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Lado-Baleato Ó, Torre J, O’Flaherty R, Alonso-Sampedro M, Carballo I, Fernández-Merino C, Vidal C, Gude F, Saldova R, González-Quintela A. Age-Related Changes in Serum N-Glycome in Men and Women-Clusters Associated with Comorbidity. Biomolecules 2023; 14:17. [PMID: 38254617 PMCID: PMC10813383 DOI: 10.3390/biom14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
(1) Aim: To describe, in a general adult population, the serum N-glycome in relation to age in men and women, and investigate the association of N-glycome patterns with age-related comorbidity; (2) Methods: The serum N-glycome was studied by hydrophilic interaction chromatography with ultra-performance liquid chromatography in 1516 randomly selected adults (55.3% women; age range 18-91 years). Covariates included lifestyle factors, metabolic disorders, inflammatory markers, and an index of comorbidity. Principal component analysis was used to define clusters of individuals based on the 46 glycan peaks obtained in chromatograms; (3) Results: The serum N-glycome changed with ageing, with significant differences between men and women, both in individual N-glycan peaks and in groups defined by common features (branching, galactosylation, sialylation, fucosylation, and oligomannose). Through K-means clustering algorithm, the individuals were grouped into a cluster characterized by abundance of simpler N-glycans and a cluster characterized by abundance of higher-order N-glycans. The individuals of the first cluster were older, showed higher concentrations of glucose and glycation markers, higher levels of some inflammatory markers, lower glomerular filtration rate, and greater comorbidity index; (4) Conclusions: The serum N-glycome changes with ageing with sex dimorphism. The N-glycome could be, in line with the inflammaging hypothesis, a marker of unhealthy aging.
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Affiliation(s)
- Óscar Lado-Baleato
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
- ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostel, 15706 Santiago de Compostela, Spain
| | - Jorge Torre
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
| | - Róisín O’Flaherty
- GlycoScience Group, National Institute for Bioprocessing Research and Training, Fosters Avenue, A94 X099 Dublin, Ireland (R.S.)
- Department of Chemistry, Maynooth University, W23 F2K8 Maynooth, Ireland
| | - Manuela Alonso-Sampedro
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
| | - Iago Carballo
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
| | - Carmen Fernández-Merino
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
- Primary Care, Santiago de Compostela Area, 15706 Santiago de Compostela, Spain
| | - Carmen Vidal
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
| | - Francisco Gude
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
- Primary Care, Santiago de Compostela Area, 15706 Santiago de Compostela, Spain
| | - Radka Saldova
- GlycoScience Group, National Institute for Bioprocessing Research and Training, Fosters Avenue, A94 X099 Dublin, Ireland (R.S.)
- UCD School of Medicine, College of Health and Agricultural Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Arturo González-Quintela
- Research Methodology Group, Health Research Institute of Santiago de Compostela (IDIS), Galician Health Service, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (Ó.L.-B.); (J.T.); (M.A.-S.); (I.C.); (C.F.-M.); (C.V.); (F.G.)
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Lado-Baleato Ó, Cadarso-Suárez C, Kneib T, Gude F. Multivariate reference and tolerance regions based on conditional transformation models: Application to glycemic markers. Biom J 2023; 65:e2200229. [PMID: 37357560 DOI: 10.1002/bimj.202200229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 06/27/2023]
Abstract
The reference interval is the most widely used medical decision-making, constituting a central tool in determining whether an individual is healthy or not. When the results of several continuous diagnostic tests are available for the same patient, their clinical interpretation is more reliable if a multivariate reference region (MVR) is available rather than multiple univariate reference intervals. MVRs, defined as regions containing 95% of the results of healthy subjects, extend the concept of the reference interval to the multivariate setting. However, they are rarely used in clinical practice owing to difficulties associated with their interpretability and the restrictions inherent to the assumption of a Gaussian distribution. Further statistical research is thus needed to make MVRs more applicable and easier for physicians to interpret. Since the joint distribution of diagnostic test results may well change with patient characteristics independent of disease status, MVRs adjusted for covariates are desirable. The present work introduces a novel formulation for MVRs based on multivariate conditional transformation models (MCTMs). Additionally, we take into account the estimation uncertainty of such MVRs by means of tolerance regions. These conditional MVRs imply no parametric restriction on the response, and potentially nonlinear continuous covariate effects can be estimated. MCTMs allow the estimation of the effects of covariates on the joint distribution of multivariate response variables and on these variables' marginal distributions, via the use of most likely transformation estimation. Our contributions proved reliable when tested with simulated data and for a real data application with two glycemic markers.
