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Ena J, Carretero-Gómez J, Manuel-Casas J, Casado P, Vázquez-Rodríguez P, Martínez-García F, González-González P, de Escalante-Yagüela B, Gandullo-Moro M, Carrasco-Sánchez FJ. Inpatient management of diabetes and hyperglycaemia: an audit of Spanish hospitals. Rev Clin Esp 2023:S2254-8874(23)00069-3. [PMID: 37295647 DOI: 10.1016/j.rceng.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Evaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain. METHODS Cross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge. RESULTS The median age of the patients was 80 years [74-87], of which 561 (47%) were women, with a Charlson index of 4 points [2-6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dL [119-213]. On the third day, the number of capillary blood glucose levels in target (80-180 mg/dL) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 (0.9%) patients suffered from hypoglycaemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p < 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001). CONCLUSIONS There is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.
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Affiliation(s)
- Javier Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Alicante, Spain.
| | | | - José Manuel-Casas
- Servicio de Medicina Interna, Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Pedro Casado
- Servicio de Medicina Interna, Hospital La Princesa, Madrid, Spain
| | | | | | | | | | - María Gandullo-Moro
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
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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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Gómez-Peralta F, Carrasco-Sánchez FJ, Pérez A, Escalada J, Álvarez-Guisasola F, Miranda-Fernández-Santos C, Mediavilla-Bravo JJ, Gómez-Huelgas R. Executive summary on the treatment of type 2 diabetes mellitus in elderly or frail individuals. 2022 update of the 2018 consensus document "Treatment of type 2 diabetes mellitus in the elderly". Rev Clin Esp 2022; 222:496-499. [PMID: 35753941 DOI: 10.1016/j.rceng.2022.03.005] [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: 10/25/2021] [Accepted: 03/17/2022] [Indexed: 10/17/2022]
Abstract
The population with type 2 DM (DM2) is highly heterogeneous, representing an important challenge for healthcare professionals. The therapeutic choice should be individualized, considering the functional status, frailty, the occurrence of comorbidities, and the preferences of patients and their caregivers. New evidence on the cardiovascular and renal protection of specific therapeutic groups and on the usefulness of new technologies for DM2 management, among other aspects, warrant an update of the consensus document on the DM2 in the elderly that was published in 2018.
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Affiliation(s)
- F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, Sociedad Española de Diabetes (SED), Spain
| | - F J Carrasco-Sánchez
- Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva, Sociedad Española de Medicina Interna (SEMI), Spain
| | - A Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Universitat Autònoma de Barcelona y Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Sociedad Española de Diabetes (SED), Spain
| | - J Escalada
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Pamplona, España, Sociedad Española de Endocrinología y Nutrición (SEEN), CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - F Álvarez-Guisasola
- Centro de Salud Ribera del Órbigo, León, Grupo de trabajo de diabetes, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), Spain
| | - C Miranda-Fernández-Santos
- Centro de Salud Buenavista Toledo, Toledo, Área Cardiovascular y Diabetes de la Sociedad Española de Médicos Generales y de Familia (SEMG), Spain
| | - J J Mediavilla-Bravo
- Centro de Salud Burgos Rural, Burgos, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Spain
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), CIBER de Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Sociedad Española de Medicina Interna (SEMI), Spain.
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Ramos-Rincon JM, Cobos-Palacios L, López-Sampalo A, Ricci M, Rubio-Rivas M, Nuñez-Rodriguez MV, Miranda-Godoy R, García-Leoni ME, Fernández-Madera-Martínez R, García-García GM, Beato-Perez JL, Monge-Monge D, Asín-Samper U, Bustamante-Vega M, Rábago-Lorite I, Freire-Castro SJ, Miramontes-González JP, Magallanes-Gamboa JO, Alcalá-Pedrajas JN, García-Gómez M, Cano-Llorente V, Carrasco-Sánchez FJ, Martinez-Carrilero J, Antón-Santos JM, Gómez-Huelgas R. Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain). BMC Geriatr 2022; 22:546. [PMID: 35773622 PMCID: PMC9244878 DOI: 10.1186/s12877-022-03191-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. Methods This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). Results Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79). Conclusions Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03191-4.
