Ácido úrico como marcador pronóstico en pacientes críticamente enfermos

Zusammenfassung

Background Elevated uric acid concentrations reflect adenosine triphosphate degradation and suggest poor prognosis sincethey indicate a cellular bioenergetic crisis. Objective To study uric acid concentrations as a prognostic marker of disease severity in critically ill children. Patients and methods Seventy-eight patients admitted to our pediatric intensivecare unit with different diseases were prospectively studied.Thirty-five patients with meningococcal infection wereretrospectively studied. Data on uric acid concentrations, diagnosis, length of stay, age, weight, the therapeutic intervention scoring system (TISS) and the pediatric risk of mortality score (PRISM) were collected. In patients with meningococcal infection severity was evaluated by studying evolution (death and the presence of sequelae or otherwise). Results Uric acid concentrations on admission were significantly correlated with TISS on the first day (r = 0.260; p = 0.023) and with PRISM during the first 24 hours r = 0.277; p = 0.015). In patients without craniocerebral trauma, correlations between uric acid concentrations and PRISM during the first 24 hours (r = 0.524; p < 0.001) and correlations between uric acid concentrations with TISSon day 1 (r = 0.483; p < 0.001) and day 2 (r = 0.373; p = 0.014) improved. In patients with craniocerebral trau-ma no significant correlations were found between uricacid and any of the other variables. In patients withmeningococcal infection, uric acid concentrations on admission were closely related to evolution (uric acidconcentrations were 13.20 ± 8.2 mg/dl in patients whodied, 8.01 ± 1.77 mg/dl in those with sequelae and4.72 ± 1.84mg/dl in in those without sequelae; p < 0.003). Conclusions Serum uric acid concentrations can be considered as a marker of severity in critically ill patients without craniocerebral trauma and especially in patients with meningococcal infection.