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Maestro de la Calle G, García Reyne A, Lora-Tamayo J, Muiño Miguez A, Arnalich-Fernandez F, Beato Pérez JL, Vargas Núñez JA, Caudevilla Martínez MA, Alcalá Rivera N, Orviz Garcia E, Sánchez Moreno B, Freire Castro SJ, Rhyman N, Pesqueira Fontan PM, Piles L, López Caleya JF, Fraile Villarejo ME, Jiménez-García N, Boixeda R, González Noya A, Gracia Gutiérrez A, Martín Oterino JÁ, Gómez Huelgas R, Antón Santos JM, Lumbreras Bermejo C. Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters. Revista Clínica Española (English Edition) 2023; 223:281-297. [PMID: 36997085 PMCID: PMC10074179 DOI: 10.1016/j.rceng.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/18/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS 7,915 COVID-19 patients were included in the analysis, 2,324 in the EP and 5,591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4,3% mortality risk reduction (HR 0.957; 95% CI 0.93 - 0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.
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Ramos-Rincón JM, Ventura PS, Casas-Rojo JM, Mauri M, Bermejo CL, de Latierro AO, Rubio-Rivas M, Mérida-Rodrigo L, Pérez-Casado L, Barrientos-Guerrero M, Giner-Galvañ V, Gallego-Lezaun C, Milián AH, Manzano L, Blázquez-Encinar JC, Solís-Marquínez MN, García MG, Lobo-García J, Valente VAR, Roig-Martí C, León-Téllez M, Tellería-Gómez P, González-Juárez MJ, Gómez-Huelgas R, López-Escobar A, Bermejo CL, Núñez-Cortés JM, Santos JMA, Huelgas RG, Corbella X, Pérez FF, Homs N, Montero A, Mora-Luján JM, Rubio-Rivas M, Bandera VA, Alegría JG, Jiménez-García N, del Pino JL, Escalante MDM, Romero FN, Rodriguez VN, Sierra JO, de Blas PA, Cañas CA, Ayuso B, Morejón JB, Escudero SC, Frías MC, Tejido SC, de Miguel Campo B, Pedroche CD, Simon RD, Reyne AG, Veganzones LI, Huerta LJ, Blanco AL, Gonzalo JL, Lora-Tamayo J, Bermejo CL, de la Calle GM, Godoy RM, Perpiña BO, Ruiz DP, Fernández MS, Montes JT, Suárez AMÁ, Vergés CD, Martínez RFM, Aizpuru EMF, Carrasco AG, Amezua CH, Caleya JFL, Martínez DL, del Mar Martínez López M, Zapico AM, Iscar CO, Casado LP, Martínez MLT, Chamorro LMT, Casas LA, de Oña ÁA, Beato RA, Gonzalo LA, Muñoz JA, Oblitas CMA, García CA, Cebrián MB, Corral JB, Guerrero MB, Estrada ADB, Moreno MC, Fernández PC, Carrillo R, Pérez SC, Muñoz EC, Moreno ADC, Carvajal MCC, de Santos S, Gómez AE, Carracedo EF, Jenaro MMFM, Valle FG, Garcia A, Fernandez-Bravo IG, Leoni MEG, Antúnez MG, Narciso CGS, Gurjian AA, Ibáñez LJ, Olleros CL, Mendo CL, García SL, Jimeno VM, Nohales CM, Núñez-Cortés JM, Ledesma SM, Míguez AM, Delgado CM, Ortega LO, Sánchez SP, Virto AP, Sanz MTP, Llorente BP, Ruiz SP, Fernández-Llamazares GS, Macías MT, Samaniego NT, do Rego AT, Garcia MVV, Villarreal G, Etayo MZ, Lara RA, Fernandez IC, García JCC, García García GM, Granados JG, Sánchez BG, Periáñez FJM, Perez MJP, Pérez JLB, Méndez MLS, Rivera NA, Vieitez AC, del Corral Beamonte E, Manglano JD, Mera IF, del Mar Garcia Andreu M, Aseguinolaza MG, Lezaun CG, Laorden CJ, Murgui RM, Sanz MTM, Ayala-Gutiérrez MM, López RB, Fonseca JB, Buonaiuto VA, Martínez LFC, Palacios LC, Muriel CC, de Windt F, Christophel ATFT, Ocaña PG, Huelgas RG, García JG, Oliver JAH, Jansen-Chaparro S, López-Carmona MD, Quirantes PL, Sampalo AL, Lorenzo-Hernández E, Sevilla JJM, Carmona JM, Pérez-Belmonte LM, de Pedro IP, Pineda-Cantero A, Gómez CR, Ricci M, Cánovas JS, Troncoso JÁ, Fernández FA, Quintana FB, Arenzana CB, Molina SC, Candalija AC, Bengoa GD, de Gea Grela A, de Lorenzo Hernández A, Vidal AD, Capitán CF, Iglesias MFG, Muñoz BG, Gil CRH, Martínez JMH, Hontañón V, Hernández MJJ, Lahoz C, Calvo CM, Gutiérrez JCM, Prieto MM, Robles EM, Saldaña AM, Fernández AM, Prieto JMM, Mozo AN, López CMO, Peláez