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fibrosis pleural &#40;14&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">3</span></a>&#44; estancia hospitalaria prolongada &#40;media de 12-15<span class="elsevierStyleHsp" style=""></span>d&#237;as y &#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mes en el 25&#37; de los casos&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> y altas tasas de mortalidad &#40;10-20&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a>&#46; Para evitar estas complicaciones es preciso llegar a un diagn&#243;stico de certeza lo antes posible y establecer un estrecho control cl&#237;nico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiolog&#237;a</span><p id="par0010" class="elsevierStylePara elsevierViewall">En Estados Unidos&#44; del mill&#243;n de hospitalizaciones anuales por neumon&#237;a&#44; alrededor de 60&#46;000 pacientes presentar&#225;n un empiema y otros 25&#46;000 lo desarrollar&#225;n por otras razones<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">7</span></a>&#46; A pesar de los avances disponibles&#44; la incidencia de IP aumenta en todos los pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">5&#44;8</span></a>&#44; independientemente de su grado de desarrollo&#44; y en todos los grupos de edad<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">9-11</span></a>&#46; En Estados Unidos&#44; en el periodo 1996-2008 la tasa de hospitalizaci&#243;n por empiema se duplic&#243; &#40;de 3&#44;04 a 5&#44;98&#47;100&#46;000 habitantes&#41;&#44; aumentando en todos los grupos de edad<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">12</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fisiopatolog&#237;a</span><p id="par0015" class="elsevierStylePara elsevierViewall">En la evoluci&#243;n del DPP existen 3 fases&#46; En la primera &#40;exudativa&#41;&#44; la formaci&#243;n del l&#237;quido pleural &#40;LP&#41; es una consecuencia de la inflamaci&#243;n localizada y de la activaci&#243;n del sistema inmune&#46; Los neutr&#243;filos activados pueden provocar una lesi&#243;n endotelial que ocasionar&#237;a un aumento de la permeabilidad capilar con la consiguiente aparici&#243;n del DP<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; El da&#241;o pleural puede conducir al comienzo de la segunda fase &#40;fibrinopurulenta&#41;&#44; con la activaci&#243;n de los componentes proinflamatorios y profibr&#243;ticos y el inicio de la cascada de la coagulaci&#243;n&#46; Por tanto&#44; la respuesta inflamatoria local se amplifica por la presencia de diversas citocinas&#44; que estimulan la quimiotaxis de neutr&#243;filos y fibroblastos<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">14</span></a>&#46; Adem&#225;s&#44; la permeabilidad de la membrana puede permitir el paso de las bacterias al espacio pleural&#46; En las &#250;ltimas etapas de esta fase es posible observar un LP con apariencia de empiema debido a la presencia de productos de degradaci&#243;n celular y restos bacterianos&#46; Durante este periodo existe tambi&#233;n una disminuci&#243;n de la fibrin&#243;lisis&#44; con el consiguiente aumento de la formaci&#243;n de fibrina en el espacio pleural&#46; Este proceso puede progresar a la &#250;ltima fase &#40;organizativa&#41;&#44; en la que se constituye una capa de fibrosis sobre ambas superficies pleurales debido al aumento de la infiltraci&#243;n fibrobl&#225;stica&#44; lo que puede provocar que el manejo de estos pacientes sea extremadamente dif&#237;cil sin tener que recurrir a una intervenci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">15&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; El aspecto&#44; an&#225;lisis y cultivo del DP pueden variar en cada una de las fases evolutivas del DPP&#46; Los cambios fisiopatol&#243;gicos que tienen lugar en el espacio pleural hacen que&#44; desde un punto de vista cl&#237;nico&#44; hablemos de DPP no complicado &#40;DPPNC&#41;&#44; que se resolver&#225; con tratamiento antibi&#243;tico&#44; de DPP complicado &#40;DPPC&#41;&#44; que necesitar&#225; un DT o cirug&#237;a para su resoluci&#243;n&#44; y de empiema&#44; es decir&#44; la presencia de pus en el espacio pleural&#44; que siempre debe drenarse&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagn&#243;stico</span><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosticar un DPP no es complejo si la presentaci&#243;n es la cl&#225;sica&#46; La cl&#237;nica es similar a la de las neumon&#237;as<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a>&#46; Una mala respuesta en el manejo de una neumon&#237;a puede indicar la presencia de un DPP o de un empiema como una complicaci&#243;n de la misma<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">18</span></a>&#46; En ocasiones es dif&#237;cil sospechar una IP&#44; ya que la sintomatolog&#237;a no es la habitual y no hay evidencia de neumon&#237;a en la radiograf&#237;a &#40;Rx&#41; de t&#243;rax<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#46; Los hemocultivos solamente son positivos en el 12&#37; de los casos&#44; el cultivo del LP es negativo en m&#225;s del 40&#37; de las muestras<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a> y&#44; en ocasiones&#44; los g&#233;rmenes responsables son muy poco habituales y requieren de microbiolog&#237;a molecular para identificarlos<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Aunque los criterios para definir los DPPC est&#225;n bien establecidos<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a>&#44; no hay datos cl&#237;nicos ni radiol&#243;gicos que identifiquen a los pacientes que desarrollar&#225;n un DPPC&#47;empiema&#46; Como estos son f&#225;cilmente identificables por su aspecto&#44; la dificultad radica en detectar&#44; lo antes posible&#44; qu&#233; pacientes con un DPP no purulento pueden evolucionar hacia un DPPC&#46; Para ello se han utilizado diversos m&#233;todos diagn&#243;sticos pero con pobres resultados hasta la actualidad&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Escalas de gravedad de las neumon&#237;as y scores</span><p id="par0025" class="elsevierStylePara elsevierViewall">Las escalas de gravedad de las neumon&#237;as<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">18&#44;21</span></a> se han utilizado para predecir la mortalidad a los 30<span class="elsevierStyleHsp" style=""></span>d&#237;as del ingreso&#44; pero no para valorar la posibilidad de desarrollar un DPPC&#47;empiema&#46; Chalmers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a> demuestran la incapacidad&#44; tanto de estas escalas como de los scores gen&#233;ricos de sepsis &#40;APACHE<span class="elsevierStyleHsp" style=""></span>II&#44;&#44; SEWS y SIRS&#41;&#44; para predecir el desarrollo de un DPPC&#47;empiema&#46; Sin embargo&#44; la regresi&#243;n log&#237;stica multivariable identifica que&#58; alb&#250;mina &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>g&#47;l&#44; Na<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; plaquetas &#62;<span class="elsevierStyleHsp" style=""></span>400&#46;000&#44; prote&#237;na C reactiva &#40;PCR&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l y antecedentes de abuso de alcohol y de drogas i&#46;v&#46; son factores independientes que se asocian al desarrollo de DPPC&#47;empiema<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">23</span></a> desarrollan una puntuaci&#243;n de riesgo cl&#237;nico validado &#40;RAPID&#41; para identificar a pacientes con IP y alto riesgo de muerte para poder implantar la mejor estrategia de manejo&#46; La puntuaci&#243;n incluye los niveles de urea&#44; la edad&#44; la purulencia o no del LP&#44; la fuente de infecci&#243;n &#40;comunidad u hospital&#41; y factores diet&#233;ticos &#40;alb&#250;mina&#41;&#46; En base a ella se constituyen grupos de bajo&#44; medio y alto riesgo&#46; La odds ratio para mortalidad a los 3<span class="elsevierStyleHsp" style=""></span>meses para los grupos de medio y alto riesgo&#44; usando como referencia a los de bajo&#44; es de 24&#44;4 y 192&#44;4&#44; respectivamente&#44; por lo que este sistema permite estratificar el riesgo de los pacientes con IP en el momento de su presentaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pruebas de imagen</span><p id="par0035" class="elsevierStylePara elsevierViewall">La Rx&#44; la ecograf&#237;a tor&#225;cica &#40;ET&#41; y la tomograf&#237;a computarizada &#40;TC&#41; de t&#243;rax pueden proporcionar informaci&#243;n sobre el tama&#241;o&#44; la extensi&#243;n y la naturaleza del DP&#46; Cantidades de LP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200-250<span class="elsevierStyleHsp" style=""></span>cc suelen apreciarse en la Rx de t&#243;rax&#44; y puede sospecharse un DPPC si la opacificaci&#243;n del espacio pleural es fija y no cambia con los efectos gravitacionales del LP&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La ET es una t&#233;cnica b&#225;sica en el manejo del DP&#44; especialmente del DPP&#44; que los neum&#243;logos deber&#237;an dominar&#46; Es m&#225;s sensible que la Rx para detectar un DP peque&#241;o&#44; establece la ecogenicidad del LP&#44; localiza con precisi&#243;n el l&#237;quido loculado&#44; estima el volumen y la profundidad del DP&#44; diferencia entre LP y consolidaci&#243;n subyacente o atelectasia&#44; mejora el rendimiento de la toracocentesis y disminuye el riesgo de complicaciones en comparaci&#243;n con el uso conjunto de exploraci&#243;n f&#237;sica y Rx<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">24</span></a>&#46; La presencia de septos en la ecograf&#237;a sugiere un DPPC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; y la hiperecogenicidad se asocia con pus en la cavidad pleural&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">La TC es la t&#233;cnica de imagen en la que mejor se visualiza la pleura&#46; Ofrece la posibilidad de reconstruir im&#225;genes&#44; determinar loculaciones y observar si existen lesiones en el pulm&#243;n subyacente&#46; Adem&#225;s&#44; permite diferenciar entre un absceso pulmonar perif&#233;rico y una IP loculada a trav&#233;s del signo <span class="elsevierStyleItalic">&#171;split pleura&#187;</span><a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La ET&#44; al estar libre de radiaciones y ser f&#225;cilmente accesible a la cabecera de la cama en los pacientes cr&#237;ticamente enfermos&#44; deber&#237;a ser la t&#233;cnica de primera elecci&#243;n&#46; Factores que puedan dificultar la calidad de la imagen&#44; como la obesidad o el enfisema subcut&#225;neo&#44; y la sospecha de un DP maligno o de una infecci&#243;n pleural con otra patolog&#237;a asociada &#40;rotura de es&#243;fago&#44; f&#237;stula broncopleural&#44; etc&#46;&#41; en que es necesario saber si hay otras anormalidades anat&#243;micas&#44; pueden hacer necesaria la realizaci&#243;n de una TC&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Microbiolog&#237;a</span><p id="par0055" class="elsevierStylePara elsevierViewall">Un cultivo positivo del LP es diagn&#243;stico de IP&#44; pero esto solamente sucede en el 58&#37; de los casos y aumenta al 74&#37; si se utiliza microbiolog&#237;a molecular<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Se asume que la IP se produce como consecuencia de la migraci&#243;n de las bacterias que hay en el par&#233;nquima pulmonar&#44; por lo que suelen denominarse DPPC&#44; interpretando que la etiolog&#237;a bacteriana de todas las IP es la misma que la que causa la neumon&#237;a&#46; Sin embargo&#44; en una revisi&#243;n de 14 estudios con un total de 1&#46;383 pacientes con empiema&#44; solamente el 70&#37; se debieron a una neumon&#237;a y el resto lo fueron a otras causas<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">26</span></a>&#46; Por tanto&#44; la elecci&#243;n antibi&#243;tica para tratar la IP basada en esta suposici&#243;n no es la m&#225;s adecuada&#44; ya que existen importantes diferencias bacteriol&#243;gicas entre ambas<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Estas diferencias se deben&#44; probablemente&#44; a que el espacio pleural infectado tiene diferencias significativas en la acidez y en la oxigenaci&#243;n en comparaci&#243;n con el pulm&#243;n ventilado&#44; por lo que se presta a la invasi&#243;n por ciertos organismos m&#225;s que por otros<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">27</span></a>&#46; Tambi&#233;n existen diferencias&#44; en lo que a tipos de microorganismos se refiere&#44; entre las IP adquiridas en la comunidad y en el hospital<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La vacuna neumoc&#243;cica heptavalente puede estar jugando un papel relevante en la evoluci&#243;n de la microbiolog&#237;a de la IP&#46; Se ha observado que los serotipos predominantes que la causan son los que no cubre la vacuna<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">28</span></a>&#44; y esto parece correlacionarse con un aumento significativo en la incidencia de empiema<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">29</span></a>&#44; lo cual sugiere un aumento de la virulencia de los nuevos g&#233;rmenes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lisis del l&#237;quido pleural</span><p id="par0065" class="elsevierStylePara elsevierViewall">El conjunto de sintomatolog&#237;a cl&#237;nica&#44; exploraci&#243;n f&#237;sica&#44; anal&#237;tica de sangre y Rx de t&#243;rax suele confirmar la existencia de una neumon&#237;a con un DPP&#46; El an&#225;lisis de las caracter&#237;sticas del LP es el m&#233;todo m&#225;s fiable para su diagn&#243;stico y para tratar de evitar la evoluci&#243;n hacia un DPPC<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">30</span></a>&#46; Por tanto&#44; se recomienda hacer una toracocentesis a todos los pacientes con sospecha de un DP infeccioso si el grosor del l&#237;quido pleural en la Rx de t&#243;rax obtenida en dec&#250;bito lateral es &#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#44; si bien la posibilidad de que un DPP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm