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      Escala Anarcyl (aneurisma de aorta roto de Castilla y León) de predicción de mortalidad de aneurisma de abdominal roto Translated title: Anarcyl scale (ruptured aortic aneurysms Castilla y León) for predicting mortality in ruptured abdominal aortic aneurysms

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          Abstract

          Resumen Introducción: el aneurisma de aorta abdominal roto (AAAr), a pesar de los avances diagnósticos y terapéuticos, continúa presentando una elevada mortalidad. Aunque la reparación endovascular (EVAR) incrementa el número de pacientes a los que se le ofrece tratamiento quirúrgico, no se encuentra exento de complicaciones. Objetivo: diseñar una escala de riesgo preoperatorio para los pacientes con AAAr intervenidos mediante EVAR. Material y métodos: estudio prospectivo de 34 pacientes intervenidos mediante EVAR de AAAr en Castilla y León entre junio de 2016 y junio de 2019. Se recogieron variables de comorbilidad, preoperatorias de estabilidad hemodinámica y analítica al ingreso, así como de morbimortalidad intrahospitalaria. Resultados: la mortalidad intrahospitalaria fue del 52,9%. El estudio univariante obtuvo como factores pronósticos de mortalidad la frecuencia cardíaca, la hemoglobina, la creatinina, el sodio, la GOT, la LDH y la troponina T ultrasensible. Tras la realización del estudio multivariante, resultaron significativas la frecuencia cardíaca (p = 0,011), la hemoglobina (p = 0,035) y la creatinina (p = 0,019). La escala resultante ofreció la siguiente fórmula de mortalidad: 0,440 + 0,560 (si hemoglobina < 7 mg/dl) + 0,169 (si frecuencia cardíaca < 70 latidos/min) + 0,084 (si creatinina > 2,8 mg/dl). El área bajo la curva del presente modelo asciende a 0,870 (Fig. 1). Una puntuación ≤ 0,440 se asoció con una mortalidad del 39,1%; una puntuación entre 0,441-0,644, con el 66,7%, y del 100%, si ≥ 0,644. Conclusión: la frecuencia cardíaca al ingreso y los niveles analíticos de hemoglobina y creatinina constituyen factores predictores de mortalidad intrahospitalaria en pacientes con AAAr tratados mediante exclusión endovascular. La aplicación de la escala propuesta en el presente estudio permite conocer a los pacientes que no se beneficiarían del tratamiento quirúrgico endovascular del AAAr.

          Translated abstract

          Abstract Introduction: the ruptured abdominal aortic aneurysm (AAAr), despite diagnostic and therapeutic advances, continues to present a high mortality. Although endovascular repair (EVAR) increases the number of patients who are offered surgical treatment, it is not without complications. Objective: design a preoperative risk scale for patients with AAAr treated by EVAR. Material and methods: prospective study of 34 patients undergoing EVAR of AAAr in Castilla y León between June 2016 and June 2019. Comorbidities, preoperative variables of hemodynamic stability, analytical at admission, as well as in-hospital morbidity and mortality were collected. Results: in-hospital mortality was 52.9%. The univariate predictors obtained were heart rate, hemoglobin, creatinine, sodium, GOT, LDH and ultrasensitive troponin T as prognostic factors. After completing the multivariate analysis, heart rate (p = 0.011), hemoglobin (p = 0.035) and creatinine (p = 0.019) were statistically different between the groups. The scale resulting from the following mortality formula: 0.440 + 0.560 (if hemoglobin < 7 mg/dl) + 0.169 (if heart rate < 70 beats/min) + 0.084 (if creatinine > 2.8). This model obtained an area under the curve of 0.870 (Fig. 1). A score < 0.440 is associated with a mortality of 39.1%, a score between 0.441-0.644 with 66.7% and 100% if > 0.644. Conclusion: the heart rate at admission and the analytical levels of hemoglobin and creatinine, are predictive factors of in-hospital mortality in patients with AAAr treated with endovascular exclusion. The application of the proposed scale allows the detection of patients who would not benefit from the endovascular surgical treatment of AAAr.

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          Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm.

