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2017, Número 3

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Acta Med 2017; 15 (3)


Diabetes mellitus y su impacto en la etiopatogenia de la sepsis

Machado-Villarroel L, Montano-Candia M, Dimakis-Ramírez DA

Idioma: Español
Referencias bibliográficas: 60
Paginas: 207-215
Archivo PDF: 231.02 Kb.


RESUMEN

Ciertas enfermedades infecciosas tienen mayor frecuencia y severidad en pacientes con diabetes mellitus (DM), lo cual incrementa sustancialmente las tasas de morbimortalidad. La DM incrementa el riesgo para bacteremia nosocomial adquirida en la comunidad. La mayor incidencia de infecciones en diabéticos está ocasionada por la hiperglucemia concomitante, lo cual ocasiona una disfunción inmunológica caracterizada por alteraciones de la función de los neutrófilos, actividad antioxidante e inmunidad humoral disminuida. Otras complicaciones son micro y macroangiopatía, neuropatía, trastornos en la motilidad urinaria y gastrointestinal, los cuales en conjunto contribuyen a la patogenia de los procesos infecciosos en estos pacientes. Actualmente se piensa que el involucro de productos finales de la glucosilación avanzada está asociado a inactivación de componentes inmunitarios, contribuyendo a una mayor vulnerabilidad frente a infecciones. Se ha propuesto una asociación entre hiperglucemia e infección en pacientes en estado crítico; no obstante, la evidencia para ello aún es limitada por la complejidad de los factores que intervienen. Distintos factores de riesgo influyen de forma negativa en el pronóstico de la sepsis severa tales como edad avanzada, inmunosupresión y alcoholismo crónico. Aún existe información contradictoria respecto al impacto que pudiese ejercer la DM en el pronóstico de pacientes sépticos.


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