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Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Department of Clinical Medicine, Miguel Hernández University of Elche, Ctra N332 s/n, 03550, Sant Joan d'Alacant, Alicante, Spain.
| | - Lidia Cobos-Palacios
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Almudena López-Sampalo
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Michele Ricci
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain
| | - Manel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, , Barcelona, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | - Uxua Asín-Samper
- Internal Medicine Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Isabel Rábago-Lorite
- Internal Medicine Department, Infanta Sofía University Hospital, S. S. de los Reyes, Madrid, Spain
| | | | | | | | | | - Miriam García-Gómez
- Internal Medicine Department, Alfredo Espinosa Hospital, Urduliz, Vizcaya, Spain
| | | | | | | | | | - Ricardo Gómez-Huelgas
- Department of Internal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Regional University Hospital of Málaga & University of Málaga, Málaga, Spain.,CIBER de Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Carrasco-Sánchez FJ, Páez-Rubio MI, Arévalo-Lorido JC, Carretero-Gómez J, Conde-Martel A, Epelde F, Álvarez-Rocha P, Salamanca-Bautista MP, Cepeda-Rodrigo JM, Montero-Pérez-Barquero M. Changes over time in the association between type 2 diabetes and post-discharge outcomes in decompensated chronic heart failure patients: Findings from the RICA Registry. Rev Clin Esp 2021; 222:63-72. [PMID: 34629306 DOI: 10.1016/j.rceng.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/05/2020] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
AIMS Heart failure (HF) and diabetes are 2 strongly associated diseases. The main objective of this work was to analyze changes in the prognosis of patients with diabetes who were admitted for heart failure in 2 time periods. METHODS This work is a prospective study comparing prognosis at one year of follow-up among patients with diabetes who were hospitalized for HF in either 2008-2011 or 2018. The patients are from the Spanish Society of Internal Medicine's National Heart Failure Registry (RICA, for its initials in Spanish). The primary endpoint was to analyze the composite outcome of total mortality and/or readmission due to HF in 12 months. A multivariate Cox regression model was used to evaluate the strength of association (hazard ratio [HR]) between diabetes and the outcomes between both periods. RESULTS A total of 936 patients were included in the 2018 cohort, of which 446 (48%) had diabetes. The baseline characteristics of the populations from the 2 periods were similar. In patients with diabetes, the composite outcome was observed in 233 (47.5%) in the 2008-2011 cohort and 162 (36%) in the 2018 cohort [HR 1.48; 95% confidence interval (95%CI) 1.18-1.85; p < .001]. The proportion of readmissions (HR 1.39; 95%CI 1.07-1.80; p = .015) and total mortality (HR 1.60; 95%CI 1.20-2.14; p < .001) were also significantly higher in patients with diabetes from the 2008-2011 cohort compared to the 2018 cohort. CONCLUSIONS In 2018, an improvement was observed in the prognosis for all-cause mortality and readmissions over one year of follow-up in patients with diabetes hospitalized for HF compared to the 2008-2011 period.
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Affiliation(s)
- F J Carrasco-Sánchez
- Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
| | - M I Páez-Rubio
- Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, UGC Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - J Carretero-Gómez
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - F Epelde
- Unidad de Estancia Corta, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - P Álvarez-Rocha
- Unidad Multidisciplinaria de Insuficiencia Cardíaca, Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | | | - J M Cepeda-Rodrigo
- Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Carrasco-Sánchez FJ, Fernández-Rodríguez JM, Ena J, Gómez-Huelgas R, Carretero-Gómez J. Medical treatment of type 2 diabetes mellitus: Recommendations of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine. Rev Clin Esp 2021; 221:101-108. [PMID: 32674850 DOI: 10.1016/j.rce.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/01/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes mellitus is a major health problem with high prevalence, morbidity and mortality, and its medical treatment is growing in complexity due to patients' diverse clinical conditions. This article presents a consensus document by the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine, with recommendations for the medical treatment of type 2 diabetes mellitus. The main objective of this article is to facilitate the therapeutic decision-making process to improve the care of patients with diabetes. The document prioritises treatments with cardiovascular benefits, especially those that benefit patients with heart and renal failure.
