Valor pronóstico de la escala de Glasgow en aneurismas de aorta abdominal infrarrenal rotos

Introduction. Mortality in cases of ruptured abdominal aortic aneurysm (rAAA) submitted to surgery ranges between 26-62%, depending on the clinical status of the patient before the operation. Aims. To apply the Glasgow scale in patients who underwent surgery for rAAA and to use it as a prognostic tool to determine the perioperative mortality rate and to observe how the indication for surgery would be modified for these patients. Patients and methods. We conducted a retrospective study of 103 patients submitted to surgery for rAAA between 1996 and 2007. The preoperative clinical status was evaluated by means of the Glasgow scale. The ROC curves (cut-off point and area below the curve) were obtained and the groups, which had been established according to the cut-off point, were compared using the chi-square test. Sensitivity, specificity, and both the negative (NPV) and positive predictive value (PPV) were determined for the cut-off point. A multivariable study was applied for the data under study and Kaplan-Meier survival charts were drawn up. Results. The frequencies of presentation of the Glasgow variables were: shock 71.8%, heart disease 34%, neuropathy 7.8% and nephropathy 36.9%. Perioperative mortality rate stood at 49.5% (n = 51). The estimated area below the curve is 0.814 (95% confidence interval, CI: 0.725-0.883), the cut-off point is 106 points (sensitivity 45.1%; specificity 94.2%; PPV: 88.5%; NPV: 63.6%). Mortality above and below the cut-off point was 88.5 and 36.4%, respectively (p < 0.001; odds ratio, 13.4; 95% 95% CI: 3.6-48.7). Above 111 points mortality was 100%. Conclusions. The Glasgow risk scale is a good tool for predicting mortality in patients with rAAA, which provides a precise cut-off point beyond which mortality increases significantly. As a result, a better indication for surgery can be achieved for this group of patients. [ANGIOLOGÍA 2008; 60: 109-16]