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Introduction: COVID-19 caused high morbidity and mortality worldwide due to the lack of effective treatment and timely recognition of individuals with worse prognosis. Objective: To evaluate the capacity of the index to predict the risk of death in patients with covid-19, based on prognostic factors. Material and Methods: An analytical cohort study was carried out in patients with COVID-19 in the General Provincial Hospital "Carlos Manuel de Céspedes" of Bayamo municipality, Granma province, from January 1, 2020 to March 31, 2023. Results: Internal validity of the index was adequate with a sensitivity of 88.96%, specificity of 92.58% and a validity index of 91.22%. The discriminative capacity of the index (area under the ROC curve of 0.975) and the calibration (Hosmer and Lemeshow: p= 0.383) were appropriate. Conclusions: The predictive capacity and calibration of the index were adequate, as well as the accuracy and reliability, so it can be used as a clinical surveillance tool.

Introduction: Tools have been used to predict the risk of COVID-19, but none have evaluated their external validity. Objective: To evaluate the capacity of a model, based on prognostic factors, to predict the risk of dying from COVID-19. Material and Methods: A cohort analytical study was carried out on patients with COVID-19 at the “Carlos Manuel de Céspedes” provincial general hospital in the Bayamo municipality, province of Granma, from January 1st, 2020 to March 31st, 2023. Confirmed COVID-19 patients were selected. Death was defined as the dependent variable and sociodemographic variables were considered as independent variables for evaluation, including: toxic habits, comorbidity, biomarkers, phenotypes, and prognostic scales. Results: The Cox proportional regression model demonstrated that the factors associated with the prognosis of death were: classifying phenotype 5 (HR= 6.41; 95% CI= 1.49 to 13.44; p= 0.015); history of arterial hypertension (HR= 2.01; 95% CI= 1.34 to 2.98; p= 0.001); and the RALE scale at 4 or more points (HR= 1.94; 95% CI=1, 47 to 7.90; p= 0.047). The discriminative capacity of the model (C statistic = 0.891) and its calibration were adequate (X2 = 5.384; p = 0.637). Conclusions: The predictive capacity and calibration of the model were adequate. The model can be used as a clinical and epidemiological surveillance instrument, by staging the risk of dying in the most vulnerable subjects.

Introduction: Nowadays disparities as for sex in patients with serious diseases can be found, which has not been explained in the clinical-epidemiological studies carried out until the moment. Objective: To identify the differences according to sex in patients admitted to intensive care units. Methods: An observational and prospective study of 187 patients admitted to the Intensive Care Units of Carlos Manuel de Céspedes Provincial General Hospital was carried out in Granma that included the months of November and December, 2018-2020. Among the analyzed variables we can mention: age, sex, origin, diagnosis at admission, state when discharged from the unit, hospital stay, syndrome of systemic inflammatory response, stage of the sepsis, risk factors, community acquired infections and required treatment. Results: In the investigation most of the patients corresponded to female sex (60.9 %) and the mean age was 31.6 and 49.6 years in women and men, respectively (p=0.000). Also, significant differences existed as for the origin (p=0.012) and the initial diagnoses (p=0.018); while the average of the APACHE II was 7.2 in women and 11.6 in men (p=0.000) and the Sequential Organ Failure Assessment Score had a mean of 0.7 and 2.0, in that same order (p=0.000). Conclusions: The patients of male sex presented average age, diagnosis, origin, seriousness and dysfunction of organs significantly different to those of female sex. Although disparities were not appreciated as for risk factors and infections associated with the community, the frequency of men that require treatment was significantly higher.