de profundidad en la TC evolucione hacia un DPPC es peque&#241;a<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis del LP puede variar en cada una de las fases evolutivas del DPP&#46; Los test a realizar ante la sospecha de un DPP se indican en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Un DPPNC es un exudado de aspecto seroso de predominio polimorfonuclear&#44; sin datos bioqu&#237;micos relevantes y cultivo negativo&#46; En caso de haber recibido previamente antibi&#243;ticos&#44; el predominio de c&#233;lulas nucleadas puede ser linfoc&#237;tico<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">32</span></a>&#46; Pero la verdadera utilidad de las determinaciones bioqu&#237;micas del LP es poder detectar&#44; lo antes posible&#44; los DPPC&#47;empiemas&#46; Mientras los empiemas siempre requieren drenaje&#44; la decisi&#243;n de drenar un DPP no purulento se basa en las caracter&#237;sticas morfol&#243;gicas del DP &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;2<span class="elsevierStyleHsp" style=""></span>hemit&#243;rax&#44; loculaciones y engrosamiento de la pleura parietal&#41;&#44; bacteriol&#243;gicas &#40;cultivo&#41; y bioqu&#237;micas &#40;pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&#41;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a>&#46; Una lactato deshidrogenasa &#40;LDH&#41; &#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;l y una glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl no mejoran la rentabilidad diagn&#243;stica y solamente se utilizar&#225;n si no se puede determinar el pH<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#46; Factores como la entrada de aire en la jeringa en la que se obtiene la muestra&#44; o restos de heparina o de anest&#233;sico local en la misma&#44; pueden alterar los resultados del pH<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">34</span></a>&#46; Adem&#225;s&#44; las IP causadas por <span class="elsevierStyleItalic">Proteus</span><span class="elsevierStyleHsp" style=""></span>spp&#46; pueden secretar enzimas que alcalinizan el LP<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">35</span></a>&#46; Algunos pacientes con un pH pleural inicial &#62;<span class="elsevierStyleHsp" style=""></span>7&#44;20 tambi&#233;n pueden necesitar DT e incluso cirug&#237;a&#46; Esto se debe a la heterogeneidad de las caracter&#237;sticas bioqu&#237;micas en los DP tabicados&#44; ya que el grado de afectaci&#243;n de la c&#225;mara puncionada puede dar lugar a &#237;ndices de gravedad de la enfermedad&#44; determinados por el pH&#44; marcadamente distintos&#46; Por tanto&#44; aunque el pH pleural es altamente espec&#237;fico &#40;91&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">36</span></a> en predecir la necesidad de DT&#44; es menos sensible a la hora de precisar la mortalidad o la eventual necesidad de intervenci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">4&#44;19</span></a>&#46; Aunque importantes sociedades cient&#237;ficas aceptan este par&#225;metro para drenar un DP<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a>&#44; un an&#225;lisis retrospectivo ha demostrado que este test no es altamente espec&#237;fico a la hora de establecer la necesidad de un DT en los DP no purulentos&#46; Es decir&#44; un grupo de pacientes con DPPNC son considerados como DPPC&#44; lo que da lugar a la colocaci&#243;n de drenajes tor&#225;cicos innecesarios<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">37</span></a>&#46; El recuento total de c&#233;lulas nucleadas y el porcentaje de polimorfonucleares suelen ser m&#225;s elevados en los DPPC&#47;empiemas<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Biomarcadores alternativos en el l&#237;quido pleural</span><p id="par0075" class="elsevierStylePara elsevierViewall">La PCR se ha utilizado para diferenciar tanto los DPP de los exudados no paraneum&#243;nicos<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38-41</span></a> como los DPPNC de los DPPC<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38&#44;39</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Hay que destacar que su especificidad aumenta &#40;96&#37;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a> y 92&#37;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">40</span></a>&#41; si valores elevados de PCR se asocian a un predominio de polimorfonucleares en el LP&#44; y que si una PCR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l se acompa&#241;a de un pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20 o de una glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; la especificidad para el diagn&#243;stico del DPPC es del 97&#37;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Aunque los valores de procalcitonina &#40;PCT&#41; se encuentran elevados en las infecciones bacterianas&#44; existe controversia acerca de las ventajas de su determinaci&#243;n en el LP y de su capacidad para separar los DPPC de los DPPNC<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39-42</span></a>&#46; Sin embargo&#44; un trabajo reciente confirma que la PCT es un biomarcador espec&#237;fico para infecci&#243;n&#44; y que sus valores no se ven afectados por la inflamaci&#243;n no infecciosa<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a>&#46; Adem&#225;s&#44; la PCT diferencia mejor que la PCR los DPP de los no infecciosos&#44; si bien no predice la necesidad de intervenci&#243;n quir&#250;rgica ni de muerte<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La rentabilidad de otros par&#225;metros &#8212;factor de necrosis tumoral-alfa &#40;TNF-&#945;&#41;&#44; interleucina &#40;IL&#41;-6&#44; IL-1&#946;&#44; IL-8&#44; productos del complemento &#40;forma soluble de C5b-9&#41;&#44; enzimas derivadas de los neutr&#243;filos &#40;elastasa polimorfonuclear y mieloperoxidasa&#41;&#44; prote&#237;na ligada a lipopolisac&#225;ridos &#40;PLL&#41; y activador del receptor soluble expresado en c&#233;lulas mieloides &#40;sTREM-1&#41;&#8212;&#44; se resume en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a><a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39&#44;44-53</span></a>&#46; Existe escepticismo entre los investigadores sobre la posibilidad de que un &#250;nico par&#225;metro &#8212;sobre todo sin tener en cuenta datos cl&#237;nicos&#44; radiol&#243;gicos o microbiol&#243;gicos&#8212; sea capaz de diagnosticar&#44; por s&#237; mismo&#44; una IP con suficiente seguridad como para cambiar la pr&#225;ctica cl&#237;nica actual<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">54</span></a>&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Tratamiento</span><p id="par0090" class="elsevierStylePara elsevierViewall">El tratamiento se basa en controlar la infecci&#243;n con el antibi&#243;tico apropiado&#44; drenar el DPPC&#47;empiema&#44; valorar el uso de fibrinol&#237;ticos y las opciones quir&#250;rgicas que existen&#44; llevar a cabo una buena nutrici&#243;n y realizar una profilaxis antitromb&#243;tica<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">55</span></a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Antibi&#243;ticos</span><p id="par0095" class="elsevierStylePara elsevierViewall">El uso de antibi&#243;ticos deber&#237;a basarse en las recomendaciones microbiol&#243;gicas locales y en los riesgos espec&#237;ficos de cada paciente e iniciarse de forma emp&#237;rica y precoz ajust&#225;ndolos al origen comunitario o nosocomial de la infecci&#243;n&#44; al resultado de los cultivos y a la actividad del antibi&#243;tico en el LP<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">56</span></a>&#46; En las IP comunitarias la asociaci&#243;n recomendada es amoxicilina-&#225;cido clavul&#225;nico en monoterapia o una cefalosporina de tercera generaci&#243;n y clindamicina&#47;metronidazol&#46; Si hay alergia a las penicilinas&#44; una opci&#243;n ser&#237;a la asociaci&#243;n de una quinolona y metronidazol&#47;clindamicina&#46; En las IP nosocomiales&#44; en las que <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a la meticilina es muy frecuente<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#44; la pauta emp&#237;rica deber&#237;a cubrir este microorganismo y los anaerobios &#40;por ejemplo&#44; vancomicina&#47;linezolid&#44; penicilinas anti-<span class="elsevierStyleItalic">Pseudomonas</span>&#44; carbapenem o cefalosporinas de tercera generaci&#243;n asociados a metronidazol&#41;&#46; Los macr&#243;lidos no suelen utilizarse de forma rutinaria&#44; ya que aunque las neumon&#237;as por <span class="elsevierStyleItalic">Legionella</span> o <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> pueden cursar con DP&#44; suelen ser autolimitados y raramente causan empiema<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">57</span></a>&#46; No se aconseja la utilizaci&#243;n de aminogluc&#243;sidos&#44; debido a su escasa penetraci&#243;n en el espacio pleural&#44; ni hay evidencias que recomienden el uso intrapleural de antibi&#243;ticos<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Drenaje tor&#225;cico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Aunque no hay consenso acerca del calibre del tubo de drenaje&#44; las gu&#237;as de la <span class="elsevierStyleItalic">British Thoracic Society</span><a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> y otros estudios<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">58</span></a> sugieren que los de peque&#241;o calibre &#40;10-14<span class="elsevierStyleHsp" style=""></span>F&#41; son los adecuados para la mayor&#237;a de los DPPC&#44; debido a que son m&#225;s f&#225;ciles de colocar&#44; son menos traum&#225;ticos y dolorosos para el paciente&#44; e igual de eficaces que los de mayor calibre &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La inserci&#243;n de un cat&#233;ter tor&#225;cico deber&#237;a guiarse siempre por una prueba de imagen&#44; generalmente una ET&#44; y sus indicaciones ser&#237;an la presencia de un LP turbio o purulento&#44; tinci&#243;n o cultivo positivo del LP&#44; loculaci&#243;n o DP mayor de la mitad del hemit&#243;rax&#44; pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&#44; o engrosamiento de la pleura parietal&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fibrinol&#237;ticos</span><p id="par0105" class="elsevierStylePara elsevierViewall">Las gu&#237;as actuales no encuentran indicaci&#243;n para el uso rutinario de fibrinol&#237;ticos intrapleurales en los pacientes con IP<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#44; y existe controversia acerca de su uso sistem&#225;tico en el manejo de los DPPC<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">59</span></a>&#46; Una revisi&#243;n Cochrane confirm&#243; que los fibrinol&#237;ticos intrapleurales aportan beneficio&#44; tanto en la reducci&#243;n de fallos del tratamiento como en la necesidad de recurrir a la cirug&#237;a en los DP loculados o empiemas&#44; pero no influyen sobre la mortalidad<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">60</span></a>&#46; Se observ&#243; que los pacientes que recib&#237;an alteplasa y deoxirribonucleasa &#40;DNasa&#41; presentaban mejor&#237;a significativa en la reducci&#243;n de la opacificaci&#243;n pleural radiol&#243;gica&#44; en la tasa de cirug&#237;a a los 3<span class="elsevierStyleHsp" style=""></span>meses y en la estancia hospitalaria media&#44; que los que recib&#237;an placebo<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a>&#46; Un metaan&#225;lisis que incluye este estudio &#40;y otros que utilizan estreptocinasa y urocinasa&#41; demuestra heterogeneidad en los resultados&#44; pero sugiere que el tratamiento con fibrinol&#237;ticos reduce las tasas de necesidad de cirug&#237;a&#44; aunque no de la mortalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">3&#44;61-67</span></a>&#46; Las gu&#237;as actuales recomiendan utilizar los fibrinol&#237;ticos de forma precoz cuando hay loculaciones en la cavidad pleural &#40;resistentes al DT&#41; y ante un empiema&#46; No hay suficiente evidencia para recomendar un f&#225;rmaco sobre el otro&#44; ni acuerdo sobre la dosis a utilizar<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;55</span></a>&#44; y se aconseja cerrar el tubo de DT durante unas horas tras su administraci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;61</span></a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cirug&#237;a</span><p id="par0110" class="elsevierStylePara elsevierViewall">La cirug&#237;a &#40;drenaje por videotoracoscopia asistida &#91;VATS&#93;&#59; toracotom&#237;a con decorticaci&#243;n pleural&#44; u otro tipo de drenaje quir&#250;rgico abierto&#41; hay que valorarla cuando falla el tratamiento m&#233;dico &#40;antibi&#243;ticos&#44; DT y fibrinol&#237;ticos&#41; tras un periodo de 5-7<span class="elsevierStyleHsp" style=""></span>d&#237;as<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#44; o cuando ya se ha establecido el empiema organizado y existe una importante fibrosis pleural&#46; El hallazgo precoz de un LP purulento o de loculaciones no es predictivo de la necesidad de cirug&#237;a<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a>&#46; La VATS permite&#44; adem&#225;s del desbridamiento pleural&#44; realizar decorticaciones en los empiemas avanzados o cr&#243;nicos&#46; En estos &#250;ltimos los resultados no son tan favorables&#44; ya que el mayor &#233;xito se obtiene cuando se hace de forma precoz&#46; No obstante&#44; la tasa global de &#233;xito de esta t&#233;cnica sobrepasa el 85&#37;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">68</span></a>&#46; Varios estudios han comparado el tratamiento conservador &#40;antibi&#243;ticos y DT con&#47;sin fibrinol&#237;ticos&#41; con la VATS como tratamiento de primera l&#237;nea&#44; tanto en ni&#241;os como en adultos&#46; El enfoque quir&#250;rgico precoz no ha demostrado ventajas en la mortalidad ni en la morbilidad grave en ning&#250;n ensayo<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">69</span></a>&#46; Adem&#225;s&#44; la