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Las plaquetas implicadas en la angiogénesis tumoral secretan factor de crecimiento endotelial vascular (VEGF). Los niveles de inhibidor del activador de plasminógeno tipo 1 (PAI-1) podrían regular la degradación de la matriz extracelular durante la angiogénesis. Durante este proceso tiene lugar la activación del sistema de la coagulación-fibrinólisis, que representa un evento clínico desfavorable. El factor de Von Willebrand (vWf), el dímero D (DD) y el fibrinógeno son marcadores sensibles de estos procesos. El recuento de plaquetas y los niveles de VEGF, PAI-1, vWf, DD y fibrinógeno podrían predecir la evolución clínica en pacientes con cáncer. En este estudio correlacionamos los niveles de VEGF, PAI-1, vWf, DD y fibrinógeno en pacientes con carcinoma colorrectal (CCR) en estadios I a IV sometidos a cirugía, a quimioterapia o a ambos métodos, con el análisis patológico/inmunohistoquímico en pacientes en estadios I-III y con la respuesta al tratamiento, y el riesgo de muerte en pacientes en estadio IV. Treinta y dos pacientes con CCR localizado o localmente avanzado y 32 con CCR metastático fueron evaluados. Las muestras sanguíneas se extrajeron antes de la cirugía y antes y después de la quimioterapia basada en fluoropirimidinas. Los enfermos en estadio IV recibieron una mediana de 3 ciclos de quimioterapia, entre muestras. En los pacientes en estadio I a III, los niveles basales de VEGF, recuento de plaquetas, fibrinógeno y PAI-1 se correlacionaron con el estadio tumoral. Además, la expresión tumoral de p21 y c-myc se asoció con niveles más elevados de vWf e inferiores de DD, respectivamente. En tumores metastásicos, los niveles prequimioterapia y posquimioterapia de VEGF, PAI-1 y CA19.9 se encontraron relacionados con las tasas de progresión.

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OBJETIVO: Devido aos avanços da medicina e ao envelhecimento da população, a proporção de pacientes em risco de morte após cirurgias está aumentando. Nosso objetivo foi avaliar o desfecho e a epidemiologia de cirurgias não cardíacas em pacientes admitidos em unidade de terapia intensiva. MÉTODOS: Estudo prospectivo, observacional, de coorte, realizado em 21 unidades de terapia intensiva. Um total de 885 pacientes adultos, cirúrgicos, consecutivamente admitidos em unidades de terapia intensiva no período de abril a junho de 2006 foi avaliado e destes, 587 foram incluídos. Os critérios de exclusão foram; trauma, cirurgias cardíacas, neurológicas, ginecológicas, obstétricas e paliativas. Os principais desfechos foram complicações pós-cirúrgicas e mortalidade na unidade de terapia intensiva e 90 dias após a cirurgia. RESULTADOS: Cirurgias de grande porte e de urgência foram realizadas em 66,4 por cento e 31,7 por cento, dos pacientes, respectivamente. A taxa de mortalidade na unidade de terapia intensiva foi de 15 por cento, e 38 por cento dos pacientes tiveram complicações no pós-operatório. A complicação mais comum foi infecção ou sepse (24,7 por cento). Isquemia miocárdica foi diagnosticada em apenas 1,9 por cento. Um total de 94 por cento dos pacientes que morreram após a cirurgia tinha co-morbidades associadas (3,4 ± 2,2). A principal causa de óbito foi disfunção de múltiplos órgãos (53 por cento). CONCLUSÃO: Sepse é a causa predominante de morbidade em pacientes submetidos a cirurgias não cardíacas. A grande maioria dos óbitos no pós-operatório ocorreu por disfunção de múltiplos órgãos.

OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4 percent and 31.7 percent of the patients, respectively. The intensive care unit mortality rate was 15 percent, and 38 percent of the patients had postoperative complications. The most common complication was infection or sepsis (24.7 percent). Myocardial ischemia was diagnosed in only 1.9 percent of the patients. A total of 94 percent of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53 percent). CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.

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OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%). Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53%). CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.