Introduction: The non invasive ventilation is an effective treatment in patients with acute lung disease. Objective: To describe the demographic, clinical, ventilatory and hemogasometric characteristics in patients treated with non invasive ventilation. Methods: An observational, descriptive, longitudinal and prospective study of 234 patients with chronic obstructive lung disease, non-invasive ventilated in the Intensive Cares Unit of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out, from January, 2011 to September, 2021. Results: In the series there was a prevalence of male sex, non hospital acquired pneumonia and chronic heart failure; while the mean age was 71 years and non invasive ventilation failed in 53.8 % of those affected. Also, the respiratory rate decreased from 34.3 to 23.5 breaths per minute in the second hour and an increase in pH was also observed, as well as in the relationship arterial pressure of O2/inspired fraction of O2 and oxygen saturation to the pulsioximetry/inspiratory fraction of O2. The arterial pressure of CO2 had average values of 61.8 mmHg to the beginning and of 60.7 mmHg in the second hour. Conclusions: The basal values of clinical, hemogasometric and ventilatory variables improved after treatment with non invasive ventilation. Among the parameters associated with the treatment failure there were heart frequency, respiratory frequency, arterial pressure of CO2, coma Glasgow scale, pH and leaks; equally, the long stay, the ventilation for more than 48 hours and mortality were related to this failure.

Introduction: Patients with community-acquired infections require assistance in intensive care units. Objective: To identify characteristics and prognostic factors of critically ill patients with community-acquired infections. Methods: A cohort study was carried out in 160 patients admitted to the intensive care unit for more than 48 hours. Variables age, sex, APACHE II index, SOFA scale, origin of the patients, stage of sepsis, comorbidity, location of the infection and therapeutic procedures were defined. Results: 58.1% of the patients were women. The median age in deceased patients was 52.5 years and 39.9 years in living (p= 0.015). The mean APACHE II in deceased patients was 22.2 points (95% CI; 18.1-26.2) (p= 0.000). The frequency of immunosuppression, neutropenia and neoplasms (p< 0.05) showed differences between living and deceased; and pneumonia as location (46.7% vs. 17.9; p= 0.007). Intra-abdominal infection (40.0%), pneumonia (20.6%) and urinary tract infection (8.8%) represented the main locations of community acquired infections. In the binary logistic regression model, APACHE II (OR= 5.96; 95% CI: 1.02-34.8) and SOFA (OR= 5.68; 95% CI: 1.4-21.7) were prognostic factors. Conclusions: The patients are characterized by being in their fourth decade, being female, having diabetes mellitus, immunosuppression or neoplasms and locations such as intra-abdominal infection and pneumonia mainly. APACHE II and SOFA are the prognostic factors for death.

Introduction: Seric albumin constitutes one of the parameters used to predict the risk of complications in patients surgically intervened. Objective: To evaluate the utility of seric albumin as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis. Method: An observational, cohorts analytic study of 54 patients with secondary diffuse peritonitis was carried out, they were assisted in the Intensive Cares Unit of Carlos Manuel de Céspedes University General Hospital in Bayamo, Granma, during 2016. The marker variable of prediction was the multiple failures of organs that was evaluated with the Sequential scale Organ Failure Assessment. Results: In the 37.7 % of patients multiple failure of organs was developed; also, the average value of seric albumin at admission (standard deviation) was 30.3 g/L (+ 3.4) in patients with this disorder and 33.2 g/L (+ 4.1) without this disorder (p=0.012). The relative risk of multiple failure of organs was 1.9 (CI: 95 % 1.1-3.2) with albumin of 30 g/L or less. In the multivariate analysis seric albumin constituted an independent factor of multiple failure of organs along with APACHE II index; while the area under the curve receiving operator presented a value of 0.7 when the discriminative capacity of the albumin was considered to predict if the multiple failure of organs was not present and 0.2 to predict its development. Conclusions: Seric albumin is useful as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis.

