Titulo:
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo.
.
Sumario:
Objetivo. La aproximación al diagnóstico de sangrado agudo (SA) manifestado con síntomas inespecíficos, utilizando el hematocrito como laboratorio de apoyo es un reto en la Sala de Emergencias (SE). Se compararon las capacidades operativas del hematocrito y radio plaqueta/hematocrito (PLHER) para discriminar pacientes con SA. Métodos. Con un diseño de precisión diagnóstica, se compararon pacientes con y sin SA atendidos en la SE de la Clínica del Occidente S.A. durante el 2017. El espectro de enfermedad (EDx) incluyó controles negativos[grupo_0], población general con o sin trauma ortopédico cerrado[grupos_1-2], pacientes con trauma ortopédico cerrado [grupo_3], con SA ginecológico [grupo_4], SA gastrointestinal [grupo_5] y controles positi... Ver más
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Aníbal A. Teherán - 2019
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PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. “PLHER" (Platelet / Hematocrit Ratio): A tool to discriminate adult patients assisted at emergency room with or without acute bleeding. Objetivo. La aproximación al diagnóstico de sangrado agudo (SA) manifestado con síntomas inespecíficos, utilizando el hematocrito como laboratorio de apoyo es un reto en la Sala de Emergencias (SE). Se compararon las capacidades operativas del hematocrito y radio plaqueta/hematocrito (PLHER) para discriminar pacientes con SA. Métodos. Con un diseño de precisión diagnóstica, se compararon pacientes con y sin SA atendidos en la SE de la Clínica del Occidente S.A. durante el 2017. El espectro de enfermedad (EDx) incluyó controles negativos[grupo_0], población general con o sin trauma ortopédico cerrado[grupos_1-2], pacientes con trauma ortopédico cerrado [grupo_3], con SA ginecológico [grupo_4], SA gastrointestinal [grupo_5] y controles positivos [grupos_6-7]. Se compararon las capacidades operativas del PLHER y hematocrito para discriminar pacientes con SA. Resultados. 655 pacientes fueron seleccionados, principalmente hombres. No hubo diferencias entre las medianas de hematocrito del grupo_0 con los grupos 1-2; comparado con el grupo 0, la mediana del PLHER fue mayor en todos los grupos del EDx. (p:<0.05). Con los puntos de corte ≥6.037 y ≥6.348 el AUC del PLHER para discriminar pacientes con posible SA [grupos 1-3] o cualquier grupo del EDx [grupos 1-7] fue 0.709 y 0.766, respectivamente. Los AUC del hematocrito para discriminar pacientes con posible SA o cualquier grupo del EDx fueron 0.682 y 0.755, respectivamente. Discusión. El PLHER presentó mejores capacidades operativas que el hematocrito para discriminar pacientes con SA. Podría ser útil para identificar pacientes con SA atendidos con signos y síntomas inespecíficos en la SE. Aim. The diagnosis of acute bleeding (AB), manifested with non-specific, using hematocrit, as a support laboratory is a challenge in the Emergency Room (ER). Ratio platelet / hematocrit (PLHER) operational capabilities to discriminate patients with AB were compared. Methods. With a diagnostic accuracy design, patients with and without AB treated in the ER of Clínica del Occidente S.A. were compared, during 2017. The disease spectrum (EDx) included negative controls [group_0], general public with or without closed orthopedic injuries [groups_1-2], patients with closed orthopedic injuries [group_3], with gynecological AB [group_4], gastrointestinal [group_5] and positive controls [groups_6-7]. It was compared the operational capabilities of PLHER and hematocrit to discriminate patients with AB. Results. 655 patients were selected, mainly men. None differences were observed between hematocrit medians of group_0 and groups_1-2. Compared to group_0, the median PLHER was higher in all EDx groups (p:<0.05). The AUC of the PLHER, to discriminate patients with possible AB [groups 1-3] or any group of the EDx were 0.709 and 0.766, respectively, considering the cut-off points ≥6.037 and ≥6.348.  The AUC of the hematocrit to discriminate patients with possible AB or any group of EDx were 0.682 and 0.755, respectively. Discussion. The PLHER showed better operational capabilities than hematocrit to discriminate patients with AB. It could be a useful tool to identify patients Teherán, Aníbal A. Ochoa, Andrés Pombo, Luis Miguel Núñez, Daniel M. Gómez, Oscar L. Ávila, Albert A. Guerrero, Luis G. Montoya, Norma Acute bleeding PLHER Hematocrit Hemorrhage, Diagnostic accuracy Emergencies Sangrado agudo PLHER Hemorragia Emergencias Hematocrito Precisión diagnóstica 25 2 Artículo de revista Journal article 2020-01-31T08:16:38Z 2020-01-31T08:16:38Z 2020-01-31 application/pdf Fundación Universitaria Juan N. Corpas Revista Cuarzo 0121-2133 2500-7181 https://revistas.juanncorpas.edu.co/index.php/cuarzo/article/view/443 10.26752/cuarzo.v25.n2.443 https://doi.org/10.26752/cuarzo.v25.n2.443 spa https://creativecommons.org/licenses/by-nc-sa/4.0/ Aníbal A. Teherán - 2019 21 27 Kumar R, Mills AM. Gastrointestinal bleeding. Emerg Med Clin North Am. 2011 May;29(2):239-52, viii. doi: 10.1016/j.emc.2011.01.003. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016 Jul;34:54-65. doi: 10.1016/j.bpobgyn.2015.11.012. Özgönenel B, Zia A, Callaghan MU, Chitlur M, Rajpurkar M, Lusher JM. Emergency department visits in children with hemophilia. Pediatr Blood Cancer. 