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Moral V, Abad Motos A, Jericó C, Antelo Caamaño ML, Ripollés Melchor J, Bisbe Vives E, García Erce JA. Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00083-0. [PMID: 38670490 DOI: 10.1016/j.redare.2024.04.015] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The "Patient Blood Management" (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. OBJECTIVE To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. MATERIAL AND METHODS A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety. Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants). In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14). The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations. Statistical treatment: tabulation of mean, median and interquartiles 25-75 of the value of each survey question (Tables 1, 2 and 3). RESULTS Except for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into: 1.- "It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients". 2.- "The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition". 3.- "There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8-10 g/dL who are candidates for potentially bleeding surgery that cannot be delayed." 4.- "It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients." 5.- "Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term". CONCLUSIONS There was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.
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Affiliation(s)
- V Moral
- Department of Anaesthesia. Hospital Universitario Sant Pau and Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - A Abad Motos
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain; Spanish Perioperative Audit and Research Network (ReDGERM), Zaragoza, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR).
| | - C Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España,www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM, www.grupogerm.es); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, Spain
| | - M L Antelo Caamaño
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
| | - J Ripollés Melchor
- Spanish Perioperative Audit and Research Network (ReDGERM), Zaragoza, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR); Department of Anesthesiology, and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - E Bisbe Vives
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España,www.awge.org); Department of Anaesthesiology, Parc de Salut Mar, Barcelona, Spain
| | - J A García Erce
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España,www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM, www.grupogerm.es); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, Spain; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain.
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Muñoz M, Aragón S, Ballesteros M, Bisbe-Vives E, Jericó C, Llamas-Sillero P, Meijide-Míguez HM, Rayó-Martin E, Rodríguez-Suárez MJ. Executive summary of the consensus document on the management of perioperative anemia in Spain. Rev Clin Esp 2024; 224:225-232. [PMID: 38423382 DOI: 10.1016/j.rceng.2024.02.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.
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Affiliation(s)
- M Muñoz
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología. Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - S Aragón
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de la Ribera, Valencia, Spain.
| | - M Ballesteros
- Servicio de Hematología y Hemoterapia, H.G.U. Gregorio Marañón, Madrid, Spain.
| | - E Bisbe-Vives
- Servicio de Anestesiología, Hospital del Mar, Barcelona, Spain.
| | - C Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Barcelona, Spain.
| | - P Llamas-Sillero
- Servicio de Hematología y Hemoterapia, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
| | - H M Meijide-Míguez
- Servicio de Medicina Interna, Hospital Quironsalud A Coruña, Grupo de Trabajo de Asistencia Compartida y Medicina Consultiva (SEMI), A Coruña, Spain.
| | - E Rayó-Martin
- Medicina de familia, EAP SARDENYA, Barcelona, Spain.
| | - M J Rodríguez-Suárez
- Servicio de Ginecología y Obstetricia, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Ruiz-Castellano M, Jericó C, García-Erce JA. [Intravenous iron administration in Home Hospitalization Units: Good practice recommendations]. Med Clin (Barc) 2023; 161:351-356. [PMID: 37537018 DOI: 10.1016/j.medcli.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Affiliation(s)
- María Ruiz-Castellano
- Unidad de Hospitalización a Domicilio, Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, España.
| | - Carlos Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi - Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), España; Grupo de Investigación de Gestión en el Paciente Sangrante, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Jose Antonio García-Erce
- Grupo Español de Rehabilitación Multimodal (GERM), España; Grupo de Investigación de Gestión en el Paciente Sangrante, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España
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Ripollés-Melchor J, Abad-Motos A, Bruna-Esteban M, García-Nebreda M, Otero-Martínez I, Abdel-Lah Fernández O, Tormos-Pérez MP, Paseiro-Crespo G, García-Álvarez R, A Mayo-Ossorio M, Zugasti-Echarte O, Nespereira-García P, Gil-Gómez L, Logroño-Ejea M, Risco R, Parreño-Manchado FC, Gil-Trujillo S, Benito C, Jericó C, De-Miguel-Cabrera MI, Ugarte-Sierra B, Barragán-Serrano C, García-Erce JA, Muñoz-Hernández H, Río-Fernández SD, Herrero-Bogajo ML, Espinosa-Moreno AM, Concepción-Martín V, Zorrilla-Vaca A, Vaquero-Pérez L, Mojarro I, Llácer-Pérez M, Gómez-Viana L, Fernández-Martín MT, Abad-Gurumeta A, Ferrando-Ortolà C, Ramírez-Rodríguez JM, Aldecoa C. Association between use of enhanced recovery after surgery protocols and postoperative complications after gastric surgery for cancer (POWER 4): a nationwide, prospective multicentre study. Cir Esp 2023; 101:665-677. [PMID: 37094777 DOI: 10.1016/j.cireng.2023.04.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial. METHODS Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence with 22 individual components of ERAS pathways were assessed in all patients, regardless of whether they were treated in a self-designed ERAS centre. Each centre had a three-month recruitment period between October 2019 and September 2020. The primary outcome was moderate-to-severe postoperative complications within 30 days after surgery. Secondary outcomes were overall postoperative complications, adherence to the ERAS pathway, 30 day-mortality and hospital length of stay (LOS). RESULTS A total of 743 patients in 72 Spanish hospitals were included, 211 of them (28.4 %) from self-declared ERAS centres. A total of 245 patients (33 %) experienced postoperative complications, graded as moderate-to-severe complications in 172 patients (23.1 %). There were no differences in the incidence of moderate-to-severe complications (22.3% vs. 23.5%; OR, 0.92 (95% CI, 0.59 to 1.41); P = 0.068), or overall postoperative complications between the self-declared ERAS and non-ERAS groups (33.6% vs. 32.7%; OR, 1.05 (95 % CI, 0.70 to 1.56); P = 0.825). The overall rate of adherence to the ERAS pathway was 52% [IQR 45 to 60]. There were no differences in postoperative outcomes between higher (Q1, > 60 %) and lower (Q4, ≤ 45 %) ERAS adherence quartiles. CONCLUSIONS Neither the partial application of perioperative ERAS measures nor treatment in self-designated ERAS centres improved postoperative outcomes in patients undergoing gastric surgery for cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03865810.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Ane Abad-Motos
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
| | - Marcos Bruna-Esteban
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, La Fe University Hospital, Valencia, Spain
| | - María García-Nebreda
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain; Department of General Surgery, Infanta Leonor University Hospital, Madrid, Spain
| | - Isabel Otero-Martínez
- Department of General Surgery, Hospital Álvaro Cunqueiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain
| | - Omar Abdel-Lah Fernández
- Department of General Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - María P Tormos-Pérez
- Department of Anaesthesia and Perioperative Medicine, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Gloria Paseiro-Crespo
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain; Department of General Surgery, Infanta Leonor University Hospital, Madrid, Spain
| | - Raquel García-Álvarez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | - María A Mayo-Ossorio
- Department of General Surgery, Hospital Universitario Puerta del Mar Cádiz, Cádiz, Spain
| | - Orreaga Zugasti-Echarte
- Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Navarra, Pamplona, Spain
| | | | - Lucia Gil-Gómez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital de Sant Joan Despí Moisès Broggi, Spain
| | - Margarita Logroño-Ejea
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital Universitario de Alava, Vitoria, Spain
| | - Raquel Risco
- Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | | | - Silvia Gil-Trujillo
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Carmen Benito
- Department of Anaesthesia and Perioperative Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Jericó
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Internal Medicine, Hospital Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain
| | - María I De-Miguel-Cabrera
- Department of Anaesthesia and Perioperative Medicine, Hospital General Universitari Castelló, Castellón de La Plana, Spain
| | - Bakarne Ugarte-Sierra
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Hospital Galdakao-Usansolo, Spain
| | | | - José A García-Erce
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Banco de Sangre y Tejidos de Navarra, Pamplona, Spain
| | - Henar Muñoz-Hernández
- Department of Anaesthesia and Perioperative Medicine, Hospital Clínico de Valladolid, Spain
| | - Sabela Del- Río-Fernández
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - María L Herrero-Bogajo
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Alma M Espinosa-Moreno
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Vanessa Concepción-Martín
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Nuestra Señora de Candelaria Hospital Universitario, Spain
| | - Andrés Zorrilla-Vaca
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Vaquero-Pérez
- Department of Anaesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Irene Mojarro
- Department of Anaesthesia and Perioperative Medicine, Juan Ramón Jiménez University Hospital, Huelva, Spain
| | - Manuel Llácer-Pérez
- Department of Anaesthesia and Perioperative Medicine, Hospital Costa del Sol, Marbella, Spain
| | - Leticia Gómez-Viana
- Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - María T Fernández-Martín
- Department of Anaesthesia and Perioperative Medicine, Hospital Medina del Campo, Medina del Campo, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Ferrando-Ortolà
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Lozano Blesa University Hospital, Universidad de Zaragoza, Zaragoza, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
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García-Erce JA, Jericó C. [It's necessary the effective implementation of PBM "Patient Blood Management" programs]. Med Clin (Barc) 2023; 161:248-250. [PMID: 37244857 DOI: 10.1016/j.medcli.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/29/2023]
Affiliation(s)
- José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, España.