cirug&#237;a no est&#225; exenta de complicaciones&#44; destacando las neuralgias intercostales poscirug&#237;a pleural&#46; El papel de la decorticaci&#243;n por toracotom&#237;a en el empiema es cada vez menor&#44; en relaci&#243;n directa con el aumento de la evidencia de que la VATS es al menos comparable&#44; o incluso superior<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">70</span></a>&#44; y suele reservarse para aquellos casos en los que fallan los procedimientos menos invasivos&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Nutrici&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Una pobre nutrici&#243;n es un determinante adverso en el resultado de un empiema pleural que habitualmente no se tiene en cuenta&#46; Las IP que se asocian a hipoalbuminemia tienen un peor resultado<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#44; y deber&#237;a proporcionarse un adecuado soporte nutricional&#44; incluida la alimentaci&#243;n enteral complementaria&#44; desde el momento del diagn&#243;stico&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Profilaxis antitromb&#243;tica</span><p id="par0120" class="elsevierStylePara elsevierViewall">Todos los pacientes ingresados por neumon&#237;a y&#47;o IP deber&#237;an recibir profilaxis con heparinas de bajo peso molecular&#44; si no est&#225;n contraindicadas<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">La incidencia del DPP est&#225; aumentando en todo el mundo y en todos los grupos de edad&#46; Aunque relacionado con la neumon&#237;a&#44; existe poca correlaci&#243;n entre los organismos que se encuentran en el espacio pleural y los que se observan en las infecciones del par&#233;nquima pulmonar&#44; lo que sugiere que la IP primaria es m&#225;s frecuente de lo que se piensa&#46; Los m&#233;todos diagn&#243;sticos actuales se enfocan en poder predecir si un DPP va a evolucionar hacia un DPPC&#47;empiema&#46; Su diagn&#243;stico y la instauraci&#243;n precoz de medidas como la pauta antibi&#243;tica y el DT siguen siendo la base del tratamiento&#46; En un grupo de pacientes&#44; los fibrinol&#237;ticos contribuyen a una mejor recuperaci&#243;n&#44; y su combinaci&#243;n con DNasa se relaciona con la obtenci&#243;n de mejores resultados&#46; Si es necesaria la cirug&#237;a&#44; cada vez hay m&#225;s evidencia de que la rentabilidad de la VATS es igual&#44; si no superior&#44; a la decorticaci&#243;n por toracotom&#237;a&#44; por lo que esta se reservar&#237;a para los casos en los que fallan los procedimientos menos invasivos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46; Se necesitan nuevos ensayos cl&#237;nicos que conformen estrategias diagn&#243;sticas y terap&#233;uticas basadas en la evidencia&#44; que proporcionen un manejo m&#225;s efectivo y estandarizado de esta enfermedad&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contribuci&#243;n de los autores</span><p id="par0130" class="elsevierStylePara elsevierViewall">Ferreiro L&#46; Autora y redactora&#46; Concepci&#243;n y dise&#241;o&#46; Aprobaci&#243;n final del manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">San Jos&#233; ME&#46; Coautora&#46; Redactora&#46; Aprobaci&#243;n final del manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Vald&#233;s L&#46; Redactor y autor&#46; Concepci&#243;n y dise&#241;o&#46; Aprobaci&#243;n final del manuscrito&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Escalas de gravedad de las neumon&#237;as y scores"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las infecciones pleurales presentan una elevada morbimortalidad&#44; y su incidencia est&#225; aumentando en todos los pa&#237;ses del mundo y en todos los grupos de edad&#46; No todos los derrames infecciosos son paraneum&#243;nicos&#44; y en esos casos&#44; los organismos que se encuentran en el espacio pleural no son los mismos que se observan en las infecciones del par&#233;nquima pulmonar&#46; La dificultad diagn&#243;stica radica en saber si un derrame infeccioso evolucionar&#225; hacia un derrame complicado&#47;empiema&#44; ya que los m&#233;todos diagn&#243;sticos utilizados con este fin ofrecen pobres resultados&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pilares del tratamiento son establecer un diagn&#243;stico precoz e instaurar&#44; lo antes posible&#44; una pauta antibi&#243;tica y un drenaje tor&#225;cico&#46; Este se llevar&#225; a cabo&#44; preferiblemente con tubos de peque&#241;o calibre&#44; ante la presencia de determinadas caracter&#237;sticas morfol&#243;gicas&#44; bacteriol&#243;gicas y bioqu&#237;micas del l&#237;quido pleural&#46; El an&#225;lisis del l&#237;quido es el m&#233;todo m&#225;s fiable para valorar su evoluci&#243;n&#44; sobre todo la determinaci&#243;n del pH&#46; En un subgrupo de pacientes los fibrinol&#237;ticos pueden contribuir a mejorar la recuperaci&#243;n&#44; y su combinaci&#243;n con deoxirribonucleasa se relaciona con la obtenci&#243;n de mejores resultados&#46; Si fracasa el tratamiento m&#233;dico y es necesaria la cirug&#237;a&#44; la rentabilidad de la cirug&#237;a toracosc&#243;pica videoasistida es&#44; al menos&#44; comparable a la decorticaci&#243;n por toracotom&#237;a&#44; por lo que esta solamente se realizar&#225; si han fallado las t&#233;cnicas anteriores&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Son necesarios m&#225;s ensayos cl&#237;nicos que analicen factores que puedan influir sobre los resultados obtenidos para conformar nuevas estrategias diagn&#243;sticas y terap&#233;uticas basadas en la evidencia&#44; que proporcionen un manejo m&#225;s efectivo y estandarizado de esta enfermedad&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pleural infections have high morbidity and mortality&#44; and their incidence in all age groups is growing worldwide&#46; Not all infectious effusions are parapneumonic and&#44; in such cases&#44; the organisms found in the pleural space are not the same as those observed in lung parenchyma infections&#46; The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion&#47;empyema&#44; as the diagnostic methods used for this purpose provide poor results&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible&#46; This should preferably be carried out with fine tubes&#44; due to certain morphological&#44; bacteriological and biochemical characteristics of the pleural fluid&#46; Fluid analysis&#44; particularly pH&#44; is the most reliable method for assessing evolution&#46; In a subgroup of patients&#44; fibrinolytics may help to improve recovery&#44; and their combination with DNase has been found to obtain better results&#46; If medical treatment fails and surgery is required&#44; video-assisted thoracoscopic surgery &#40;VATS&#41; is&#44; at least&#44; comparable to decortication by thoracotomy&#44; so should only undertaken if previous techniques have failed&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Further clinical trials are needed to analyze factors that could affect the results obtained&#44; in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective&#44; standardized management of this disease&#46;</p></span>"
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          "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fisiopatolog&#237;a&#44; aspecto&#44; par&#225;metros bioqu&#237;micos y microbiolog&#237;a del derrame pleural paraneum&#243;nico&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Modificada de Bhatnagar y Maskell<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>&#46;</p>"
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      1 => array:7 [
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural anecoico&#46; B&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural con m&#250;ltiples septos y loculaciones&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">L&#58; loculaci&#243;n&#59; LP&#58; l&#237;quido pleural&#59; S&#58; septo&#46;</p>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Microbiolog&#237;a de la infecci&#243;n pleural adquirida en la comunidad y en el hospital<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MRSA&#58; <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a la meticilina&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para el tratamiento del derrame pleural paraneum&#243;nico&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DP&#58; derrame pleural&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DT&#58; drenaje tor&#225;cico&#59; EF&#58; exploraci&#243;n f&#237;sica&#59; ET&#58; ecograf&#237;a tor&#225;cica&#59; G&#58; generaci&#243;n&#59; HC&#58; historia cl&#237;nica&#59; LP&#58; l&#237;quido pleural&#59; Rx&#58; radiograf&#237;a&#59; TC&#58; tomograf&#237;a computarizada&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">1</span> Si alergia a la penicilina&#58; quinolona<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>metronidazol&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">2</span> Si no se puede determinar el pH&#44; utilizar LDH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;l o glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ADA&#58; adenosina desaminasa&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; LDH&#58; lactato deshidrogenasa&#59; LP&#58; l&#237;quido pleural&#59; PCR&#58; prote&#237;na C reactiva&#46;</p>"
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                0 => """
                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Determinaciones&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">Caracter&#237;sticas del DPPC&#47;empiema&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">Comentarios&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">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Se debe medir en un analizador de gases sangu&#237;neosValores bajos si acidosis en el espacio pleural&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">Glucosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Se debe al aumento del metabolismo celular&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">LDH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000 UI&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determinar en LP y en sangreSe debe a la destrucci&#243;n celular&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">Prote&#237;nas totales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determinar en LP y en sangre&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">Recuento total y porcentual de c&#233;lulas nucleadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recuento total elevado con predominio de polimorfonucleares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alta dispersi&#243;n de valores al depender de la afectaci&#243;n de la c&#225;mara pleural puncionadaSi tratamiento previo con antibi&#243;ticos&#44; el predominio puede ser linfoc&#237;tico&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">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l y se acompa&#241;a de un pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20 o glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alta especificidad para el diagn&#243;stico de los DPP si se asocia a un predominio polimorfonuclear&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">Cultivo del LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Puede ser positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mayor rentabilidad si se recoge en frascos de hemocultivo&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">Citolog&#237;a del LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">En ocasiones&#44; en el l&#237;quido de los derrames malignos se pueden observar cambios similares a los de los DPP&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">ADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Puede estar elevadaPredominio de polimorfonucleares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A determinar si sospecha de tuberculosis&#59; en este caso&#44; predominio linfocitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Determinaciones en l&#237;quido pleural ante la sospecha de un derrame pleural infeccioso</p>"
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      ]