EP, Pampyn MP, Simón MAQ, Ramos Ramos JC, Ruperto LR, Purificación AS, Bueso TS, Torre RS, Abanedes CIS, Tabares YU, Mayoral MV, Manau JV, del Carmen Beceiro Abad M, Romero MAF, Castro SM, Guillan EMP, Nuñez MP, Fontan PMP, de Larriva APA, Espinal PC, Lista JD, Fuentes-Jiménez F, del Carmen Guerrero Martínez M, Vázquez MJG, Torres JJ, Pérez LL, López-Miranda J, Piedra LM, Orge MM, Vinagre JP, Pérez-Martinez P, Vílchez MER, Martínez AR, Cabrera JLR, Torres-Peña JD, Tomás MA, Balaz D, Tur DB, Navarro RC, Pérez PC, Redondo JC, White ED, Espínola ME, Del Barrio LE, Atiénzar PJE, Cervera CG, Núñez DFG, Navarro FG, Galvañ VG, Uranga AG, Martínez JG, Isasi IH, Villar LL, Sempere VM, Cruz JMN, Fernández SP, García JJP, Pleguezuelos RP, Pérez AR, Ripoll JMS, Mira AS, Wikman-Jorgensen P, Ayllón JAA, Artero A, del Mar Carmona Martín M, Valls MJF, de Mar Fernández Garcés M, Belda ABG, Cruz IL, López MM, Sanchis EM, Gandia JM, Roger LP, Belmonte AMP, García AV, Eisenhofer AA, Milla AA, Pérez IB, Gutiérrez LB, Garay JB, Parra JC, Díaz AC, Da Silva EC, Hernández MC, Díaz RC, Sánchez MJC, Gozalo CC, Martínez VCM, Doblado LD, de la Fuente Moral S, de Santiago AD, Yagüe ID, Velasco ID, Duca AM, del Campo PD, López GE, Palomo EE, Cruz AF, Gómez AG, Prieto SG, Revilla BG, Viejo MÁG, Irusta JG, Merino PG, Abreu EVG, Martín IG, Rojas ÁG, Villanueva AG, Jiménez JH, Estéllez FI, del Estal PL, Sáiz MCM, de Mendoza Fernández C, Urbistondo MM, Vera FM, Seirul-lo MM, Pita SM, Sánchez PAM, Hernández EM, Vargas AM, Concha VMT, De La Torre IM, Rubio EM, de Benito RM, Serrano AM, Palomo PN, Pascual IP, Martín-Vegue AJR, Martínez AR, Olleros CR, Montaud AR, Pizarro YR, García SR, de Domingo DR, Ortiz DS, Chica ES, Almena IS, Martin ES, Chen YT, de Ureta PT, Alijo ÁV, Comendador JMV, Núñez JAV, Yeguas IA, Gómez JA, Cuchillo JB, López IB, Clotet NC, Elías AEC, Manuel EC, de Luque CMC, Benbunan CC, Vilan LD, Hernández CD, Peralta EED, Pérez VE, Fernandez-Castelao S, Saavedra MOF, Klepzig JLG, del Rosario Iguarán Bermúdez M, Ferrer EJ, Rodríguez AM, de Pedro AM, Sánchez RÁM, Bailón MM, Álvarez SM, Orantos MJN, Mata CO, García EO, Mata DO, González CO, Perez-Somarriba J, Mateos PP, Muñoz MER, Regaira XR, Gallardo LMR, Fornie IS, Botrán AS, Robles MS, Urbano ME, González AMV, Martínez MV, Monge Monge D, Pasos EMF, García AV, Comet LS, Giménez LL, Samper UA, Repiso GA, Bruñén JMG, Barrio ML, Martínez MAC, Igual JJG, Fenoll RG, García MA, Monge EA, Rodríguez JÁ, Varela CA, Gòdia MB, Molina MB, Vega MB, Curbelo J, de las Heras Moreno A, Godoy ID, Alvarez ACE, Martín-Caro IF, López-Mosteiro AF, Marquez GG, Blanco MJG, del Álamo Hernández YG, Encina CGR, González NG, Rodríguez CG, Martín NLS, Báez MM, Delgado CM, Caballero PP, Serrano JP, Rodríguez LR, Cortés PR, Franco CR, Roy-Vallejo E, Vega MR, Lloret AS, Moreno BS, Alba MS, Ballesteros JS, Somovilla A, Fernández CS, Tirado MV, Marti AV, Pareja JFP, Fraile IP, Blanco AM, del Castillo Cantero R, López JLV, Lorite IR, Martínez RF, García IS, Rangel LS, Álvarez AA, Juarros OA, López AA, Castiñeira CC, Calviño AC, Sánchez MC, Varela RF, Castro SJF, Trigo AP, Jarel RP, Varea FR, Freán IR, Alonso LR, Pensado FJS, Porto DV, Saavedra CC, Gómez JF, López BG, Garrido MSH, Amorós AIL, Gil SL, de los Reyes Pascual Pérez M, Perea NR, García AT, Lobo JA, Casanovas LF, Amigo JL, Fernández MM, Bermúdez IO, Fernández MP, Rhyman N, Piqueras NV, Pedrajas JNA, García AM, Vargas I, Jiménez IA, González MC, Cobos-Siles M, Corral-Gudino L, Cubero-Morais P, Fernández MG, González JPM, Dehesa MP, Espinosa PS, Blanco SC, Gamboa JOM, Mosteiro CS, Asiain AS, Santos JMA, Barrera ABB, Vela BB, Muiño CB, Fernández CB, Hernáiz RC, López IC, Rojo JMC, Troncoso AC, Romano PC, Deodati F, Santiago AE, Sánchez GGC, Guijarro EG, Sánchez