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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La diabetes mellitus &#40;DM&#41; es una enfermedad cr&#243;nica del metabolismo de los hidratos de carbono&#44; cuya incidencia y prevalencia han experimentado un incremento marcado en las 2 &#250;ltimas d&#233;cadas&#46; Aunque datos recientes en Estados Unidos reflejan una estabilizaci&#243;n desde el a&#241;o 2008&#44; la prevalencia es muy elevada en el momento actual<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Un estudio epidemiol&#243;gico publicado en el a&#241;o 2012 cifra la prevalencia de DM en nuestro pa&#237;s en el 13&#44;8&#37;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El tratamiento hospitalario de pacientes con DM es un problema frecuente&#44; ya que se estima que suponen entre un 30 y 40&#37; de los pacientes atendidos en Urgencias y hasta un 25&#37; de los enfermos ingresados en el hospital&#44; tanto en plantas m&#233;dicas como quir&#250;rgicas<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; A pesar de la falta de evidencia de que el tratamiento intensivo de la glucemia reduzca la mortalidad en el paciente ingresado<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; hay estudios epidemiol&#243;gicos que demuestran que diversos par&#225;metros de control gluc&#233;mico&#44; como la glucemia media &#40;GM&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; pueden influir en el pron&#243;stico del paciente&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pacientes con igual GM pueden tener perfiles gluc&#233;micos muy diferentes&#46; Aunque no hay un est&#225;ndar de referencia para cuantificar la variabilidad gluc&#233;mica &#40;VG&#41;&#44; cada vez se acumulan m&#225;s datos que sugieren su importancia pron&#243;stica&#46; Los &#250;ltimos datos del estudio ADVANCE<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> demostraron que un incremento de la variabilidad visita a visita &#40;desviaci&#243;n est&#225;ndar&#41; en los niveles de HbA1c y de la glucemia en ayunas se asociaban a un incremento del riesgo de aparici&#243;n de complicaciones micro y macrovasculares&#46; Tambi&#233;n recientemente se ha reconocido la importancia de la VG intrahospitalaria&#44; tanto en el desarrollo de eventos cardiovasculares a medio plazo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> &#40;un a&#241;o&#41; como en la mortalidad a los 90 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Por ello se considera necesario realizar estudios de intervenci&#243;n que puedan responder definitivamente a la pregunta de si la reducci&#243;n de la VG puede disminuir el riesgo de aparici&#243;n de complicaciones en la DM<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo del presente trabajo fue evaluar factores predictores de mortalidad en pacientes con hiperglucemia ingresados en un Servicio de Medicina Interna&#46; Espec&#237;ficamente&#44; analizamos la importancia pron&#243;stica de diversas medidas de control gluc&#233;mico que reflejaban no solo la GM&#44; sino tambi&#233;n la VG&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio de cohortes retrospectivo longitudinal anal&#237;tico&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluy&#243; a pacientes dados de alta durante un periodo de 8 meses del Servicio de Medicina Interna del Hospital Cl&#237;nico Universitario &#171;Lozano Blesa&#187; de Zaragoza con alg&#250;n diagn&#243;stico &#40;principal o secundario&#41; 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<span class="elsevierStyleItalic">3&#41;</span> variables bioqu&#237;micas&#58; glucosa&#44; creatinina&#44; iones&#44; HbA1c y hemograma inicial&#44; y <span class="elsevierStyleItalic">4&#41;</span> variables generadas&#58; El tratamiento ambulatorio de los pacientes antes del ingreso se recodific&#243; en 3 categor&#237;as &#40;dieta y&#47;o antidiab&#233;ticos orales como categor&#237;a de referencia&#44; insulina basal con o sin antidiab&#233;ticos orales y mezclas o basal-bolo&#41; debido al limitado n&#250;mero de pacientes en tratamiento basal-bolo&#46; A partir de los valores de glucemia capilar se determinaron como medidas de valoraci&#243;n del control gluc&#233;mico intrahospitalario&#58; glucemia m&#225;xima &#40;el valor de glucemia capilar m&#225;s elevado durante el ingreso&#41;&#44; GM en las primeras 24 h&#44; GM durante el ingreso&#44; definida como la media de todas las glucemias capilares del paciente&#44; GM corregida &#40;media de las medias diarias de glucemias capilares&#41;&#44; desviaci&#243;n est&#225;ndar de todas las glucemias capilares del paciente &#40;VG&#41; y coeficiente de variaci&#243;n &#40;CV&#41;&#44; definido como el cociente entre la desviaci&#243;n est&#225;ndar y la GM durante el ingreso &#40;VG&#47;GM&#41;&#46; Seg&#250;n su glucemia inicial&#44; los pacientes se clasificaron en 4 categor&#237;as&#44; con puntos de corte en 140&#44; 180 y 250<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">M&#233;todos de laboratorio</span><p id="par0040" class="elsevierStylePara elsevierViewall">La glucemia plasm&#225;tica se determin&#243; mediante un m&#233;todo enzim&#225;tico con hexoquinasa&#44; la HbA1c mediante cromatograf&#237;a de alta resoluci&#243;n y la glucemia capilar con medidor Optium Xceed<span class="elsevierStyleSup">&#174;</span>&#44; cuya precisi&#243;n es de 3-3&#44;6&#37; &#40;CV&#41;&#44; con una exactitud r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;98 respecto a la glucemia plasm&#225;tica