Enterocolitis neutropénica: revisión sistemática de casos publicados

  • Andrés Felipe Cardona Instituto Nacional de Cancerología
  • Ludovic Reveiz Grupo Colombiano de la Colaboración Cochrane
  • Edgar Guillermo Ospina Grupo Colombiano de la Colaboración Cochrane
  • Alexandra Casasbuenas Hospital de San José
  • Diego Mauricio Aponte Clínica Reina Sofía
  • Pedro Ramos Instituto Nacional de Cancerología
Palabras clave: Enterocolitis neutropénica, revisión sistemática, colitis, enterocolitis, necrotizante

Resumen

Introducción: La enterocolitis neutropénica (ECN) es una entidad clínico patológica bien reconocida que amenaza habitualmente la vida y se asocia con diversas neoplasias sólidas y hematológicas y con la anemia aplásica.
Objetivo: Evaluar la mortalidad global de la ECN, describir los hallazgos clínicos más frecuentes y las intervenciones terapéuticas reportadas en la literatura médica, con la finalidad de generar hipótesis acerca de los factores que influyen sobre la mortalidad y en la realización de intervenciones quirúrgicas.
Materiales y métodos: Se realizaron búsquedas avanzadas en las bases de datos Medline, Embase, Lilacs y en el motor general Google; además, se utilizaron como estrategias adicionales, búsquedas manuales en diversas revistas. Los reportes fueron considerados según la definición del caso teniendo en cuenta criterios específicos para inclusión y exclusión.
Resultados: Se seleccionaron 228 casos; 109 fueron casos individuales y 40 reportes correspondieron a series de casos. La comparación de los datos obtenidos a partir de los reportes individuales y de las series de casos no reveló diferencias significativas respecto de la mortalidad, intervenciones quirúrgicas, edad y sexo. Se encontró una mortalidad mayor en las mujeres (x2=7,51 p=0,006) comparadas con los hombres (50% vs. 28%). No se identificaron diferencias significativas entre las combinaciones de antibióticos respecto de la mortalidad (x2= 12,85 df 13 p=0,45). La mortalidad (x2=3,89 df 1, p=0,049), las intervenciones quirúrgicas (x2=7,64 df 1, p=0,006) y la duración de la diarrea (x2=4,71 df 1, p=0,043) fueron significativamente diferentes en el 26,4% de los individuos que fueron tratados con antifúngicos; el 81 % de los pacientes que no recibieron estos medicamentos murieron, en comparación con el 19% de los sujetos en que se reportó la utilización de antimicóticos.
Conclusión: La evidencia sugiere que los agentes antifúngicos deben ser usados tempranamente en los pacientes que padecen ECN. Sin embargo, esta hipótesis debe ser evaluada en experimentos clínicos multicentricos con asignación aleatoria.

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Biografía del autor/a

Andrés Felipe Cardona, Instituto Nacional de Cancerología

Grupo Oncología Clínica, Instituto Nacional de Cancerología E.S.E., Bogotá, D.C., Colombia

Ludovic Reveiz, Grupo Colombiano de la Colaboración Cochrane

Grupo Colombiano de la Colaboración Cochrane

Edgar Guillermo Ospina, Grupo Colombiano de la Colaboración Cochrane

Grupo Colombiano de la Colaboración Cochrane

Alexandra Casasbuenas, Hospital de San José

Departamento de Ginecología y Obstetricia, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, D.C., Colombia

Diego Mauricio Aponte, Clínica Reina Sofía

Departamento de Gastroenterología y Endoscopia de Vías Digestivas, Clínica Reina Sofía, Bogotá, D.C., Colombia

Pedro Ramos, Instituto Nacional de Cancerología

Grupo Oncología Clínica, Instituto Nacional de Cancerología E.S.E., Bogotá, D.C., Colombia

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Publicado
2005-09-01
Cómo citar
[1]
Cardona, A.F., Reveiz, L., Ospina, E.G., Casasbuenas, A., Aponte, D.M. y Ramos, P. 2005. Enterocolitis neutropénica: revisión sistemática de casos publicados. Revista Colombiana de Cancerología. 9, 3 (sep. 2005), 82-92.
Sección
Artículos de investigación/originales