Introduction: Data of characteristics of critically ill patients generally come from of European countries. Objective: To identify the clinical, epidemiological and therapeutic characteristics of patients treated in the intensive care unit. Methods: An observational, prospective study was carried out in the intensive care unit, in periods of the years 2018, 2019 and 2020. Patients admitted for more than 24 hours were included. The variables age, sex, origin and diagnosis of the patients, degree of severity, risk factors, community infections and those associated with health care were defined. Results: The patient's average age was 38.6 years (36.1-46.3) and 61.0 % belonged to female. APACHE II mean value and standard deviation was 8.9+6.4 and 1,2 + 2.1 for SOFA. Mortality was 7.0 %. Hypoalbuminemia (24.5 %) were the most important risk factor; 27.3 % of patients received a central venous catheter and 13.9 % mechanical ventilation. Community infections were developed by 54.0% of patients and 8.0 % acquired healthcare associated infections. Conclusions: The population it is characterized by being close to fourth decade, belonging to female sex, proceeding from operating room, clinical conditions, hypoalbuminemia and low values of APACHE II and SOFA scores. Mortality remains stable and the incidence of community infections is high.

RESUMEN Se describe el caso clínico de una adulta, de 21 años de edad, con antecedentes de salud, que fue ingresada por encefalitis viral, en la cual aparecieron lesiones cutáneas localizadas en las manos y pies, bilaterales y simétricas; eritematovesicoampollares, con presencia en la piel de ampollas y vesículas de contenido hemorrágico rodeadas de halo eritematoso, que apuntan a vasculitis cutánea por sepsis. En el líquido cefalorraquídeo, la reacción en cadena de la polimerasa fue positiva para citomegalovirus y virus tipo Epstein-Barr. En los hemocultivos se aisló Staphylococcus aureus. El tratamiento consistió en sostén de órganos vitales, antimicrobianos (aciclovir, vancomicina y linezolid, principalmente) y corticosteroides. La evolución fue favorable al egreso. ABSTRACT We describe the case of an adult, 21 years of age, with a health history, who was admitted for viral encephalitis, in which localized skin lesions appeared on the hands and feet, bilateral and symmetrical; erythematovesicoampollars, with blisters and vesicles of hemorrhagic content surrounded by erythematous halo, which point to cutaneous vasculitis due to sepsis. In the cerebrospinal fluid, the polymerase chain reaction was positive for cytomegalovirus and Epstein-Barr virus. Staphylococcus aureus was used in blood cultures. Treatment consisted of support of vital organs, antimicrobials (acyclovir, vancomycin and linezolid, mainly) and corticosteroids. The evolution was favorable at discharge from the institution.

A cases and control study was carried out in patients with migraine, diagnosed by means of a cross-sectional study in Bayamo municipality, Granma province, between January, 2007 to December, 2009, with the objective of creating and validating a predictive index for the risk of developing moderate to severe disability due to migraine. The creation of the index included the selection of risk factors and the calculation of its values. A quantitative index was obtained which was subdivided in 4 categories of risk, while the validity was satisfactory in all the evaluated aspects. This index demonstrated to have good discriminative capacity (area under the curve ROC 0.937) and it allowed to diagnose correctly 89.74 % of the patients, with sensibility of 86.74 % and specificity of 91.12 %. The Kappa index between observers was 0.950 (p=0.000), the global index was 0.965 (p=0.000) and the coefficient Alpha of Cronbach, 0.627.

Se describe el caso clínico de una adulta de 33 años de edad con antecedentes de asma bronquial, que fue ingresada en el Hospital General Universitario "Carlos Manuel de Céspedes", en Bayamo (Granma), por choque séptico a causa de una bronconeumonía bacteriana, además de disfunción orgánica y acidosis metabólica sostenida, que requerían el apoyo de drogas vasoactivas a altas dosis. También aparecieron lesiones diseminadas en la piel, principalmente en las áreas distales de las manos y los pies, con coloración violácea y necrosis isquémicas hacia los pulpejos de los dedos. En los hemocultivos se aisló el Staphylococcus aureus, y el tratamiento consistió en sostén hemodinámico, antimicrobianos de amplio espectro, corticoesteroides y curas de las lesiones cutáneas, que incluyó la escisión del tejido necrosado

