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incluyendo el d&#237;a de ingreso que se inicia cada t&#233;cnica y la duraci&#243;n de la misma&#46;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Para la valoraci&#243;n de la funci&#243;n renal se utilizaron los valores de las mediciones repetidas de creatinina en sangre y la diuresis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El da&#241;o renal se defini&#243; y categoriz&#243; siguiendo la adaptaci&#243;n pedi&#225;trica de los criterios RIFLE &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El filtrado glomerular se estim&#243; con la f&#243;rmula de Schwartz&#58; FGe<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>K<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>talla &#40;cm&#41;&#47;creatinina &#40;mg&#47;dL&#41;&#46; Los valores de K dependen de la edad&#58; 0&#44;45 en<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>12 meses&#44; 0&#44;55 entre uno y 12 a&#241;os&#44; 057 en mujeres<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>de 12 a&#241;os y 0&#44;70 en varones<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 a&#241;os&#46; Se utilizaron las 3 primeras categor&#237;as de gravedad&#44; obvi&#225;ndose las categor&#237;as &#171;L&#187; y &#171;E&#187; por hacer referencia al resultado final m&#225;s que a un cambio agudo&#46; Se consideraron DRA grave aquellas situaciones que cumplieron los criterios de las categor&#237;as &#171;I&#187; o &#171;F&#187; de la clasificaci&#243;n pRIFLE&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Cuando no se dispon&#237;a de un valor de creatinina basal sobre el que evaluar los cambios evolutivos para la categorizaci&#243;n del DRA&#44; se procedi&#243; de la siguiente manera&#58; si el paciente dispon&#237;a de un valor de creatinina en los 6 meses previos al ingreso se utiliz&#243; este&#44; siempre y cuando no se tratase del primer mes de vida&#44; y si no exist&#237;a una creatinina conocida&#44; se recurri&#243; a los valores de referencia recientes para lactantes y ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Asimismo&#44; se determin&#243; el momento de inicio del da&#241;o renal y la duraci&#243;n del mismo&#46; Se defini&#243; DRA precoz como el que se iniciaba en las primeras 72<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCIP &#40;probablemente relacionado con la enfermedad que motiv&#243; el ingreso&#41; y tard&#237;o el que se present&#243; posteriormente &#40;que puede estar m&#225;s relacionado con complicaciones de la enfermedad inicial o del ingreso prolongado en la UCIP&#41;&#46; Se consider&#243; da&#241;o prerrenal cuando se resolvi&#243; antes de las 72<span class="elsevierStyleHsp" style=""></span>h&#44; y da&#241;o renal prolongado si la duraci&#243;n era mayor o igual a 72<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para la valoraci&#243;n de la morbilidad se analiz&#243; la necesidad y duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; la duraci&#243;n del ingreso en la UCIP y en el hospital&#44; y la mortalidad&#46; Se consider&#243; ingreso prolongado en UCIP aquel con una duraci&#243;n superior a 12 d&#237;as<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#44; y como hospitalario prolongado el superior a 28 d&#237;as&#46; Asimismo se defini&#243; como ventilaci&#243;n mec&#225;nica prolongada la recibida durante m&#225;s de 7 d&#237;as&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los ni&#241;os que fallecieron fueron excluidos del an&#225;lisis de la duraci&#243;n de la estancia y de la ventilaci&#243;n mec&#225;nica&#46; En los 5 ni&#241;os que presentaron una ventilaci&#243;n mec&#225;nica superior a 42 d&#237;as se les asign&#243; el valor de 1&#46;000<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los datos fueron procesados con el programa SPSS<span class="elsevierStyleSup">&#174;</span> 18&#46;0&#46; Se comprob&#243; la distribuci&#243;n normal de las variables cuantitativas con el test de Kolmogorov-Smirnov&#46; Los datos se presentan en medianas &#40;P25-P75&#41; y frecuencias y porcentajes&#46; Las comparaciones de las variables cualitativas se realizaron con el test de la Chi-cuadrado y el test exacto de Fisher si era necesario&#44; y la de las cuantitativas&#44; con el test U de Mann-Whitney&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La asociaci&#243;n del DRA con la morbimortalidad se comprob&#243; con regresi&#243;n log&#237;stica univariante y multivariante&#44; construy&#233;ndose modelos ajustados por edad&#44; diagn&#243;stico y duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; y para el