          A substantial proportion of patients with a ruptured abdominal aortic aneurysm (rAAA) die outside hospital. The objective of this study was to estimate the total mortality, including prehospital deaths, of patients with rAAA. This was a systematic review and meta-analysis following the MOOSE guidelines. The Embase, MEDLINE and Cochrane Library databases were searched. All population-based studies reporting both prehospital and in-hospital mortality in patients with rAAA were included. Studies were assessed for methodological quality and heterogeneity, and pooled estimates of mortality from rAAA were calculated using a random-effects model. From a total of 3667 studies, 24 retrospective cohort studies, published between 1977 and 2012, met the inclusion criteria. The quality of included studies varied, in particular the method of determining prehospital deaths from rAAA. The estimated pooled total mortality rate was 81 (95 per cent confidence interval 78 to 83) per cent. A decline in mortality was observed over time (P = 0·002); the pooled estimate of total mortality in high-quality studies before 1990 was 86 (83 to 89) per cent, compared with 74 (72 to 77) per cent since 1990. Some 32 (27 to 37) per cent of patients with rAAA died before reaching hospital. The in-hospital non-intervention rate was 40 (33 to 47) per cent, which also declined over the years. The pooled estimate of total mortality from rAAA is very high, although it has declined over the years. Most patients die outside hospital, and there is no surgical intervention in a considerable number of those who survive to reach hospital. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
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            Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair.

            Despite the intuitive advantages of endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (AAAs), uncertainty remains about the optimal management in the absence of convincing high-quality evidence. Our objective was to undertake a comprehensive literature review and perform a meta-analysis of outcome data of treatment modalities for ruptured AAAs. Systematic searches were conducted of electronic information sources to identify studies comparing perioperative outcomes of EVAR and open repair for AAA rupture. Summary estimates of odds ratios (ORs) or standardized mean difference and 95% confidence intervals (CIs) were obtained with a random-effects model. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time. We selected 41 studies for analysis. The entire meta-analysis population comprised 59,941 patients (8201 EVAR patients and 51,740 open repair patients). EVAR was associated with a significantly lower incidence of in-hospital mortality (OR, 0.56; 95% CI, 0.50-0.64; P < .01; meta-analysis of risk-adjusted observational studies and randomized controlled trials: OR, 0.58; 95% CI, 0.46-0.73; P < .01). EVAR patients had a significantly decreased risk of developing respiratory complications (OR, 0.59; 95% CI, 0.49-0.69; P < .01) and acute renal failure (OR, 0.65; 95% CI, 0.55-0.78; P < .01) and a trend toward a reduced incidence of cardiac complications (OR, -0.02; 95% CI, -0.03 to 0.00; P = .05) and mesenteric ischemia (OR, 0.66; 95% CI, 0.44-1.00; P = .05). Patients treated with EVAR had significantly less requirements of intraoperative blood transfusion (standardized mean difference, -0.88; 95% CI, -1.06 to -0.70; P < .01). Random-effects meta-regression revealed no statistical evidence for an association between death and year of publication (P = .19). Our analysis provides evidence to motivate the adoption of an EVAR-first policy in a nonelective setting and the establishment of standardized protocols for the management ruptured AAAs. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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              Preoperative risk score for the prediction of mortality after repair of ruptured abdominal aortic aneurysms

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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                June 2020
                : 72
                : 3
                : 126-134
                Affiliations
                [1] Valladolid orgnameHospital Clínico Universitario de Valladolid orgdiv1Servicio de Angiología y Cirugía Vascular Spain
                [2] León orgnameComplejo Asistencial Universitario de León orgdiv1Servicio de Angiología y Cirugía Vascular Spain
                Article
                S0003-31702020000300003 S0003-3170(20)07200300003
                10.20960/angiologia.00087
                5738fc91-140c-41d7-a3a1-bdce53969660

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 04 December 2019
                : 27 August 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 9
                Product

                SciELO Spain

                Categories
                Originales

                Castilla y León,Aortic rupture,Abdominal aortic aneurysm,Pronóstico,Tratamiento endovascular,Mortalidad,Rotura aórtica,Aneurisma aorta abdominal,Prognosis,Endovascular treatment,Mortality

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