| | - Carlos Jericó
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, España; Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Bisbe E, Basora M, Colomina MJ, Becerra-Bolaños Á, Bermúdez-López M, Massa-Gómez C, Albaladejo-Magdalena J, Solar-Herrera A, Pérez-Chrzanowska H, Yárnoz C, Fedriani-de-Matos JJ, Blanco-Del-Val B, Fabián-González D, Bellver J, Redondo-Enríquez JM, Serrat-Puyol J, Abad-Gurumeta A, Zorrilla-Vaca A, Aldecoa C, García-Erce JA. Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty. Acta Anaesthesiol Scand 2023; 67:629-639. [PMID: 36795045 DOI: 10.1111/aas.14217] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. METHODS Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl-1 for females and < 13 g dl-1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30-day moderate-to-severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. RESULTS A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl-1 was associated with fewer postoperative complications. CONCLUSION Preoperative haemoglobin ≥14 g dl-1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.
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Affiliation(s)
- Ane Abad-Motos
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Javier Ripollés-Melchor
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Complex Hospitalari Moisès Broggi, Barcelona, Spain
| | - Elvira Bisbe
- Department of Anaesthesiology, Parc de Salut Mar, Barcelona, Spain
| | | | - Maria J Colomina
- Department of Anaesthesiology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Bermúdez-López
- Department of Anaesthesiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Cristina Massa-Gómez
- Department of Anaesthesiology, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | | | - Ana Solar-Herrera
- Department of Anaesthesiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Hanna Pérez-Chrzanowska
- Department of Anaesthesiology, Hospital Cantoblanco, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Yárnoz
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain
| | | | | | - David Fabián-González
- Department of Anaesthesiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Bellver
- Department of Anaesthesiology, Hospital Universitario Dr Peset, Valencia, Spain
| | | | | | - Alfredo Abad-Gurumeta
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | | | - César Aldecoa
- Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
- Department of Anaesthesiology, Hospital Universitario Rio Hortega, Valladolid, Spain
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7
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Juárez-Vela R, Quintana-Diaz M, Rodríguez-Calvo A, Santos-Sánchez JÁ, Gero-Escapa M, Gallego-Curto E, Satústegui-Dordá PJ, Sánchez-González JL, Jericó C, Ruiz de Viñaspre-Hernández R, Gil-Fernández G, García-Erce JA. Profile and characteristics of the adequacy of blood transfusions in Trauma Intensive Care. A cross sectional multicenter study. Front Public Health 2023; 11:1133191. [PMID: 37020819 PMCID: PMC10067921 DOI: 10.3389/fpubh.2023.1133191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/24/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Major trauma is one of the major health care problems facing modern society, trauma systems require careful planning to achieve an ideal level of coverage for the population. The Patient Blood Management Program is an integrated and global strategy to provide patient care that aims to assess and address, when possible, the etiology of blood abnormalities rather than transfuse without treating the underlying cause. We aimed to describe the factors that are associated with the clinical decision to transfuse polytraumatized patients admitted to the Intensive Care Unit (ICU). Method We performed a cross sectional multicenter study of patients admitted to ICUs for trauma in 14 Spanish hospitals from September 2020 to December 2021. Results A total of 69 patients were treated in the emergency room due to polytrauma, 46% of them were considered serious in the initial triage. Thirty were caused by a fall from considerable height (43.47%), followed by 39 patients admitted due to trac accidents (56.52%). The location of the trauma was mainly cranioencephalic, followed by thoracic trauma. Of the 69 patients, 25 received a blood transfusion during their ICU stay (36.23%). Discussion No significant differences were observed between transfused and non-transfused patients, except for the severity scales, where transfused patients have a higher score on all the scales assessed in the ICU except for the Revised Trauma Score. As we can see, the incidence of kidney failure was also different between the groups analyzed, reaching 44.00% in transfused patients and 13.64% in the group of patients without blood transfusion, p = 0.005. In this sense, 92.00% of the transfusions performed were inadequate according to the criteria of Hb in blood prior to the decision to transfuse (Hb < 9). Our data support the need to consider clinical practice guidelines regarding blood transfusion and its practices.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Department of Nursing, Research Group in Care (GRUPAC), University of La Rioja, Logroño, Spain
- Center of Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - Manuel Quintana-Diaz
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
- Intensive Care Unit, PBM Group, IdiPAZ, Hospital La Paz, Madrid, Spain
| | - Antonio Rodríguez-Calvo
- Complex Hospital University of Salamanca, Salamanca, Spain
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Complex Hospital University of Salamanca, Salamanca, Spain
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | | | | | - Pedro José Satústegui-Dordá
- Research Group of the University of Zaragoza B43_20R Water and Environmental Health, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Carlos Jericó
- Internal Medicine Department, Complex Hospitalari Moisés Broggi, Sant Joan Despí, Spain
| | - Regina Ruiz de Viñaspre-Hernández
- Department of Nursing, Research Group in Care (GRUPAC), University of La Rioja, Logroño, Spain
- Center of Biomedical Research of La Rioja (CIBIR), Logroño, Spain
- *Correspondence: Regina Ruiz de Viñaspre-Hernández
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8
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Jericó C, Puértolas N, Osorio J, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Pulido L, Pera M. Cost analysis of a patient blood management program for patients undergoing gastric cancer surgery. Eur J Surg Oncol 2023; 49:293-297. [PMID: 36163062 DOI: 10.1016/j.ejso.2022.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
Patient Blood Management (PBM) programs have probed to reduce blood transfusions and postoperative complications following gastric cancer resection, but evidence on their economic benefit is scarce. A recent prospective interventional study of our group described a reduction in transfusions, infectious complications and length of stay after implementation of a multicenter PBM program in patients undergoing elective gastric cancer resection with curative intent. The aim of the present study was to analyze the economic impact associated with these clinical benefits. The mean [and 95% CI] of total healthcare cost per patient was lower (-1955 [-3764, -119] €) after the PBM program implementation. The main drivers of this reduction were the hospital stay (-1847 [-3161, -553] €), blood transfusions (-100 [-145, -56] €), and post-operative complications (-162 [-718, 411] €). Total societal cost was reduced by -2243 [-4244, -210] € per patient. These findings highlight the potential economic benefit of PBM strategies.