an&#225;lisis de la duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; modelos ajustados por edad y diagn&#243;stico&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio ingresaron 320 pacientes mayores de un mes en la UCIP&#44; de los que 5 se excluyeron por haber sido sometidos a trasplante renal&#44; quedando 315 pacientes para el estudio&#46; Las caracter&#237;sticas demogr&#225;ficas se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">La enfermedad m&#225;s frecuente que motiv&#243; el ingreso fue el postoperatorio de cirug&#237;a card&#237;aca &#40;134 ni&#241;os&#44; 42&#44;5&#37;&#41;&#46; Como puede verse en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; 148 ni&#241;os &#40;47&#37;&#41; precisaron ventilaci&#243;n mec&#225;nica&#44; con una duraci&#243;n de 48<span class="elsevierStyleHsp" style=""></span>h &#40;13-192&#41;&#46; La estancia en la UCIP fue de 4 d&#237;as &#40;3-8&#41;&#44; mientras que la duraci&#243;n total del ingreso hospitalario fue de 11 d&#237;as &#40;8-22&#41;&#46; Cincuenta y nueve ni&#241;os &#40;18&#44;7&#37;&#41; carec&#237;an de creatinina basal conocida y para ellos se utiliz&#243; un valor de creatinina de referencia adecuado a su edad&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">De los 315 ni&#241;os&#44; el 40&#44;6&#37; &#40;128 ni&#241;os&#41; sufrieron DRA en alg&#250;n momento de su ingreso&#44; de los que 107 &#40;83&#44;6&#37;&#41; presentaron un DRA precoz</p><p id="par0115" class="elsevierStylePara elsevierViewall">En relaci&#243;n con el diagn&#243;stico&#44; el DRA fue m&#225;s frecuente en los ni&#241;os sometidos a cirug&#237;a card&#237;aca&#44; produci&#233;ndose en 78 &#40;58&#44;2&#37;&#41; de ellos &#40;lo que supone el 60&#44;9&#37; del total de casos de DRA&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los pacientes con DRA precisaron ventilaci&#243;n mec&#225;nica con una frecuencia significativamente mayor &#40;61&#44;7&#37;&#41; que el resto de los ni&#241;os ingresado en la UCIP&#44; y la duraci&#243;n de la misma tambi&#233;n fue mayor&#46; Igualmente&#44; la necesidad de oxigenaci&#243;n por membrana extracorp&#243;rea fue superior &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Los ni&#241;os que desarrollaron DRA tuvieron una estancia significativamente m&#225;s prolongada&#44; tanto en la UCIP como en el hospital&#44; y tambi&#233;n una asociaci&#243;n con mayor mortalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra la categorizaci&#243;n del DRA seg&#250;n el momento de inicio&#44; la gravedad y la duraci&#243;n&#46; El 58&#44;6&#37; de los pacientes presentaron un DRA prerrenal&#46; Se encontr&#243; relaci&#243;n entre la gravedad y la duraci&#243;n del DRA&#44; existiendo un mayor n&#250;mero de casos en la categor&#237;a m&#225;s leve en el DRA prerrenal&#44; mientras que los casos de categor&#237;as m&#225;s graves se asociaron con una mayor duraci&#243;n del DRA &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">El criterio de oliguria se encontr&#243; en muy pocos pacientes&#58; un paciente con SHU que present&#243; anuria desde el ingreso junto a una creatinina de 4&#44;09<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;cumple ambos criterios de Failure&#41; y en 2 ni&#241;os con disfunci&#243;n card&#237;aca grave que requirieron tratamiento con oxigenaci&#243;n por membrana extracorp&#243;rea&#44; y seguidamente tuvieron depuraci&#243;n extrarrenal&#46; En otros 20 ni&#241;os en los que se inici&#243; depuraci&#243;n extrarrenal por sobrecarga h&#237;drica con alteraci&#243;n de la creatinina y del filtrado glomerular se alcanz&#243; el criterio de oliguria&#44; pero estando ya con la depuraci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Veinticuatro ni&#241;os &#40;18&#44;7&#37; de los pacientes con DRA&#41; precisaron t&#233;cnicas de depuraci&#243;n extrarrenal &#40;23&#44; t&#233;cnicas de depuraci&#243;n extrarrenal continuas&#44; y uno&#44; di&#225;lisis peritoneal&#41;&#46; La mortalidad de los pacientes con DRA grave &#40;Injury o Failure&#41; fue del 23&#44;7&#37;&#44; mucho mayor que la de los que presentaron DRA leve &#40;Risk&#41;&#44; que fue del 2&#44;7&#37;&#44; y la de los ni&#241;os sin DRA&#44; del 0&#44;5&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se encontr&#243; una asociaci&#243;n muy significativa del DRA con una estancia prolongada en UCIP y en el hospital y la necesidad de una ventilaci&#243;n mec&#225;nica prolongada&#46; Esta asociaci&#243;n fue independiente de la edad y enfermedad de los pacientes&#44; tras controlar estas variables en la regresi&#243;n log&#237;stica multivariante &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Adem&#225;s&#44; se encontr&#243; un aumento paralelo de la morbimortalidad con la mayor gravedad del DRA &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Posteriormente estudiamos de forma separada los ni&#241;os que presentaron un DRA prerrenal de aquellos que presentaron un DRA m&#225;s prolongado &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; Los ni&#241;os que presentaron un DRA prerrenal tuvieron una estancia m&#225;s prolongada en la UCIP y en el hospital que los que no tuvieron DRA&#44; aunque no fue diferente la utilizaci&#243;n y duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#46; Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#44; los ni&#241;os con DRA establecido eran m&#225;s peque&#241;os y tuvieron mayor morbimortalidad que los ni&#241;os sin DRA y que aquellos con DRA prerrenal&#46; Se encontr&#243; una asociaci&#243;n muy significativa del DRA establecido con una estancia prolongada en UCIP y en el hospital y la necesidad de una ventilaci&#243;n mec&#225;nica prolongada&#44; que fue independiente de la edad y enfermedad de los pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#41;&#46; No pudo establecerse esta asociaci&#243;n para los ni&#241;os que tuvieron un DRA prerrenal&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los resultados encontrados en este estudio demuestran una importante asociaci&#243;n entre el desarrollo de DRA y la morbimortalidad de los ni&#241;os que ingresan en la UCIP&#46; Asimismo&#44; muestra como el riesgo aumenta con la gravedad del DRA&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Hay pocos estudios publicados que eval&#250;en la repercusi&#243;n del DRA en ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; En una reciente revisi&#243;n sistem&#225;tica<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> se encontr&#243; una falta de concordancia en los resultados publicados en los diferentes estudios&#44; atribuida&#44; en parte&#44; a la aplicaci&#243;n de una forma heterog&#233;nea de los criterios de DRA y en los criterios de inclusi&#243;n y exclusi&#243;n utilizados y el tipo de pacientes estudiados<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;25</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La utilizaci&#243;n homog&#233;nea de unos criterios uniformes y comunes para la definici&#243;n de DRA en la poblaci&#243;n pedi&#225;trica deber&#237;a permitir la comparaci&#243;n de resultados de diferentes estudios&#46; Los criterios pRIFLE pueden servir para este fin&#44; pero su aplicaci&#243;n de una forma heterog&#233;nea en los estudios publicados hasta ahora no ha permitido alcanzar este objetivo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos incluido a todos los ni&#241;os en estado cr&#237;tico que requirieron asistencia en UCIP&#44; independientemente del tipo de enfermedad y de si el ingreso fue urgente o programado&#44; lo que nos permite obtener una mejor aproximaci&#243;n a la magnitud del problema que representa el desarrollo de DRA sobre la morbimortalidad en la poblaci&#243;n general pedi&#225;trica&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n de los estudios son las variaciones en el m&#233;todo para determinar el valor de la creatinina s&#233;rica de referencia cuando esta es desconocida&#44; y en algunos no se especifica<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;28</span></a>&#46; En el presente estudio un gran n&#250;mero de pacientes dispon&#237;an de valores previos&#44; y para el resto se utilizaron valores de referencia publicados recientemente<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">El criterio de oliguria no se ha utilizado en los principales estudios que se han llevado a cabo sobre el DRA en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24&#44;29</span></a>&#46; En nuestro trabajo el criterio de oliguria se cumpli&#243; en pocas ocasiones&#46; Probablemente influye que un mismo valor de diuresis &#40;ml&#47;kg&#47;h&#41; para definir oliguria es un criterio mucho m&#225;s severo cuanto m&#225;s peque&#241;o es el paciente&#44; dado que el aporte de agua que recibe el ni&#241;o en relaci&#243;n con su peso es mucho mayor cuanto m&#225;s peque&#241;o es&#46; Una valoraci&#243;n en ml&#47;m<span class="elsevierStyleSup">2</span> de superficie corporal o ml&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> obviar&#237;a probablemente este problema&#46; Tambi&#233;n puede influir en la evaluaci&#243;n de la oliguria la dificultad para cuantificar la diuresis en ni&#241;os no sondados&#44; m&#225;s a&#250;n si se