y un cumplimiento de la norma ISO del 99&#37;&#46; El resto de los par&#225;metros bioqu&#237;micos y el hemograma se midieron mediante procedimientos rutinarios en un autoanalizador&#46; El filtrado glomerular &#40;FG&#41;&#44; expresado en ml&#47;minuto&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#44; se calcul&#243; mediante f&#243;rmula de MDRD a partir de la edad y la creatinina plasm&#225;tica&#59; los pacientes se clasificaron en 4 categor&#237;as seg&#250;n su FG fuese &#8805; 60&#44; 45-59&#44; 30-44 o<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;minuto&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">M&#233;todos estad&#237;sticos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se describen con su media &#177; desviaci&#243;n est&#225;ndar &#40;DE&#41;&#44; mientras que las variables cualitativas se describen con la distribuci&#243;n de frecuencias&#46; La comparaci&#243;n de variables cuantitativas se realiz&#243; con la t de Student para muestras independientes &#40;2 grupos&#41; o ANOVA &#40;m&#225;s de 2 grupos&#41; o con pruebas no param&#233;tricas de Mann-Whitney o Kruskal-Wallis&#44; respectivamente&#46; La comparaci&#243;n de variables cualitativas se realiz&#243; mediante &#967;<span class="elsevierStyleSup">2</span> o test exacto de Fisher&#44; con test de tendencia lineal en las variables predictivas con categor&#237;as ordenadas&#46; La correlaci&#243;n entre variables cuantitativas &#40;GM y GM corregida&#41; se evalu&#243; con el coeficiente de correlaci&#243;n de Pearson&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La determinaci&#243;n de los factores predictores de mortalidad intrahospitalaria se realiz&#243; mediante regresi&#243;n log&#237;stica uni y multivariante&#46; Para determinar los mejores modelos predictivos se incluyeron en los modelos multivariante las variables seg&#250;n criterios estad&#237;sticos &#40;p &#8804; 0&#44;1 en an&#225;lisis univariante&#41; y seg&#250;n su sentido cl&#237;nico&#46; Posteriormente&#44; se comput&#243; un procedimiento de exclusi&#243;n secuencial para obtener el modelo finalmente seleccionado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; una comparaci&#243;n de la utilidad para predecir mortalidad intrahospitalaria de la adici&#243;n conjunta de variables relacionadas con el control gluc&#233;mico &#40;glucemia inicial&#44; HbA1c&#44; GM&#44; VG y administraci&#243;n de insulina programada&#41; a un modelo b&#225;sico &#40;compuesto por edad&#44; sexo&#44; ayuno&#44; tratamiento con corticoides&#44; &#237;ndice de Charlson&#44; FG&#44; PAS&#44; sodio y leucocitos iniciales&#41; mediante an&#225;lisis de curvas ROC y mediante el c&#225;lculo del &#237;ndice de mejor&#237;a de la discriminaci&#243;n &#40;IDI&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se consideraron significativas las asociaciones con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Los programas inform&#225;ticos utilizados fueron SPSS versi&#243;n 22&#46;0 y R versi&#243;n 3&#46;1&#46;2&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 384 pacientes&#44; de los cuales 193 &#40;50&#44;3&#37;&#41; fueron varones&#46; La edad media &#177; DE fue de 78&#44;5 &#177; 10&#44;3 a&#241;os&#46; Los motivos de ingreso m&#225;s frecuentes fueron disnea &#40;41&#44;1&#37;&#41; y s&#237;ndrome febril &#40;10&#44;4&#37;&#41;&#46; Los diagn&#243;sticos relacionados con la DM m&#225;s frecuentes fueron DM tipo 2 &#40;83&#44;6&#37;&#41; e hiperglucemia de estr&#233;s &#40;6&#44;8&#37;&#41;&#46; El tratamiento domiciliario de los pacientes con DM era con medidas higi&#233;nico-diet&#233;ticas de forma aislada &#40;16&#44;7&#37;&#41;&#44; antidiab&#233;ticos orales &#40;42&#44;9&#37;&#41;&#44; insulina basal &#40;26&#44;3&#37;&#41;&#44; mezclas de insulina &#40;10&#44;7&#37;&#41; o insulinizaci&#243;n bolo-basal &#40;3&#44;4&#37;&#41;&#46; El tiempo de evoluci&#243;n de la DM fue de 12&#44;1 &#177; 8&#44;6 a&#241;os y la puntuaci&#243;n media en el &#237;ndice de Charlson fue de 2&#44;9 &#177; 1&#44;6 puntos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Hubo un 17&#44;5&#37; de pacientes que precisaron ingreso en situaci&#243;n de ayuno y un 34&#44;4&#37; que necesitaron recibir tratamiento con corticoides&#46; La duraci&#243;n media del ingreso fue de 13&#44;8 &#177; 18&#44;5 d&#237;as&#46; Experimentaron durante el ingreso hipoglucemias un 27&#37; de los pacientes &#40;22&#44;8&#37; con hipoglucemias leves y 4&#44;2&#37; intensas&#41;&#46; La GM corregida tuvo un coeficiente de correlaci&#243;n respecto a la GM de 0&#44;99 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; por lo que se utiliz&#243; la GM para todos los c&#225;lculos de los an&#225;lisis de regresi&#243;n&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se produjo el fallecimiento intrahospitalario en 31 &#40;8&#44;1&#37;&#41; pacientes&#59; no hubo diferencias significativas entre pacientes con hiperglucemia de estr&#233;s y pacientes con DM previa &#40;7&#44;7 vs&#46; 8&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86&#41;&#46; Las causas de muerte fueron infecciosas &#40;16&#41;&#44; cardiovasculares &#40;7&#41;&#44; respiratorias &#40;4&#41; u otras causas &#40;4&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> quedan reflejadas las caracter&#237;sticas generales de los pacientes en funci&#243;n de su glucemia inicial&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se comparan las caracter&#237;sticas generales de los pacientes y