FJG, de la Torre PG, de Guzmán García-Monge M, Luordo D, González MM, Bermejo JAM, Valverde CP, Quero JLP, Rojas FR, García LR, Gonzalo ES, Muñoz FJT, de la Sota JV, Martínez JV, Gómez MG, Sánchez PR, Gonzalez GA, Iraurgi AL, Arostegui AA, Martínez PA, Fernández IMP, Becerro EM, Jiménez AI, Núñez CV, López MA, López EG, Losada MSA, Estévez BR, Muñoz AMA, Fernández MB, Cano V, Moreno RC, Garcia-Tenorio FC, Nájera BDT, González RE, Butenegro MPG, Díez AG, Caverzaschi VG, Pedraza PMG, Moraleja JG, Carvajal RH, Aranda PJ, González RL, Caparachini ÁL, Castañeyra PL, Ancin AL, Garcia JDM, Romero CM, Saiz MJM, Moríñigo HM, Nicolás GM, Platon EM, Oliveri F, Ortiz Ortiz E, Rafael RP, Galán PR, Berrocal MAS, de Ávila VSR, Sierra PT, Aranda YU, Clemente JV, Bergua CY, de la Peña Fernández A, Milián AH, Manrique MA, Erdozain AC, Ruiz ALI, Luque FJB, Carrasco-Sánchez FJ, de-Sousa-Baena M, Leal JD, Rubio AE, Huertas MF, Bravo JAG, Macías AG, Jiménez EG, Jiménez AH, Quintero CL, Reguera CM, Marcos FJM, Beamud FM, Pérez-Aguilar M, Jiménez AP, Castaño VR, dedel AlcazarRío AS, Ruiz LT, González DA, de Zabalza IAP, Hernández SA, Sáenz JC, Dendariena B, del Mazo MG, de Narvajas Urra IM, Hernández SM, Fernández EM, Somovilla JLP, Pejenaute ER, Rodríguez-Solís JB, Osorio LC, del Pilar Fidalgo Montero M, Soriano MIF, Rincón EEL, Hermida AM, Carrilero JM, Santiago JÁP, Robledo MS, Rojas PS, Yebes NJT, Vento V, Vaca LFA, Arnanz AA, García OA, González MB, Sanz PB, Llisto AC, de Pedro Baena S, Del Hoyo Cuenda B, Fabregate-Fuente M, Osorio MAG, Sánchez IG, García AG, Cisneros OAL, Manzano L, Martínez-Lacalzada M, Ortiz BM, Rey-García J, González ER, Díaz CS, Fajardo GS, Carantoña CS, Viteri-Noël A, Zhilina Zhilina S, Claudio GMA, Rodríguez VB, Muñoz CC, Pérez AC, Orbes MVC, Sánchez DE, Revuelta SI, Martín MM, González JIM, Oterino JÁM, Alonso LM, Balbuena SP, García MLP, Prados AR, Rodríguez-Alonso B, Alegría ÁR, Ledesma MS, Pérez RJT, Encinar JCB, Cilleros CM, Martínez IJ, Delange TG, González RF, Noya AG, Ceron CH, Avanzini II, Diez AL, Mato PL, Vizcaya AML, Benítez DP, Zemsch MMP, Expósito LP, Bar MP, González LR, Lara LR, Cabañero D, Ballester MC, Fernández PC, Sánchez RG, Escrig MJ, Amela CM, Gómez LP, Navarro CP, Parra JAT, de Almeida CT, Villarejo MEF, Calvo VP, Otero SP, López BG, Frías CA, Romero VM, Pérez LA, Velado EM, González RA, Boixeda R, Fernández Fernández J, Mármol CL, Navarro MP, Guzmán AR, Fustier AS, Castro JL, Reboiro MLL, González CS, Sala ER, Izuel JMP, Zamrani ZK, Diaz HA, Lopez TD, Pego EM, Pérez CM, Ferro AP, Trigo SS, Sambade DS, Ferrin MT, del Carmen Vázquez Friol M, Maneiro LV, Rodríguez BC, Espartero MEG, Rivas LM, de la Sierra Navas Alcántara M, Tirado-Miranda R, Marquínez MNS, García VA, Suárez DB, Arenas NG, García PM, Copa DC, García AÁ, Álvarez JC, Calderón MJM, Noriega RG, Rubia MC, García JL, Martínez LT, Celeiro JF, Aguilar DEO, Riesco IM, Bécares JV, Mateos AB, García AAT, Casamayor JD, Silvera DG, Díaz AA, Carballo CH, Tejera A, Prieto MJM, Muñoz MBM, Del Arco Delgado JM, Díaz DR, Feria MB, Herrera Herrera FJ, de la Luz Padilla Salazar M, Luis RH, Ledezma EMC, del Mar López Gámez M, Hernández LT, Pérez SC, García SGA, Gainett GC, Hidalgo AG, Daza JM, Peraza MH, Santos RA, Bernabeu-Wittel M, Suárez SR, Nieto M, Miranda LG, Mancera RMG, Torre FE, Quiles CH, Guzmán CC, de la Cuesta JD, Vega JET, del Carmen López Ríos M, Jiménez PD, Franco BB, de Juan CJ, Rivero SG, Tenllado JL, Lara VA, Estrada AG, Ena J, Segado JEG, Ferrer RG, Lorenzo VG, Arroyo RM, García MG, Hernández FJV, González ÁLM, Montes BV, Die RMG, Molinero AM, Regidor MM, Díez RR, Sierra BH, García LFD, Acedo IEA, Cano CMS, García VH, Bernal BR, Jiménez JC, Bazán EC, Reniu AC, Grabalosa JR, Solà JF, De Boulle IC, Xancó CG, Núñez