Utilidad del CRIB para predecir la muerte hospitalaria y la hemorragia intraventricular en los prematuros de muy bajo peso y extremado bajo peso al nacer

Rivas Ruiz, R.; Guzmán Cabañas, J.M.ª; Párraga Quiles, M.ªJ.; Ruiz González, M.ªD.; Huertas Muñoz, M.ªD.; Álvarez Marcos, R.; Zapatero Martínez, M.

doi:10.1157/13098931

Article information

Objetivo

Evaluar la utilidad del Clinical Risk Index for Babies (CRIB) para predecir la muerte hospitalaria y la hemorragia intraventricular (HIV) en pacientes recién nacidos prematuros de muy bajo peso (RNMBP) y de peso extremadamente bajo al nacer (RNEBP).

Método

Se siguió de forma prospectiva una cohorte de recién nacidos con peso inferior a 1.500 g ingresados en la unidad de cuidados intensivos neonatales (UCIN), desde enero de 2002 a diciembre de 2004. Se registraron datos de morbimortalidad del estudio multicéntrico SEN-1500, incluida la valoración del CRIB a las 12 h de vida. Se evaluaron los datos globales así como en dos subgrupos según peso: muy bajo peso (entre 1.000 y 1.500 g) y peso extremadamente bajo (< 1.000 g).

Se realizaron curvas ROC para estimar el poder de predicción mediante el área bajo la curva (Az) y se procesaron modelos multivariantes.

Resultados

Se registraron los datos de 163 pacientes. La media de peso al nacer (+DE) fue de 1.114 g (±270) y de edad gestacional (+DE) fue de 29 semanas (±3). El Az del CRIB para la muerte intrahospitalaria fue 0,757, del peso al nacer 0,758 y de la edad gestacional 0,703. El Az del índice CRIB para la HIV fue 0,66, del peso 0,62 y de edad gestacional 0,64.

En los dos modelos multivariantes para mortalidad y HIV, el CRIB fue el mejor predictor.

En el grupo de RNMBP el Az del CRIB para la muerte hospitalaria fue 0,77 (p < 0,001), siendo 0,63 en el grupo de RNEBP (p = 0,82).

Conclusiones

La utilidad del CRIB en los recién nacidos menores de 1.500 g para predecir muerte hospitalaria y HIV es similar a la del peso. Al estratificar por grupos de peso, encontramos que en los pacientes mayores de 1.000 g, el CRIB fue el mejor predictor de muerte hospitalaria, mientras que en los menores de 1.000 g el CRIB no fue mejor que el azar.

Palabras clave:

CRIB

Índices de severidad de la enfermedad

Bajo peso al nacimiento

Peso extremadamente bajo al nacimiento

Curvas ROC

Objective

To assess the utility of the CRIB score as a predictor of hospital death and intraventricular hemorrhage (IVH) in very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates.

Method

A prospective cohort of VLBW neonates admitted to the neonatal intensive care unit from January 2002 to December 2004 was studied. The data was assessed following the protocol of the SEN 1500 multicenter study. This protocol included assessment of the CRIB score in the first 12 hours of life. Data for the entire group, as well as for two subgroups divided according to birth weight (BW) – VLBW neonates (between 1000 and 1500 g) and ELBW neonates (below 1,000 g) – were evaluated. The area under the receiver operating characteristic curve (Az) was calculated to assess the utility of CRIB score, BW and gestational age (GA). Two multivariate models were used.

Results

The cohort consisted of 163 patients. The mean (±SD) birthweight was 1.114 (±270) g and gestational age (±SD) was 29 (±3) weeks. The Az for hospital death was 0.757 for the CRIB, 0.758 for BW and 0.703 for GA. The Az for IVH was 0.66 for the CRIB, 0.62 for BW and 0.64 for GA. In the multivariate models for hospital death and IVH, the CRIB was the best predictor. The Az of the CRIB for hospital death was 0.77 for VLBW neonates (p < 0.001) and 0.63 for ELBW neonates (p = 0.82).

Conclusions

The predictive utility of the CRIB for hospital death and IVH is similar to that of BW. In the stratification by groups of weight, we found that the CRIB was the best predictor of hospital death in the group weighing > 1,000 g but was no better than chance in the group weighing < 1,000 g.

Key words:

CRIB

Disease severity indexes

Low birthweight

Extremely low birth weight

ROC curves

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