Introducción: la infección intrahospitalaria es la que el paciente adquiere cuando es internado en un centro de salud. Objetivo: identificar los factores de riesgo de infección intrahospitalaria en pacientes ingresados en una unidad de cuidados intensivos. Métodos: se realizó un estudio de casos y testigos, atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario "Carlos Manuel de Céspedes del Castillo", de Bayamo, Granma, desde enero hasta diciembre del 2011. Resultados: en el análisis estadístico bivariado solo el sexo no constituyó factor de riesgo de infección intrahospitalaria, en tanto, el multivariado mostró que los factores independientes fueron la estadía hospitalaria, la presencia de la sonda nasogástrica, la edad y el coma. Conclusiones: las variables antes señaladas constituyeron factores de riesgo de infección intrahospitalaria en la unidad de cuidados intensivos antes citada.

Los índices de predicción son muy útiles para la valoración integral de los pacientes, tanto en medio hospitalario como ambulatorio. Se desarrolló esta investigación para construir y validar un índice que logre predecir el riesgo de desarrollar cardiopatía hipertensiva. La construcción incluyó la selección de los factores de riesgo y sus ponderaciones mediante cálculo de los odds ratio, para esta fase se investigaron 900 pacientes con hipertensión arterial, atendidos en la policlínica "Carlos Manuel de Céspedes" de Bayamo, desde el 1rode marzo de 2007 hasta el 31 de diciembre de 2008. Se obtuvo un índice con 2 variantes, uno cuantitativo y otro ordinal con 4 categorías de riesgo. La validación incluyó 4 aspectos de la validez y la consistencia interna. Se tomaron 300 pacientes para evaluar la validez por construcción, de criterio y confiabilidad. La validez fue muy satisfactoria en la mayoría de los aspectos. El coeficiente de confiabilidad fue 0,68. El coeficiente de Kappa ponderado fue 0,644 (p< 0,001), los Kappa por categorías oscilaron entre 0,632 para la categoría 1 y 0,985 para la 4. El alfa de Cronbach general fue 0,557 y el estandarizado, 0,643. Finalmente, se calculó el coeficiente de determinación (R²) que mostró alto grado de correlación entre cada ítem y el resto. El índice propuesto se considera listo para su aplicación.The prediction rates are vey useful to integral valuation of patients in the hospital and ambulatory means. A research to construct and to validate a rate achieving to predict the risk to develop a hypertensive heart disease was conducted, which includes the selection of risk factors and their weighing by estimation of the odds ratios; for this phase 900 patients with high blood pressure were investigated, seen in the "Carlos Manuel de Céspedes" Polyclinic of Bayamo province from March 1, 2007 to December 31, 2008. It was possible to achieve a rate with two variants, one of quantitative type and other of ordinal type with 4 risk categories. Validation included 4 features of validity and the internal consistency. Sample included 300 patients to assess the validity by construction, of criterion and reliability. Validity was very satisfactory in most of the features. Reliability coefficient was of 0,644 (p < 0,001), the Kappas ones fluctuate between 0,632 for the 1 category and 0,985 for the 4 one. The general Cronbach's Alpha was of 0,557 and standardized one was of 0,643. Finally, the determination coefficient (R²) was estimated showing a high degree of correlation between each item and the remainder. The proposed rate is ready for its implementation.