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Affiliation(s)
- Óscar Lado-Baleato
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Biostatistics and Biomedical Data Science Research Group, Department of Statistics, Mathematical Analysis, and Optimization, University of Santiago de Compostela, Galicia, Spain
- Galician Centre for Mathematical Research and Technology (CITMAGA), Santiago de Compostela, Galicia, Spain
| | - Thomas Kneib
- Statistics and Campus Institute Data Science, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Francisco Gude
- Clinical Epidemiology Unit, Complexo Hospitalario de Santiago de Compostela, Galicia, Spain
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Toubes-Navarro ME, Gude-Sampedro F, Álvarez-Dobaño JM, Reyes-Santias F, Rábade-Castedo C, Rodríguez-García C, Lado-Baleato Ó, Lago-Fidalgo R, Sánchez-Martínez N, Ricoy-Gabaldón J, Casal-Mouriño A, Abelleira-Paris R, Riveiro-Blanco V, Zamarrón-Sanz C, Rodríguez-Núñez N, Lama-López A, Ferreiro-Fernández L, Valdés-Cuadrado L. A pulmonary rehabilitation program reduces hospitalizations in chronic obstructive pulmonary disease patients: A cost-effectiveness study. Ann Thorac Med 2023; 18:190-198. [PMID: 38058789 PMCID: PMC10697305 DOI: 10.4103/atm.atm_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 08/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Although pulmonary rehabilitation (PR) is recommended in patients with chronic obstructive pulmonary disease (COPD), there is a scarcity of data demonstrating the cost-effectiveness and effectiveness of PR in reducing exacerbations. METHODS A quasi-experimental study in 200 patients with COPD was conducted to determine the number of exacerbations 1 year before and after their participation in a PR program. Quality of life was measured using the COPD assessment test and EuroQol-5D. The costs of the program and exacerbations were assessed the year before and after participation in the PR program. The incremental cost-effectiveness ratio (ICER) was estimated in terms of quality-adjusted life years (QALYs). RESULTS The number of admissions, length of hospital stay, and admissions to the emergency department decreased after participation in the PR program by 48.2%, 46.6%, and 42.5%, respectively (P < 0.001 for all). Results on quality of life tests improved significantly (P < 0.001 for the two tests). The cost of PR per patient and the cost of pre-PR and post-PR exacerbations were €1867.7 and €7895.2 and €4201.9, respectively. The PR resulted in a cost saving of €1826 (total, €365,200) per patient/year, and the gain in QALYs was+0.107. ICER was -€17,056. The total cost was <€20,000/QALY in 78% of patients. CONCLUSIONS PR contributes to reducing the number of exacerbations in patients with COPD, thereby slowing clinical deterioration. In addition, it is cost-effective in terms of QALYs.