OR, Ripper CJ, Gutiérrez AG, Trallero LER, Novo MFA, Lecumberri JJN, Ruiz NP, Riancho J, García IS, Baena PC, Sevilla JE, Padilla LG, Ronquillo PG, Bustos PG, Botías MN, Taboada JR, Rodríguez MR, Alvarez VA, Suárez NM, Suárez SR, Díaz SS, Pérez LS, Gómez MF, Castaño CM, Rodríguez LM, Vázquez C, Estévanez IC, Gutiérrez CY, Sela MM, Cosío SF, Álvaro CMG, García JL, Piñeiro AP, Viera YC, Rodríguez LC, de Juan Alvarez C, Benitez GF, Escudero LG, Torres JM, Escriche PM, Canteli SP, Pérez MCR, Soler JA, Remolar MB, Álvarez AC, Carlotti DD, Gimeno MJE, Juana SF, López PG, Soler MTG, de la Sota DP, Castellanos GP, Catalán IP, Martí CR, Monzó PR, Padilla JR, Gaya NT, Blasco JU, Pascual MAM, Vidal LJ, Conesa AA, Rivas MCA, Alsina MH, Romero JM, Diez-Canseco AMU, Martínez FA, Vásquez EA, Stablé JCE, Belmonte AH, Peiró AM, Goñi RM, Castellanos MCP, Belda BS, Navarro DV, Lombraña AS, Ugartondo JC, Plaza ABM, Asensio AN, Alves BP, López NV, Téllez ML, Epelde F, Torrente I, Vasco PG, Santacruz AR, Muñoz AV, Giner MJE, Calvo-Sotelo AE, Sardón EG, González JG, Salazar LG, Garcia AA, Días IM, Gomez AS, Matos MC, Gaspar SN, Nieto AG, Méndez RG, Álvarez AR, Hernández OP, Ramírez AP, González MCM, Lorite MNN, Navarrete LG, Negrin JCA, González JFA, Jiménez I, Toledo PO, Ponce EM, Torres XTE, González SG, Fernández CN, Gómez PT, Gisbert OA, Llistosella MB, Casanova PC, Flores AG, Hinojo AG, Martínez AIM, del Carmen Nogales Nieves M, Austrui AR, Cervantes AZ, Castro VA, Lomba AMB, Aparicio RB, Morales MF, Villar JMF, Monteagudo MTL, García CP, Ferreira LR, Llovo DS, Feijoo MBV, Romero JAM, de Albornoz JLSC, Pérez MJS, Martín ES, Astrua TC, Giraldo PTG, Juárez MJG, Fernandez VM, Echevarry AVR, Arche JFV, Rivero MGR, Martínez AM, Bernad RV, Limia C, Fernández CA, Fernández AT, Fajardo LP, de Vega Santos T, Ruiz AL, Míguez HM. Validation of the RIM Score-COVID in the Spanish SEMI-COVID-19 Registry. Intern Emerg Med 2023; 18:907-915. [PMID: 36680737 PMCID: PMC9862219 DOI: 10.1007/s11739-023-03200-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
The significant impact of COVID-19 worldwide has made it necessary to develop tools to identify patients at high risk of severe disease and death. This work aims to validate the RIM Score-COVID in the SEMI-COVID-19 Registry. The RIM Score-COVID is a simple nomogram with high predictive capacity for in-hospital death due to COVID-19 designed using clinical and analytical parameters of patients diagnosed in the first wave of the pandemic. The nomogram uses five variables measured on arrival to the emergency department (ED): age, sex, oxygen saturation, C-reactive protein level, and neutrophil-to-platelet ratio. Validation was performed in the Spanish SEMI-COVID-19 Registry, which included consecutive patients hospitalized with confirmed COVID-19 in Spain. The cohort was divided into three time periods: T1 from February 1 to June 10, 2020 (first wave), T2 from June 11 to December 31, 2020 (second wave, pre-vaccination period), and T3 from January 1 to December 5, 2021 (vaccination period). The model's accuracy in predicting in-hospital COVID-19 mortality was assessed using the area under the receiver operating characteristics curve (AUROC). Clinical and laboratory data from 22,566 patients were analyzed: 15,976 (70.7%) from T1, 4,233 (18.7%) from T2, and 2,357 from T3 (10.4%). AUROC of the RIM Score-COVID in the entire SEMI-COVID-19 Registry was 0.823 (95%CI 0.819-0.827) and was 0.834 (95%CI 0.830-0.839) in T1, 0.792 (95%CI 0.781-0.803) in T2, and 0.799 (95%CI 0.785-0.813) in T3. The RIM Score-COVID is a simple, easy-to-use method for predicting in-hospital COVID-19 mortality that uses parameters measured in most EDs. This tool showed good predictive ability in successive disease waves.