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Affiliation(s)
- F J Carrasco-Sánchez
- Área de Insuficiencia Cardíaca, Diabetes y Riesgo Vascular, Unidad de Gestión Clínica de Medicina Interna y Cuidados Paliativos, Hospital Universitario Juan Ramón Jiménez, Huelva, España.
| | - J M Fernández-Rodríguez
- Servicio de Medicina Interna, Hospital Carmen y Severo Ochoa, Cangas de Narcea, Asturias, España
| | - J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Alicante, España
| | - R Gómez-Huelgas
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, España
| | - J Carretero-Gómez
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
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Carretero Gómez J, Ena J, Arévalo Lorido JC, Seguí Ripoll JM, Carrasco-Sánchez FJ, Gómez-Huelgas R, Pérez Soto MI, Delgado Lista J, Pérez Martínez P. Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity. Rev Clin Esp 2020; 221:S0014-2565(20)30180-6. [PMID: 32723530 DOI: 10.1016/j.rce.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. MATERIAL AND METHODS Between September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. RESULTS We obtained 599 responses. The respondents mean age was 44.4±11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). CONCLUSIONS The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members.
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Affiliation(s)
| | - J Ena
- Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, España
| | | | - J M Seguí Ripoll
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante, Alicante, España
| | - F J Carrasco-Sánchez
- Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna. Hospital Regional Universitario de Málaga, Málaga. Instituto de Investigación Biomédica de Málaga Institute of Biomedical (IBIMA). CIBER Physiopathology of Obesity and Nutrition - CIBERobn
| | - M I Pérez Soto
- Servicio de Medicina Interna, Hospital Universitario de Vinalopó, Elche, Alicante, España
| | - J Delgado Lista
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - P Pérez Martínez
- Unidad de Lípidos y Arterioesclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
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Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, Artero-Mora A, Arnalich-Fernández F, García-Bruñén JM, Vargas-Núñez JA, Freire-Castro SJ, Manzano-Espinosa L, Perales-Fraile I, Crestelo-Viéitez A, Puchades-Gimeno F, Rodilla-Sala E, Solís-Marquínez MN, Bonet-Tur D, Fidalgo-Moreno MP, Fonseca-Aizpuru EM, Carrasco-Sánchez FJ, Rabadán-Pejenaute E, Rubio-Rivas M, Torres-Peña JD, Gómez-Huelgas R. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. Rev Clin Esp 2020; 220:480-494. [PMID: 33994573 PMCID: PMC7368900 DOI: 10.1016/j.rce.2020.07.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/13/2023]
Abstract
Antecedentes España ha sido uno de los países más afectados por la pandemia de COVID-19. Objetivo Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. Métodos Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. Resultados Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥ 80 años: 46%). Conclusiones El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad.
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Affiliation(s)
- J M Casas-Rojo
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España
| | - J M Antón-Santos
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España.
| | | | | | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - E Roy-Vallejo
- Servicio de Medicina Interna, H. U. La Princesa, Madrid, España
| | - A Artero-Mora
- Servicio de Medicina Interna, H. U. Dr. Peset, Valencia, España
| | | | | | - J A Vargas-Núñez
- Servicio de Medicina Interna, H. U. Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - I Perales-Fraile
- Servicio de Medicina Interna, H. U. Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | | | - F Puchades-Gimeno
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - E Rodilla-Sala
- Servicio de Medicina Interna, H. de Sagunto, Sagunto, Valencia, España
| | | | - D Bonet-Tur
- Servicio de Medicina Interna, H. U. San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | | | | | | | | | - M Rubio-Rivas
- Servicio de Medicina Interna, H. U. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J D Torres-Peña
- Servicio de Medicina Interna, H. U. Reina Sofía, Córdoba, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, H. Regional Universitario de Málaga, Málaga, España.