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Affiliation(s)
- Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Noelia Puértolas
- Department of Surgery, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, Pamplona, Spain.
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, Girona, Spain.
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
| | - Alexis Luna
- Service of Surgery, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, Granollers, Barcelona, Spain.
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, Tarragona, Spain.
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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9
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Puértolas N, Osorio J, Jericó C, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Molinas J, Pulido L, Gimeno M, Pera M. Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection. Cancers (Basel) 2022; 15:cancers15010144. [PMID: 36612141 PMCID: PMC9818188 DOI: 10.3390/cancers15010144] [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: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06−2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14−2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40−1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88−2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64−4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence.
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Affiliation(s)
- Noelia Puértolas
- Service of Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
- Correspondence: ; Tel.: +34-637286009
| | - Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, 17007 Girona, Spain
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Alexis Luna
- Service of Surgery, Consorci Corporació Sanitària Parc Taulí de Sabadell, 08208 Sabadell, Spain
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, 08402 Granollers, Spain
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, 43005 Tarragona, Spain
| | - Joan Molinas
- Service of Surgery, Hospital Universitari de Vic, 08500 Vic, Spain
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
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10
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Montoro M, Cucala M, Lanas Á, Villanueva C, Hervás AJ, Alcedo J, Gisbert JP, Aisa ÁP, Bujanda L, Calvet X, Mearin F, Murcia Ó, Canelles P, García López S, Martín de Argila C, Planella M, Quintana M, Jericó C, García Erce JA. Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts. Front Med (Lausanne) 2022; 9:903739. [PMID: 36186804 PMCID: PMC9519983 DOI: 10.3389/fmed.2022.903739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023] Open
Abstract
Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs.
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Affiliation(s)
- Miguel Montoro
- Unidad de Gastroenterología, Hepatología y Nutrición, Hospital Universitario San Jorge, Huesca, Spain
- Departamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS), Zaragoza, Spain
- *Correspondence: Miguel Montoro,
| | | | - Ángel Lanas
- Departamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS), Zaragoza, Spain
- Servicio de Aparato Digestivo, Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Cándido Villanueva
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Servei de Digestiu, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonio José Hervás
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Javier Alcedo
- Departamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ángeles P. Aisa
- Servicio de Aparato Digestivo, Hospital Universitario Costa del Sol, Marbella, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Donostia, Donostia, Spain
- Instituto de Investigación Sanitaria Biodonostia, Universidad del País Vasco (UPV/EHU), Donostia, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Servei de Digestiu, Corporació Sanitaria Park Taulí, Sabadell, Spain
- Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Fermín Mearin
- Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain
| | - Óscar Murcia
- Servicio de Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pilar Canelles
- Servicio de Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, Spain
| | - Santiago García López
- Departamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Montserrat Planella
- Servei de Digestiu, Hospital Universitario Arnau de Vilanova, Lleida, Spain
- Department of Medicine, Universidad de Lleida, Lleida, Spain
| | - Manuel Quintana
- Servicio a Medicina Intensiva, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carlos Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
| | - José Antonio García Erce
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
- Instituto Aragonés de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
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11
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Leache L, Gutiérrez-Valencia M, Enguita-Germán M, Librero J, Gorricho J, Jericó C, García-Erce JA. COVID-19 infection and complications according to ABO blood group in the elderly: A population-based subcohort and meta-analysis. Vox Sang 2022; 117:1230-1234. [PMID: 35843888 PMCID: PMC9349979 DOI: 10.1111/vox.13334] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES It is reported that ABO antibodies have a role in COVID-19 infection and severity; however, ABO antibody titres vary with advanced age. The aim was to analyse the association between ABO blood group and risk of COVID-19 infection and complications in elderly patients, and to contrast this data with findings in the overall adult population. MATERIALS AND METHODS A prospective cohort study of the Navarre (Spain) population aged ≥60 years and a meta-analysis of published studies including participants of ≥60 years were carried out. RESULTS In the Navarre elderly population, a higher risk of COVID-19 infection was identified in the A versus non-A and O group and lower risk in O versus non-O, with no significant association between hospitalization, intensive care unit admission or mortality and any of the blood groups, results that coincide with those of the overall Navarre adult population. The meta-analyses using studies that included participants of ≥60 years demonstrated a higher risk of hospitalization and mortality in A versus non-A and a lower mortality risk with B versus non-B. Similar mortality results were found in the meta-analyses of the overall adult population. CONCLUSION There are no relevant differences between the overall adult population and population aged ≥60 years in the risk of COVID-19 infection and severity according to ABO blood groups, suggesting that age-related changes in ABO would be of limited clinical significance.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mónica Enguita-Germán
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Unit of Methodology, Navarrabiomed, Pamplona, Spain.,University Hospital of Navarra (HUN), Pamplona, Spain.,Public University of Navarre (UPNA), Pamplona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Javier Gorricho
- Service of Evaluation and Dissemination of Results, Navarre Health Service, Pamplona, Spain
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Jose Antonio García-Erce
- Blood and Tissue Bank of Navarre, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Sciences Institute (IACS), Zaragoza, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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12
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurumeta A, Quintana Díaz M. PBM: Now more than ever necessary. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:351-354. [PMID: 35760689 PMCID: PMC9226968 DOI: 10.1016/j.redare.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, Spain
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, Spain
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), Spain
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), Spain
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Spain
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, Spain
| | - A Abad-Gurumeta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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13
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Enguita-Germán M, Librero J, Leache L, Gutiérrez-Valencia M, Tamayo I, Jericó C, Gorricho J, García-Erce JA. Role of the AB0 blood group in COVID-19 infection and complications: A population-based study. Transfus Apher Sci 2022; 61:103357. [PMID: 35148968 PMCID: PMC8762836 DOI: 10.1016/j.transci.2022.103357] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern Spain) with no history of SARS-CoV-2 infection and with known ABO blood group, after one year of the pandemic (May 2020 - May 2021). The risk of infection, hospitalization, Intensive Care Unit (ICU) admission and death was analyzed using multivariate logistic regression, adjusting for possible confounding variables. A lower risk of infection was observed in group 0 vs non-0 groups [OR 0.94 (95 %CI 0.90-0.99)], a higher risk of infection in group A vs non-A groups [OR 1.09 (95 %CI 1.04-1.15)] and a higher risk of infection in group A vs group 0 [OR 1.08 (95CI 1.03-1.14)] (when the 4 groups are analyzed separately). No association was observed between blood groups and hospitalization, ICU admission, or death in SARS-CoV-2 infected subjects. Regarding the risk of SARS-CoV-2 infection, we observed a protective role of group O and a greater risk in the A group.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Julián Librero
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Spain.
| | | | - Ibai Tamayo
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Javier Gorricho
- Servicios de Evaluación y Difusión de Resultados, Servicio Navarro de Salud-Osasunbidea, Spain.