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Affiliation(s)
| | - Paula Sol Ventura
- Fundacio Institut d’Investigacio en Ciències de La Salut Germans Trias I Pujol (IGTP), 08916 Badalona, Spain
| | - José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981 Madrid, Spain
| | - Marc Mauri
- Data Scientist, Kaizen AI, Barcelona, Spain
| | | | | | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Vicente Giner-Galvañ
- Internal Medicine Department. Hospital, Clínico Universitario de Sant Joan d’Alacant, Alicante, Spain
| | | | | | - Luis Manzano
- Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | - Alejandro López-Escobar
- Pediatrics Department, Clinical Research Unit, Hospital Universitario Vithas Madrid La Milagrosa, Fundación Vithas. Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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3
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Gracia Gutiérrez A, Grados Saso D, Esteban Cabello EI, Salas Trigo EM, Sánchez Marteles M, Garcés Horna V, Ioakeim-Skoufa I, Gimeno-Miguel A, Prados-Torres A, Ruiz Laiglesia FJ. Clinical characteristics of heart failure patients with mid-range ejection fraction. Acta Cardiol 2022; 78:233-240. [PMID: 35947112 DOI: 10.1080/00015385.2022.2059135] [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] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction. METHODS We conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010-2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (<40%), HFmrEF (40-49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics. RESULTS The mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes. CONCLUSION HFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.
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Affiliation(s)
- Anyuli Gracia Gutiérrez
- Internal Medicine Service, Hospital General de la Defensa, Zaragoza, Spain.,Research Group on Heart Failure, IIS Aragón, Zaragoza, Spain
| | - Daniel Grados Saso
- Research Group on Heart Failure, IIS Aragón, Zaragoza, Spain.,Cardiology Service, Hospital de Barbastro, Barbastro, Spain
| | | | | | - Marta Sánchez Marteles
- Research Group on Heart Failure, IIS Aragón, Zaragoza, Spain.,Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Vanesa Garcés Horna
- Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Fernando J Ruiz Laiglesia
- Research Group on Heart Failure, IIS Aragón, Zaragoza, Spain.,Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
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4
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Rubio-Rivas M, Mora-Luján JM, Formiga F, Corrales González MÁ, García Andreu MDM, Moreno-Torres V, García García GM, Alcalá Pedrajas JN, Boixeda R, Pérez-Lluna L, Cortés-Rodríguez B, Mella-Pérez C, Navas Alcántara MDLS, López Reboiro ML, Alfaro-Lara V, Pérez-Martín S, Martín-Oterino JÁ, Gracia Gutiérrez A, Martín-Urda Díez-Canseco A, Comas Casanova P, Pérez García C, Varona JF, Gómez-Huelgas R, Antón-Santos JM, Lumbreras-Bermejo C. Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry. Intern Emerg Med 2022; 17:1115-1127. [PMID: 35235131 PMCID: PMC8890024 DOI: 10.1007/s11739-021-02924-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022]
Abstract
Uncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. They were included in the Spanish SEMI-COVID-19 registry from March 1, 2020 to May 1, 2021. The primary outcome was in-hospital mortality. Hierarchical cluster analysis identified 7 clusters. C1 is characterized by lymphopenia, C2 by elevated ferritin, and C3 by elevated LDH. C4 is characterized by lymphopenia plus elevated CRP and LDH and frequently also ferritin. C5 is defined by elevated CRP, and C6 by elevated ferritin and D-dimer, and frequently also elevated CRP and LDH. Finally, C7 is characterized by an elevated D-dimer. The clusters with the highest in-hospital mortality were C4, C6, and C7 (17.4% vs. 18% vs. 15.6% vs. 36.8% vs. 17.5% vs. 39.3% vs. 26.4%). Inflammation clusters were found as independent factors for in-hospital mortality. In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters: C2 (OR = 1.30, p = 0.001), C3 (OR = 1.14, p = 0.178), C4 (OR = 2.28, p < 0.001), C5 (OR = 1.07, p = 0.479), C6 (OR = 2.29, p < 0.001), and C7 (OR = 1.28, p = 0.001). We identified 7 groups based on the presence of lymphopenia, elevated CRP, LDH, ferritin, and D-dimer at the time of hospital admission for COVID-19. Clusters C4 (lymphopenia + LDH + CRP), C6 (ferritin + D-dimer), and C7 (D-dimer) had the worst prognosis in terms of in-hospital mortality.