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Casas-Rojo JM, Antón-Santos JM, Millán-Núñez-Cortés J, Lumbreras-Bermejo C, Ramos-Rincón JM, Roy-Vallejo E, Artero-Mora A, Arnalich-Fernández F, García-Bruñén JM, Vargas-Núñez JA, Freire-Castro SJ, Manzano-Espinosa L, Perales-Fraile I, Crestelo-Viéitez A, Puchades-Gimeno F, Rodilla-Sala E, Solís-Marquínez MN, Bonet-Tur D, Fidalgo-Moreno MP, Fonseca-Aizpuru EM, Carrasco-Sánchez FJ, Rabadán-Pejenaute E, Rubio-Rivas M, Torres-Peña JD, Gómez-Huelgas R. Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. Rev Clin Esp 2020. [PMID: 32762922 PMCID: PMC7480740 DOI: 10.1016/j.rceng.2020.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.
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Affiliation(s)
- J M Casas-Rojo
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España
| | - J M Antón-Santos
- Servicio de Medicina Interna, H. U. Infanta Cristina, Parla, Madrid, España.
| | | | | | - J M Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - E Roy-Vallejo
- Servicio de Medicina Interna, H. U. La Princesa, Madrid, España
| | - A Artero-Mora
- Servicio de Medicina Interna, H. U. Dr. Peset, Valencia, España
| | | | | | - J A Vargas-Núñez
- Servicio de Medicina Interna, H. U. Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - I Perales-Fraile
- Servicio de Medicina Interna, H. U. Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | | | - F Puchades-Gimeno
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - E Rodilla-Sala
- Servicio de Medicina Interna, H. de Sagunto, Sagunto, Valencia, España
| | | | - D Bonet-Tur
- Servicio de Medicina Interna, H. U. San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | | | | | | | | | - M Rubio-Rivas
- Servicio de Medicina Interna, H. U. de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - J D Torres-Peña
- Servicio de Medicina Interna, H. U. Reina Sofía, Córdoba, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, H. Regional Universitario de Málaga, Málaga, España.
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Ena J, Gómez-Huelgas R, Gracia-Tello BC, Vázquez-Rodríguez P, Alcalá-Pedrajas JN, Carrasco-Sánchez FJ, Murcia-Casas B, Romero-Sánchez M, Segura-Heras JV, Carretero J. Derivation and validation of a predictive model for the readmission of patients with diabetes mellitus treated in internal medicine departments. Rev Clin Esp 2018; 218:271-278. [PMID: 29731294 DOI: 10.1016/j.rce.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/11/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We developed a predictive model for the hospital readmission of patients with diabetes. The objective was to identify the frail population that requires additional strategies to prevent readmissions at 90 days. METHODS Using data collected from 1977 patients in 3 studies on the national prevalence of diabetes (2015-2017), we developed and validated a predictive model of readmission at 90 days for patients with diabetes. RESULTS A total of 704 (36%) readmissions were recorded. There were no differences in the readmission rates over the course of the 3 studies. The hospitals with more than 500 beds showed significantly (p=.02) higher readmission rates than those with fewer beds. The main reasons for readmission were infectious diseases (29%), cardiovascular diseases (24) and respiratory diseases (14%). Readmissions directly related to diabetic decompensations accounted for only 2% of all readmissions. The independent variables associated with hospital readmission were patient's age, degree of comorbidity, estimated glomerular filtration rate, degree of disability, presence of previous episodes of hypoglycaemia, use of insulin in treating diabetes and the use of systemic glucocorticoids. The predictive model showed an area under the ROC curve (AUC) of 0.676 (95% confidence interval [95% CI] 0.642-0.709; p=.001) in the referral cohort. In the validation cohort, the model showed an AUC of 0.661 (95% CI 0.612-0.710; p=.001). CONCLUSION The model we developed for predicting readmissions for hospitalised patients with type 2 diabetes helps identify a subgroup of frail patients with a high risk of readmission.
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Affiliation(s)
- J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, España.