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Affiliation(s)
| | - Francisco Gude-Sampedro
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
| | - José Manuel Álvarez-Dobaño
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
- University Clinical Hospital of Santiago de Compostela, Spain
| | - Francisco Reyes-Santias
- Department of Human Resources and General Services, University Clinical Hospital of Santiago de Compostela, Spain
| | - Carlos Rábade-Castedo
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | | | - Óscar Lado-Baleato
- Research Methods Group, Health Research Institute of Santiago de Compostela, Spain
- ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela, Spain
| | - Raquel Lago-Fidalgo
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
- Mathematics University of Santiago de Compostela, Spain
| | - Noelia Sánchez-Martínez
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago de Compostela, Spain
- Mathematics University of Santiago de Compostela, Spain
| | - Jorge Ricoy-Gabaldón
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Ana Casal-Mouriño
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Romina Abelleira-Paris
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Vanessa Riveiro-Blanco
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Carlos Zamarrón-Sanz
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Adriana Lama-López
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
| | - Lucía Ferreiro-Fernández
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
| | - Luis Valdés-Cuadrado
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Spain
- Interdisciplinary Group of research in Pulmonology, Institute of Sanitary research from Compostela, Spain
- Medicine University of Santiago de Compostela, Spain
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Casal-Mouriño A, Álvarez-Dobaño JM, Domínguez MJ, Gude F, Toubes ME, Lado-Baleato Ó, Martínez de Alegría A, Taboada M, Riveiro V, Rodríguez-Núñez N, Lama A, Ferreiro L, Otero B, Suárez-Antelo J, Pose A, Valdés L. Development of prognostic models to estimate the probability of lung injury one year after COVID-19-related hospitalization-a prospective study. J Thorac Dis 2023; 15:2971-2983. [PMID: 37426134 PMCID: PMC10323564 DOI: 10.21037/jtd-22-1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/24/2023] [Indexed: 07/11/2023]
Abstract
Background Long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection still under study. The objectives of this study were to identify persistent pulmonary lesions 1 year after coronavirus disease 2019 (COVID-19) hospitalization and assess whether it is possible to estimate the probability that a patient develops these complications in the future. Methods A prospective study of ≥18 years old patients hospitalized for SARS-COV-2 infection who develop persistent respiratory symptoms, lung function abnormalities or have radiological findings 6-8 weeks after hospital discharge. Logistic regression models were used to identify prognostic factors associated with a higher risk of developing respiratory problems. Models performance was assessed in terms of calibration and discrimination. Results A total of 233 patients [median age 66 years [interquartile range (IQR): 56, 74]; 138 (59.2%) male] were categorized into two groups based on whether they stayed in the critical care unit (79 cases) or not (154). At the end of follow-up, 179 patients (76.8%) developed persistent respiratory symptoms, and 22 patients (9.4%) showed radiological fibrotic lesions with pulmonary function abnormalities (post-COVID-19 fibrotic pulmonary lesions). Our prognostic models created to predict persistent respiratory symptoms [post-COVID-19 functional status at initial visit (the higher the score, the higher the risk), and history of bronchial asthma] and post-COVID-19 fibrotic pulmonary lesions [female; FVC% (the higher the FVC%, the lower the probability); and critical care unit stay] one year after infection showed good (AUC 0.857; 95% CI: 0.799-0.915) and excellent performance (AUC 0.901; 95% CI: 0.837-0.964), respectively. Conclusions Constructed models show good performance in identifying patients at risk of developing lung injury one year after COVID-19-related hospitalization.
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Affiliation(s)
- Ana Casal-Mouriño
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | | | - María Jesús Domínguez
- Internal Medicine Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Clinical Epidemiology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - María E. Toubes
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Óscar Lado-Baleato
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Manuel Taboada
- Anesthesia and Resuscitation Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Adriana Lama
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Borja Otero
- Esteve Teijin Company, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Antonio Pose
- Internal Medicine Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Esteve Teijin Company, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Medicine Department, University of Santiago, Santiago de Compostela, Spain
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Rañó-Santamaría O, Fernandez-Merino C, Castaño-Carou AI, Lado-Baleato Ó, Fernández-Domínguez MJ, Sanchez-Castro JJ, Gude F. Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study. Front Med (Lausanne) 2022; 9:1015195. [PMID: 36507495 PMCID: PMC9726913 DOI: 10.3389/fmed.2022.1015195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health. Objectives (1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality. Materials and methods In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression. Results A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33). Conclusion (1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.