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Affiliation(s)
- Manuel Rubio-Rivas
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José María Mora-Luján
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francesc Formiga
- grid.418284.30000 0004 0427 2257Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | | | | | - Víctor Moreno-Torres
- grid.73221.350000 0004 1767 8416Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | | | - Ramon Boixeda
- Department of Internal Medicine, Mataró Hospital, Barcelona, Spain
| | - Leticia Pérez-Lluna
- grid.414561.30000 0000 9193 0174Department of Internal Medicine, Sagunto Hospital. Sagunto, Valencia, Spain
| | - Begoña Cortés-Rodríguez
- grid.459309.20000 0004 1794 9992Department of Internal Medicine, Alto Guadalquivir Hospital. Andújar, Jaén, Spain
| | - Carmen Mella-Pérez
- Department of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña Spain
| | | | | | - Verónica Alfaro-Lara
- grid.411109.c0000 0000 9542 1158Department of Internal Medicine, Vírgen del Rocío University Hospital, Sevilla, Spain
| | | | - José Ángel Martín-Oterino
- grid.11762.330000 0001 2180 1817Department of Internal Medicine, Salamanca University Hospital, Salamanca, Spain
| | | | | | | | - Cristina Pérez García
- Department of Internal Medicine, Do Salnes Hospital, Vilagarcía de Arousa, Pontevedra, Spain
| | - José F Varona
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain
- grid.4795.f0000 0001 2157 7667School of Medicine, San Pablo University-CEU, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- grid.10215.370000 0001 2298 7828Department of Internal Medicine, Málaga Regional University Hospital, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
- grid.413448.e0000 0000 9314 1427CIBER Obesidad Y Nutricion (CIBERobn), ISCIII, Madrid, Spain
| | - Juan-Miguel Antón-Santos
- grid.411171.30000 0004 0425 3881Department of Internal Medicine. Infanta, Cristina University Hospital, Parla, Madrid, Spain
| | - Carlos Lumbreras-Bermejo
- grid.144756.50000 0001 1945 5329Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain
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5
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Rubio-Rivas M, Mora-Luján JM, Formiga F, Arévalo-Cañas C, Lebrón Ramos JM, Villalba García MV, Fonseca Aizpuru EM, Díez-Manglano J, Arnalich Fernández F, Romero Cabrera JL, García García GM, Pesqueira Fontan PM, Vargas Núñez JA, Freire Castro SJ, Loureiro Amigo J, Pascual Pérez MDLR, Alcalá Pedrajas JN, Encinas-Sánchez D, Mella Pérez C, Ena J, Gracia Gutiérrez A, Esteban Giner MJ, Varona JF, Millán Núñez-Cortés J, Casas-Rojo JM. WHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales. J Gen Intern Med 2022; 37:1980-1987. [PMID: 35396659 PMCID: PMC8992782 DOI: 10.1007/s11606-022-07511-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. OBJECTIVE The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades, and the hybrid model. DESIGN Retrospective cohort study with patient data collected and followed up from March 1, 2020, to May 1, 2021, from the nationwide SEMI-COVID-19 Registry. The primary study outcome was in-hospital mortality. As this was a hospital-based study, the patients included corresponded to categories 3 to 7 of the WHO ordinal scale. Categories 6 and 7 were grouped in the same category. KEY RESULTS A total of 17,225 patients were included in the study. Patients classified as high risk in each of the WHO categories according to the degree of inflammation were as follows: 63.8% vs. 79.9% vs. 90.2% vs. 95.1% (p<0.001). In-hospital mortality for WHO ordinal scale categories 3 to 6/7 was as follows: 0.8% vs. 24.3% vs. 45.3% vs. 34% (p<0.001). In-hospital mortality for the combined categories of ordinal scale 3a to 5b was as follows: 0.4% vs. 1.1% vs. 11.2% vs. 27.5% vs. 35.5% vs. 41.1% (p<0.001). The predictive regression model for in-hospital mortality with our proposed combined ordinal scale reached an AUC=0.871, superior to the two models separately. CONCLUSIONS The present study proposes a new severity grading scale for COVID-19 hospitalized patients. In our opinion, it is the most informative, representative, and predictive scale in COVID-19 patients to date.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain.
| | - José María Mora-Luján
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Coral Arévalo-Cañas
- Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | | | | | - Juan Luis Romero Cabrera
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Paula M Pesqueira Fontan
- Department of Internal Medicine, Santiago de Compostela Clinical Hospital, Santiago de Compostela, La Coruña, Spain
| | | | | | - José Loureiro Amigo
- Department of Internal Medicine, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | | | | | | | - Carmen Mella Pérez
- Department of Internal Medicine, Ferrol Clinical University Hospital, Ferrol, La Coruña, Spain
| | - Javier Ena
- Department of Internal Medicine, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
| | | | | | - José F Varona
- Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain.,Medicine School, San Pablo-CEU University, CEU Universities, Madrid, Spain
| | | | - José-Manuel Casas-Rojo
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain
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6
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Roteta Unceta-Barrenechea A, Melero Polo J, Andrés Gracia A, Revilla Martí P, Menao Guillén S, Lahuerta Pueyo C, Pérez-Palacios R, Moreno Gázquez I, Gutiérrez AG, Aibar Arregui MÁ. Coexistence of Positive 99mTc-DPD Scintigraphy and Monoclonal Gammopathy: A Frequent Challenge. Acta Cardiol Sin 2022; 38:169-174. [PMID: 35273438 PMCID: PMC8888328 DOI: 10.6515/acs.202203_38(2).20210927a] [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] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/27/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cardiac involvement is common in amyloidosis, and the vast majority of cases of amyloid cardiomyopathy are attributed to primary amyloidosis or transthyretin amyloidosis (ATTR). Although the coexistence of scintigraphy suggestive of ATTR with monoclonal gammopathy of undetermined significance is well documented, the correct diagnosis is still challenging in non-referral centers. METHODS We performed a retrospective study reviewing all amyloid cardiomyopathy cases diagnosed at our center over the last 5 years, and described our experience and diagnostic approach. RESULTS During the last 5 years, 74 patients with positive scintigraphy were identified. Of these patients, 41 were included in this study as they had all necessary tests for a complete diagnosis. Two of these 41 patients had variant ATTR and 29 had wild-type ATTR. Ten patients had monoclonal gammopathy (24.4%), and it was consequently impossible to obtain a specific diagnosis. During follow-up, 14 patients (34.1%), five of them from the monoclonal gammopathy group, died, reflecting the severity of disease. CONCLUSIONS In patients with ATTR-suggestive scintigraphy, monoclonal gammopathy frequently occurs concomitantly, thus not allowing to establish a specific diagnosis. A biopsy could only be replaced by genetic testing in selected cases.
