superiores a 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Se realiz&#243; un an&#225;lisis estad&#237;stico descriptivo&#44; comparativo bivariante&#44; y un an&#225;lisis multivariante mediante regresi&#243;n log&#237;stica binaria &#40;SPSS&#46;v&#46;24&#46;&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 234 pacientes&#46; La prevalencia de hiperglucemia en la poblaci&#243;n bajo estudio fue del 44&#37;&#46; Las principales diferencias observadas en el an&#225;lisis bivariante entre los pacientes hipergluc&#233;micos y normogluc&#233;micos se relacionaron con edad&#44; comorbilidades previas&#44; servicio m&#233;dico&#44; presencia de sepsis&#44; duraci&#243;n y aporte de glucosa en la NP&#44; as&#237; como los valores anal&#237;ticos de glucemia y el tratamiento con corticoides&#46; Los factores predictivos de hiperglucemia obtenidos tras el an&#225;lisis multivariante fueron&#58; aclaramiento renal &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;982&#59; IC95&#37; 0&#44;968-0&#44;996&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41;&#44; glucemia previa a la NP &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;039&#59; IC95&#37; 1&#44;026-1&#44;051&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; diabetes mellitus &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;016&#59; IC95&#37; 3&#44;028-31&#44;697&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; medicina intensiva &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;303&#59; IC95&#37; 1&#44;183-9&#44;219&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; corticoides &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;115&#59; IC95&#37; 1&#44;179-8&#44;226&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El aclaramiento renal disminuido&#44; la glucemia previa elevada&#44; la diabetes&#44; la utilizaci&#243;n de corticoides y el paciente cr&#237;tico son factores predictores de hiperglucemia&#44; por lo que ser&#237;a conveniente considerarlos en el dise&#241;o de la f&#243;rmula de inicio de NP&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To identify the predictive factors of hyperglycaemia in patients receiving parenteral nutrition &#40;PN&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational study &#40;January 2016-December 2016&#41; conducted in a 450-bed university hospital&#46; Adult hospitalized patients who received total PN through a central line for at least 48<span class="elsevierStyleHsp" style=""></span>hours were included&#46; The required variables to characterize patients&#44; and those related to the PN received were collected and hyperglycaemia was defined as 3 consecutive glycaemias greater than 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or 2 greater than 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; A descriptive&#44; comparative bivariate statistical analysis was carried out&#44; as well as a multivariate analysis using binary logistic regression &#40;SPSS&#46;v&#46;24&#46;&#41;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">234 patients were included&#46; The prevalence of hyperglycaemia in the population under study was 44&#46;0&#37;&#46; The main differences observed in the bivariate analysis between hyperglycaemic and normoglycemic patients were related to age&#44; previous comorbidities&#44; medical department&#44; presence of sepsis&#44; duration and glucose contribution in PN&#44; as well as blood glucose levels and corticosteroids&#46; The predictors of hyperglycaemia obtained after the multivariate analysis were&#58; renal clearance &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;982&#44; 95&#37; CI &#46;968-&#46;996&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;010&#41;&#44; pre-PN glycaemia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;039&#44; 95&#37; CI 1&#46;026-1&#46;051&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; diabetes mellitus &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;016&#44; 95&#37; CI 3&#46;028-31&#46;697&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; intensive medicine &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;303&#44; 95&#37; CI 1&#46;183-9&#46;219&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;023&#41;&#44; corticosteroids &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;155&#44; 95&#37; CI 1&#46;179-8&#46;226&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Decreased renal clearance&#44; high blood glucose levels&#44; diabetes&#44; corticosteroid use&#44; and critical patients are predictors of hyperglycaemia&#44; therefore it would be advisable to consider them in the design of PN start formula&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; DL&#58; dislipidemia&#59; DM&#58; diabetes mellitus&#59; HTA&#58; hipertensi&#243;n arterial&#59; IH&#58; insuficiencia hep&#225;tica&#59; IMC&#58; &#237;ndice de masa corporal&#59; IR&#58; insuficiencia renal&#59; NP&#58; nutrici&#243;n parenteral&#59; UCI&#58; unidad de cuidados intensivos&#59; x&#175;&#58; media&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas</th><th class="td" title="\n
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                  \t\t\t\t" scope="col">Todos los pacientes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p</th></tr><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>131 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Demogr&#225;ficas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad &#40;a&#241;os&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;3 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;7 &#40;14&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;4 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sexo &#40;hombres&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154 &#40;65&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;47&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;52&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#40;kg&#47;m2&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;1 &#40;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;5 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;6 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;20&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DL&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;54&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;45&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;70&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IH&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;708&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobrepeso u obesidad&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;51&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;52&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;47&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Perfil de paciente &#40;servicio m&#233;dico&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCI&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;76&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;23&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirug&#237;a&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;38&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dico&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postoperatorio&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;67&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;664&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Complicaciones posquir&#250;rgicas&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;57&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;42&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reposo intestinal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;24&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;42&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;57&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">26 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duodenopancreatectom&#237;a y pancreatitis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;54&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">23 &#40;45&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;077&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;3 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HC &#40;g&#47;kg&#47;d&#237;a&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;7 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ritmo infusi&#243;n glucosa &#40;mg HC&#47;kg&#47;min&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;11 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;04 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;16 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucemia previa a la NP &#40;mg&#47;dl&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">135&#44;7 &#40;47&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">163&#44;7 &#40;53&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">113&#44;7 &#40;24&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucemia m&#237;nima durante la NP &#40;mg&#47;dl&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">141&#44;4 &#40;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">172&#44;3 &#40;48&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">117&#44;1 &#40;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucemia m&#225;xima durante la NP &#40;mg&#47;dl&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191&#44;3 &#40;80&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">253&#44;5 &#40;81&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">142&#44;4 &#40;30&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clr previo a la NP &#40;ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m2&#41;&#44; x&#175; &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">72&#44;9 &#40;28&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">85&#44;5 &#40;24&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">39 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>An&#225;logos de la somatostatina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;58&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;41&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;202&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunosupresores&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;982&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;968-0&#44;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glucemia previa a la NP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;039&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;026-1&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;028-31&#44;697&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
DOI:10.1016/j.medcli.2019.05.004
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