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Identificación y validación de subfenotipos de enfermedades crónicas críticas utilizando trayectorias de la relación
Wanting Su1, Zhigang Cui2, Jinhe Sun1
1Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
Clinical nutrition (Edinburgh, Scotland)
|September 2, 2025
Resumen
Las trayectorias de los pacientes con enfermedades críticas crónicas (ICC) identificaron tres subfenotipos utilizando la relación urea-creatinina (UCR). Una mayor ingesta nutricional mejoró los resultados, especialmente en los grupos de alto riesgo de UCR, lo que sugiere estrategias de nutrición personalizadas.
Área de la Ciencia:
- Medicina para cuidados intensivos
- Nefrología
- Investigación metabólica
Sus antecedentes:
- La enfermedad crítica crónica (ICC) es un desafío significativo en las unidades de cuidados intensivos (UCI), caracterizadas por una alta heterogeneidad.
- La comprensión de la heterogeneidad de los pacientes es crucial para optimizar las estrategias de tratamiento en la ICC.
Objetivo del estudio:
- Desarrollar y validar subfenotipos de pacientes con ICC utilizando las trayectorias de la relación urea-creatinina (UCR).
- Investigar los efectos heterogéneos del tratamiento de la terapia de nutrición médica en los subfenotipos identificados.
Principales métodos:
- Análisis retrospectivo de 4047 pacientes con ICC de tres bases de datos de cuidados intensivos.
- Modelado de trayectoria basado en grupos (GBTM) aplicado a los datos UCR para la identificación y validación de subfenotipos.
- Regresión de Cox multivariada y ecuaciones de estimación generalizadas utilizadas para evaluar las asociaciones de mortalidad y los efectos del tratamiento.
Principales resultados:
- Se identificaron tres subfenotipos distintos de la trayectoria de la UCR: baja estable, intermedia y alta estable.
- El subfenotipo alto estable exhibió las tasas más altas de ICU, hospital y mortalidad a los 28 días.
- Una mayor ingesta nutricional dentro de los 5 días posteriores al diagnóstico se asoció con una mejor supervivencia, especialmente en los subfenotipos altos intermedios y estables.
Conclusiones:
- Las trayectorias longitudinales de UCR son biomarcadores robustos para estratificar la heterogeneidad de los pacientes con CCI en subfenotipos distintos.
- El aumento de la nutrición enteral y de la ingesta de proteínas puede mejorar el pronóstico en pacientes con ICC, en particular en aquellos con un UCR basal más alto y un pronóstico más pobre.
- Se necesitan estudios prospectivos para validar estos hallazgos y orientar las intervenciones nutricionales personalizadas en cuidados intensivos.
Palabras clave:
Enfermedad crónica graveModelado de la trayectoria por gruposTerapia de nutrición médicaLos subfenotiposRelación entre urea y creatininaMás Videos Relacionados
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