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Grupo idiPAZ de «Investigación en PBM», Madrid, Spain.
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14
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Jericó C, Zalba-Marcos S, Quintana-Díaz M, López-Villar O, Santolalla-Arnedo I, Abad-Motos A, Laso-Morales MJ, Sancho E, Subirà M, Bassas E, Ruiz de Viñaspre-Hernández R, Juárez-Vela R, García-Erce JA. Relationship between ABO Blood Group Distribution and COVID-19 Infection in Patients Admitted to the ICU: A Multicenter Observational Spanish Study. J Clin Med 2022; 11:jcm11113042. [PMID: 35683430 PMCID: PMC9181327 DOI: 10.3390/jcm11113042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic in December 2019, a relationship between the ABO blood group type and the novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, has been reported, noting that individuals with the O blood group are the least likely to be infected. Spain is one of the most badly affected countries worldwide, with high rates of patients diagnosed, hospitalized, and deceased due to COVID-19 infection. The present study aimed to analyze the possible relationship of ABO in COVID-19 patients hospitalized in different Spanish centers during the first wave of the COVID-19 pandemic, for which the ABO group was available. Physicians from the transfusion services of different Spanish hospitals, who have developed a multicenter retrospective observational study, were invited to participate voluntarily in the research and 12,115 patients with COVID-19 infection were admitted to the nine participating hospitals. The blood group was known in 1399 cases (11.5%), of which 365 (26.1%) were admitted to the ICU. Regarding the distribution of ABO blood groups, a significant increase in the non-O blood groups and reduction for the O blood group was observed in patients hospitalized due to COVID-19, compared to the reference general population. Among the patients admitted to the ICU, after multivariate analysis, adjusted for the rest of the confounding variables, patients with the O blood group presented a significantly lower risk for admission to the ICU. We conclude that an association was observed between patients with the O blood group and their lower susceptibility to SARS-CoV-2 infection, both for those admitted to the hospitalization ward and for those who required admission to the ICU.
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Affiliation(s)
- Carlos Jericó
- Internal Medicine Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | - Saioa Zalba-Marcos
- Haematology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain;
| | - Manuel Quintana-Díaz
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Intensive Care Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Olga López-Villar
- Transfusion Service, Haematology Department, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | | | - Ane Abad-Motos
- Anaesthesia Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | | | - Esther Sancho
- Haematology Department, Hospital General de Granollers, 08402 Granollers, Spain;
| | - Maricel Subirà
- Haematology Department, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | - Eva Bassas
- Anaesthesia Department, Complex Hospitalari Moisés Broggi, 08970 Sant Joan Despí, Spain;
| | | | - Raúl Juárez-Vela
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Department of Nursing-GRUPAC, University of La Rioja, La Rioja, 26006 Logroño, Spain;
- Correspondence: (R.R.d.V.-H.); (R.J.-V.)
| | - José Antonio García-Erce
- PBM Research Group, Idi-Paz Research Institute, 28046 Madrid, Spain; (M.Q.-D.); (J.A.G.-E.)
- Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, 31003 Pamplona, Spain
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15
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Gutiérrez‐Valencia M, Leache L, Librero J, Jericó C, Enguita Germán M, García‐Erce JA. ABO blood group and risk of COVID-19 infection and complications: A systematic review and meta-analysis. Transfusion 2022; 62:493-505. [PMID: 34773411 PMCID: PMC8661771 DOI: 10.1111/trf.16748] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Marta Gutiérrez‐Valencia
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain,Navarra Institute for Health Research (IdiSNA)PamplonaSpain
| | - Leire Leache
- Unit of Innovation and OrganizationNavarre Health ServicePamplonaSpain
| | - Julián Librero
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain,Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Carlos Jericó
- Department of Internal MedicineHospital Sant Joan Despí‐Moisès Broggi, Consorci Sanitari Integral. Sant Joan DespíBarcelonaSpain
| | - Mónica Enguita Germán
- Navarrabiomed ‐ Complejo Hospitalario de Navarra – UPNAPamplonaSpain,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC)MadridSpain
| | - Jose Antonio García‐Erce
- Navarra's Blood and Tissue BankNavarre Health ServicePamplonaSpain,Grupo Español de Rehabilitación Multimodal (GERM)Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
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16
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Marquès M, Correig E, Ibarretxe D, Anoro E, Antonio Arroyo J, Jericó C, Borrallo RM, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Masana L, Domingo JL. Long-term exposure to PM 10 above WHO guidelines exacerbates COVID-19 severity and mortality. Environ Int 2022; 158:106930. [PMID: 34678637 PMCID: PMC8519784 DOI: 10.1016/j.envint.2021.106930] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. OBJECTIVES We aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. METHODS A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. RESULTS We found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM10 (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DISCUSSION These results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
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Affiliation(s)
- Montse Marquès
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Eudald Correig
- Universitat Rovira i Virgili, Department of Biostatistics, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Daiana Ibarretxe
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | - Rosa M Borrallo
- Internal Medicine Department. Terrasa Hospital. Consorci Sanitari Terrassa, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili. Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
| | - Lluís Masana
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - José L Domingo
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
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17
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Marquès M, Correig E, Ibarretxe D, Anoro E, Antonio Arroyo J, Jericó C, Borrallo RM, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Masana L, Domingo JL. Long-term exposure to PM 10 above WHO guidelines exacerbates COVID-19 severity and mortality. Environ Int 2022; 158:106930. [PMID: 34678637 DOI: 10.21203/rs.3.rs-569549/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. OBJECTIVES We aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. METHODS A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. RESULTS We found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM10 (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DISCUSSION These results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
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Affiliation(s)
- Montse Marquès
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Eudald Correig
- Universitat Rovira i Virgili, Department of Biostatistics, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Daiana Ibarretxe
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | - Rosa M Borrallo
- Internal Medicine Department. Terrasa Hospital. Consorci Sanitari Terrassa, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili. Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
| | - Lluís Masana
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - José L Domingo
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
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18
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurrumenta A, Quintana Díaz M. PBM: Now more than ever necessary. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00181-X. [PMID: 34563367 PMCID: PMC8486592 DOI: 10.1016/j.redar.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/12/2023]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, España
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, España
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, España
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, España
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), España
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), España
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, España
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, España
| | - A Abad-Gurrumenta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España
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19
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Beverina I, Jericó C, Quintana-Díaz M, García-Erce JA. Therapeutic Alternative to Transfusion in Nonpregnant Women With Iron Deficiency Anemia Caused by Uterine Blood Loss. J Emerg Med 2021; 60:565-566. [PMID: 33902882 DOI: 10.1016/j.jemermed.2020.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/12/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain; Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain
| | - Manuel Quintana-Díaz
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain; PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Intensive Care Unit, University Hospital La Paz, Madrid, Spain
| | - José Antonio García-Erce
- PBM Group, Hospital La Paz, Institute for Health Research, Madrid, Spain; Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
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20
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Masana L, Correig E, Ibarretxe D, Anoro E, Arroyo JA, Jericó C, Guerrero C, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Plana N, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J. Low HDL and high triglycerides predict COVID-19 severity. Sci Rep 2021; 11:7217. [PMID: 33785815 PMCID: PMC8010012 DOI: 10.1038/s41598-021-86747-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [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] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Lipids are indispensable in the SARS-CoV-2 infection process. The clinical significance of plasma lipid profile during COVID-19 has not been rigorously evaluated. We aim to ascertain the association of the plasma lipid profile with SARS-CoV-2 infection clinical evolution. Observational cross-sectional study including 1411 hospitalized patients with COVID-19 and an available standard lipid profile prior (n: 1305) or during hospitalization (n: 297). The usefulness of serum total, LDL, non-HDL and HDL cholesterol to predict the COVID-19 prognosis (severe vs mild) was analysed. Patients with severe COVID-19 evolution had lower HDL cholesterol and higher triglyceride levels before the infection. The lipid profile measured during hospitalization also showed that a severe outcome was associated with lower HDL cholesterol levels and higher triglycerides. HDL cholesterol and triglyceride concentrations were correlated with ferritin and D-dimer levels but not with CRP levels. The presence of atherogenic dyslipidaemia during the infection was strongly and independently associated with a worse COVID-19 infection prognosis. The low HDL cholesterol and high triglyceride concentrations measured before or during hospitalization are strong predictors of a severe course of the disease. The lipid profile should be considered as a sensitive marker of inflammation and should be measured in patients with COVID-19.