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Affiliation(s)
| | | | | | - Óscar Lado-Baleato
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,*Correspondence: Óscar Lado-Baleato,
| | | | | | - Francisco Gude
- Health Research Institute (IDIS), Santiago de Compostela, Spain,Clinical Epidemiology Unit, University Clinic Hospital, Santiago de Compostela, Spain
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Lado-Baleato Ó, Roca-Pardiñas J, Cadarso-Suárez C, Gude F. Modeling conditional reference regions: Application to glycemic markers. Stat Med 2021; 40:5926-5946. [PMID: 34396576 DOI: 10.1002/sim.9163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022]
Abstract
Many clinical decisions are taken based on the results of continuous diagnostic tests. Usually, only the results of one single test is taken into consideration, the interpretation of which requires a reference range for the healthy population. However, the use of two different tests, can be necessary in the diagnosis of certain diseases. This obliges a bivariate reference region be available for their interpretation. It should also be remembered that reference regions may depend on patient variables (eg, age and sex) independent of the suspected disease. However, few proposals have been made regarding the statistical modeling of such reference regions, and those put forward have always assumed a Gaussian distribution, which can be rather restrictive. The present work describes a new statistical method that allows such reference regions to be estimated with no insistence on the results being normally distributed. The proposed method is based on a bivariate location-scale model that provides probabilistic regions covering a specific percentage of the bivariate data, dependent on certain covariates. The reference region is estimated nonparametrically and the nonlinear effects of continuous covariates via polynomial kernel smoothers in additive models. The bivariate model is estimated using a backfitting algorithm, and the optimal smoothing parameters of the kernel smoothers selected by cross-validation. The model performed satisfactorily in simulation studies under the assumption of non-Gaussian conditions. Finally, the proposed methodology was found to be useful in estimating a reference region for two continuous diagnostic tests for diabetes (fasting plasma glucose and glycated hemoglobin), taking into account the age of the patient.
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Affiliation(s)
- Óscar Lado-Baleato
- Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Galicia, Spain
| | - Javier Roca-Pardiñas
- Statistical Inference, Decision and Operations Research, Universidade de Vigo, Galicia, Spain
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Galicia, Spain
| | - Francisco Gude
- Clinical Epidemiology Unit, Complexo Hospitalario de Santiago de Compostela, Galicia, Spain
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Gude-Sampedro F, Fernández-Merino C, Ferreiro L, Lado-Baleato Ó, Espasandín-Domínguez J, Hervada X, Cadarso CM, Valdés L. Development and validation of a prognostic model based on comorbidities to predict COVID-19 severity: a population-based study. Int J Epidemiol 2021; 50:64-74. [PMID: 33349845 PMCID: PMC7799114 DOI: 10.1093/ije/dyaa209] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The prognosis of patients with COVID-19 infection is uncertain. We derived and validated a new risk model for predicting progression to disease severity, hospitalization, admission to intensive care unit (ICU) and mortality in patients with COVID-19 infection (Gal-COVID-19 scores). METHODS This is a retrospective cohort study of patients with COVID-19 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) in Galicia, Spain. Data were extracted from electronic health records of patients, including age, sex and comorbidities according to International Classification of Primary Care codes (ICPC-2). Logistic regression models were used to estimate the probability of disease severity. Calibration and discrimination were evaluated to assess model performance. RESULTS The incidence of infection was 0.39% (10 454 patients). A total of 2492 patients (23.8%) required hospitalization, 284 (2.7%) were admitted to the ICU and 544 (5.2%) died. The variables included in the models to predict severity included age, gender and chronic comorbidities such as cardiovascular disease, diabetes, obesity, hypertension, chronic obstructive pulmonary disease, asthma, liver disease, chronic kidney disease and haematological cancer. The models demonstrated a fair-good fit for predicting hospitalization {AUC [area under the receiver operating characteristics (ROC) curve] 0.77 [95% confidence interval (CI) 0.76, 0.78]}, admission to ICU [AUC 0.83 (95%CI 0.81, 0.85)] and death [AUC 0.89 (95%CI 0.88, 0.90)]. CONCLUSIONS The Gal-COVID-19 scores provide risk estimates for predicting severity in COVID-19 patients. The ability to predict disease severity may help clinicians prioritize high-risk patients and facilitate the decision making of health authorities.