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Affiliation(s)
- Ana Roteta Unceta-Barrenechea
- Department of Nuclear Medicine (UCMHMNA), Hospital Clínico Universitario, Zaragoza;
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Instituto de Investigación Sanitaria de Aragón
| | - Jorge Melero Polo
- Instituto de Investigación Sanitaria de Aragón;
,
Department of Cardiology
| | - Alejandro Andrés Gracia
- Department of Nuclear Medicine (UCMHMNA), Hospital Clínico Universitario, Zaragoza;
,
Instituto de Investigación Sanitaria de Aragón
| | | | - Sebastian Menao Guillén
- Instituto de Investigación Sanitaria de Aragón;
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Department of Biochemistry and Genetic, Hospital Clínico Universitario
| | - Carmen Lahuerta Pueyo
- Instituto de Investigación Sanitaria de Aragón;
,
Department of Biochemistry and Genetic, Hospital Clínico Universitario
| | | | - Inmaculada Moreno Gázquez
- Instituto de Investigación Sanitaria de Aragón;
,
Department of Biochemistry and Genetic, Hospital Clínico Universitario
| | - Anyuli Gracia Gutiérrez
- Instituto de Investigación Sanitaria de Aragón;
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Department of Neurology, Hospital General de la Defensa
| | - Miguel Ángel Aibar Arregui
- Instituto de Investigación Sanitaria de Aragón;
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Department of Internal Medicine, Hospital Clínico Universitario, Zaragoza, Spain
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7
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Rodilla E, López-Carmona MD, Cortes X, Cobos-Palacios L, Canales S, Sáez MC, Campos Escudero S, Rubio-Rivas M, Díez Manglano J, Freire Castro SJ, Vázquez Piqueras N, Mateo Sanchis E, Pesqueira Fontan PM, Magallanes Gamboa JO, González García A, Madrid Romero V, Tamargo Chamorro L, González Moraleja J, Villanueva Martínez J, González Noya A, Suárez-Lombraña A, Gracia Gutiérrez A, López Reboiro ML, Ramos Rincón JM, Gómez Huelgas R. Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain. Hypertension 2021; 77:856-867. [PMID: 33377393 PMCID: PMC7884247 DOI: 10.1161/hypertensionaha.120.16563] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023]
Abstract
Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively, P<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio [ORadj]: 1.27, P=0.0001; ORadj: 1.48, P=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6, P=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7, P=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6, P=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization.
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Affiliation(s)
- Enrique Rodilla
- From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.)
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.)
| | - Maria Dolores López-Carmona
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain (M.D.L.-C., L.C.-P., R.G.H.)
| | - Xavi Cortes
- From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.)
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.)
| | - Lidia Cobos-Palacios
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain (M.D.L.-C., L.C.-P., R.G.H.)
| | - Sergio Canales
- From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.)
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.)
| | - Maria Carmen Sáez
- From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.)
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.)
| | | | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat (Barcelona), Spain (M.R.-R.)
| | - Jesus Díez Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain (J.D.M.)
| | | | - Nuria Vázquez Piqueras
- Internal Medicine Department, Consorci Sanitari Integral, Moisès Broggi Hospital Sant Joan Despí (Barcelona), Spain (N.V.P.)
| | | | | | | | - Andrés González García
- Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain (A.G.G.)
- Internal Medicine Department, Defensa General Hospital, Zaragoza, Spain (A.G.G.)
| | | | | | | | | | - Amara González Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain (A.G.N.)
| | | | - Anyuli Gracia Gutiérrez
- Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain (A.G.G.)
- Internal Medicine Department, Defensa General Hospital, Zaragoza, Spain (A.G.G.)
| | | | - José Manuel Ramos Rincón
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain (J.M.R.R.)
| | - Ricardo Gómez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain (M.D.L.-C., L.C.-P., R.G.H.)