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Affiliation(s)
- Lluís Masana
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain.
| | - Eudald Correig
- Statistics Department, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira I Virgili, Reus, Spain
| | - Daiana Ibarretxe
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu I Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain
| | - Carolina Guerrero
- Internal Medicine Department, Terrasa Hospital, Consorci Sanitari Terrassa, Barcelona, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de La Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM, Universitat Rovira I Virgili, Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | - Núria Plana
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain
| | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme I La Selva, Hospital de Blanes, Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
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21
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García-Erce JA, Romón-Alonso Í, Jericó C, Domingo-Morera JM, Arroyo-Rodríguez JL, Sola-Lapeña C, Bueno-Cabrera JL, Juárez-Vela R, Zalba-Marcos S, Abad-Motos A, Gea-Caballero V, Santolalla-Arnedo I, Quintana-Díaz M. Blood Donations and Transfusions during the COVID-19 Pandemic in Spain: Impact According to Autonomous Communities and Hospitals. Int J Environ Res Public Health 2021; 18:ijerph18073480. [PMID: 33801650 PMCID: PMC8037479 DOI: 10.3390/ijerph18073480] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Worldwide, the COVID-19 pandemic has caused a decline in blood donations, between 30% and 70% in some of the most affected countries. In Spain, during the initial eight weeks after the State of Emergency was decreed on 14 March 2020, in the weekly reports of the Health Ministry, an average decrease of 20% was observed between 11 and week 25 compared with the 2018 donation. We aimed to investigate the impact of the COVID-19 pandemic on blood donations and blood distribution in four autonomous communities, and to explore the evolution of the consumption of blood components (BCs) in ten hospitals of six autonomous communities. We performed a prospective study of grouped cohorts on the donation and distribution of blood in four regional transfusion centers in four autonomous communities in Spain, and a retrospective study of the consumption of blood components in ten hospitals in six autonomous communities. Regarding donations, there was no significant decrease in donations, with differences between autonomous communities, which started between 1 and 15 March 2020 (−11%). The increase in donations in phase II (from 26 May 2020) stands out. Regarding consumption, there was a significant reduction in the consumption of packed red blood cells (RBCs) (24.5%), plasma (45.3%), and platelets (25.3%) in the central period (16 March–10 May). The reduction in the consumption of RBCs was significant in the period from 1–15 March. Conclusions: The COVID-19 pandemic has affected the donation and consumption of BCs.
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Affiliation(s)
- José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro Salud, Grupo Español de Rehabilitación Multimodal (GERM), IACS, Zaragoza, Grupo IdiPaz. Madrid, 31008 Pamplona, Spain;
| | - Íñigo Romón-Alonso
- Servicio Hematología y Hemoterapia, Universitario Marqués de Valdecilla, 39003 Santander, Spain;
| | - Carlos Jericó
- Hospital Sant Joan Despí de Barcelona Servicio de Medicina Interna, 08970 Barcelona, Spain;
| | | | | | | | - José Luis Bueno-Cabrera
- Servicio Hematología-Hemoterapia, Hospital Universitario Puerta de Hierro, 28222 Majadahonda-Madrid, Spain;
| | - Raúl Juárez-Vela
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Saioa Zalba-Marcos
- Servicio Hematología-Hemoterapia, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Ane Abad-Motos
- Servicio Anestesia y Reanimación, Hospital Infanta Leonor, 28031 Madrid, Spain;
| | - Vicente Gea-Caballero
- Health Research Institut La Fe, Adscript Center Universidad de Valencia, Nursing School La Fe, 46026 Valencia, Spain;
| | - Iván Santolalla-Arnedo
- Departamento de Enfermería, Universidad de la Rioja, Centro de Investigación Biomédica de La Rioja CIBIR-GISOSS, 26004 Logroño, Spain
- Correspondence: (R.J.-V.); (I.S.-A.)
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Grupo IdiPaz. Madrid, 28046 Madrid, Spain;
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22
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Armario P, Jericó C. Benefits of LDL cholesterol reduction in the secondary prevention of ischemic stroke New evidence. Clin Investig Arterioscler 2021; 33:53-54. [PMID: 32792089 DOI: 10.1016/j.arteri.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Pedro Armario
- Área de Atención Integrada de Riesgo Vascular. Servicio de Medicina Interna. Hospital de Sant Joan Despí Moisès Broggi. Consorci Sanitari Integral, Barcelona, España; Universitat de Barcelona, Barcelona, España.
| | - Carlos Jericó
- Área de Atención Integrada de Riesgo Vascular. Servicio de Medicina Interna. Hospital de Sant Joan Despí Moisès Broggi. Consorci Sanitari Integral, Barcelona, España
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23
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Masana L, Correig E, Rodríguez-Borjabad C, Anoro E, Arroyo JA, Jericó C, Pedragosa A, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Plana N, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Group OBOTSXR. EFFECT oF STATIN THERAPY oN SARS-CoV-2 INFECTION-RELATED. Eur Heart J Cardiovasc Pharmacother 2020; 8:157-164. [PMID: 33135047 PMCID: PMC7665420 DOI: 10.1093/ehjcvp/pvaa128] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Aim Assessing the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality. Methods and Results Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients (1234 men, 923 women; age: 67 y/o (IQR 54-78)) admitted to the hospital were retrieved from the clinical records in anonymized manner. 353 deaths occurred. 581 patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on statin therapy than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: p = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared to the GM non-statin group (17.4%; p = 0.045). The Cox model applied to the CSH function (HR = 0.58(CI: 0.39-0.89); p = 0.01) and the competing risks FG model (HR = 0.60(CI: 0.39-0.92); p = 0.02) suggest that statins are associated with reduced COVID-19-related mortality. Conclusions A lower SARS-CoV-2 infection-related mortality was observed in patients treated with statin therapy prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.