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Affiliation(s)
- Francisco Gude-Sampedro
- Departamento de Epidemiología. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
- Grupo de Métodos de Investigación, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Carmen Fernández-Merino
- Grupo de Métodos de Investigación, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
- Departamento de Medicina Familiar y Comunitaria. Centro de Saúde A Estrada. Pontevedra, Spain
| | - Lucía Ferreiro
- Servicio de Neumología. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología. Instituto de Investigaciones Sanitarias de Santiago (IDIS). Santiago de Compostela, Spain
| | - Óscar Lado-Baleato
- Departamento de Estadística, Análisis Matemático y Optimización. Grupo Interdisciplinar de Bioestadística y Ciencia de Datos Biométricos (GRID-BDS), Universidad de Santiago de Compostela. Santiago de Compostela, Spain
| | - Jenifer Espasandín-Domínguez
- Departamento de Epidemiología. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
| | - Xurxo Hervada
- Subdirección de Información sobre Saúde e Epidemioloxía. Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia. Santiago de Compostela, Spain
| | - Carmen M Cadarso
- Departamento de Estadística, Análisis Matemático y Optimización. Grupo Interdisciplinar de Bioestadística y Ciencia de Datos Biométricos (GRID-BDS), Universidad de Santiago de Compostela. Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain
- Grupo Interdisciplinar de Investigación en Neumología. Instituto de Investigaciones Sanitarias de Santiago (IDIS). Santiago de Compostela, Spain
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González-Salvado V, Peña-Gil C, Lado-Baleato Ó, Cadarso-Suárez C, Prada-Ramallal G, Prescott E, Wilhelm M, Eser P, Iliou MC, Zeymer U, Ardissino D, Bruins W, van der Velde AE, Van't Hof AWJ, de Kluiver EP, Kolkman EK, Prins L, González Juanatey JR. Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study. Eur J Prev Cardiol 2021; 28:558-568. [PMID: 33558875 DOI: 10.1093/eurjpc/zwaa104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. METHODS AND RESULTS The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. CONCLUSION In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.
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Affiliation(s)
- Violeta González-Salvado
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Carlos Peña-Gil
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Óscar Lado-Baleato
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Prada-Ramallal
- Epidemiology, Statistics and Research Methodology Unit, Santiago de Compostela Institute for Research Foundation (FIDIS), Santiago de Compostela, Spain
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Astrid E van der Velde
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | | | - José Ramón González Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
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9
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Ferreiro L, Lado-Baleato Ó, Toubes ME, Suárez-Antelo J, Pose-Reino A, San José ME, Álvarez-Dobaño JM, González-Barcala FJ, Ricoy J, Gude F, Valdés L. Identification of Pleural Response Patterns: A Cluster Analysis. Arch Bronconeumol 2019; 56:426-434. [PMID: 31759846 DOI: 10.1016/j.arbres.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pleural effusion occurs as a response of the pleura to aggressions. The pleura reacts differently according to the type of injury. However, pleural reactions have not yet been characterized. The objective of this study was to identify homogeneous clusters of patients based on the analytical characteristics of their pleural fluid and identify pleural response patterns. METHODS A prospective study was conducted of consecutive patients seen in our unit for pleural effusion. Principal component and cluster analyses were carried out to identify pleural response patterns based on a combination of pleural fluid biomarkers. RESULTS A total of 1613 patients were grouped into six clusters, namely: cluster 1 (10.5% of the cohort, primarily composed of patients with malignant pleural effusions); cluster 2 (17.4%, pleural effusions with inflammatory biomarkers); cluster 3 (16.1%, primarily composed of patients with infectious pleural effusions); cluster 4 (2.5%, a subcluster of cluster 3, superinfectious effusions); cluster 5 (23.4%, paucicellular pleural effusions); and cluster 6 (30.1%, miscellaneous). Significant differences were observed across clusters in terms of the analytical characteristics of PF (p<0.001 for all), age (p<0.001), and gender (p=0.016). A direct relationship was found between the type of cluster and the etiology of pleural effusion. CONCLUSION Pleural response is heterogeneous. The pleura may respond differently to the same etiology or similarly to different etiologies, which hinders diagnosis of pleural effusion.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Óscar Lado-Baleato