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        "etiqueta" => "Tabla 2"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">AUC&#58; &#225;rea bajo la curva&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; DPPNC&#58; derrame pleural paraneum&#243;nico no complicado&#59; E&#58; especificidad&#59; IL&#58; interleucina&#59; PCR&#58; prote&#237;na C reactiva&#59; PLP&#58; prote&#237;nas ligadas a lipopolisac&#225;ridos&#59; Ref&#58; referencia&#59; S&#58; sensibilidad&#59; SC5b-9&#58; forma soluble de C5b-9&#59; sTREM-1&#58; activador del receptor soluble expresado en c&#233;lulas mieloides&#59; TNF-&#945;&#58; factor de necrosis tumoral alfa&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <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="left" valign="top" scope="col">Par&#225;metro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DPP versus otros derrames</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DPPNC versus DPPC&#47;empiema</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">Punto de corte&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">AUC&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">S &#40;&#37;&#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">E &#40;&#37;&#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">Punto de corte&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">AUC&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">S &#40;&#37;&#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">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>3&#44;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&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;820&#44;830&#44;750&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75497354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75937377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&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;810&#44;810&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">586872&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">887571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38394042<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>49&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">Procalcitonina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#44;18<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#44;19<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&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;570&#44;590&#44;750&#44;830&#44;710&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">455267766765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">726777817068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&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;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39404141<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>42<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>42<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&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">TNF-&#945;&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&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">IL-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>77&#44;3<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&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">IL-1&#946;&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>16&#44;7<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IL-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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;130<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;870&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4950&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">SC5b-9&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&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">Elastasa polimorfonuclear&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;500<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&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">Mieloperoxidasa&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&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">PLL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&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;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&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;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&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">sTREM-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&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;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>180<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \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="left" valign="top" scope="col">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Calibre del tubo&#44; F</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">&#60; 10&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">10-14&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">15-20&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; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pacientes &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&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  " 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">Sexo&#44; n &#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>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;71&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>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;71&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">Edad&#44; media &#40;DE&#41;</span>&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;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;11&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">Opacificaci&#243;n Rx de t&#243;rax por DP &#40;&#37; del hemit&#243;rax&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;54&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">Caracter&#237;sticas LP</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Purulencia&#44; n &#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">42 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 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"><span class="elsevierStyleHsp" style=""></span>Gram positivo para bacteria&#44; n &#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">19 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;42&#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;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;63&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>Cultivo positivo para bacteria&#44; n &#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">16 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;49&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>pH&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;89 &#40;0&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;87 &#40;0&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;82 &#40;0&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;64 &#40;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;51&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>Glucosa &#40;mmol&#47;l&#41;&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;1 &#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="char" valign="top">3&#44;3 &#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="char" valign="top">2&#44;2 &#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="char" valign="top">4&#44;3 &#40;4&#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">p &#61; 0&#44;10&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>LDH &#40;UI&#47;L&#41;&#44; mediana &#40;RIQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;580 &#40;34&#46;700&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;820 &#40;22&#46;280&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;400 &#40;28&#46;300&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;580 &#40;37&#46;550&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 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  " 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">Fuente de infecci&#243;n&#44; n &#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>Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;73&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>Comunidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163 &#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">52 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;73&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">Combinaci&#243;n de cirug&#237;a y muerte&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#47;58 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#47;208 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#47;70 &#40;40&#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&#47;69 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;27&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">Muerte al a&#241;o&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;58 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#47;208 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;70 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;69 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;67&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">Cirug&#237;a al a&#241;o&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;58 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#47;208 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;70 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;69 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;97&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">Estancia hospital&#44; d&#237;as &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;37&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">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">a los 3 meses&#44; L &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;46 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;16 &#40;0&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;30 &#40;0&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;15 &#40;0&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;32&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">FVC a los 3 meses&#44; l &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;30 &#40;1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;98 &#40;0&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;18 &#40;1&#44;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">2&#44;84 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;24&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">Reducci&#243;n de la anormalidad de la Rx de t&#243;rax con respecto a la basal a los 3 meses&#44; mediana &#37; hemit&#243;rax &#40;RIQ&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;52-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes seg&#250;n el tama&#241;o del calibre del tubo tor&#225;cico&#44; y el efecto de este sobre los resultados cl&#237;nicos primarios y secundarios</p>"
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; E&#58; empiema&#59; ET&#58; ecograf&#237;a tor&#225;cica&#59; F&#58; French&#59; N&#46;S&#46;&#58; no significativo&#59; Pbo&#58; grupo placebo&#59; Rx&#58; radiograf&#237;a&#59; TC&#58; tomograf&#237;a computarizada&#59; Tto&#58; grupo tratamiento</p>"
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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="left" valign="top" scope="col">Referencia&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">Pa&#237;s&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">Pacientes incluidos&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">Tipos de DPP incluidos&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">Imagen<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&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">Tama&#241;o drenaje&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">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mortalidad &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tasa de cirug&#237;a &#40;&#37;&#41;</th></tr><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="" 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="" 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="" 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="" 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="" 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="" 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">Tto&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">Pbo&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">Tto&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">Pbo&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">Maskell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12-20 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3<span class="elsevierStyleHsp" style=""></span>d&#237;as&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;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&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;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;5&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">t-PA y DNasa&#58; 10 mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&#59; 1 dosis&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;03&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">Davies et al&#46;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&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">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">No aportado&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">Bouros et al&#46;<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28-32 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urocinasa&#58; 100&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;05&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">Tuncozgur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Turqu&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E estadio II<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-36 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urocinasa&#58; 100&#46;000 UI&#59;1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&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">Diacon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sud&#225;frica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-28 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;7 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#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">4&#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&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;5&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;02&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">Misthos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28-32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#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">4&#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">12&#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">32&#44;9&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;05&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></tbody></table>
                  """
              ]
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              ]
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Modalidad de imagen utilizada para evaluar los derrames&#46;</p>"
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            1 => array:3 [
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Revisión
Manejo del derrame pleural paraneumónico en adultos
Management of Parapneumonic Pleural Effusion in Adults
Lucía Ferreiroa, María Esther San Joséb,c, Luis Valdésa,c,
Corresponding author
luis.valdes.cuadrado@sergas.es

Autor para correspondencia.
a Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España
b Servicio de Análisis Clínicos, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, La Coruña, España
c Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural anecoico&#46; B&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural con m&#250;ltiples septos y loculaciones&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">L&#58; loculaci&#243;n&#59; LP&#58; l&#237;quido pleural&#59; S&#58; septo&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Un derrame pleural &#40;DP&#41; paraneum&#243;nico &#40;DPP&#41; es aquel que se asocia a una neumon&#237;a bacteriana&#44; un absceso pulmonar o a bronquiectasias infectadas<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">1</span></a>&#46; Tambi&#233;n hablamos de infecci&#243;n pleural &#40;IP&#41; o de DP complicado &#40;DPC&#41; cuando no se observa enfermedad parenquimatosa acompa&#241;ante&#46; Aunque la mayor&#237;a de los DPP se resuelven &#250;nicamente con tratamiento antibi&#243;tico&#44; un subgrupo de pacientes puede presentar complicaciones graves&#44; como&#58; DPP refractario al tratamiento antibi&#243;tico y al drenaje tor&#225;cico &#40;DT&#41; con necesidad de drenaje quir&#250;rgico &#40;33&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a>&#44; fibrosis pleural &#40;14&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">3</span></a>&#44; estancia hospitalaria prolongada &#40;media de 12-15<span class="elsevierStyleHsp" style=""></span>d&#237;as y &#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mes en el 25&#37; de los casos&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> y altas tasas de mortalidad &#40;10-20&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a>&#46; Para evitar estas complicaciones es preciso llegar a un diagn&#243;stico de certeza lo antes posible y establecer un estrecho control cl&#237;nico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Epidemiolog&#237;a</span><p id="par0010" class="elsevierStylePara elsevierViewall">En Estados Unidos&#44; del mill&#243;n de hospitalizaciones anuales por neumon&#237;a&#44; alrededor de 60&#46;000 pacientes presentar&#225;n un empiema y otros 25&#46;000 lo desarrollar&#225;n por otras razones<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">7</span></a>&#46; A pesar de los avances disponibles&#44; la incidencia de IP aumenta en todos los pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">5&#44;8</span></a>&#44; independientemente de su grado de desarrollo&#44; y en todos los grupos de edad<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">9-11</span></a>&#46; En Estados Unidos&#44; en el periodo 1996-2008 la tasa de hospitalizaci&#243;n por empiema se duplic&#243; &#40;de 3&#44;04 a 5&#44;98&#47;100&#46;000 habitantes&#41;&#44; aumentando en todos los grupos de edad<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">12</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fisiopatolog&#237;a</span><p id="par0015" class="elsevierStylePara elsevierViewall">En la evoluci&#243;n del DPP existen 3 fases&#46; En la primera &#40;exudativa&#41;&#44; la formaci&#243;n del l&#237;quido pleural &#40;LP&#41; es una consecuencia de la inflamaci&#243;n localizada y de la activaci&#243;n del sistema inmune&#46; Los neutr&#243;filos activados pueden provocar una lesi&#243;n endotelial que ocasionar&#237;a un aumento de la permeabilidad capilar con la consiguiente aparici&#243;n del DP<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; El da&#241;o pleural puede conducir al comienzo de la segunda fase &#40;fibrinopurulenta&#41;&#44; con la activaci&#243;n de los componentes proinflamatorios y profibr&#243;ticos y el inicio de la cascada de la coagulaci&#243;n&#46; Por tanto&#44; la respuesta inflamatoria local se amplifica por la presencia de diversas citocinas&#44; que estimulan la quimiotaxis de neutr&#243;filos y fibroblastos<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">14</span></a>&#46; Adem&#225;s&#44; la permeabilidad de la membrana puede permitir el paso de las bacterias al espacio pleural&#46; En las &#250;ltimas etapas de esta fase es posible observar un LP con apariencia de empiema debido a la presencia de productos de degradaci&#243;n celular y restos bacterianos&#46; Durante este periodo existe tambi&#233;n una disminuci&#243;n de la fibrin&#243;lisis&#44; con el consiguiente aumento de la formaci&#243;n de fibrina en el espacio pleural&#46; Este proceso puede progresar a la &#250;ltima fase &#40;organizativa&#41;&#44; en la que se constituye una capa de fibrosis sobre ambas superficies pleurales debido al aumento de la infiltraci&#243;n fibrobl&#225;stica&#44; lo que puede provocar que el manejo de estos pacientes sea extremadamente dif&#237;cil sin tener que recurrir a una intervenci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">15&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; El aspecto&#44; an&#225;lisis y cultivo del DP pueden variar en cada una de las fases evolutivas del DPP&#46; Los cambios fisiopatol&#243;gicos que tienen lugar en el espacio pleural hacen que&#44; desde un punto de vista cl&#237;nico&#44; hablemos de DPP no complicado &#40;DPPNC&#41;&#44; que se resolver&#225; con tratamiento antibi&#243;tico&#44; de DPP complicado &#40;DPPC&#41;&#44; que necesitar&#225; un DT o cirug&#237;a para su resoluci&#243;n&#44; y de empiema&#44; es decir&#44; la presencia de pus en el espacio pleural&#44; que siempre debe drenarse&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagn&#243;stico</span><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosticar un DPP no es complejo si la presentaci&#243;n es la cl&#225;sica&#46; La cl&#237;nica es similar a la de las neumon&#237;as<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a>&#46; Una mala respuesta en el manejo de una neumon&#237;a puede indicar la presencia de un DPP o de un empiema como una complicaci&#243;n de la misma<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">18</span></a>&#46; En ocasiones es dif&#237;cil sospechar una IP&#44; ya que la sintomatolog&#237;a no es la habitual y no hay evidencia de neumon&#237;a en la radiograf&#237;a &#40;Rx&#41; de t&#243;rax<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#46; Los hemocultivos solamente son positivos en el 12&#37; de los casos&#44; el cultivo del LP es negativo en m&#225;s del 40&#37; de las muestras<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a> y&#44; en ocasiones&#44; los g&#233;rmenes responsables son muy poco habituales y requieren de microbiolog&#237;a molecular para identificarlos<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Aunque los criterios para definir los DPPC est&#225;n bien establecidos<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">17</span></a>&#44; no hay datos cl&#237;nicos ni radiol&#243;gicos que identifiquen a los pacientes que desarrollar&#225;n un DPPC&#47;empiema&#46; Como estos son f&#225;cilmente identificables por su aspecto&#44; la dificultad radica en detectar&#44; lo antes posible&#44; qu&#233; pacientes con un DPP no purulento pueden evolucionar hacia un DPPC&#46; Para ello se han utilizado diversos m&#233;todos diagn&#243;sticos pero con pobres resultados hasta la actualidad&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Escalas de gravedad de las neumon&#237;as y scores</span><p id="par0025" class="elsevierStylePara elsevierViewall">Las escalas de gravedad de las neumon&#237;as<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">18&#44;21</span></a> se han utilizado para predecir la mortalidad a los 30<span class="elsevierStyleHsp" style=""></span>d&#237;as del ingreso&#44; pero no para valorar la posibilidad de desarrollar un DPPC&#47;empiema&#46; Chalmers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a> demuestran la incapacidad&#44; tanto de estas escalas como de los scores gen&#233;ricos de sepsis &#40;APACHE<span class="elsevierStyleHsp" style=""></span>II&#44;&#44; SEWS y SIRS&#41;&#44; para predecir el desarrollo de un DPPC&#47;empiema&#46; Sin embargo&#44; la regresi&#243;n log&#237;stica multivariable identifica que&#58; alb&#250;mina &#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>g&#47;l&#44; Na<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#44; plaquetas &#62;<span class="elsevierStyleHsp" style=""></span>400&#46;000&#44; prote&#237;na C reactiva &#40;PCR&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l y antecedentes de abuso de alcohol y de drogas i&#46;v&#46; son factores independientes que se asocian al desarrollo de DPPC&#47;empiema<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">23</span></a> desarrollan una puntuaci&#243;n de riesgo cl&#237;nico validado &#40;RAPID&#41; para identificar a pacientes con IP y alto riesgo de muerte para poder implantar la mejor estrategia de manejo&#46; La puntuaci&#243;n incluye los niveles de urea&#44; la edad&#44; la purulencia o no del LP&#44; la fuente de infecci&#243;n &#40;comunidad u hospital&#41; y factores diet&#233;ticos &#40;alb&#250;mina&#41;&#46; En base a ella se constituyen grupos de bajo&#44; medio y alto riesgo&#46; La odds ratio para mortalidad a los 3<span class="elsevierStyleHsp" style=""></span>meses para los grupos de medio y alto riesgo&#44; usando como referencia a los de bajo&#44; es de 24&#44;4 y 192&#44;4&#44; respectivamente&#44; por lo que este sistema permite estratificar el riesgo de los pacientes con IP en el momento de su presentaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Pruebas de imagen</span><p id="par0035" class="elsevierStylePara elsevierViewall">La Rx&#44; la ecograf&#237;a tor&#225;cica &#40;ET&#41; y la tomograf&#237;a computarizada &#40;TC&#41; de t&#243;rax pueden proporcionar informaci&#243;n sobre el tama&#241;o&#44; la extensi&#243;n y la naturaleza del DP&#46; Cantidades de LP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200-250<span class="elsevierStyleHsp" style=""></span>cc suelen apreciarse en la Rx de t&#243;rax&#44; y puede sospecharse un DPPC si la opacificaci&#243;n del espacio pleural es fija y no cambia con los efectos gravitacionales del LP&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La ET es una t&#233;cnica b&#225;sica en el manejo del DP&#44; especialmente del DPP&#44; que los neum&#243;logos deber&#237;an dominar&#46; Es m&#225;s sensible que la Rx para detectar un DP peque&#241;o&#44; establece la ecogenicidad del LP&#44; localiza con precisi&#243;n el l&#237;quido loculado&#44; estima el volumen y la profundidad del DP&#44; diferencia entre LP y consolidaci&#243;n subyacente o atelectasia&#44; mejora el rendimiento de la toracocentesis y disminuye el riesgo de complicaciones en comparaci&#243;n con el uso conjunto de exploraci&#243;n f&#237;sica y Rx<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">24</span></a>&#46; La presencia de septos en la ecograf&#237;a sugiere un DPPC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; y la hiperecogenicidad se asocia con pus en la cavidad pleural&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">La TC es la t&#233;cnica de imagen en la que mejor se visualiza la pleura&#46; Ofrece la posibilidad de reconstruir im&#225;genes&#44; determinar loculaciones y observar si existen lesiones en el pulm&#243;n subyacente&#46; Adem&#225;s&#44; permite diferenciar entre un absceso pulmonar perif&#233;rico y una IP loculada a trav&#233;s del signo <span class="elsevierStyleItalic">&#171;split pleura&#187;</span><a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La ET&#44; al estar libre de radiaciones y ser f&#225;cilmente accesible a la cabecera de la cama en los pacientes cr&#237;ticamente enfermos&#44; deber&#237;a ser la t&#233;cnica de primera elecci&#243;n&#46; Factores que puedan dificultar la calidad de la imagen&#44; como la obesidad o el enfisema subcut&#225;neo&#44; y la sospecha de un DP maligno o de una infecci&#243;n pleural con otra patolog&#237;a asociada &#40;rotura de es&#243;fago&#44; f&#237;stula broncopleural&#44; etc&#46;&#41; en que es necesario saber si hay otras anormalidades anat&#243;micas&#44; pueden hacer necesaria la realizaci&#243;n de una TC&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Microbiolog&#237;a</span><p id="par0055" class="elsevierStylePara elsevierViewall">Un cultivo positivo del LP es diagn&#243;stico de IP&#44; pero esto solamente sucede en el 58&#37; de los casos y aumenta al 74&#37; si se utiliza microbiolog&#237;a molecular<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Se asume que la IP se produce como consecuencia de la migraci&#243;n de las bacterias que hay en el par&#233;nquima pulmonar&#44; por lo que suelen denominarse DPPC&#44; interpretando que la etiolog&#237;a bacteriana de todas las IP es la misma que la que causa la neumon&#237;a&#46; Sin embargo&#44; en una revisi&#243;n de 14 estudios con un total de 1&#46;383 pacientes con empiema&#44; solamente el 70&#37; se debieron a una neumon&#237;a y el resto lo fueron a otras causas<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">26</span></a>&#46; Por tanto&#44; la elecci&#243;n antibi&#243;tica para tratar la IP basada en esta suposici&#243;n no es la m&#225;s adecuada&#44; ya que existen importantes diferencias bacteriol&#243;gicas entre ambas<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46; Estas diferencias se deben&#44; probablemente&#44; a que el espacio pleural infectado tiene diferencias significativas en la acidez y en la oxigenaci&#243;n en comparaci&#243;n con el pulm&#243;n ventilado&#44; por lo que se presta a la invasi&#243;n por ciertos organismos m&#225;s que por otros<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">27</span></a>&#46; Tambi&#233;n existen diferencias&#44; en lo que a tipos de microorganismos se refiere&#44; entre las IP adquiridas en la comunidad y en el hospital<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La vacuna neumoc&#243;cica heptavalente puede estar jugando un papel relevante en la evoluci&#243;n de la microbiolog&#237;a de la IP&#46; Se ha observado que los serotipos predominantes que la causan son los que no cubre la vacuna<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">28</span></a>&#44; y esto parece correlacionarse con un aumento significativo en la incidencia de empiema<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">29</span></a>&#44; lo cual sugiere un aumento de la virulencia de los nuevos g&#233;rmenes&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lisis del l&#237;quido pleural</span><p id="par0065" class="elsevierStylePara elsevierViewall">El conjunto de sintomatolog&#237;a cl&#237;nica&#44; exploraci&#243;n f&#237;sica&#44; anal&#237;tica de sangre y Rx de t&#243;rax suele confirmar la existencia de una neumon&#237;a con un DPP&#46; El an&#225;lisis de las caracter&#237;sticas del LP es el m&#233;todo m&#225;s fiable para su diagn&#243;stico y para tratar de evitar la evoluci&#243;n hacia