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Gracia Gutiérrez A, Poblador-Plou B, Prados-Torres A, Ruiz Laiglesia FJ, Gimeno-Miguel A. Sex Differences in Comorbidity, Therapy, and Health Services' Use of Heart Failure in Spain: Evidence from Real-World Data. Int J Environ Res Public Health 2020; 17:ijerph17062136. [PMID: 32210137 PMCID: PMC7143043 DOI: 10.3390/ijerph17062136] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is becoming increasingly prevalent and affects both men and women. However, women have traditionally been underrepresented in HF clinical trials. In this study, we aimed to analyze sex differences in the comorbidity, therapy, and health services’ use of HF patients. We conducted a cross-sectional study in Aragón (Spain) and described the characteristics of 17,516 patients with HF. Women were more frequent (57.4 vs. 42.6%, p < 0.001) and older (83 vs. 80 years, p < 0.001) than men, and presented a 33% lower risk of 1-year mortality (p < 0.001). Both sexes showed similar disease burdens, and 80% suffered six or more diseases. Some comorbidities were clearly sex-specific, such as arthritis, depression, and hypothyroidism in women, and arrhythmias, ischemic heart disease, and COPD in men. Men were more frequently anti-aggregated and anti-coagulated and received more angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers, whereas women had more angiotensin II antagonists, antiinflammatories, antidepressants, and thyroid hormones dispensed. Men were admitted to specialists (79.0 vs. 70.6%, p < 0.001), hospital (47.0 vs. 38.1%, p < 0.001), and emergency services (57.6 vs. 52.7%, p < 0.001) more frequently than women. Our results highlight the need to conduct future studies to confirm the existence of these differences and of developing separate HF management guidelines for men and women that take into account their sex-specific comorbidity.
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Affiliation(s)
- Anyuli Gracia Gutiérrez
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Hospital General de la Defensa, 50009 Zaragoza, Spain;
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (B.P.-P.); (A.P.-T.)
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (B.P.-P.); (A.P.-T.)
| | - Fernando J Ruiz Laiglesia
- Research Group on Heart Failure, Faculty of Medicine, Internal Medicine Service, Lozano Blesa University Hospital, 50009 Zaragoza, Spain;
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, REDISSEC, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (B.P.-P.); (A.P.-T.)
- Correspondence: ; Tel.: +34-976-765-500 (ext. 5375)
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9
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Gimeno-Miguel A, Gracia Gutiérrez A, Poblador-Plou B, Coscollar-Santaliestra C, Pérez-Calvo JI, Divo MJ, Calderón-Larrañaga A, Prados-Torres A, Ruiz-Laiglesia FJ. Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records. BMJ Open 2019; 9:e033174. [PMID: 31874886 PMCID: PMC7008407 DOI: 10.1136/bmjopen-2019-033174] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality. DESIGN Observational retrospective population study based on electronic health records. SETTING EpiChron Cohort (Aragón, Spain). PARTICIPANTS All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients' electronic health records until 31 December 2011. PRIMARY OUTCOME We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality. RESULTS Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality. CONCLUSIONS Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
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Affiliation(s)
- Antonio Gimeno-Miguel
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Anyuli Gracia Gutiérrez
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Carlos Coscollar-Santaliestra
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Care Health Centre San Pablo, SALUD, Zaragoza, Spain
| | - J Ignacio Pérez-Calvo
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
- University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Alexandra Prados-Torres
- EpiChron Research Group. IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- REDISSEC, Zaragoza, Spain
| | - Fernando J Ruiz-Laiglesia
- Research Group on Heart Failure, IIS Aragón, Internal Medicine Service, Lozano Blesa University Hospital, Zaragoza, Spain
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Bueno Juana E, Vicente de Vera Floristán C, Gracia Gutiérrez A, Pérez Calvo JI, Tejero Juste C. [Myoclonus associated with Ciprofloxacin therapy]. Farm Hosp 2016; 40:622-623. [PMID: 27894232 DOI: 10.7399/fh.2016.40.6.10536] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
| | | | | | | | - Carlos Tejero Juste
- Servicio Neurología. Hospital Clínico Universitario Lozano Blesa (Zaragoza).
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11
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García-Ramos E, Gutiérrez AG, Ortega-Palma O, Pizarro-Suárez E. [Mycoplasma sp. in the respiratory tract of hospitalized children]. Rev Latinoam Microbiol 1993; 35:143-6. [PMID: 8209106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mycoplasma pneumoniae is one of the most common bacteria causing respiratory diseases in other countries, specially in older children, adolescents and young adults and less frequently in the age group studied here, nevertheless the determination of its presence in this group was considered important. Two hundred and fifty throat swabs were taken from children, under five years of age, hospitalized with a diagnosis of acute respiratory infections (ARI) and to 50 children, same age, with no ARI (controls). The samples were placed in transport media and were incubated at 37 degrees C during 7 to 15 days. They were reinoculated in PPLO agar and typical colonies were looked for, 5 to 8 days later. The organisms were identified by biochemical tests. Eight Mycoplasma sp (3.2%) were obtained, five of them were M. pneumoniae (2.0%) and three M. hominis (1.2%). Only in 2 cases adenoviruses with M. hominis were found in the absence of other pathogens. It was shown that M. pneumoniae also infects children under five years old, so its present should be suspected, specially when the patient's health does not improve with the installed treatment. Some important suggestions for the isolation of mycoplasma are given.
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Affiliation(s)
- E García-Ramos
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, México, D.F., Mexico
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