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Antecedentes: La elevación del ácido úrico refleja degradación del adenosintrifosfato (ATP) e implica mal pronóstico pues traduce una crisis energética celular. Objetivo: Estudiar el comportamiento del ácido úrico como marcador pronóstico en niños ingresados en una unidad decuidados intensivos pediátricos (UCIP). Pacientes y métodos: Estudio prospectivo y observacional de 78pacientes ingresados en la UCIP con diversas enfermedades, y análisis retrospectivo de 35pacientes con infección meningocócica. Se recogieron datos relativos a valores de ácido úrico,diagnóstico, tiempo de estancia, edad, peso, Therapeutic Intervention Scoring System (TISS) y Pediatric Risk of Mortality Score (PRISM). En los pacientes con infección meningocócica se valoró la gravedad según la evolución(muerte, secuelas y no secuelas). Resultados: El ácido úrico al ingreso estaba asociado con el TISS delprimer día (r = 0,260; p = 0,023) y el PRISM a las 24 h(r = 0,277; p = 0,015). Entre los pacientes sin traumatismocraneoencefálico destacan las correlaciones entre el ácidoúrico y el PRISM a las 24h (r = 0,524; p < 0,001) y el TISS delprimer día (r = 0,483; p < 0,001) y segundo día (r = 0,373; p = 0,014). En pacientes con traumatismo craneoencefálicono son significativas las correlaciones entre ácido úrico yninguna de las variables consideradas. En el grupo de sepsis meningocócica el ácido úrico al ingreso está muy relacionado con su evolución (concentraciones de ácido úricode 13,20 ± 8,2; 8,01 ± 1,77 y 4,72 ± 1,84mg/dl en los grupos de muerte, secuelas y no secuelas, respectivamente;p < 0,003). Conclusiones: El valor sérico de ácido úrico podría considerarse marcador de gravedad solamente en los pacientes críticos sin traumatismo craneoencefálico y especialmente en los quepresentan infección meningocócica. : 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. |
