SAS - Hospital San Juan de Dios del Aljarafe

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Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.
(2022) Estella, Á; Garcia Garmendia, J L; de la Fuente, C; Machado Casas, J F; Yuste, M E; Amaya Villar, R; Estecha, M A; Yaguez Mateos, L; Cantón Bulnes, M L; Loza, A; Mora, J; Fernández Ruiz, L; Díez Del Corral Fernández, B; Rojas Amezcua, M; Rodriguez Higueras, M I; Díaz Torres, I; Recuerda Núñez, M; Zaheri Beryanaki, M; Rivera Espinar, F; Matallana Zapata, D F; Moreno Cano, S G; Gimenez Beltrán, B; Muñoz, N; Sainz de Baranda Piñero, A; Bustelo Bueno, P; Moreno Barriga, E; Rios Toro, J J; Pérez Ruiz, M; Gómez González, C; Breval Flores, A; de San José Bermejo Gómez, A; Ruiz Cabello Jimenez, M A; Guerrero Marín, M; Ortega Ordiales, A; Tejero-Aranguren, J; Rodriguez Mejías, C; Gomez de Oña, J; de la Hoz, C; Ocaña Fernández, D; Ibañez Cuadros, S; Garnacho Montero, J; Work Group of Infectious Disease (GTEI) de la Sociedad Andaluza de Medicina Intensiva y Unidades coronarias SAMIUC
The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Prospective descriptive multicenter cohort study. 26 Intensive care units (ICU) from Andalusian region in Spain. Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. None. Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission 470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.
Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study.
(2022-05-29) Benítez, Iván D; de Batlle, Jordi; Torres, Gerard; González, Jessica; de Gonzalo-Calvo, David; Targa, Adriano D S; Gort-Paniello, Clara; Moncusí-Moix, Anna; Ceccato, Adrián; Fernández-Barat, Laia; Ferrer, Ricard; Garcia-Gasulla, Dario; Menéndez, Rosario; Motos, Anna; Peñuelas, Oscar; Riera, Jordi; Bermejo-Martin, Jesús F; Peñasco, Yhivian; Ricart, Pilar; Martin Delgado, María Cruz; Aguilera, Luciano; Rodríguez, Alejandro; Boado Varela, Maria Victoria; Suarez-Sipmann, Fernando; Pozo-Laderas, Juan Carlos; Solé-Violan, Jordi; Nieto, Maite; Novo, Mariana Andrea; Barberán, José; Amaya Villar, Rosario; Garnacho-Montero, José; García-Garmendia, Jose Luis; Gómez, José M; Lorente, José Ángel; Blandino Ortiz, Aaron; Tamayo Lomas, Luis; López-Ramos, Esther; Úbeda, Alejandro; Catalán-González, Mercedes; Sánchez-Miralles, Angel; Martínez Varela, Ignacio; Jorge García, Ruth Noemí; Franco, Nieves; Gumucio-Sanguino, Víctor D; Huerta Garcia, Arturo; Bustamante-Munguira, Elena; Valdivia, Luis Jorge; Caballero, Jesús; Gallego, Elena; Martínez de la Gándara, Amalia; Castellanos-Ortega, Álvaro; Trenado, Josep; Marin-Corral, Judith; Albaiceta, Guillermo M; de la Torre, Maria Del Carmen; Loza-Vázquez, Ana; Vidal, Pablo; Lopez Messa, Juan; Añón, Jose M; Carbajales Pérez, Cristina; Sagredo, Victor; Bofill, Neus; Carbonell, Nieves; Socias, Lorenzo; Barberà, Carme; Estella, Angel; Valledor Mendez, Manuel; Diaz, Emili; López Lago, Ana; Torres, Antoni; Barbé, Ferran; CIBERESUCICOVID Project (COV20/00110, ISCIII)
The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. ISCIII, UNESPA, CIBERES, FEDER, ESF.