- Department of Epidemiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Research Group on Epidemiology of Common Diseases, Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - María E Toubes
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Antonio Pose-Reino
- Department of Internal Medicine, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - María E San José
- Department of Clinical Laboratory Analysis, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Manuel Álvarez-Dobaño
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco J González-Barcala
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Department of Epidemiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Research Group on Epidemiology of Common Diseases, Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain; Interdisciplinary Group of Research in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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10
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Ferreiro L, Lado-Baleato Ó, Suárez-Antelo J, Toubes ME, San José ME, Lama A, Rodríguez-Núñez N, Álvarez-Dobaño JM, González-Barcala FJ, Ricoy J, Gude F, Valdés L. La combinación de la determinación de parámetros bioquímicos del líquido pleural mejora la predicción diagnóstica de la infección pleural complicada/empiema. Arch Bronconeumol 2019; 55:565-572. [DOI: 10.1016/j.arbres.2019.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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11
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Ferreiro L, Lado-Baleato Ó, Suárez-Antelo J, Toubes ME, San José ME, Lama A, Rodríguez-Núñez N, Álvarez-Dobaño JM, González-Barcala FJ, Ricoy J, Gude F, Valdés L. Diagnosis of infectious pleural effusion using predictive models based on pleural fluid biomarkers. Ann Thorac Med 2019; 14:254-263. [PMID: 31620209 PMCID: PMC6784446 DOI: 10.4103/atm.atm_77_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION: Diagnosis of pleural infection (PI) may be challenging. The purpose of this paper is to develop and validate a clinical prediction model for the diagnosis of PI based on pleural fluid (PF) biomarkers. METHODS: A prospective study was conducted on pleural effusion. Logistic regression was used to estimate the likelihood of having PI. Two models were built using PF biomarkers. The power of discrimination (area under the curve) and calibration of the two models were evaluated. RESULTS: The sample was composed of 706 pleural effusion (248 malignant; 28 tuberculous; 177 infectious; 48 miscellaneous exudates; and 212 transudates). Areas under the curve for Model 1 (leukocytes, percentage of neutrophils, and C-reactive protein) and Model 2 (the same markers plus interleukin-6 [IL-6]) were 0.896 and 0.909, respectively (not significant differences). However, both models showed higher capacity of discrimination than their biomarkers when used separately (P < 0.001 for all). Rates of correct classification for Models 1 and 2 were 88.2% (623/706: 160/177 [90.4%] with infectious pleural effusion [IPE] and 463/529 [87.5%] with non-IPE) and 89.2% (630/706: 153/177 [86.4%] of IPE and 477/529 [90.2%] of non-IPE), respectively. CONCLUSIONS: The two predictive models developed for IPE showed a good diagnostic performance, superior to that of any of the markers when used separately. Although IL-6 contributes a slight greater capacity of discrimination to the model that includes it, its routine determination does not seem justified.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Santiago de Compostela, Spain
| | - Óscar Lado-Baleato
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Research Group for Epidemiology of Common Diseases, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - María Esther San José
- Interdisciplinary Research Group in Pulmonology, Santiago de Compostela, Spain.,Department of Clinical Laboratory Analysis, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Adriana Lama
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - José Manuel Álvarez-Dobaño
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Santiago de Compostela, Spain
| | - Francisco J González-Barcala
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Department of Clinical Epidemiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Research Group for Epidemiology of Common Diseases, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Santiago de Compostela, Spain
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