2013 Jul;60(7):1188-91. doi: 10.1002/pbc.24401. Rubboli A, Becattini C, Verheugt FW. Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy. World J Cardiol. 2011 Nov 26;3(11):351-8. doi: 10.4330/wjc.v3.i11.351. Lawton LD, Roncal S, Leonard E, Stack A, Dinh MM, Byrne CM, et al. The utility of Advanced Trauma Life Support (ATLS) clinical shock grading in assessment of trauma. Emerg Med J. 2014 May;31(5):384-9. doi: 10.1136/emermed-2012-201813. Rose JS, Bair AE, Mandavia D, Kinser DJ. The UHP Ultrasound Protocol: A Novel Ultrasound Approach to the Empiric Evaluation of the Undifferentiated Hypotensive Patient. Am J Emerg Med. 2001;19:299-302. Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol. 2015 Jun 28;21(24):7500-5. doi: 10.3748/wjg.v21.i24.7500. Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding. Am J Emerg Med. 1999 Jan;17(1):70-2. Stanley Adrian J, Laine Loren, Dalton Harry R, Ngu Jing H, Schultz Michael, Abazi Roseta et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study BMJ 2017; 356 :i6432 Institute of Medicine (US) Committee on Fluid Resuscitation for Combat Casualties; Pope A, French G, Longnecker DE, editors. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington (DC): National Academies Press (US); 1999. 2, Pathophysiology of Acute Hemorrhagic Shock. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224592/ Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017 Jul;58:1-13. doi: 10.1016/j.ctrv.2017.05.005. Karakonstantis S, Kalemaki D. Neutrophil to Lymphocyte Ratio As a Risk Stratification Tool for Older Adults with Pneumonia. J Am Geriatr Soc. 2017 Nov 20. doi: 10.1111/jgs.15206. Gale AJ. Continuing education course #2: current understanding of hemostasis. Toxicol Pathol. 2011 Jan;39(1):273-80. doi: 10.1177/0192623310389474. Mondal H, Budh DP. Hematocrit (HCT) [Updated 2019 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542276/ Taghavi S, Askari R. Hypovolemic Shock. [Updated 2019 Jun 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513297/ Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC. The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes. Am J Med. 2011 Oct;124(10):970-6. doi: 10.1016/j.amjmed.2011.04.032. Valeri CR, Dennis RC, Ragno G, Macgregor H, Menzoian JO, Khuri SF. Limitations of the hematocrit level to assess the need for red blood cell transfusion in hypovolemic anemic patients. Transfusion. 2006 Mar;46(3):365-71. Takanishi DM, Yu M, Lurie F, Biuk-Aghai E, Yamauchi H, Ho HC, et al. Peripheral blood hematocrit in critically ill surgical patients: an imprecise surrogate of true red blood cell volume. Anesth Analg. 2008 Jun;106(6):1808-12. doi: 10.1213/ane.0b013e3181731d7c. Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, Raux M, et al. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Ann Intensive Care. 2018 Jul 6;8(1):76. doi: 10.1186/s13613-018-0420-8. Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018 Jan 25;378(4):370-379. doi: 10.1056/NEJMra1705649. Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Trop Med Int Health. 2006 Aug;11(8):1295-302. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3. https://revistas.juanncorpas.edu.co/index.php/cuarzo/article/download/443/423 info:eu-repo/semantics/article http://purl.org/coar/resource_type/c_6501 http://purl.org/redcol/resource_type/ARTREF info:eu-repo/semantics/publishedVersion http://purl.org/coar/version/c_970fb48d4fbd8a85 info:eu-repo/semantics/openAccess http://purl.org/coar/access_right/c_abf2 Text Publication |
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FUNDACION UNIVERSITARIA JUAN N. CORPAS |
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https://nuevo.metarevistas.org/FUNDACIONUNIVERSITARIAJUANN.CORPAS/logo.png |
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Colombia |
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Revista Cuarzo |
| title |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| spellingShingle |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. Teherán, Aníbal A. Ochoa, Andrés Pombo, Luis Miguel Núñez, Daniel M. Gómez, Oscar L. Ávila, Albert A. Guerrero, Luis G. Montoya, Norma Acute bleeding PLHER Hematocrit Hemorrhage, Diagnostic accuracy Emergencies Sangrado agudo PLHER Hemorragia Emergencias Hematocrito Precisión diagnóstica |
| title_short |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| title_full |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| title_fullStr |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| title_full_unstemmed |
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| title_sort |
plher (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo. |
| title_eng |
“PLHER" (Platelet / Hematocrit Ratio): A tool to discriminate adult patients assisted at emergency room with or without acute bleeding. |
| description |
Objetivo. La aproximación al diagnóstico de sangrado agudo (SA) manifestado con síntomas inespecíficos, utilizando el hematocrito como laboratorio de apoyo es un reto en la Sala de Emergencias (SE). Se compararon las capacidades operativas del hematocrito y radio plaqueta/hematocrito (PLHER) para discriminar pacientes con SA.