Se realizó un estudio de casos y controles de pacientes con diagnóstico de hipertensión arterial, atendidos en la consulta especializada, para identificar si existe asociación entre distintos factores hipotéticamente influyentes sobre el desarrollo de la cardiopatía hipertensiva. Los pacientes fueron tomados aleatoriamente 1:2 (300 casos: 600 controles). Se observó que la edad mayor o igual a 63 años triplicó el riesgo de padecer la enfermedad (OR 3,02; IC 95 % 2,27-4,03) y el tabaquismo lo duplicó (OR 2,06; IC 95 % 1,55-2,73). Dentro de los biomarcadores de riesgo cardiovascular sobresalen la proteína C reactiva que eleva a más de 13 el riesgo (OR 13; IC 95 % 9,70-19,3) seguido de la creatinina (OR 5,03; IC 95 % 3,37-7,51) y glucemia (OR 4,96; IC 95 % 93,61-6,81). El tiempo de evolución de la enfermedad (OR 4,26; IC 95 % 3,18-5,72) el grado de hipertensión (OR 2,21; IC 95 % 1,65-2,96) y la falta de control de la hipertensión arterial (OR 2,16; IC 95 % 1,63-2,87), se comportaron como factores de riesgo. Se concluyó con un análisis de regresión logística que mostró que la proteína C reactiva, el ácido úrico, la glucemia y la microalbuminaria son los factores de riesgo independientes más importantes para el desarrollo de la enfermedad.A case-control study of patients diagnosed with arterial hypertension seen in specialized consultation was conducted to identify if there is a association among different supposedly influential factors on the development of the hypertensive heart disease. Patients were selected in a random way 1:2 (300 cases: 600 controls). Patients aged over or equal to 63 tripled the risk to suffer the disease (OR 3.02; CI 95 % 2.27-4.03) and smoking double it (OR 2.06; CI 95 % 1.55-2.73). Within the cardiovascular risk biomarkers are the reactive C protein raising the risk to more than 13 (OR 13; CI 95 % 9.70-19.3) followed by creatinine (OR 5.03; CI 95 % 3.37-7.51) and glycemia (OR 4.96; CI 95 % 93.61-6.81). Disease course time (OR 4.26; CI 95 % 3.18-5.72), hypertension degree (OR 2.21; CI 95 % 1.65-2.96), and lack arterial hypertension control (OR 2.16; CI 95 % 1.63-2.87) were the risk factors. We conclude with a logistic regression analysis showing that reactive C protein, uric acid, glycemia and microalbuminuria are the more significant independent risk factors for the disease development.

Se realizó un estudio retrospectivo, descriptivo y longitudinal de la neumonía nosocomial en la Unidad de Cuidados Intensivos del Hospital General Provincial Docente "Carlos M. de Céspedes", de Bayamo, en un período de 2 años. Se detectó este episodio en 81 pacientes, para el 9,3 % del total de ingresos. Las grandes cirugías torácicas y abdominales (30,9 %) y los politraumatismos (26,8 %) figuran dentro de los principales motivos de ingreso. Se destacó la ventilación mecánica artificial como factor de riesgo asociado (74,0 %). El germen aislado con mayor frecuencia fue el Enterobacter s.p. (42,4 %), le siguió en orden decreciente, la Pseudomona s.p. (27,1 %). Aunque es difícil determinar con exactitud el índice de mortalidad atribuible a esta infección, el 35,8 % de los enfermos fallecieron durante su estancia en la Unidad. La aparición del cuadro entre el tercero y cuarto días en el mayor porcentaje de los estudiados sugiere la intensificación de la vigilancia clínica, radiológica y microbiológica.A retrospective, descriptive, and longitudinal study of nosocomial pneumonia was carried out at the Intensive Care Unit of "Carlos Manuel de Céspedes" general provincial teaching hospital from Bayamo over a 2-year period. Nosocomial pneumonia was detected in 81 patients accounting for 9.3 % of the total number of admitted patients. Major thoraccic and abdominal surgical procedures (30.9 %), and polytraumatisms (26.8 % are found to be the principal reasons for hospital admissions. Artificial mechanical ventilation was pointed out as an associated risk factor (74.0 %). The most frequently isolated germ was Enterobacter s.p. (42. 4 %) followed in decreasing order by Pseudomona s.p. (27.1 %). Although it is difficult to accurately determine the index of mortality attributable to this kind of infection, 35.8 % of patients died during their stay at the Intensive Care Unit. The occurrence of the clinical picture within the third and fourth days in the greatest percentage of patients studied suggests that clinical, radiologic, and microbiological surveillance is essential.

