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Variabilidad de la hemoglobina predice la mortalidad en pacientes con lesión renal aguda en terapia de reemplazo
Yumin Huang1,2, Ran Jiang1,2, Kang Liu1
1Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China.
Renal failure
|December 16, 2025
Resumen
La alta variabilidad de la hemoglobina a corto plazo (ARV de Hb) durante la terapia de reemplazo renal continuo (TRRC) en pacientes con lesión renal aguda (LRA) predice un aumento de la mortalidad intrahospitalaria y a 1 año. Este hallazgo destaca la ARV de Hb como un indicador pronóstico crucial.
Área de la Ciencia:
- Nefrología
- Medicina de Cuidados Intensivos
- Hematología
Sus antecedentes:
- La variabilidad de la hemoglobina a corto plazo (ARV de Hb) durante la terapia de reemplazo renal continuo (TRRC) puede indicar inestabilidad del volumen sanguíneo en la lesión renal aguda (LRA).
- Las implicaciones pronósticas de la ARV de Hb para la mortalidad en pacientes con LRA en TRRC no se comprenden bien.
Objetivo del estudio:
- Investigar la asociación entre la variabilidad de la hemoglobina a corto plazo (ARV de Hb) y la mortalidad intrahospitalaria y a 1 año en pacientes adultos con lesión renal aguda (LRA) que reciben TRRC.
- Cuantificar el riesgo de mortalidad asociado con diferentes niveles de ARV de Hb.
Principales métodos:
- Estudio multidatabase que utiliza datos de las bases de datos MIMIC-IV, eICU, AmsterdamUMC y JSPH CRRT.
- Análisis de pacientes adultos con LRA que recibieron TRRC durante más de 24 horas, evaluando la ARV de Hb utilizando regresión de Cox y curvas de regresión cúbica restringida.
- Evaluación de las asociaciones entre la ARV de Hb y la mortalidad intrahospitalaria y a 1 año.
Principales resultados:
- En cuatro cohortes (un total de 2.777 pacientes), la ARV de Hb media osciló entre 5,0 y 6,3 g/L, con tasas de mortalidad intrahospitalaria entre el 41,2% y el 48,2%.
- Las curvas de regresión cúbica restringida indicaron relaciones en forma de J o lineales entre la ARV de Hb y la mortalidad.
- El cuartil más alto de ARV de Hb se relacionó significativamente con un aumento de la mortalidad intrahospitalaria en tres cohortes y con un aumento de la mortalidad a 1 año en dos cohortes.
Conclusiones:
- La variabilidad elevada de la hemoglobina a corto plazo (ARV de Hb) durante la TRRC es un predictor significativo de una mayor mortalidad intrahospitalaria en pacientes con LRA.
- El aumento de la ARV de Hb también se asocia con una mayor mortalidad a largo plazo (1 año), lo que subraya su valor pronóstico.
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