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Fernández Alonso C, Fuentes Ferrer ME, García-Lamberechts EJ, Aguiló Mir S, Jiménez S, Jacob J, Piñera Salmerón P, Gil-Rodrigo A, Llorens P, Burillo-Putze G, Alquezar-Arbé A, Bretones Baena S, Fernández Cardona M, Hernández González R, Moreno Martín M, Barnes Parra A, El Farh I, Valle Borrego B, Quero Motto E, Artieda Larrañaga A, Soy Ferrer E, Hong Cho JU, Gros Bañeres B, Gayoso Martín S, Sánchez Sindín G, Prieto Zapico A, Cirera Lorenzo I, Guardiola Tey JM, Llauger L, González Del Castillo J, Miró Ò. Impact of dementia on 30-, 180-, and 365-day mortality during the first pandemic wave in older adults seen in spanish emergency departments diagnosed with or without COVID-19. Aging Ment Health 2024:1-9. [PMID: 38597417 DOI: 10.1080/13607863.2024.2337144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave. METHOD We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis. RESULTS We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32), p < .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58). CONCLUSION Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Manuel E Fuentes Ferrer
- Investigation Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Sira Aguiló Mir
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Adriana Gil-Rodrigo
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pere Llorens
- Emergency Department, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | | | - Aitor Alquezar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Ana Barnes Parra
- Emergency Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Imane El Farh
- Emergency Department, Hospital Francecs de Borja, Gandía, Spain
| | | | - Eva Quero Motto
- Emergency Department, Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Tost J, Díez MPL, Traveria L, Torres-Gárate R, Alonso MI, Agüera C, Valero A, Javaloyes P, Peacock WF, Bueno H, Mebazaa A, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGYM, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, Rodríguez-Adrada E, Rodríguez B. Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study. Eur J Intern Med 2019; 70:24-32. [PMID: 31451322 DOI: 10.1016/j.ejim.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. METHODS Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. RESULTS We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH <6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) >15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. CONCLUSIONS Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy.
| | - Joan Padrosa
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Koji Takagi
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Étienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - María Mir Montero
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Lissete Traveria
- Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Torres-Gárate
- Emergency Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | | | - Carmen Agüera
- Emergency Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Amparo Valero
- Emergency Department, Hospital Doctor Peset, València, Spain
| | - Patricia Javaloyes
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - W Frank Peacock
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Emergency Department, Baylor College of Medicine, Ben Taub General Hospital, Houston, USA
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eva Salvo
- Hospital Politénic La Fe de Valencia, Spain
| | - José Pavón
- Hospital Dr. Negrín de Las Palmas de Gran Canaria, Spain
| | - Antonio Noval
- Hospital Insular de Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aitor Alquezar
- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | | | - Sergio Herrera
- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | - Alex Roset
- Hospital Universitari de Bellvitge de Barcelona, Spain
| | - Irene Cabello
- Hospital Universitari de Bellvitge de Barcelona, Spain
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- Hospital Juan XXIII de Tarragona, Spain
| | | | - María Mir
- Hospital Infanta Leonor de Madrid, Spain
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Martín-Sánchez FJ, Cuesta Triana F, Rossello X, Pardo García R, Llopis García G, Caimari F, Vidán MT, Ruiz Artacho P, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Fernández Pérez C, Gil P, Bueno H, Miró Ò, Matía Martín P, Rodríguez Adrada E, Santos MC, Salgado L, Brizzi BN, Docavo ML, Del Mar Suárez-Cadenas M, Xipell C, Sánchez C, Aguiló S, Gaytan JM, Jerez A, Pérez-Durá MJ, Berrocal Gil P, López-Grima ML, Valero A, Aguirre A, Pedragosa MÀ, Piñera P, LázaroAragues P, Sánchez Nicolás JA, Rizzi MA, Herrera Mateo S, Alquezar A, Roset A, Ferrer C, Llopis F, Álvarez Pérez JM, López Diez MP, Richard F, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Andueza JA, Sevillano Fernández JA, Romero R, Merlo Loranca M, Álvarez Rodríguez V, Lorca MT, Calderón L, Soy Ferrer E, Manuel Garrido J, Martín Mojarro E. Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments. Eur J Intern Med 2019; 65:69-77. [PMID: 31076345 DOI: 10.1016/j.ejim.2019.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Federico Cuesta Triana
