Proteína C reactiva y lactato deshidrogenasa en el diagnóstico de la obstrucción intestinal en un servicio de urgencias
DOI:
https://doi.org/10.23938/S1137-6627/2016000100013Palabras clave:
Obstrucción intestinal, Proteína C Reactiva (PCR), Lactatodeshidrogenasa (LDH), cáncer colorrectal, urgenciasResumen
Fundamento. La obstrucción intestinal es una de las urgencias quirúrgicas más frecuentes. Su diagnóstico se basa esencialmente en la historia clínica, la exploración física y las pruebas de imagen. El objetivo de este estudio fue analizar el valor diagnóstico de reactantes de fase aguda en pacientes con obstrucción intestinal benigna versus maligna.
Método. Se ha realizado un estudio de cohortes histórico sobre 53 pacientes sometidos a cirugía por obstrucción intestinal y/o cáncer colorrectal no obstructivo. Los pacientes se encuadraron en 3 grupos: grupo 1 (cáncer colorrectal con obstrucción intestinal) (n=23), grupo 2 (obstrucción intestinal benigna) (n=10) y grupo 3 (con cáncer de colon no obstructivo) (n= 20). Se determinan los valores plasmáticos iniciales de la proteína C reactiva (PCR) y el enzima lactato deshidrogenasa (LDH).
Resultados.La PCR se elevó cuantitativamente más en pacientes con obstrucción intestinal benigna (grupo 2) (p=0,001), mientras quela LDH en el grupo 1 (pacientes con cáncer obstructivo). Los niveles plasmáticos de LDH fueron significativamente mayores en los grupos con obstrucción intestinal (Grupos 1 y 2) que en pacientes sin obstrucción (p<0,001). Niveles plasmáticos de PCR mayores de 11 mg/l y de LDH mayores de 317 U/L mostraron una validez diagnóstica aceptable para diferenciar los pacientes con obstrucción intestinal, con áreas bajo la curva ROC de 80% (IC 95% = 68-92%) y de 86% (IC 95%= 75-96%) respectivamente. Su validez diagnóstica para diferenciar el origen benigno o maligno es menor, con áreas bajo la curva ROC de 56% para niveles de PCR > 24 ng/l (IC 95 % = 30-82%) y de 52% (IC 95% = 29-74%) para niveles de LDH > 359 U/L.
Conclusión. La determinación de las concentraciones plasmáticas dela PCR puede ayudar al diagnóstico de la obstrucción intestinal y orientar hacia su origen benigno o maligno en los servicios de urgencias.
Palabras clave. Obstrucción intestinal. Proteína C reactiva (PCR). Lactato deshidrogenasa (LDH). Cáncer colorrectal. Urgencias.
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