Métodos. Con un diseño de precisión diagnóstica, se compararon pacientes con y sin SA atendidos en la SE de la Clínica del Occidente S.A. durante el 2017. El espectro de enfermedad (EDx) incluyó controles negativos[grupo_0], población general con o sin trauma ortopédico cerrado[grupos_1-2], pacientes con trauma ortopédico cerrado [grupo_3], con SA ginecológico [grupo_4], SA gastrointestinal [grupo_5] y controles positivos [grupos_6-7]. Se compararon las capacidades operativas del PLHER y hematocrito para discriminar pacientes con SA.
Resultados. 655 pacientes fueron seleccionados, principalmente hombres. No hubo diferencias entre las medianas de hematocrito del grupo_0 con los grupos 1-2; comparado con el grupo 0, la mediana del PLHER fue mayor en todos los grupos del EDx. (p:<0.05). Con los puntos de corte ≥6.037 y ≥6.348 el AUC del PLHER para discriminar pacientes con posible SA [grupos 1-3] o cualquier grupo del EDx [grupos 1-7] fue 0.709 y 0.766, respectivamente. Los AUC del hematocrito para discriminar pacientes con posible SA o cualquier grupo del EDx fueron 0.682 y 0.755, respectivamente.
Discusión. El PLHER presentó mejores capacidades operativas que el hematocrito para discriminar pacientes con SA. Podría ser útil para identificar pacientes con SA atendidos con signos y síntomas inespecíficos en la SE.
|
| description_eng |
Aim. The diagnosis of acute bleeding (AB), manifested with non-specific, using hematocrit, as a support laboratory is a challenge in the Emergency Room (ER). Ratio platelet / hematocrit (PLHER) operational capabilities to discriminate patients with AB were compared.
Methods. With a diagnostic accuracy design, patients with and without AB treated in the ER of Clínica del Occidente S.A. were compared, during 2017. The disease spectrum (EDx) included negative controls [group_0], general public with or without closed orthopedic injuries [groups_1-2], patients with closed orthopedic injuries [group_3], with gynecological AB [group_4], gastrointestinal [group_5] and positive controls [groups_6-7]. It was compared the operational capabilities of PLHER and hematocrit to discriminate patients with AB.
Results. 655 patients were selected, mainly men. None differences were observed between hematocrit medians of group_0 and groups_1-2. Compared to group_0, the median PLHER was higher in all EDx groups (p:<0.05). The AUC of the PLHER, to discriminate patients with possible AB [groups 1-3] or any group of the EDx were 0.709 and 0.766, respectively, considering the cut-off points ≥6.037 and ≥6.348.  The AUC of the hematocrit to discriminate patients with possible AB or any group of EDx were 0.682 and 0.755, respectively.