un DPPC<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">30</span></a>&#46; Por tanto&#44; se recomienda hacer una toracocentesis a todos los pacientes con sospecha de un DP infeccioso si el grosor del l&#237;quido pleural en la Rx de t&#243;rax obtenida en dec&#250;bito lateral es &#62;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#44; si bien la posibilidad de que un DPP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm de profundidad en la TC evolucione hacia un DPPC es peque&#241;a<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis del LP puede variar en cada una de las fases evolutivas del DPP&#46; Los test a realizar ante la sospecha de un DPP se indican en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Un DPPNC es un exudado de aspecto seroso de predominio polimorfonuclear&#44; sin datos bioqu&#237;micos relevantes y cultivo negativo&#46; En caso de haber recibido previamente antibi&#243;ticos&#44; el predominio de c&#233;lulas nucleadas puede ser linfoc&#237;tico<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">32</span></a>&#46; Pero la verdadera utilidad de las determinaciones bioqu&#237;micas del LP es poder detectar&#44; lo antes posible&#44; los DPPC&#47;empiemas&#46; Mientras los empiemas siempre requieren drenaje&#44; la decisi&#243;n de drenar un DPP no purulento se basa en las caracter&#237;sticas morfol&#243;gicas del DP &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;2<span class="elsevierStyleHsp" style=""></span>hemit&#243;rax&#44; loculaciones y engrosamiento de la pleura parietal&#41;&#44; bacteriol&#243;gicas &#40;cultivo&#41; y bioqu&#237;micas &#40;pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&#41;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a>&#46; Una lactato deshidrogenasa &#40;LDH&#41; &#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;l y una glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl no mejoran la rentabilidad diagn&#243;stica y solamente se utilizar&#225;n si no se puede determinar el pH<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#46; Factores como la entrada de aire en la jeringa en la que se obtiene la muestra&#44; o restos de heparina o de anest&#233;sico local en la misma&#44; pueden alterar los resultados del pH<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">34</span></a>&#46; Adem&#225;s&#44; las IP causadas por <span class="elsevierStyleItalic">Proteus</span><span class="elsevierStyleHsp" style=""></span>spp&#46; pueden secretar enzimas que alcalinizan el LP<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">35</span></a>&#46; Algunos pacientes con un pH pleural inicial &#62;<span class="elsevierStyleHsp" style=""></span>7&#44;20 tambi&#233;n pueden necesitar DT e incluso cirug&#237;a&#46; Esto se debe a la heterogeneidad de las caracter&#237;sticas bioqu&#237;micas en los DP tabicados&#44; ya que el grado de afectaci&#243;n de la c&#225;mara puncionada puede dar lugar a &#237;ndices de gravedad de la enfermedad&#44; determinados por el pH&#44; marcadamente distintos&#46; Por tanto&#44; aunque el pH pleural es altamente espec&#237;fico &#40;91&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">36</span></a> en predecir la necesidad de DT&#44; es menos sensible a la hora de precisar la mortalidad o la eventual necesidad de intervenci&#243;n quir&#250;rgica<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">4&#44;19</span></a>&#46; Aunque importantes sociedades cient&#237;ficas aceptan este par&#225;metro para drenar un DP<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;33</span></a>&#44; un an&#225;lisis retrospectivo ha demostrado que este test no es altamente espec&#237;fico a la hora de establecer la necesidad de un DT en los DP no purulentos&#46; Es decir&#44; un grupo de pacientes con DPPNC son considerados como DPPC&#44; lo que da lugar a la colocaci&#243;n de drenajes tor&#225;cicos innecesarios<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">37</span></a>&#46; El recuento total de c&#233;lulas nucleadas y el porcentaje de polimorfonucleares suelen ser m&#225;s elevados en los DPPC&#47;empiemas<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Biomarcadores alternativos en el l&#237;quido pleural</span><p id="par0075" class="elsevierStylePara elsevierViewall">La PCR se ha utilizado para diferenciar tanto los DPP de los exudados no paraneum&#243;nicos<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38-41</span></a> como los DPPNC de los DPPC<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">38&#44;39</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Hay que destacar que su especificidad aumenta &#40;96&#37;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a> y 92&#37;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">40</span></a>&#41; si valores elevados de PCR se asocian a un predominio de polimorfonucleares en el LP&#44; y que si una PCR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l se acompa&#241;a de un pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20 o de una glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; la especificidad para el diagn&#243;stico del DPPC es del 97&#37;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">38</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Aunque los valores de procalcitonina &#40;PCT&#41; se encuentran elevados en las infecciones bacterianas&#44; existe controversia acerca de las ventajas de su determinaci&#243;n en el LP y de su capacidad para separar los DPPC de los DPPNC<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39-42</span></a>&#46; Sin embargo&#44; un trabajo reciente confirma que la PCT es un biomarcador espec&#237;fico para infecci&#243;n&#44; y que sus valores no se ven afectados por la inflamaci&#243;n no infecciosa<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a>&#46; Adem&#225;s&#44; la PCT diferencia mejor que la PCR los DPP de los no infecciosos&#44; si bien no predice la necesidad de intervenci&#243;n quir&#250;rgica ni de muerte<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">43</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La rentabilidad de otros par&#225;metros &#8212;factor de necrosis tumoral-alfa &#40;TNF-&#945;&#41;&#44; interleucina &#40;IL&#41;-6&#44; IL-1&#946;&#44; IL-8&#44; productos del complemento &#40;forma soluble de C5b-9&#41;&#44; enzimas derivadas de los neutr&#243;filos &#40;elastasa polimorfonuclear y mieloperoxidasa&#41;&#44; prote&#237;na ligada a lipopolisac&#225;ridos &#40;PLL&#41; y activador del receptor soluble expresado en c&#233;lulas mieloides &#40;sTREM-1&#41;&#8212;&#44; se resume en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a><a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">39&#44;44-53</span></a>&#46; Existe escepticismo entre los investigadores sobre la posibilidad de que un &#250;nico par&#225;metro &#8212;sobre todo sin tener en cuenta datos cl&#237;nicos&#44; radiol&#243;gicos o microbiol&#243;gicos&#8212; sea capaz de diagnosticar&#44; por s&#237; mismo&#44; una IP con suficiente seguridad como para cambiar la pr&#225;ctica cl&#237;nica actual<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">54</span></a>&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Tratamiento</span><p id="par0090" class="elsevierStylePara elsevierViewall">El tratamiento se basa en controlar la infecci&#243;n con el antibi&#243;tico apropiado&#44; drenar el DPPC&#47;empiema&#44; valorar el uso de fibrinol&#237;ticos y las opciones quir&#250;rgicas que existen&#44; llevar a cabo una buena nutrici&#243;n y realizar una profilaxis antitromb&#243;tica<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">55</span></a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Antibi&#243;ticos</span><p id="par0095" class="elsevierStylePara elsevierViewall">El uso de antibi&#243;ticos deber&#237;a basarse en las recomendaciones microbiol&#243;gicas locales y en los riesgos espec&#237;ficos de cada paciente e iniciarse de forma emp&#237;rica y precoz ajust&#225;ndolos al origen comunitario o nosocomial de la infecci&#243;n&#44; al resultado de los cultivos y a la actividad del antibi&#243;tico en el LP<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">56</span></a>&#46; En las IP comunitarias la asociaci&#243;n recomendada es amoxicilina-&#225;cido clavul&#225;nico en monoterapia o una cefalosporina de tercera generaci&#243;n y clindamicina&#47;metronidazol&#46; Si hay alergia a las penicilinas&#44; una opci&#243;n ser&#237;a la asociaci&#243;n de una quinolona y metronidazol&#47;clindamicina&#46; En las IP nosocomiales&#44; en las que <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a la meticilina es muy frecuente<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#44; la pauta emp&#237;rica deber&#237;a cubrir este microorganismo y los anaerobios &#40;por ejemplo&#44; vancomicina&#47;linezolid&#44; penicilinas anti-<span class="elsevierStyleItalic">Pseudomonas</span>&#44; carbapenem o cefalosporinas de tercera generaci&#243;n asociados a metronidazol&#41;&#46; Los macr&#243;lidos no suelen utilizarse de forma rutinaria&#44; ya que aunque las neumon&#237;as por <span class="elsevierStyleItalic">Legionella</span> o <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> pueden cursar con DP&#44; suelen ser autolimitados y raramente causan empiema<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">57</span></a>&#46; No se aconseja la utilizaci&#243;n de aminogluc&#243;sidos&#44; debido a su escasa penetraci&#243;n en el espacio pleural&#44; ni hay evidencias que recomienden el uso intrapleural de antibi&#243;ticos<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Drenaje tor&#225;cico</span><p id="par0100" class="elsevierStylePara elsevierViewall">Aunque no hay consenso acerca del calibre del tubo de drenaje&#44; las gu&#237;as de la <span class="elsevierStyleItalic">British Thoracic Society</span><a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a> y otros estudios<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">58</span></a> sugieren que los de peque&#241;o calibre &#40;10-14<span class="elsevierStyleHsp" style=""></span>F&#41; son los adecuados para la mayor&#237;a de los DPPC&#44; debido a que son m&#225;s f&#225;ciles de colocar&#44; son menos traum&#225;ticos y dolorosos para el paciente&#44; e igual de eficaces que los de mayor calibre &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La inserci&#243;n de un cat&#233;ter tor&#225;cico deber&#237;a guiarse siempre por una prueba de imagen&#44; generalmente una ET&#44; y sus indicaciones ser&#237;an la presencia de un LP turbio o purulento&#44; tinci&#243;n o cultivo positivo del LP&#44; loculaci&#243;n o DP mayor de la mitad del hemit&#243;rax&#44; pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&#44; o engrosamiento de la pleura parietal&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fibrinol&#237;ticos</span><p id="par0105" class="elsevierStylePara elsevierViewall">Las gu&#237;as actuales no encuentran indicaci&#243;n para el uso rutinario de fibrinol&#237;ticos intrapleurales en los pacientes con IP<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">19</span></a>&#44; y existe controversia acerca de su uso sistem&#225;tico en el manejo de los DPPC<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">59</span></a>&#46; Una revisi&#243;n Cochrane confirm&#243; que los fibrinol&#237;ticos intrapleurales aportan beneficio&#44; tanto en la reducci&#243;n de fallos del tratamiento como en la necesidad de recurrir a la cirug&#237;a en los DP loculados o empiemas&#44; pero no influyen sobre la mortalidad<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">60</span></a>&#46; Se observ&#243; que los pacientes que recib&#237;an alteplasa y deoxirribonucleasa &#40;DNasa&#41; presentaban mejor&#237;a significativa en la reducci&#243;n de la opacificaci&#243;n pleural radiol&#243;gica&#44; en la tasa de cirug&#237;a a los 3<span class="elsevierStyleHsp" style=""></span>meses y en la estancia hospitalaria media&#44; que los que recib&#237;an placebo<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a>&#46; Un metaan&#225;lisis que incluye este estudio &#40;y otros que utilizan estreptocinasa y urocinasa&#41; demuestra heterogeneidad en los resultados&#44; pero sugiere que el tratamiento con fibrinol&#237;ticos reduce las tasas de necesidad de cirug&#237;a&#44; aunque no de la mortalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">3&#44;61-67</span></a>&#46; Las gu&#237;as actuales recomiendan utilizar los fibrinol&#237;ticos de forma precoz cuando hay loculaciones en la cavidad pleural &#40;resistentes al DT&#41; y ante un empiema&#46; No hay suficiente evidencia para recomendar un f&#225;rmaco sobre el otro&#44; ni acuerdo sobre la dosis a utilizar<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;55</span></a>&#44; y se aconseja cerrar el tubo de DT durante unas horas tras su administraci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">19&#44;61</span></a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cirug&#237;a</span><p id="par0110" class="elsevierStylePara elsevierViewall">La cirug&#237;a &#40;drenaje por videotoracoscopia asistida &#91;VATS&#93;&#59; toracotom&#237;a con decorticaci&#243;n pleural&#44; u otro tipo de drenaje quir&#250;rgico abierto&#41; hay que valorarla cuando falla el tratamiento m&#233;dico &#40;antibi&#243;ticos&#44; DT y fibrinol&#237;ticos&#41; tras un periodo de 5-7<span class="elsevierStyleHsp" style=""></span>d&#237;as<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#44; o cuando ya se ha establecido el empiema organizado y existe una importante fibrosis pleural&#46; El hallazgo precoz de un LP purulento o de loculaciones no es predictivo de la necesidad de cirug&#237;a<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">2</span></a>&#46; La VATS permite&#44; adem&#225;s del desbridamiento pleural&#44; realizar decorticaciones en los empiemas avanzados o cr&#243;nicos&#46; En estos &#250;ltimos los resultados no son tan favorables&#44; ya que el mayor &#233;xito se obtiene cuando se hace de forma precoz&#46; No obstante&#44; la tasa global de &#233;xito de esta t&#233;cnica sobrepasa el 85&#37;<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">68</span></a>&#46; Varios estudios han comparado el tratamiento conservador &#40;antibi&#243;ticos y DT con&#47;sin fibrinol&#237;ticos&#41; con la VATS como tratamiento de primera l&#237;nea&#44; tanto en ni&#241;os como en adultos&#46; El enfoque quir&#250;rgico precoz no ha demostrado ventajas en la mortalidad ni en la morbilidad grave en ning&#250;n ensayo<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">69</span></a>&#46; Adem&#225;s&#44; la cirug&#237;a no est&#225; exenta de complicaciones&#44; destacando las neuralgias intercostales poscirug&#237;a pleural&#46; El papel de la decorticaci&#243;n por toracotom&#237;a en el empiema es cada vez menor&#44; en