Resumen INTRODUCCIÓN La afección de órganos diana por hipertensión arterial que presenta mayor morbilidad y mortalidad es la cardiopatía hipertensiva. Su prevención debería ser objeto de los programas de atención a pacientes hipertensos. OBJETIVO Identificar la influencia de los diferentes factores de riesgo para el desarrollo de la cardiopatía hipertensiva. MÉTODOS Realizamos un estudio prospectivo de cohorte en pacientes hipertensos atendidos en la consulta especializada de hipertensión arterial de la policlínica de especialidades del Hospital General Universitario “Carlos Manuel de Céspedes” del municipio Bayamo, Cuba, desde el 1ro de enero de 2000 hasta el 31 de diciembre de 2009. RESULTADOS El análisis multivariado mostró una relación estadística significativa independiente entre la mayoría de los factores y el riesgo de aparición de la cardiopatía. El lugar más relevante lo ocupó la falta de control adecuado de la presión arterial (HR: 2,022; IC 95%: 1,659-2,465; p

Introducción: la cardiopatía hipertensiva representa altas morbilidad y mortalidad. La complejidad de su prevención radica en el número de factores de riesgo implicados en su desarrollo. Objetivo: diseñar y validar un árbol de predicción para el desarrollo de la cardiopatía hipertensiva, a partir de factores hemodinámicos y no hemodinámicos. Métodos: se realizó el diseño y validación de un árbol de predicción para el desarrollo de la cardiopatía hipertensiva, mediante el procedimiento de descubrimiento de conocimientos en bases de datos y minería de datos, en pacientes hipertensos atendidos en la consulta especializada de hipertensión arterial de la Policlínica de Especialidades del Hospital General Universitario "Carlos Manuel de Céspedes" del municipio Bayamo, provincia de Granma, Cuba, desde el 1ro de enero de 2004 hasta el 31 de diciembre de 2009. Resultados: el árbol predijo el riesgo de desarrollar la cardiopatía hipertensiva a 82,598 % de los pacientes; con un área bajo la curva ROC de 0,861 y una tasa de verdaderos positivos de 0,733 y de 0,921 para las clases 1 y 2, respectivamente. El factor más importante lo constituyó la proteína C reactiva, seguida en orden de importancia por la glucemia, el ácido úrico, el colesterol y la microalbuminuria. Conclusiones: el árbol de toma de decisiones y el conjunto de reglas derivado de este, permitieron predecir el riesgo de desarrollar la cardiopatía hipertensiva en individuos hipertensos, por lo que su introducción en la práctica clínica, mejorará la evaluación del paciente con hipertensión arterial.

Se realizó un estudio transversal en la Unidad de Cuidados Intensivos del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia de Granma, desde enero de 2010 hasta diciembre de 2014, a fin de de caracterizar la morbilidad materna extrema según variables clinicoepidemiológicas. De 504 pacientes atendidas, 153 (30,3 %) presentaron complicaciones severas. La histerectomía por infección y hemorragia, el choque circulatorio, la saturación de oxígeno menor de 90 % y la frecuencia respiratoria mayor que 40 o menor que 6 por minuto constituyeron los indicadores fundamentales de morbilidad extrema en estas féminas. Las tasas de mortalidad y morbilidad materna fueron de 11,1 por 100 nacidos vivos y 5,6 por 1 000 nacidos vivos, respectivamente. Entre los factores de riesgo de morbilidad extremadamente grave sobresalieron: edad gestacional mayor de 36 semanas, operación cesárea y antecedente de esta operación