en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> las diversas medidas de glucemia en funci&#243;n de que los pacientes falleciesen o no&#46; Los pacientes que murieron durante su estancia hospitalaria presentaron mayor edad&#44; menor proporci&#243;n de tratamiento insul&#237;nico en domicilio&#44; menor FG y mayor puntuaci&#243;n en el &#237;ndice de Charlson&#59; adem&#225;s&#44; se encontraron con mayor frecuencia en situaci&#243;n de ayuno y precisaron tambi&#233;n con mayor frecuencia tratamiento con corticoides&#44; mientras que recibieron con menor probabilidad insulina programada&#46; En cuanto a las medidas de control gluc&#233;mico&#44; los pacientes que fallecieron ten&#237;an mayor glucemia inicial y&#44; en el l&#237;mite de la significaci&#243;n estad&#237;stica&#44; mayor GM las primeras 24 h y durante el ingreso&#44; as&#237; como mayor VG &#40;desviaci&#243;n est&#225;ndar&#41;&#46; Los predictores univariante con p &#8804; 0&#44;1 quedan reflejados en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En an&#225;lisis multivariante el mejor modelo predictivo de mortalidad &#40;R<span class="elsevierStyleSup">2</span> 0&#44;326&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; fue el compuesto&#44; por orden de importancia pron&#243;stica&#44; por la edad &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;19&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;094&#59; IC del 95&#37;&#44; 1&#44;020-1&#44;174&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; &#237;ndice de Charlson &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;28&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;48&#59; IC del 95&#37;&#44; 1&#44;11-1&#44;99&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#44; glucemia inicial &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;05&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;007&#59; IC del 95&#37;&#44; 1&#44;001-1&#44;014&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#44; &#250;ltima HbA1c &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;76&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#59; IC del 95&#37;&#44; 0&#44;33-1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; VG &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;41&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;031&#59; IC del 95&#37;&#44; 1-1&#44;062&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#44; necesidad de tratamiento con corticoides &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;03&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;1&#59; IC del 95&#37;&#44; 1-9&#44;64&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41;&#44; administraci&#243;n de insulina programada &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;98&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#59; IC del 95&#37;&#44; 0&#44;066-1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; y PAS &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;92&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;985&#59; IC del 95&#37;&#44; 0&#44;97-1&#44;003&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;088&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La adici&#243;n de las medidas de control gluc&#233;mico mejor&#243; la capacidad para predecir la mortalidad de los modelos &#40;&#225;rea bajo la curva ROC 0&#44;887 vs&#46; 0&#44;830&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#59; <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#41;&#44; as&#237; como su poder de discriminaci&#243;n &#40;IDI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;079&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mediante una revisi&#243;n de las historias cl&#237;nicas de los pacientes dados de alta en nuestro hospital con un diagn&#243;stico relacionado con la presencia de DM&#44; hemos comprobado que la consideraci&#243;n de diversas medidas de control gluc&#233;mico puede mejorar la capacidad para predecir mortalidad intrahospitalaria&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Las personas con DM tienen m&#225;s probabilidades de ser ingresadas en el hospital&#44; mayor duraci&#243;n de la estancia hospitalaria y mayor mortalidad intrahospitalaria que las personas sin DM<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Debido a ello se han intentado descubrir factores predictivos de mal pron&#243;stico hospitalario en el paciente con DM&#46; En un estudio reciente se encontr&#243; que la mortalidad intrahospitalaria de los pacientes con DM fue de un 5&#44;1&#37; y se consigui&#243; construir un modelo predictivo de mortalidad con variables cl&#237;nicas y anal&#237;ticas recogidas en las primeras 72 h de admisi&#243;n&#59; no obstante&#44; una limitaci&#243;n del estudio fue no disponer de las medidas de control gluc&#233;mico<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La hiperglucemia en el momento de la admisi&#243;n en el hospital se ha revelado como un marcador de mal pron&#243;stico hospitalario<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;10</span></a>&#44; especialmente en los pacientes sin un diagn&#243;stico previo de DM<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro estudio&#44; la glucemia en el momento de la admisi&#243;n fue un factor pron&#243;stico independiente de mortalidad&#44; aunque no hubo diferencias significativas de mortalidad entre pacientes con DM previamente conocida o no&#46; En el an&#225;lisis multivariante hubo relaci&#243;n inversa entre HbA1c y mortalidad&#44; lo que