realiza de forma retrospectiva&#46; Adem&#225;s&#44; la utilizaci&#243;n de diur&#233;ticos&#44; que es frecuente en los ni&#241;os ingresados en la UCI&#44; influida por el alto porcentaje de ni&#241;os con cardiopat&#237;as &#40;53&#37; en nuestro estudio&#41;&#44; puede contribuir a que se cumpla menos la oliguria&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">De los 12 art&#237;culos publicados que tratan de relacionar el desarrollo de DRA con la morbimortalidad&#44; tan solo dos de ellos aportan datos suficientes para verificar que las medidas empleadas para definir la presencia de da&#241;o renal corresponden a una correcta aplicaci&#243;n de los criterios pRIFLE<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Varios estudios han hallado una relaci&#243;n entre la existencia de DRA y la mortalidad<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21&#44;29</span></a>&#44; al igual que ocurri&#243; en nuestro estudio&#46; De los 4 trabajos que analizaron la mortalidad con el grado de severidad seg&#250;n el estadio pRIFLE<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;20&#44;21&#44;29</span></a>&#44; solo 2 de ellos mostraron una relaci&#243;n significativa<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;29</span></a>&#46; Probablemente estas diferencias se deban al peque&#241;o tama&#241;o de la poblaci&#243;n de los estudios publicados y la baja incidencia de mortalidad en las UCIP&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">La mayor morbilidad asociada al DRA&#44; valorada como una duraci&#243;n mayor del ingreso en la UCIP&#44; ingreso en el hospital y duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; ha sido mostrada en estudios realizados en adultos<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10&#44;12&#44;13</span></a> y ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;20&#8211;22&#44;27&#44;29&#44;30</span></a>&#46; En estudios en adultos se encontr&#243;&#44; adem&#225;s&#44; un riesgo creciente con la mayor gravedad del DRA seg&#250;n los criterios RIFLE&#44; datos que coinciden con nuestros resultados&#46; Sin embargo&#44; esta asociaci&#243;n no hab&#237;a sido descrita en las series previamente publicadas en ni&#241;os&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; hemos analizado separadamente los ni&#241;os con DRA prerrenal de aquellos con un DRA establecido&#44; para comprobar el efecto de la disfunci&#243;n pasajera frente al de un DRA establecido sobre la morbilidad&#46; Como era de esperar&#44; se demuestra que los ni&#241;os que tienen un DRA establecido presentan mayor morbilidad que los que presentan un DRA prerrenal&#46; Adem&#225;s&#44; pudo establecerse una asociaci&#243;n independiente del DRA establecido con los par&#225;metros de morbilidad estudiados&#46; La ausencia de esta asociaci&#243;n en nuestro estudio con los ni&#241;os que tuvieron DRA prerrenal pudo verse influida por cumplirse los criterios de morbilidad estudiados en pocos de estos ni&#241;os &#40;5 tuvieron ventilaci&#243;n mec&#225;nica durante m&#225;s de 7 d&#237;as&#44; 10 una estancia en UCIP superior a 12 d&#237;as y 10 ingreso en el hospital mayor de 28 d&#237;as&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Dada la gran morbimortalidad asociada al desarrollo de DRA en los ni&#241;os en estado grave&#44; la utilizaci&#243;n precoz de medidas que disminuyan la incidencia y&#47;o la gravedad del DRA podr&#237;an mejorar la evoluci&#243;n de estos ni&#241;os&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Este estudio presenta una serie de limitaciones&#58; 1&#41; estudio retrospectivo y unic&#233;ntrico&#59; 2&#41; n&#250;mero peque&#241;o de pacientes incluidos&#59; 3&#41; el filtrado glomerular estimado basal de una parte de los ni&#241;os tuvo que extrapolarse desde valores de creatinina adecuados a la edad del ni&#241;o publicados en tablas de referencia&#59; 4&#41; el criterio de oliguria no pudo evaluarse de forma adecuada en todos los pacientes por no estar todos los ni&#241;os sondados&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0215" class="elsevierStylePara elsevierViewall">El desarrollo de DRA en los ni&#241;os ingresados en la UCIP se asocia a una mayor morbimortalidad&#46; La categorizaci&#243;n del DRA con los criterios pRIFLE y la utilizaci&#243;n de definiciones y criterios bien definidos permiten una adecuada identificaci&#243;n del riesgo de morbimortalidad asociada y puede detectar de forma precoz a los pacientes con riesgo de presentar un DRA y aplicar medidas para disminuir la incidencia y la gravedad de este s&#237;ndrome&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0220" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2013-04-24"