Introduction: The monitoring of the carbon dioxide exhaled is frequently used in the intensive cares units, but its use in non invasive ventilation is scarce. Objective: To identify the association between the blood pressure of carbon dioxide and the carbon dioxide exhaled, during non invasive ventilation, in patients with acute chronic obstructive lung disease. Methods: An observational, descriptive, longitudinal and prospective study of 126 patients admitted with acute chronic obstructive lung disease was carried out, they were treated with non invasive ventilation, in the Intensive Cares Unit of Saturnino Lora Torres Teaching Provincial Clinical-Surgical Hospital in Santiago de Cuba, from January, 2019 to the same month in 2022, selected by intentional non probabilistic sampling. Clinical, ventilatory and hemogasometric variables were analyzed, of which the minimum and maximum values were identified, as well as the mean, standard and medium deviation. The Pearson correlation coefficient was applied. Results: The average values of carbon dioxide exhaled were 57.83 ± 8.9 and those of arterial pressure of carbon dioxide, 59.85± 9.3. When analyzing the correlation among the variables, positive correlation was observed among both, for a Pearson correlation coefficient of 0.920. Conclusions: The monitoring of carbon dioxide exhaled acts as a variable to consider in the monitoring of patients with acute chronic obstructive lung disease, treated with non invasive ventilation, whenever the appropriate face mask is used and the leaks are controlled, with strong correlation with the arterial pressure of the carbon dioxide.

RESUMEN Introducción: la migraña es la séptima causa de discapacidad laboral, doméstica y social en el mundo y es la principal causa de discapacidad entre las afecciones neurológicas. Los factores asociados al grado de discapacidad por migraña se han estudiado poco. Objetivo: identificar los factores de riesgo con influencia independiente sobre la discapacidad moderada a grave por migraña. Método: se realizó un estudio de casos y testigos en pacientes con migraña. El tamaño de la muestra se calculó mediante el programa EpiDat 3.0. La muestra definitiva se conformó con 104 pacientes con discapacidad moderada a grave (casos) y 208 pacientes con discapacidad mínima a ligera (testigos). Resultados: se observó que la frecuencia de días con cefaleas en los tres meses previos incrementó el riesgo de discapacidad moderada a grave en más de 24 veces (OR 24,24 IC95 % 8,10-72,46), tener asociadas otros patrones de cefalea casi decuplicó el riesgo (OR 9,04 IC95 % 3,75-21,80) y tener una mala calidad del sueño lo sextuplicó (OR 6,06 IC95 %, 29-16,06). La fonofobia moderada o intensa (OR 4,99 IC95 % 2,06-12,09); las nauseas frecuentes (OR 3,24 IC95% 1,29-8,11); la ansiedad patológica (OR 3,06 IC95 % 1,28-7,34); el abuso de analgésicos (OR 2,95 IC95 % 1,26-6,88 y la depresión (OR 2,79 IC95 % 1,09-7,21) también se comportaron como factores de riesgo. Conclusiones: los factores de riesgo con influencia independiente más importantes sobre la discapacidad moderada a grave por migraña fueron la frecuencia de cefaleas, tener asociadas otros patrones de cefalea, tener mala calidad del sueño y la fonofobia moderada o intensa. ABSTRACT Introduction: migraine is the seventh cause of work, domestic and social disability in the world and is the main cause of disability among neurological conditions. Factors associated with the degree of migraine disability have been little studied. Objective: to identify risk factors with independent influence on moderate to severe migraine disability. Method: a case-control study was conducted in patients with migraine. The sample size was calculated using the EpiDat 3.0 program. The final sample consisted of 104 patients with moderate to severe disability (cases) and 208 patients with mild to moderate disability (controls). Results: it was observed that the frequency of days with headaches in the previous three months increased the risk of moderate to severe disability by more than 24 times (OR- 24.24; 95 % CI- 8.10-72.46), have associated other patterns of headache almost doubled the risk (OR- 9.04; 95 % CI- 3.75-21.80) and having a poor sleep quality increased sextupled (OR- 6.06; 95 % CI- 2.29-16.06). Moderate or intense phonophobia (OR- 4.99; 95 % CI- 2.06-12.09); frequent nausea (OR 3.24 95% CI 1.29-8.11); pathological anxiety (OR- 3.06; 95 % CI- 1.28-7.34); the abuse of analgesics (OR- 2.95 95 % CI- 1.26-6.88 and depression (OR- 2.79; 95 % CI- 1.09-7.21) also behaved as risk factors. Conclusions: the most important independent influencing risk factors for moderate to severe migraine disability were the frequency of headaches, associated headache patterns, poor sleep quality, and moderate or severe phonophobia.