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Affiliation(s)
- Lluís Masana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eudald Correig
- Statistics Department, Institut Investigació Sanitaria Pere Virgili, Reus, Spain
| | - Cèlia Rodríguez-Borjabad
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | | | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili., Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | - Núria Plana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
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24
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Jericó C, Beverina I, Quintana-Diaz M, Salvadori U, Melli C, Rondinelli MB, Recasens V, Brando B, Garcia-Erce JA. Efficacy and safety of high-dose intravenous iron as the first-choice therapy in outpatients with severe iron deficiency anemia. Transfusion 2020; 60:1443-1449. [PMID: 32597514 DOI: 10.1111/trf.15870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Asymptomatic severe iron deficiency anemia is a common finding in subjects admitted to the outpatient anemia clinic. Although the condition can be easily be reversed with intravenous iron (IVI) therapy and several guidelines have suggested a restrictive threshold for using transfusion in hemodynamically stable patients, transfusion is often the rule in clinical practice. This study describes clinical practice results of IVI therapy without transfusion. STUDY DESIGN AND METHODS In this multicenter retrospective observational study, data of severely anemic outpatients treated only with high-dose IVI with ferric carboxymaltose were collected. Inclusion criteria were hemoglobin (Hb) level of less than 7.0 g/dL and ferritin level of less than 30 ng/mL or mean corpuscular volume of less than 75 fL. RESULTS Overall, 303 patients referred to the anemia clinic mainly from primary health care centers (46.2%) or the emergency department (28.7%) met the inclusion criteria. Median (interquartile range [IQR]) age was 47 (37-62) years and 84.5% were female. The median (IQR) Hb concentration at first visit was 6.5 (6.1-6.8) g/dL, 64 patients (21.1%) presented with a Hb level of less than 6.0 g/dL at diagnosis, and 11 of them (3.6%) had extreme anemia (Hb ≤ 5 g/dL). Gynecologic and gastroenteric bleeding were the main cause. After a mean IV administration of 1500 mg of iron, the Hb increased by a median of 5.7 g/dL. Thirteen patients experienced only mild side effects. CONCLUSIONS In chronic very severe sideropenic anemias, third-generation IVI is effective and safe for quick correction and avoidance of red blood cell transfusion. These results suggest that more specific guidelines for this clinical setting are warranted.
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Affiliation(s)
- Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain.,Department of Medicine, Autonomous University of Madrid, Madrid, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Ivo Beverina
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - Manuel Quintana-Diaz
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain.,PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Intensive Care Unit, University Hospital La Paz, Madrid, Spain
| | - Ugo Salvadori
- Department of Immunohaematology and Transfusion, Central Hospital of Bolzano, Bolzano, Italy
| | - Cristina Melli
- Department of Transfusion Medicine, Udine University Hospital, Udine, Italy
| | | | - Valle Recasens
- Department of Hematology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Bruno Brando
- Blood Transfusion Centre, Legnano General Hospital, Legnano, Italy
| | - José Antonio Garcia-Erce
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,REDGERM, Grupo Español de Rehabilitación Multimodal, Zaragoza, Spain.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
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25
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Basora M, Aldecoa C, Cabellos-Olivares M, Navarro-Pérez R, Bisbe E, García-Erce JA. Patient Blood Management for primary hip and knee replacement. A survey among POWER.2 study researchers. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:237-244. [PMID: 32165061 DOI: 10.1016/j.redar.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implementation of Patient Blood Management programs remain variable in Europe, and even in centres with well-established PBM programs variability exists in transfusion practices. OBJECTIVES AND METHODS We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip and knee replacement among researchers involved in POWER.2 Study in Spain (an observational prospective study evaluating enhanced recovery pathways in orthopaedic surgery). RESULTS A total of 322 responses were obtained (37.8%). Half of responders check Haemoglobin levels in patients at least 4 weeks before surgery; 35% treat all anaemic patients, although 99.7% consider detection and treatment of preoperative anaemia could influence the postoperative outcomes. Lack of infrastructure (76%) and lack of time (51%) are the main stated reasons not to treat anaemic patients. Iron status is routinely checked by 19% before surgery, and 36% evaluate it solely in the anaemic patient. Hb<9.9 g/dl is the threshold to delay surgery for 61% of clinicians, and 22% would consider transfusing preoperatively clinically stable patients without active bleeding. The threshold to transfuse patients without cardiovascular disease is 8 g/dl for 43%, and 7 g/dl for 34% of the responders; 75% of clinicians consider they use "restrictive thresholds", and 90% follow the single unit transfusion policy. CONCLUSIONS The results of our survey show variability in clinical practice in Patient Blood Management in major orthopaedic surgery, despite being the surgery with the greatest tradition in these programs.
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Affiliation(s)
- A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari, Barcelona, España; Anemia Working Group España (AWGE)
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - M Cabellos-Olivares
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Guadalajara, Guadalajara, España
| | - R Navarro-Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Clínico San Carlos, Madrid, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España; Anemia Working Group España (AWGE)
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
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26
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Reina D, Jericó C, Estrada P, Navarro V, Torrente V, Armario P, Corominas H. Ecografía en el diagnóstico y manejo de los xantomas tendinosos en la hipercolesterolemia familiar. ACTA ACUST UNITED AC 2019; 15:305-306. [DOI: 10.1016/j.reuma.2017.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/22/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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28
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Jericó C, Osorio J, García-Erce JA, Pera M. Patient Blood Management strategies for iron deficiency anemia management in gastric cancer. Eur J Gastroenterol Hepatol 2019; 31:547-548. [PMID: 30829765 DOI: 10.1097/meg.0000000000001383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisés Broggi, Sant Joan Despi.,Spanish Multidisciplinary Group for the Study and Management of Surgical Patient Anemia
| | - Javier Osorio
- Department of Surgery, University Hospital Mutua Terrasa, Terrassa, Barcelona.,EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona
| | - José A García-Erce
- EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona.,Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain
| | - Manuel Pera
- Department of Surgery, University Hospital del Mar, Barcelona.,EUropean REgister for Cancer CARe-EURECCA-Oesophago-Gastric Cancer Registry, Barcelona and Pamplona
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29
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Osorio J, Jericó C, Miranda C, Garsot E, Luna A, Miró M, Santamaría M, Artigau E, Rodríguez-Santiago J, Castro S, Feliu J, Aldeano A, Olona C, Momblan D, Ruiz D, Galofré G, Pros I, García-Albéniz X, Lozano M, Pera M. Conducta transfusional perioperatoria en la cirugía del cáncer gástrico: análisis del registro del grupo español EURECCA de cáncer esófago-gástrico. Cir Esp 2018; 96:546-554. [DOI: 10.1016/j.ciresp.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022]
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30
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Laso-Morales M, Jericó C, Gómez-Ramírez S, Castellví J, Viso L, Roig-Martínez I, Pontes C, Muñoz M. Preoperative management of colorectal cancer-induced iron deficiency anemia in clinical practice: data from a large observational cohort. Transfusion 2017; 57:3040-3048. [PMID: 28833205 DOI: 10.1111/trf.14278] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC. STUDY DESIGN AND METHODS This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January 2012 to December 2013). Preoperative anemia was defined as a hemoglobin (Hb) level of less than 13 g/dL and treated with intravenous iron (IVI) or standard care (oral iron or no iron). Red blood cell transfusion (RBCT) requirements was the primary outcome variable. Postoperative infection rate and length of hospital stay (LOS) were secondary outcome variables. Patients were managed with a restrictive transfusion trigger (Hb < 8 g/dL). Infection was diagnosed clinically and confirmed by laboratory, microbiologic, and/or radiologic evidence. RESULTS Overall, 322 of 571 patients (56%) presented with anemia: 232 received IVI and 90 standard care. There were differences in RBCT rate between no anemia and anemia (2% vs. 16%; p < 0.01), but not in postoperative infections (19% vs. 22%; p = NS) or LOS. Compared to those on standard care, anemic patients on IVI presented with lower Hb (10.8 g/dL vs. 12.0 g/dL; p < 0.001) at baseline, but similar Hb on day of surgery and Postoperative Day 30. There were no between-group differences in RBCT rates (16% vs. 17%; p = NS), but infection rates were lower among IVI-treated patients (18% vs. 29%; p < 0.05). No relevant IVI-related side effects were recorded. CONCLUSION Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.