indicar&#237;a que es el control metab&#243;lico a corto plazo el que est&#225; asociado a un mal pron&#243;stico hospitalario&#46; De hecho&#44; en el estudio de Timmer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> en pacientes con infarto agudo de miocardio con elevaci&#243;n de ST&#44; la glucemia inicial predijo la mortalidad a los 30 d&#237;as&#44; mientras que la HbA1c inicial predijo la mortalidad a largo plazo&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Adem&#225;s de las medidas en el momento de la admisi&#243;n&#44; tambi&#233;n el control gluc&#233;mico durante la hospitalizaci&#243;n puede ser importante&#46; En pacientes hospitalizados con infarto agudo de miocardio<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> y en pacientes no cr&#237;ticos sometidos a tratamiento con nutrici&#243;n parenteral<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> se ha descrito un incremento de mortalidad asociado con la elevaci&#243;n de las cifras de GM intrahospitalarias&#46; Aunque en estos estudios<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;15</span></a> no se evaluaron medidas de VG&#44; recientes datos apoyan su importancia pron&#243;stica<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; En el estudio de Mendez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> se incluy&#243; a 620 pacientes &#40;935 ingresos&#41; y se obtuvo para cada ingreso la GM &#40;182<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; la VG &#40;57&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; y el CV &#40;31&#44;9&#37;&#41;&#44; constat&#225;ndose que la VG era un factor predictivo de mortalidad en los primeros 90 d&#237;as&#44; independiente de la GM y de la presencia de hipoglucemias&#46; En nuestro estudio&#44; las medidas de glucemia fueron totalmente superponibles a las del trabajo anterior&#44; y tambi&#233;n encontramos que la medida de control gluc&#233;mico m&#225;s asociada al riesgo de mortalidad fue la VG&#44; en el l&#237;mite de la significaci&#243;n en el an&#225;lisis univariante&#44; pero significativa en el multivariante&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A pesar de la asociaci&#243;n epidemiol&#243;gica&#44; los estudios de intervenci&#243;n destinados a demostrar la eficacia del control gluc&#233;mico intensivo en pacientes hospitalizados fuera de la UCI son escasos&#46; Un metaan&#225;lisis reciente<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> demostraba que el tratamiento intensivo hospitalario de la hiperglucemia fuera de la UCI lograba reducir las infecciones &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;41&#59; IC del 95&#37;&#44; 0&#44;21-0&#44;77&#41; pero no la mortalidad&#44; con un incremento en el l&#237;mite de la significaci&#243;n estad&#237;stica en el riesgo de hipoglucemias &#40;RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;58&#59; IC del 95&#37;&#44; 0&#44;97-2&#44;57&#41;&#46; En nuestro trabajo&#44; la aparici&#243;n de hipoglucemias fue m&#225;s frecuente en los pacientes que fallecieron&#44; aunque la diferencia no fue significativa&#44; probablemente debido al limitado n&#250;mero de sujetos&#46; Utilizando la evidencia disponible sobre riesgos y beneficios del control metab&#243;lico en el paciente ingresado fuera de la UCI&#44; las sociedades cient&#237;ficas<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> recomiendan en la actualidad conseguir cifras de glucemia preprandiales &#60;140<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y aleatorias &#60; 180<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Aunque no hay recomendaciones espec&#237;ficas para evaluar y reducir la VG&#44; hay consenso en la necesidad de la realizaci&#243;n de ensayos de intervenci&#243;n que demuestren su papel etiol&#243;gico<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;18</span></a>&#46; En nuestro estudio&#44; la utilizaci&#243;n de insulina programada se asoci&#243; a una reducci&#243;n en el riesgo de mortalidad&#44; apoyando la necesidad de evitar el tratamiento aislado con pautas de insulina r&#225;pida<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> y la necesidad de implementar protocolos espec&#237;ficos de manejo intrahospitalario<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Como limitaciones del presente trabajo deber&#237;amos considerar su naturaleza observacional y retrospectiva&#44; que reduce la posibilidad de establecer inferencias causales&#44; y el limitado n&#250;mero de pacientes&#46; Como ventajas estar&#237;an la recogida de todas las medidas de glucemia intrahospitalaria&#44; lo que permiti&#243; la evaluaci&#243;n cuidadosa de su importancia pron&#243;stica&#44; y la posibilidad de ajuste en el an&#225;lisis multivariante para reconocidos factores predictores de mortalidad&#44; como el &#237;ndice de Charlson&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en una muestra de pacientes hospitalizados en una planta de Medicina Interna hemos constatado que la evaluaci&#243;n de diversas medidas de control gluc&#233;mico a&#241;ade informaci&#243;n pron&#243;stica al riesgo de mortalidad&#46; El aumento de la glucemia inicial y de la VG intrahospitalaria incrementaron el riesgo de mortalidad&#44; mientras que la utilizaci&#243;n de insulina programada se asoci&#243; a una reducci&#243;n de la mortalidad intrahospitalaria&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran que no tienen ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Introduction"