relaci&#243;n directa con el aumento de la evidencia de que la VATS es al menos comparable&#44; o incluso superior<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">70</span></a>&#44; y suele reservarse para aquellos casos en los que fallan los procedimientos menos invasivos&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Nutrici&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Una pobre nutrici&#243;n es un determinante adverso en el resultado de un empiema pleural que habitualmente no se tiene en cuenta&#46; Las IP que se asocian a hipoalbuminemia tienen un peor resultado<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#44; y deber&#237;a proporcionarse un adecuado soporte nutricional&#44; incluida la alimentaci&#243;n enteral complementaria&#44; desde el momento del diagn&#243;stico&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Profilaxis antitromb&#243;tica</span><p id="par0120" class="elsevierStylePara elsevierViewall">Todos los pacientes ingresados por neumon&#237;a y&#47;o IP deber&#237;an recibir profilaxis con heparinas de bajo peso molecular&#44; si no est&#225;n contraindicadas<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">16&#44;19&#44;55</span></a>&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">La incidencia del DPP est&#225; aumentando en todo el mundo y en todos los grupos de edad&#46; Aunque relacionado con la neumon&#237;a&#44; existe poca correlaci&#243;n entre los organismos que se encuentran en el espacio pleural y los que se observan en las infecciones del par&#233;nquima pulmonar&#44; lo que sugiere que la IP primaria es m&#225;s frecuente de lo que se piensa&#46; Los m&#233;todos diagn&#243;sticos actuales se enfocan en poder predecir si un DPP va a evolucionar hacia un DPPC&#47;empiema&#46; Su diagn&#243;stico y la instauraci&#243;n precoz de medidas como la pauta antibi&#243;tica y el DT siguen siendo la base del tratamiento&#46; En un grupo de pacientes&#44; los fibrinol&#237;ticos contribuyen a una mejor recuperaci&#243;n&#44; y su combinaci&#243;n con DNasa se relaciona con la obtenci&#243;n de mejores resultados&#46; Si es necesaria la cirug&#237;a&#44; cada vez hay m&#225;s evidencia de que la rentabilidad de la VATS es igual&#44; si no superior&#44; a la decorticaci&#243;n por toracotom&#237;a&#44; por lo que esta se reservar&#237;a para los casos en los que fallan los procedimientos menos invasivos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46; Se necesitan nuevos ensayos cl&#237;nicos que conformen estrategias diagn&#243;sticas y terap&#233;uticas basadas en la evidencia&#44; que proporcionen un manejo m&#225;s efectivo y estandarizado de esta enfermedad&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contribuci&#243;n de los autores</span><p id="par0130" class="elsevierStylePara elsevierViewall">Ferreiro L&#46; Autora y redactora&#46; Concepci&#243;n y dise&#241;o&#46; Aprobaci&#243;n final del manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">San Jos&#233; ME&#46; Coautora&#46; Redactora&#46; Aprobaci&#243;n final del manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Vald&#233;s L&#46; Redactor y autor&#46; Concepci&#243;n y dise&#241;o&#46; Aprobaci&#243;n final del manuscrito&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Epidemiolog&#237;a"
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          "titulo" => "Diagn&#243;stico"
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              "identificador" => "sec0025"
              "titulo" => "Escalas de gravedad de las neumon&#237;as y scores"
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              "titulo" => "Biomarcadores alternativos en el l&#237;quido pleural"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las infecciones pleurales presentan una elevada morbimortalidad&#44; y su incidencia est&#225; aumentando en todos los pa&#237;ses del mundo y en todos los grupos de edad&#46; No todos los derrames infecciosos son paraneum&#243;nicos&#44; y en esos casos&#44; los organismos que se encuentran en el espacio pleural no son los mismos que se observan en las infecciones del par&#233;nquima pulmonar&#46; La dificultad diagn&#243;stica radica en saber si un derrame infeccioso evolucionar&#225; hacia un derrame complicado&#47;empiema&#44; ya que los m&#233;todos diagn&#243;sticos utilizados con este fin ofrecen pobres resultados&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los pilares del tratamiento son establecer un diagn&#243;stico precoz e instaurar&#44; lo antes posible&#44; una pauta antibi&#243;tica y un drenaje tor&#225;cico&#46; Este se llevar&#225; a cabo&#44; preferiblemente con tubos de peque&#241;o calibre&#44; ante la presencia de determinadas caracter&#237;sticas morfol&#243;gicas&#44; bacteriol&#243;gicas y bioqu&#237;micas del l&#237;quido pleural&#46; El an&#225;lisis del l&#237;quido es el m&#233;todo m&#225;s fiable para valorar su evoluci&#243;n&#44; sobre todo la determinaci&#243;n del pH&#46; En un subgrupo de pacientes los fibrinol&#237;ticos pueden contribuir a mejorar la recuperaci&#243;n&#44; y su combinaci&#243;n con deoxirribonucleasa se relaciona con la obtenci&#243;n de mejores resultados&#46; Si fracasa el tratamiento m&#233;dico y es necesaria la cirug&#237;a&#44; la rentabilidad de la cirug&#237;a toracosc&#243;pica videoasistida es&#44; al menos&#44; comparable a la decorticaci&#243;n por toracotom&#237;a&#44; por lo que esta solamente se realizar&#225; si han fallado las t&#233;cnicas anteriores&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Son necesarios m&#225;s ensayos cl&#237;nicos que analicen factores que puedan influir sobre los resultados obtenidos para conformar nuevas estrategias diagn&#243;sticas y terap&#233;uticas basadas en la evidencia&#44; que proporcionen un manejo m&#225;s efectivo y estandarizado de esta enfermedad&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pleural infections have high morbidity and mortality&#44; and their incidence in all age groups is growing worldwide&#46; Not all infectious effusions are parapneumonic and&#44; in such cases&#44; the organisms found in the pleural space are not the same as those observed in lung parenchyma infections&#46; The diagnostic difficulty lies in knowing whether an infectious effusion will evolve into a complicated effusion&#47;empyema&#44; as the diagnostic methods used for this purpose provide poor results&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The mainstays of treatment are to establish an early diagnosis and to commence an antibiotic regimen and chest drain as soon as possible&#46; This should preferably be carried out with fine tubes&#44; due to certain morphological&#44; bacteriological and biochemical characteristics of the pleural fluid&#46; Fluid analysis&#44; particularly pH&#44; is the most reliable method for assessing evolution&#46; In a subgroup of patients&#44; fibrinolytics may help to improve recovery&#44; and their combination with DNase has been found to obtain better results&#46; If medical treatment fails and surgery is required&#44; video-assisted thoracoscopic surgery &#40;VATS&#41; is&#44; at least&#44; comparable to decortication by thoracotomy&#44; so should only undertaken if previous techniques have failed&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Further clinical trials are needed to analyze factors that could affect the results obtained&#44; in order to define new evidence-based diagnostic and therapeutic strategies that provide more effective&#44; standardized management of this disease&#46;</p></span>"
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          "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fisiopatolog&#237;a&#44; aspecto&#44; par&#225;metros bioqu&#237;micos y microbiolog&#237;a del derrame pleural paraneum&#243;nico&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Modificada de Bhatnagar y Maskell<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">16</span></a>&#46;</p>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural anecoico&#46; B&#41;<span class="elsevierStyleHsp" style=""></span>Derrame pleural con m&#250;ltiples septos y loculaciones&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">L&#58; loculaci&#243;n&#59; LP&#58; l&#237;quido pleural&#59; S&#58; septo&#46;</p>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Microbiolog&#237;a de la infecci&#243;n pleural adquirida en la comunidad y en el hospital<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">20</span></a>&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MRSA&#58; <span class="elsevierStyleItalic">Staphylococcus aureus</span> resistente a la meticilina&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para el tratamiento del derrame pleural paraneum&#243;nico&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DP&#58; derrame pleural&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DT&#58; drenaje tor&#225;cico&#59; EF&#58; exploraci&#243;n f&#237;sica&#59; ET&#58; ecograf&#237;a tor&#225;cica&#59; G&#58; generaci&#243;n&#59; HC&#58; historia cl&#237;nica&#59; LP&#58; l&#237;quido pleural&#59; Rx&#58; radiograf&#237;a&#59; TC&#58; tomograf&#237;a computarizada&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">1</span> Si alergia a la penicilina&#58; quinolona<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>metronidazol&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">2</span> Si no se puede determinar el pH&#44; utilizar LDH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;l o glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ADA&#58; adenosina desaminasa&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; LDH&#58; lactato deshidrogenasa&#59; LP&#58; l&#237;quido pleural&#59; PCR&#58; prote&#237;na C reactiva&#46;</p>"
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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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Determinaciones&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">Caracter&#237;sticas del DPPC&#47;empiema&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">Comentarios&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">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Se debe medir en un analizador de gases sangu&#237;neosValores bajos si acidosis en el espacio pleural&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">Glucosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Se debe al aumento del metabolismo celular&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">LDH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000 UI&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determinar en LP y en sangreSe debe a la destrucci&#243;n celular&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">Prote&#237;nas totales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Determinar en LP y en sangre&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">Recuento total y porcentual de c&#233;lulas nucleadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recuento total elevado con predominio de polimorfonucleares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alta dispersi&#243;n de valores al depender de la afectaci&#243;n de la c&#225;mara pleural puncionadaSi tratamiento previo con antibi&#243;ticos&#44; el predominio puede ser linfoc&#237;tico&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">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable si &#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l y se acompa&#241;a de un pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;20 o glucosa &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alta especificidad para el diagn&#243;stico de los DPP si se asocia a un predominio polimorfonuclear&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">Cultivo del LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Puede ser positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mayor rentabilidad si se recoge en frascos de hemocultivo&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">Citolog&#237;a del LP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">En ocasiones&#44; en el l&#237;quido de los derrames malignos se pueden observar cambios similares a los de los DPP&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">ADA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Puede estar elevadaPredominio de polimorfonucleares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A determinar si sospecha de tuberculosis&#59; en este caso&#44; predominio linfocitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">AUC&#58; &#225;rea bajo la curva&#59; DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; DPPNC&#58; derrame pleural paraneum&#243;nico no complicado&#59; E&#58; especificidad&#59; IL&#58; interleucina&#59; PCR&#58; prote&#237;na C reactiva&#59; PLP&#58; prote&#237;nas ligadas a lipopolisac&#225;ridos&#59; Ref&#58; referencia&#59; S&#58; sensibilidad&#59; SC5b-9&#58; forma soluble de C5b-9&#59; sTREM-1&#58; activador del receptor soluble expresado en c&#233;lulas mieloides&#59; TNF-&#945;&#58; factor de necrosis tumoral alfa&#46;</p>"