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Affiliation(s)
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí Moisés Broggi-Consorci Sanitari Integral, Barcelona, Spain
| | - Susana Gómez-Ramírez
- Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Jordi Castellví
- Department of General Surgery, Hospital Sant Joan Despí Moisés Broggi-Consorci Sanitari Integral, Barcelona, Spain
| | - Lorenzo Viso
- Department of General Surgery, Hospital Sant Joan Despí Moisés Broggi-Consorci Sanitari Integral, Barcelona, Spain
| | | | - Caridad Pontes
- Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Sabadell, Spain
| | - Manuel Muñoz
- Perioperative Transfusion Medicine, Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
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31
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Armario P, Jericó C, Vila L, Freixa R, Martin-Castillejos C, Rotllan M. Área de Atención Integrada de Riesgo Vascular: un nuevo modelo organizativo para el control global de los factores de riesgo. Hipertensión y Riesgo Vascular 2017; 34:72-77. [DOI: 10.1016/j.hipert.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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32
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Jericó C, Bretón I, García Ruiz de Gordejuela A, de Oliveira AC, Rubio MÁ, Tinahones FJ, Vidal J, Vilarrasa N. [Diagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery]. ACTA ACUST UNITED AC 2015; 63:32-42. [PMID: 26611153 DOI: 10.1016/j.endonu.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/19/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023]
Abstract
Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.
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Affiliation(s)
- Carlos Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Barcelona, España. Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (www.awge.org).
| | - Irene Bretón
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Gregorio Marañón, Madrid, España
| | - Amador García Ruiz de Gordejuela
- Unidad de Cirugía Bariátrica y Metabólica. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Francisco J Tinahones
- Servicio de Endocrinología, Hospital Virgen de la Victoria, Málaga, España; CIBEROBN Instituto de Salud Carlos III, Madrid, España
| | - Josep Vidal
- Unidad de obesidad, Hospital Clínic Universitari, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España. Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, España
| | - Nuria Vilarrasa
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Bellvitge-IDIBELL, Barcelona, España. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
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Knobel H, Jericó C, Montero M, Sorli ML, Velat M, Guelar A, Saballs P, Pedro-Botet J. Global cardiovascular risk in patients with HIV infection: concordance and differences in estimates according to three risk equations (Framingham, SCORE, and PROCAM). AIDS Patient Care STDS 2007; 21:452-7. [PMID: 17651026 DOI: 10.1089/apc.2006.0165] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To compare cardiovascular risk stratification according to Framingham, PROCAM (Prospective Cardiovascular Münster), and SCORE (Systematic Coronary Risk Evaluation) equations in patients with HIV infection, a cross-sectional study of a well-characterized cohort of 760 HIV-infected adults managed at the outpatient Infectious Disease Unit in 2003 was conducted. Cardiovascular risk score was examined and patients were classified as having low, moderate, or high risk using Framingham and PROCAM (<10%, 10%-20%, and <20%, respectively) and SCORE (<3%, 3%-4%, and >/=5%, respectively) equations. The prevalence of patients with low, moderate and high cardiovascular risk was 76.6%, 15.1%, and 8.3% by the Framingham, respectively, 90.1%, 4.9%, and 5% by the PROCAM, respectively, and 88.6%, 3%, and 8.4% by SCORE, respectively. Concordance between these three risk functions was significant, but globally moderate (Framingham and PROCAM, kappa 0.36, p < 0.0001; Framingham and SCORE, kappa 0.32, p < 0.0001; PROCAM and SCORE, kappa 0.46, p < 0.0001). The Framingham equation categorized a higher proportion of HIV-infected male patients with moderate cardiovascular risk and a lower proportion of those with low risk (p < 0.0001) compared with PROCAM and SCORE. The present study showed a high prevalence of HIV-infected patients at low cardiovascular risk regardless of the assessed coronary risk system used. However, compared with PROCAM and SCORE, Framingham risk equation in HIV-infected patients identified a higher number of male patients with moderate cardiovascular risk.
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Affiliation(s)
- Hernando Knobel
- Internal Medicine and Infectious Disease Department, Hospital del Mar, Barcelona, Spain
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Jericó C, Knobel H, Sorli ML, Montero M, Guelar A, Pedro-Botet J. Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH. Rev Clin Esp 2006; 206:556-9. [PMID: 17178075 DOI: 10.1157/13096303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. PATIENTS AND METHOD A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. RESULTS The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. CONCLUSION Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort.
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Affiliation(s)
- C Jericó
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
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Jericó C, Knobel H, Calvo N, Sorli ML, Guelar A, Gimeno-Bayón JL, Saballs P, López-Colomés JL, Pedro-Botet J. Subclinical carotid atherosclerosis in HIV-infected patients: role of combination antiretroviral therapy. Stroke 2006; 37:812-7. [PMID: 16439699 DOI: 10.1161/01.str.0000204037.26797.7f] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Whether or not combination antiretroviral therapy (CART) alone directly contributes to accelerating atherosclerosis in HIV-infected patients has not been studied in depth. This study aimed to ascertain the relationship between this therapy and subclinical carotid atherosclerosis according to cardiovascular risk. METHODS Sixty-eight HIV-infected patients with < or =1 cardiovascular risk factors and 64 with > or =2 risk factors completed the study protocol consisting of clinical, laboratory, and vascular evaluation by carotid high-resolution B-mode ultrasonography. Univariate and multivariate logistic regression analyses were performed with the presence of subclinical carotid atherosclerosis, defined by carotid intima-media thickness >0.8 mm or the presence of plaque being the dependent variable. RESULTS Among the 132 enrolled patients, 93 (70.5%) were on CART and 39 (29.5%) had never been on antiretroviral therapy. In accordance with cardiovascular risk stratification, subclinical carotid atherosclerosis was found in 26.6% (17 of 64 patients) of the very low-risk group (10-year coronary risk <5%), 35.3% (12 of 34 patients) of the low-risk group (10-year coronary risk between 5% and 9%) and 76.5% (26 of 34 patients) of the moderate/high-risk group (10-year coronary risk > or =10%). Thus, 55 (41.7%) of the 132 HIV-infected patients had subclinical carotid atherosclerosis, and independent variables associated with carotid atherosclerosis (odds ratio; 95% CI) were: CART exposure (10.5; 2.8 to 39) and 10-year coronary risk > or =10% (4.2; 1.5 to 12). In very low coronary risk patients (<5%), age (per 10-year increment: 4.01; 1.12 to 14.38), systolic blood pressure (per unit mm Hg 1.07; 1.01 to 1.14), and CART exposure (8.65; 1.54 to 48.54) were independently associated with subclinical carotid atherosclerosis. CONCLUSIONS CART should be considered a strong, independent predictor for the development of subclinical atherosclerosis in HIV-infected patients, regardless of known major cardiovascular risk factors and atherogenic metabolic abnormalities induced by this therapy.