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              "titulo" => "Pacientes"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-02-12"
    "fechaAceptado" => "2015-06-07"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Mortalidad hospitalaria"
            1 => "Diabetes"
            2 => "Insulina"
            3 => "Variabilidad gluc&#233;mica"
            4 => "Manejo hospitalario de la hiperglucemia"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Hospital mortality"
            1 => "Diabetes"
            2 => "Insulin"
            3 => "Glycaemic variability"
            4 => "Hospital management of hyperglycaemia"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue evaluar la importancia pron&#243;stica de diversas medidas de control gluc&#233;mico sobre la mortalidad intrahospitalaria&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes retrospectivo anal&#237;tico con inclusi&#243;n de pacientes ingresados en Medicina Interna con alg&#250;n diagn&#243;stico relacionado con la diabetes mellitus &#40;DM&#41;&#44; excluyendo descompensaciones agudas&#46; El punto final cl&#237;nico fue la mortalidad intrahospitalaria&#46; Se recogieron variables cl&#237;nicas&#44; anal&#237;ticas y relacionadas con el control gluc&#233;mico &#40;administraci&#243;n de insulina programada&#44; glucemia plasm&#225;tica al ingreso&#44; HbA1c&#44; glucemia media &#40;GM&#41; y variabilidad gluc&#233;mica &#40;VG&#41; intrahospitalarias e hipoglucemias&#41;&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La determinaci&#243;n de los factores predictivos de mortalidad intrahospitalaria se realiz&#243; mediante regresi&#243;n log&#237;stica uni y multivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 384 pacientes &#40;50&#44;3&#37; varones&#41;&#46; La edad media &#177; DE fue de 78&#44;5 &#177; 10&#44;3 a&#241;os&#46; Los diagn&#243;sticos relacionados con la DM fueron diabetes tipo 2 &#40;83&#44;6&#37;&#41; e hiperglucemia de estr&#233;s &#40;6&#44;8&#37;&#41;&#46; Se produjo el fallecimiento intrahospitalario en 31 &#40;8&#44;1&#37;&#41; pacientes&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En el an&#225;lisis multivariante el mejor modelo predictivo de mortalidad &#40;R<span class="elsevierStyleSup">2</span> 0&#44;326&#59; p &#60; 0&#44;0001&#41; fue el compuesto&#44; por orden de importancia&#44; por la edad &#40;&#967;<span class="elsevierStyleSup">2</span> &#61; 8&#44;19&#59; OR &#61; 1&#44;094&#59; IC del 95&#37;&#44; 1&#44;020-1&#44;174&#59; p &#61; 0&#44;004&#41;&#44; &#237;ndice de Charlson &#40;&#967;<span class="elsevierStyleSup">2</span> &#61; 7&#44;28&#59; OR &#61; 1&#44;48&#59; IC del 95&#37;&#44; 1&#44;11-1&#44;99&#59; p &#61; 0&#44;007&#41;&#44; glucemia inicial &#40;&#967;<span class="elsevierStyleSup">2</span> &#61; 6&#44;05&#59; OR &#61; 1&#44;007&#59; IC del 95&#37;&#44; 1&#44;001-1&#44;014&#59; p &#61; 0&#44;014&#41;&#44; HbA1c &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;76&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;59&#59; IC del 95&#37;&#44; 0&#44;33-1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; VG &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;41&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;031&#59; IC del 95&#37; 1-1&#44;062&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#44; necesidad de tratamiento con corticoides &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;03&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;1&#59; IC del 95&#37;&#44; 1-9&#44;64&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41;&#44; administraci&#243;n de insulina programada &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;98&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#59; IC del 95&#37;&#44; 0&#44;066-1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; y presi&#243;n arterial sist&#243;lica &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;92&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;985&#59; IC del 95&#37;&#44; 0&#44;97-1&#44;003&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;088&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un incremento de glucemia inicial y de VG intrahospitalarias predice el riesgo de mortalidad en pacientes hospitalizados con DM&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Conclusi&#243;n"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The objective was to assess the prognostic importance of various glycaemic control measures on hospital mortality&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Retrospective&#44; analytical cohort study that included patients hospitalised in internal medicine departments with a diagnosis related to diabetes mellitus &#40;DM&#41;&#44; excluding acute decompensations&#46; The clinical endpoint was hospital mortality&#46; We recorded clinical&#44; analytical and glycaemic control-related variables &#40;scheduled insulin administration&#44; plasma glycaemia at admission&#44; HbA1c&#44; mean glycaemia &#40;MG&#41; and in-hospital glycaemic variability and hypoglycaemia&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The measurement of hospital mortality predictors was performed using univariate and multivariate logistic regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A total of 384 patients &#40;50&#46;3&#37; men&#41; were included&#46; The mean age was 78&#46;5 &#40;SD&#44; 10&#46;3&#41; years&#46; The DM-related diagnoses were type 2 diabetes &#40;83&#46;6&#37;&#41; and stress hyperglycaemia &#40;6&#46;8&#37;&#41;&#46; Thirty-one &#40;8&#46;1&#37;&#41; patients died while in hospital&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In the multivariate analysis&#44; the best model for predicting mortality &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;326&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41; consisted&#44; in order of importance&#44; of age &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;19&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;094&#59; 95&#37; CI 1&#46;020&#8211;1&#46;174&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;004&#41;&#44; Charlson index &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;28&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;48&#59; 95&#37; CI 1&#46;11&#8211;1&#46;99&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;007&#41;&#44; initial glycaemia &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;05&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;007&#59; 95&#37; CI 1&#46;001&#8211;1&#46;014&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;014&#41;&#44; HbA1c &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;76&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#59; 95&#37; CI 0&#46;33&#8211;1&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;016&#41;&#44; glycaemic variability &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;41&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;031&#59; 95&#37; CI 1-1&#46;062&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;036&#41;&#44; need for corticosteroid treatment &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;03&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;1&#59; 95&#37; CI 1&#8211;9&#46;64&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;045&#41;&#44; administration of scheduled insulin &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;98&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#59; 95&#37; CI 0&#46;066&#8211;1&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;046&#41; and systolic blood pressure &#40;&#967;<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;92&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;985&#59; 95&#37; CI 0&#46;97&#8211;1&#46;003&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;088&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An increase in initial glycaemia and in-hospital glycaemic variability predict the risk of mortality for hospitalised patients with DM&#46;</p></span>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n mediante curva ROC de la diferencia de poder predictivo de mortalidad de los modelos con &#40;pre&#95;4&#41; y sin &#40;pre&#95;3&#41; medidas relacionadas con el control gluc&#233;mico&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Glucemia en mg&#47;dl &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60; 140 &#40;105&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">140-180 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">141-250 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62; 250 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;4 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;7 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;3 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#44;7&#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sexo &#40;&#37; var&#243;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Insulina basal en domicilio &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mezclas o bolo-basal en domicilio &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Uso de insulina programada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hipoglucemia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice de Charlson &#40;puntos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;9 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ayuno &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Corticoides &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PAS inicial &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137 &#40;25&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">133 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Saturaci&#243;n O2 inicial &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Temperatura inicial &#40;&#176;C&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;7 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;8 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;8 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;5 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Filtrado glomerular &#40;ml&#47;min&#47;1&#44;73m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;4 &#40;22&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;4 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;3 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;4 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Categor&#237;as filtrado glomerular &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>45-59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sodio &#40;mEq&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137&#40;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hemoglobina &#40;g&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;8 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;4 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;4 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Leucocitos &#40;n&#47;mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;155 &#40;4&#46;678&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;309 &#40;7&#46;286&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;874 &#40;10&#46;050&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;860 &#40;5834&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#44;9 &#40;10&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#44;8 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hiperglucemia de estr&#233;s &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mezclas o bolo-basal en domicilio &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Utilizaci&#243;n insulina programada &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hipoglucemia &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice de Charlson &#40;puntos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;9 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;5 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ayuno &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Corticoides &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica inicial &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">127 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;094&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Saturaci&#243;n O2 inicial &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;4 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;4 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#44;1 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Temperatura inicial &#40;&#176;C&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;9 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;9 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;9 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Filtrado glomerular &#40;ml&#47;min&#47;1&#44;73m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;9 &#40;22&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#44;2 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;3 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Categor&#237;as filtrado glomerular</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>45-59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sodio &#40;mEq&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#44;7 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">138&#44;4 &#40;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141&#44;3 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hemoglobina &#40;g&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;1 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;8 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Leucocitos &#40;n&#47;mm</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;022 &#40;7&#46;337&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;926 &#40;7&#46;439&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;022 &#40;6&#46;183&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupo total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No fallecimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fallecimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucemia inicial &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">201 &#40;102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">196 &#40;98&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">254 &#40;129&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HbA1c &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;43 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;46 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;1 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucemia media en ingreso &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182 &#40;43&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">181 &#40;42&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">197 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;083&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucemia m&#225;xima en ingreso &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">302 &#40;82&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">302 &#40;82&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">322 &#40;82&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Coeficiente variaci&#243;n en ingreso &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Variabilidad gluc&#233;mica ingreso &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;8 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Glucemia primeras 24 h &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">204 &#40;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">202 &#40;78&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">224 &#40;68&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                      "titulo" => "Impact of admission glycemic variability&#44; glucose and glycosylated hemoglobin on major adverse cardiac events after acute myocardial infarction"
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ORIGINAL
Importancia pronóstica de la variabilidad glucémica sobre la mortalidad intrahospitalaria en pacientes ingresados en Medicina Interna
Prognostic importance of glycaemic variability on hospital mortality in patients hospitalised in Internal Medicine Departments
D. Sáenz-Abada,
Autor para correspondencia
danielsaenzabad@hotmail.com

Autor para correspondencia.
, J.A. Gimeno-Ornab, J.I. Pérez-Calvoa
a Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España
b Servicio de Endocrinología, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España

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