    "fechaAceptado" => "2013-07-17"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec350538"
          "palabras" => array:4 [
            0 => "Da&#241;o renal agudo"
            1 => "Pediatr&#237;a"
            2 => "Cuidados Intensivos"
            3 => "Morbilidad"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec350539"
          "palabras" => array:4 [
            0 => "Acute kidney injury"
            1 => "Pediatrics"
            2 => "Intensive Care"
            3 => "Morbidity"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la morbimortalidad asociada a da&#241;o renal agudo &#40;DRA&#41; definido por los criterios RIFLE adaptados a Pediatr&#237;a en los ni&#241;os que ingresan en la Unidad de Cuidados Intensivos Pedi&#225;tricos &#40;UCIP&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de cohorte&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">UCIP de un hospital terciario&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Pacientes o participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Trescientos veinte ni&#241;os ingresados en la UCIP en el a&#241;o 2011&#46; Se excluyeron los neonatos y los trasplantados renales&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Variables principales El DRA fue definido con los criterios RIFLE adaptados a Pediatr&#237;a&#46; Para la valoraci&#243;n de la morbimortalidad se utiliz&#243; la duraci&#243;n de las estancias en la UCIP y en el hospital&#44; la necesidad de ventilaci&#243;n mec&#225;nica y la mortalidad&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 315 ni&#241;os&#44; con una mediana de edad de 19 meses &#40;6-72&#41;&#46; Presentaron DRA 128 ni&#241;os &#40;40&#44;6&#37;&#41; &#40;73 en la categor&#237;a de Risk &#91;riesgo&#93; y 55 en las categor&#237;as Injury &#91;da&#241;o&#93; y Failure &#91;fallo&#93;&#41;&#46; Los ni&#241;os con DRA presentaron mayor mortalidad &#40;11&#44;7&#37;&#41; que el resto de pacientes &#40;0&#44;5&#37;&#41;&#44; una estancia m&#225;s prolongada en UCIP &#40;6&#44;0 &#91;4&#44;0-12&#44;5&#93; frente a 3&#44;5 &#91;2&#44;0-7&#44;0&#93; d&#237;as&#41; y en el hospital &#40;17 &#40;10-32&#41; frente a 10 &#40;7-15&#93; d&#237;as&#41; y m&#225;s ni&#241;os precisaron ventilaci&#243;n mec&#225;nica &#40;61&#44;7 frente a 36&#44;9&#37;&#41;&#46; El desarrollo de DRA fue un factor independiente de morbilidad&#44; asociado a una mayor estancia en UCIP y hospitalaria y a una ventilaci&#243;n mec&#225;nica m&#225;s prolongada&#44; increment&#225;ndose esta morbilidad de forma paralela a la gravedad del da&#241;o renal&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0035">Conclusi&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El desarrollo de DRA en ni&#241;os en estado cr&#237;tico se asocia a un incremento en la morbimortalidad&#44; que es directamente proporcional a la magnitud de la gravedad del da&#241;o renal&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0045">Aim</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To describe the morbimortality associated to the development of acute kidney injury &#40;AKI&#41; defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit &#40;PICU&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was carried out&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Children admitted to a PICU in a tertiary care hospital&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011&#46; Neonates and renal transplant patients were excluded&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria&#46; PICU and hospital stays&#44; use of mechanical ventilation and mortality were used to evaluate morbimortality&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 315 children met the inclusion criteria&#44; with a median age of 19 months &#40;range 6-72&#41;&#46; Of these patients&#44; 128 presented AKI &#40;73 reached the Risk category and 55 reached the Injury and Failure categories&#41;&#46; Children with AKI presented a longer PICU stay &#40;6&#46;0 &#91;4&#46;0-12&#46;5&#93; vs&#46; 3&#46;5 &#91;2&#46;0-7&#46;0&#93; days&#41; and hospital stay &#40;17 &#91;10-32&#93; vs&#46; 10 &#91;7-15&#93; days&#41;&#44; and a greater need for mechanical ventilation &#40;61&#46;7 vs&#46; 36&#46;9&#37;&#41;&#46; The development of AKI was an independent factor of morbidity&#44; associated with a longer PICU and hospital stay&#44; and with a need for longer mechanical ventilation&#44; with a proportional relationship between increasing morbidity and the severity of AKI&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The development of AKI in critically ill children is associated with increased morbimortality&#44; which is proportional to the severity of renal injury&#46;</p>"