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Guillermo Llopis García
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisca Caimari
- Department of Endocrinology, University College London, Hospitals NHS Foundation Trust, London, UK
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Ruiz Artacho
- Department of Internal Medicine, Clínica Universitaria de Navarra, Madrid, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Emergency Department-UCE-UHD, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Cristina Fernández Pérez
- Universidad Complutense de Madrid, Madrid, Spain; Preventive Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Gil
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Héctor Bueno
- Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Pilar Matía Martín
- Universidad Complutense de Madrid, Madrid, Spain; Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Roset
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Ferrer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ferrán Llopis
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Rossello X, Miró Ò, Llorens P, Jacob J, Herrero-Puente P, Gil V, Rizzi MA, Pérez-Durá MJ, Espiga FR, Romero R, Sevillano JA, Vidán MT, Bueno H, Pocock SJ, Martín-Sánchez FJ, Fuentes M, Gil C, Alonso H, Garmila P, Rodríguez Adrada E, Llopis García G, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Mínguez Masó S, Isabel Alonso M, Ruiz F, Miguel Franco J, Díaz E, Belén Mecina A, Tost J, Sánchez S, Carbajosa V, Piñera P, Sánchez Nicolás JA, Torres Garate R, Alquezar A, Alberto Rizzi M, Herrera S, Roset A, Cabello I, Richard F, Álvarez Pérez JM, Pilar López Diez M, Vázquez Álvarez J, Alonso Morilla A, Irimia A, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Antonio Andueza J, Antonio Sevillano J, Romero R, Calvache R, Lorca MT, Calderón L, Amores Arriaga B, Sierra B, Martín Mojarro E, Travería Bécquer L, Burillo G, Llauger García L, Corominas LaSalle G, Agüera Urbano C, Belén García A, Elisa Delgado Padial S, Soy Ferrer E, Garrido M, Javier Lucas F, Gaya R. Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute Heart Failure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute Heart Failure in Emergency Departments Registry. Ann Emerg Med 2019; 73:589-598. [DOI: 10.1016/j.annemergmed.2018.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/09/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
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Ferrer ES, García-Navas V, Sanz JJ, Ortego J. Individual genetic diversity and probability of infection by avian malaria parasites in blue tits (Cyanistes caeruleus). J Evol Biol 2014; 27:2468-82. [PMID: 25264126 DOI: 10.1111/jeb.12489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
Understanding the importance of host genetic diversity for coping with parasites and infectious diseases is a long-standing goal in evolutionary biology. Here, we study the association between probability of infection by avian malaria (Plasmodium relictum) and individual genetic diversity in three blue tit (Cyanistes caeruleus) populations that strongly differ in prevalence of this parasite. For this purpose, we screened avian malaria infections and genotyped 789 blue tits across 26 microsatellite markers. We used two different arrays of markers: 14 loci classified as neutral and 12 loci classified as putatively functional. We found a significant relationship between probability of infection and host genetic diversity estimated at the subset of neutral markers that was not explained by strong local effects and did not differ among the studied populations. This relationship was not linear, and probability of infection increased up to values of homozygosity by locus (HL) around 0.15, reached a plateau at values of HL from 0.15 to 0.40 and finally declined among a small proportion of highly homozygous individuals (HL > 0.4). We did not find evidence for significant identity disequilibrium, which may have resulted from a low variance of inbreeding in the study populations and/or the small power of our set of markers to detect it. A combination of subtle positive and negative local effects and/or a saturation threshold in the association between probability of infection and host genetic diversity in combination with increased resistance to parasites in highly homozygous individuals may explain the observed negative quadratic relationship. Overall, our study highlights that parasites play an important role in shaping host genetic variation and suggests that the use of large sets of neutral markers may be more appropriate for the study of heterozygosity-fitness correlations.
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Affiliation(s)
- E S Ferrer
- Grupo de Investigación de la Biodiversidad Genética y Cultural, Instituto de Investigación en Recursos Cinegéticos - IREC (CSIC, UCLM, JCCM), Ciudad Real, Spain; Departamento de Ciencias Ambientales, Facultad de Ciencias Ambientales y Bioquímica, Universidad de Castilla-La Mancha, Toledo, Spain
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