Discussion. The PLHER showed better operational capabilities than hematocrit to discriminate patients with AB. It could be a useful tool to identify patients
|
| author |
Teherán, Aníbal A. Ochoa, Andrés Pombo, Luis Miguel Núñez, Daniel M. Gómez, Oscar L. Ávila, Albert A. Guerrero, Luis G. Montoya, Norma |
| author_facet |
Teherán, Aníbal A. Ochoa, Andrés Pombo, Luis Miguel Núñez, Daniel M. Gómez, Oscar L. Ávila, Albert A. Guerrero, Luis G. Montoya, Norma |
| topic |
Acute bleeding PLHER Hematocrit Hemorrhage, Diagnostic accuracy Emergencies Sangrado agudo PLHER Hemorragia Emergencias Hematocrito Precisión diagnóstica |
| topic_facet |
Acute bleeding PLHER Hematocrit Hemorrhage, Diagnostic accuracy Emergencies Sangrado agudo PLHER Hemorragia Emergencias Hematocrito Precisión diagnóstica |
| topicspa_str_mv |
Sangrado agudo PLHER Hemorragia Emergencias Hematocrito Precisión diagnóstica |
| citationvolume |
25 |
| citationissue |
2 |
| publisher |
Fundación Universitaria Juan N. Corpas |
| ispartofjournal |
Revista Cuarzo |
| source |
https://revistas.juanncorpas.edu.co/index.php/cuarzo/article/view/443 |
| language |
spa |
| format |
Article |
| rights |
https://creativecommons.org/licenses/by-nc-sa/4.0/ Aníbal A. Teherán - 2019 info:eu-repo/semantics/openAccess http://purl.org/coar/access_right/c_abf2 |
| references |
Kumar R, Mills AM. Gastrointestinal bleeding. Emerg Med Clin North Am. 2011 May;29(2):239-52, viii. doi: 10.1016/j.emc.2011.01.003. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016 Jul;34:54-65. doi: 10.1016/j.bpobgyn.2015.11.012. Özgönenel B, Zia A, Callaghan MU, Chitlur M, Rajpurkar M, Lusher JM. Emergency department visits in children with hemophilia. Pediatr Blood Cancer. 2013 Jul;60(7):1188-91. doi: 10.1002/pbc.24401. Rubboli A, Becattini C, Verheugt FW. Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy. World J Cardiol. 2011 Nov 26;3(11):351-8. doi: 10.4330/wjc.v3.i11.351. Lawton LD, Roncal S, Leonard E, Stack A, Dinh MM, Byrne CM, et al. The utility of Advanced Trauma Life Support (ATLS) clinical shock grading in assessment of trauma. Emerg Med J. 2014 May;31(5):384-9. doi: 10.1136/emermed-2012-201813. Rose JS, Bair AE, Mandavia D, Kinser DJ. The UHP Ultrasound Protocol: A Novel Ultrasound Approach to the Empiric Evaluation of the Undifferentiated Hypotensive Patient. Am J Emerg Med. 2001;19:299-302. Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol. 2015 Jun 28;21(24):7500-5. doi: 10.3748/wjg.v21.i24.7500. Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding. Am J Emerg Med. 1999 Jan;17(1):70-2. Stanley Adrian J, Laine Loren, Dalton Harry R, Ngu Jing H, Schultz Michael, Abazi Roseta et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study BMJ 2017; 356 :i6432 Institute of Medicine (US) Committee on Fluid Resuscitation for Combat Casualties; Pope A, French G, Longnecker DE, editors. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington (DC): National Academies Press (US); 1999. 2, Pathophysiology of Acute Hemorrhagic Shock. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224592/ Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017 Jul;58:1-13. doi: 10.1016/j.ctrv.2017.05.005. Karakonstantis S, Kalemaki D. Neutrophil to Lymphocyte Ratio As a Risk Stratification Tool for Older Adults with Pneumonia. J Am Geriatr Soc. 2017 Nov 20. doi: 10.1111/jgs.15206. Gale AJ. Continuing education course #2: current understanding of hemostasis. Toxicol Pathol. 2011 Jan;39(1):273-80. doi: 10.1177/0192623310389474. Mondal H, Budh DP. Hematocrit (HCT) [Updated 2019 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542276/ Taghavi S, Askari R. Hypovolemic Shock. [Updated 2019 Jun 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513297/ Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC. The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes. Am J Med. 2011 Oct;124(10):970-6. doi: 10.1016/j.amjmed.2011.04.032. Valeri CR, Dennis RC, Ragno G, Macgregor H, Menzoian JO, Khuri SF. Limitations of the hematocrit level to assess the need for red blood cell transfusion in hypovolemic anemic patients. Transfusion. 2006 Mar;46(3):365-71. Takanishi DM, Yu M, Lurie F, Biuk-Aghai E, Yamauchi H, Ho HC, et al. Peripheral blood hematocrit in critically ill surgical patients: an imprecise surrogate of true red blood cell volume. Anesth Analg. 2008 Jun;106(6):1808-12. doi: 10.1213/ane.0b013e3181731d7c. Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, Raux M, et al. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Ann Intensive Care. 2018 Jul 6;8(1):76. doi: 10.1186/s13613-018-0420-8. Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018 Jan 25;378(4):370-379. doi: 10.1056/NEJMra1705649. Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Trop Med Int Health. 2006 Aug;11(8):1295-302. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3. |
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