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Affiliation(s)
- Carlos Jericó
- Department of Medicine, Hospital del Mar, Barcelona, Spain
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Jericó C, Knobel H, Montero M, Sorli ML, Guelar A, Gimeno JL, Saballs P, López-Colomés JL, Pedro-Botet J. Hypertension in HIV-infected patients: prevalence and related factors. Am J Hypertens 2005; 18:1396-401. [PMID: 16280270 DOI: 10.1016/j.amjhyper.2005.05.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 05/10/2005] [Accepted: 05/10/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Little is known about hypertension in the HIV-infected population. This study aimed to assess the prevalence of hypertension and related factors in HIV-infected patients. METHODS In this prospective cross-sectional study, 710 HIV-infected patients (626 on combination antiretroviral therapy and 84 naive) managed at the outpatient clinic of a tertiary hospital during 2003 and 802 controls completed the study protocol consisting of medical examination and a 6-month follow-up period including three control visits. RESULTS Hypertension prevalence was 13.1% in HIV-infected patients and 13.5% in the control group. Age (per 10-year increment) (odds ratio [OR]: 1.92; 95% confidence interval [CI]: 1.48-2.48), body mass index (OR: 1.18; 95% CI: 1.10-1.27), and lipoaccumulation pattern of fat redistribution (OR: 2.26; 95% CI: 1.20-4.24) were independently and significantly associated with the presence of hypertension in HIV-infected patients at logistic regression analysis. CONCLUSIONS The present results suggest no meaningful difference in prevalence of hypertension between subjects with and without HIV infection. Thus, the influence of combination antiretroviral therapy appears to have little impact on the prevalence of hypertension.
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Affiliation(s)
- Carlos Jericó
- Department of Medicine, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
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Pedro-Botet J, Jericó C. Etiopatogenia de la arteriosclerosis. Aspectos celulares y moleculares del daño vascular. Aten Primaria 2005. [DOI: 10.1016/s0212-6567(05)70579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jericó C, Knobel H, Montero M, Ordoñez-Llanos J, Guelar A, Gimeno JL, Saballs P, López-Colomés JL, Pedro-Botet J. Metabolic syndrome among HIV-infected patients: prevalence, characteristics, and related factors. Diabetes Care 2005; 28:132-7. [PMID: 15616246 DOI: 10.2337/diacare.28.1.132] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence in HIV-infected patients of the metabolic syndrome as defined by the National Cholesterol Education Program, i.e., three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose. RESEARCH DESIGN AND METHODS In this cross-sectional study, 710 HIV-infected patients managed at the outpatient clinic of a tertiary hospital during 2003 completed the study protocol consisting of a medical examination and laboratory analysis after a 12-h overnight fast. RESULTS Metabolic syndrome prevalence was 17% and increased from 5.1% among HIV-infected patients under age 30 years to 27.0% for those aged 50-59 years. Age (per 10-year increment) (odds ratio [OR] 1.41 [95% CI 1.12-1.77]), BMI (1.27 [1.19-1.36]), past and present protease inhibitor exposure (2.96 [1.03-3.55] and 4.18 [1.4-12.5], respectively) were independently associated with the metabolic syndrome on logistic regression analysis. Furthermore, only stavudine (d4T) (1.74 [1.01-2.98]) and lopinavir/ritonavir (2.46 [1.28-4.71]) were associated with the metabolic syndrome after adjustment for age and BMI. CONCLUSIONS The prevalence of metabolic syndrome among these HIV-infected patients is similar to that previously reported in uninfected individuals. Of specific concern is the association of protease inhibitor exposure with the metabolic syndrome and, more specifically, with exposure to stavudine and lopinavir/ritonavir when individual antiretroviral drugs were analyzed.
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Affiliation(s)
- Carlos Jericó
- Department of Medicine, Hospital del Mar, Barcelona, Spain
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Sorli ML, Jericó C, Pedro-Botet J. [Bilateral otitis media as presentation form of microscopic polyangiitis]. An Med Interna 2004; 21:364-5. [PMID: 15347248 DOI: 10.4321/s0212-71992004000700015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Jericó C, Knobel H, Montero M, Sorli M, López-Colomés J, Pedro-Botet J. W09.228 Prevalence of metabolic syndrome (MS) among HIV-infected patients. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jericó C, Sorli ML, Pedro-Botet J. Masa paravertebral como primera manifestación de un hepatocarcinoma. Gastroenterología y Hepatología 2004; 27:69-70. [PMID: 14733883 DOI: 10.1016/s0210-5705(03)79090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jericó C, Knobel H, Carmona A, Sorli ML, López-Colomés JL, Pedro-Botet J. Enfermedad cardiovascular sintomática en pacientes infectados por el virus de la inmunodeficiencia humana que reciben tratamiento antirretroviral de gran actividad. Med Clin (Barc) 2004; 122:298-300. [PMID: 15030741 DOI: 10.1016/s0025-7753(04)74214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Our goal was to assess the main characteristics of cardiovascular disease in HIV-infected patients on highly active antiretroviral therapy (HAART). PATIENTS AND METHOD Retrospective analysis of the clinico-epidemiological characteristics of 16 HIV-infected patients treated with HAART who had suffered a cardiovascular event from a 1,459 patients' cohort. RESULTS Clinical presentation of cardiovascular disease was an acute coronary syndrome in 12 cases, ischemic stroke in 2 and peripheral vascular disease in 2. Patients included in the study had a mean of 3.2 cardiovascular risk factors, smoking and low HDL levels being the more prevalent risk factors. Eight (50%, 95% CI, 25-75%) patients fulfilled the criteria of metabolic syndrome. The mean CD4 count was 548 x 10(6)/l. CONCLUSIONS HIV-infected patients on HAART ha-ve a high cardiovascular risk. A strict management of modifiable risk factors must be warranted in these patients.
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Affiliation(s)
- Carlos Jericó
- Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital del Mar, Universidad Autónoma de Barcelona, Spain
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Jericó C, Iglesias ML, Pedro-Botet J. [Descending necrotizing mediastinitis: an unfrequent life-threatening complication]. Med Clin (Barc) 2002; 119:198-9. [PMID: 12200025 DOI: 10.1016/s0025-7753(02)73360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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