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
| | - B C Gracia-Tello
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - P Vázquez-Rodríguez
- Servicio de Medicina Interna, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - J N Alcalá-Pedrajas
- Servicio de Medicina Interna, Hospital Comarcal de Pozoblanco, Pozoblanco, Córdoba, España
| | | | - B Murcia-Casas
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M Romero-Sánchez
- Servicio de Medicina Interna, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España
| | - J V Segura-Heras
- Centro de Investigación Operativa, Universidad Miguel Hernández, Elche, Alicante, España
| | - J Carretero
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, España
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Carrasco-Sánchez FJ, Carretero-Gómez J, Gómez-Huelgas R, Garcia-Ordoñez MA, Pardo-Ortega MV, de Escalante-Yanguela B, Mateos-Polo L, Formiga F, Ena J. Stress-induced hyperglycemia on complications in non-critically elderly hospitalized patients. Rev Clin Esp 2018; 218:223-231. [PMID: 29661504 DOI: 10.1016/j.rce.2018.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/17/2017] [Revised: 02/11/2018] [Accepted: 02/28/2018] [Indexed: 12/12/2022]
Abstract
AIMS Hospital complications and hyperglycemia are common in elderly patients during hospitalization. Our aim was to analyze the relationship between hyperglycemia and hospital complications in an ageing population. METHODS We conducted an observational study to evaluate the association between maximum blood glucose (MBG) levels and hospital complications. Patients were stratified according to the quartiles of MBG levels. Diabetes mellitus (DM) was determined by patient history and/or admission glycated hemoglobin (HbA1c) level ≥6.5%. Hyperglycemia in patients without DM was defined as stress-induced hyperglycemia (SH). The composite primary end-point included frequent complications and/or all-cause hospital mortality. RESULTS Among 461 patients, mean age 80±7.5years, 238 (51.6%) patients had DM, 20 had undiagnosed DM, and 162 (35.1%) developed hospital complications. Patients with complications had higher mean daily BG levels (215±84 vs 195±85mg/dl, P<.01). The incidence of complications was directly associated with severity of hyperglycemia according to the quartiles of MBG levels in patients without DM, namely SH (<140 mg/dl, 22.2%; 140-185mg/dl, 40%; 186-250mg/dl, 47%; >250mg/dl, 60%; P=.002), but not in patients with DM (<140mg/dl, 26.3%; 140-185mg/dl, 40.4%; 186-250mg/dl, 35.6%; >250mg/dl, 37.4%; P=.748). In the multivariate analyses, SH was independently associated with complications: OR 2.60 (CI95%: 1.2-5.6), 2.82 (CI95%: 1.2-6.5), 5.50 (CI95%: 1.4-20.8) for the second, third and fourth quartile respectively (P=.01), as compared to the first quartile. We found no association with readmissions and all-cause mortality. CONCLUSIONS SH in elderly patients is associated with hospital complications, but not with all-cause mortality, compared to patients with diabetes or normoglycemia.
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Affiliation(s)
| | - J Carretero-Gómez
- Servicio de Medicina Interna, Hospital de Zafra, Zafra, Badajoz, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario, Málaga, España; CIBER de Fisiopatología de la Obesidad y la Nutrición, España
| | | | | | | | | | - F Formiga
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - J Ena
- Hospital de la Marina Baixa, la Vila Joiosa, Alicante, España
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Carrasco-Sánchez FJ, López-Domínguez JM, Casado-Chocán JL, Pérez-Gutiérrez S, Onaindía-Rico JM, Borrero-Martín JJ, Blanco-Ollero A. [Uremic myopathy]. Rev Neurol 2000; 30:1154-6. [PMID: 10935242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The neurological features of chronic renal failure are very varied. Uremic myopathy is a controversial condition. In most cases it is related to the secondary hyperparathyroidism which these patients develop, and its characteristics are superimposed on their osteomalacia myopathy. CLINICAL CASES AND CONCLUSIONS We report two patients with terminal chronic renal failure on hemodialysis who complained on difficulty with walking. The clinical findings, laboratory and neurophysiological investigations and the histopathological report of the muscle biopsy were similar to those of osteomalacia myopathy. The muscle weakness of patients with terminal chronic renal failure is related to many factors. The most important of these is the secondary hyperparathyroidism which leads to osteomalacia myopathy. On muscle biopsy there was isolated fibre necrosis of both types 1 and 2 (case 1) and of type 2 alone (case 2), which is considered to be the commonest finding. Although treatment with high doses of vitamin D3, or its hydroxylated metabolites, has been recommended, it was not effective in our patients.
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