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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="left" valign="top" scope="col">Par&#225;metro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DPP versus otros derrames</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DPPNC versus DPPC&#47;empiema</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">Punto de corte&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">AUC&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">S &#40;&#37;&#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">E &#40;&#37;&#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">Punto de corte&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">AUC&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">S &#40;&#37;&#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">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>3&#44;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&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;820&#44;830&#44;750&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75497354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75937377&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mg&#47;l&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mg&#47;l&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;810&#44;810&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">586872&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">887571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38394042<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>49&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">Procalcitonina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;14<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#44;18<span class="elsevierStyleHsp" style=""></span>ng&#47;ml0&#44;19<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&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;570&#44;590&#44;750&#44;830&#44;710&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">455267766765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">726777817068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&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;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39404141<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>42<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>42<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a>&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">TNF-&#945;&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&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">IL-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>77&#44;3<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&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">IL-1&#946;&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>16&#44;7<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IL-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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;000<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;130<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;870&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4950&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">SC5b-9&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&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">Elastasa polimorfonuclear&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;500<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&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">Mieloperoxidasa&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;000<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&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;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&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">PLL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&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;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml&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;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&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">&#62;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&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;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>180<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&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;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
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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">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Calibre del tubo&#44; F</th><th class="td" title="table-head  " align="left" valign="top" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><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">&#60; 10&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">10-14&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">15-20&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; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pacientes &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&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  " 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">Sexo&#44; n &#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>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">144 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;71&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>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;71&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">Edad&#44; media &#40;DE&#41;</span>&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;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;11&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">Opacificaci&#243;n Rx de t&#243;rax por DP &#40;&#37; del hemit&#243;rax&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;54&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">Caracter&#237;sticas LP</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Purulencia&#44; n &#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">42 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 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"><span class="elsevierStyleHsp" style=""></span>Gram positivo para bacteria&#44; n &#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">19 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;42&#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;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;63&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>Cultivo positivo para bacteria&#44; n &#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">16 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;49&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>pH&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;89 &#40;0&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;87 &#40;0&#44;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;82 &#40;0&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;64 &#40;0&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;51&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>Glucosa &#40;mmol&#47;l&#41;&#44; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;1 &#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="char" valign="top">3&#44;3 &#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="char" valign="top">2&#44;2 &#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="char" valign="top">4&#44;3 &#40;4&#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">p &#61; 0&#44;10&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>LDH &#40;UI&#47;L&#41;&#44; mediana &#40;RIQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;580 &#40;34&#46;700&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;820 &#40;22&#46;280&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;400 &#40;28&#46;300&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;580 &#40;37&#46;550&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 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  " 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">Fuente de infecci&#243;n&#44; n &#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>Hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;73&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>Comunidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163 &#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">52 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;73&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">Combinaci&#243;n de cirug&#237;a y muerte&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#47;58 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#47;208 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#47;70 &#40;40&#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&#47;69 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;27&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">Muerte al a&#241;o&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;58 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#47;208 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;70 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;69 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;67&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">Cirug&#237;a al a&#241;o&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;58 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#47;208 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;70 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;69 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;97&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">Estancia hospital&#44; d&#237;as &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;37&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">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">a los 3 meses&#44; L &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;46 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;16 &#40;0&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;30 &#40;0&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;15 &#40;0&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;32&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">FVC a los 3 meses&#44; l &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;30 &#40;1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;98 &#40;0&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;18 &#40;1&#44;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">2&#44;84 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;24&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">Reducci&#243;n de la anormalidad de la Rx de t&#243;rax con respecto a la basal a los 3 meses&#44; mediana &#37; hemit&#243;rax &#40;RIQ&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;52-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;77-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p &#61; 0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes seg&#250;n el tama&#241;o del calibre del tubo tor&#225;cico&#44; y el efecto de este sobre los resultados cl&#237;nicos primarios y secundarios</p>"
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">DPP&#58; derrame pleural paraneum&#243;nico&#59; DPPC&#58; derrame pleural paraneum&#243;nico complicado&#59; E&#58; empiema&#59; ET&#58; ecograf&#237;a tor&#225;cica&#59; F&#58; French&#59; N&#46;S&#46;&#58; no significativo&#59; Pbo&#58; grupo placebo&#59; Rx&#58; radiograf&#237;a&#59; TC&#58; tomograf&#237;a computarizada&#59; Tto&#58; grupo tratamiento</p>"
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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="left" valign="top" scope="col">Referencia&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">Pa&#237;s&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">Pacientes incluidos&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">Tipos de DPP incluidos&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">Imagen<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&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">Tama&#241;o drenaje&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">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mortalidad &#40;&#37;&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tasa de cirug&#237;a &#40;&#37;&#41;</th></tr><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="" 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="" 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="" 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="" 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="" 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="" 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">Tto&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">Pbo&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">Tto&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">Pbo&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">Maskell et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12-20 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3<span class="elsevierStyleHsp" style=""></span>d&#237;as&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;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&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;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;5&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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">Rahman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">t-PA y DNasa&#58; 10 mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&#59; 1 dosis&#47;12<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#61; 0&#44;03&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">Davies et al&#46;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reino Unido&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">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">No aportado&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">Bouros et al&#46;<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28-32 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urocinasa&#58; 100&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;05&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">Tuncozgur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Turqu&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E estadio II<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&#44; TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-36 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urocinasa&#58; 100&#46;000 UI&#59;1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&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">Diacon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sud&#225;frica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DPPC y E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-28 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;7 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#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">4&#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&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;5&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#46;S&#46;&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;02&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">Misthos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grecia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rx&#44; ET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28-32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estreptocinasa&#58; 250&#46;000 UI&#59; 1 dosis&#47;24<span class="elsevierStyleHsp" style=""></span>h&#47;3 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#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">4&#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">12&#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">32&#44;9&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="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&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><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;001&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><td class="td" title="table-entry  " align="left" valign="top">p &#60; 0&#44;05&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></tbody></table>
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Article information
ISSN: 03002896
Original language: Spanish
DOI:10.1016/j.arbres.2015.01.009
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