      ]
    ]
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">FGe&#58; filtrado glomerular estimado&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Creatinina s&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diuresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#44;5-2 o descenso FGe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2-3 o descenso FGe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 veces o descenso FGe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>75&#37; o FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;3<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h o anuria<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Criterios RIFLE adaptados a Pediatr&#237;a de da&#241;o renal agudo</p>"
        ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cr&#58; creatinina&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Creatinina s&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diuresis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estadio 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#44;5-2 o aumento<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span> 6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estadio 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2-3 veces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estadio 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 veces o Cr<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;con un incremento agudo<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;3<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h o anuria durante 12<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Criterios AKIN de da&#241;o renal agudo</p>"
        ]
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Cr&#58; creatinina&#59; DRA&#58; da&#241;o renal agudo&#59; ECMO&#58; oxigenaci&#243;n por membrana extracorp&#243;rea&#59; PO&#58; postoperatorio&#59; IRA&#58; insuficiencia respiratoria aguda&#59; UCIP&#58; Unidad de Cuidados Intensivos Pedi&#225;tricos&#59; VMC&#58; ventilaci&#243;n mec&#225;nica&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Todos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Con DRA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Sin DRA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128 &#40;40&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187 &#40;59&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otras cardiopat&#237;as &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Duraci&#243;n VMC</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;horas&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Cr basal</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;mg&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estancia UCIP</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;d&#237;as&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estancia total</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;d&#237;as&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;7-15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;91&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;13&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;86&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Total DRA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">128&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">75 &#40;58&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53 &#40;41&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">62 &#40;57&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n del da&#241;o renal agudo seg&#250;n su gravedad&#44; momento de inicio y duraci&#243;n</p>"
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          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">DRA&#58; da&#241;o renal agudo&#59; OR&#58; odds ratio&#59; UCIP&#58; Unidad de Cuidados Intensivos Pedi&#225;tricos&#59; VMC&#58; ventilaci&#243;n mec&#225;nica&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Regresi&#243;n log&#237;stica&#44; odds ratio &#40;IC 95&#37;&#41;&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Estancia UCIP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>12 d&#237;as<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PO cirug&#237;a card&#237;aca &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;26&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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