Anterior Cruciate Ligament Revision Surgery Associated to Lateral Collateral and Anterolateral Ligaments Reconstruction With Single Achilles Tendon Allograft and Single Femoral Tunnel
(Elsevier, 2022-10-20) Espejo-Reina, Alejandro; Josefa Espejo-Reina, Maria; Lombardo-Torre, Maximiano; Sevillano-Perez, Enrique; Llanos-Rodriguez, Alvaro; Espejo-Baena, Alejandro; [Espejo-Reina, Alejandro] Clin Espejo, Malaga, Spain; [Espejo-Baena, Alejandro] Clin Espejo, Malaga, Spain; [Espejo-Reina, Alejandro] Hosp Vithas Malaga, Malaga, Spain; [Lombardo-Torre, Maximiano] Hosp Vithas Malaga, Malaga, Spain; [Sevillano-Perez, Enrique] Hosp Vithas Malaga, Malaga, Spain; [Llanos-Rodriguez, Alvaro] Hosp Vithas Malaga, Malaga, Spain; [Espejo-Baena, Alejandro] Hosp Vithas Malaga, Malaga, Spain; [Josefa Espejo-Reina, Maria] Hosp San de Juan Dios Aljarafe, Seville, Spain; [Lombardo-Torre, Maximiano] Hosp Univ Virgen de la Victoria, Malaga, Spain; [Sevillano-Perez, Enrique] Hosp Reg Univo Malaga, Malaga, Spain; [Llanos-Rodriguez, Alvaro] Hosp Antequera, Malaga, Spain
Lateral collateral ligament (LC) injuries that go unnoticed when associated with an anterior cruciate ligament (ACL) tear can increase stress forces on the ACL graft causing its failure. Furthermore, it is a main stabilizer to varus stress and external rotation. On the other hand, the reinforcement of anterolateral structures during ACL reconstruction has regained popularity in recent years, because evidence has shown that it increases the control of rotational laxity and decreases ACL graft failures, especially in revision surgery. The present article shows a technique to perform an ACL reconstruction, associated with the reconstruction of the LCL and of the anterolateral ligament using a single Achilles tendon allograft, which is split after the fixation of the ACL graft into two fascicles.
Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units.
(2022-04-15) Torres, Antoni; Motos, Anna; Ceccato, Adrián; Bermejo-Martin, Jesús; de Gonzalo-Calvo, David; Pérez, Raquel; Barroso, Marta; Pascual, Ion Zubizarreta; Gonzalez, Jessica; Fernández-Barat, Laia; Ferrer, Ricard; Riera, Jordi; García-Gasulla, Dario; Peñuelas, Oscar; Lorente, José Ángel; Almansa, Raquel; Menéndez, Rosario; Kiarostami, Kasra; Canseco, Joan; Villar, Rosario Amaya; Añón, José M; Mariño, Ana Balan; Barberà, Carme; Barberán, José; Ortiz, Aaron Blandino; Boado, Maria Victoria; Bustamante-Munguira, Elena; Caballero, Jesús; Cantón-Bulnes, María Luisa; Pérez, Cristina Carbajales; Carbonell, Nieves; Catalán-González, Mercedes; de Frutos, Raúl; Franco, Nieves; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D; Torre, María Del Carmen de la; Díaz, Emili; Estella, Ángel; Gallego, Elena; Garmendia, José Luis García; Gómez, José M; Huerta, Arturo; García, Ruth Noemí Jorge; Loza-Vázquez, Ana; Marin-Corral, Judith; Delgado, María Cruz Martin; Gándara, Amalia Martínez de la; Varela, Ignacio Martínez; Messa, Juan López; Albaiceta, Guillermo M; Nieto, Maite; Novo, Mariana Andrea; Peñasco, Yhivian; Pérez-García, Felipe; Pozo-Laderas, Juan Carlos; Ricart, Pilar; Sagredo, Víctor; Sánchez-Miralles, Ángel; Chinesta, Susana Sancho; Serra-Fortuny, Mireia; Socias, Lorenzo; Solé-Violan, Jordi; Suárez-Sipmann, Fernando; Lomas, Luis Tamayo; Trenado, José; Úbeda, Alejandro; Valdivia, Luis Jorge; Vidal, Pablo; Barbé, Ferran; CIBERESUCICOVID Project (COV20/00110, ISCIII)
The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs.
Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections.
(2022-07-07) Fernández-Galilea, A; Estella, A; García-Garmendia, J L; Loza, A; Palacios-García, I; Sierra-Camerino, R; Seller, G; Rodríguez-Delgado, M; Rodriguez-Higueras, I; Garnacho-Montero, J
Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality. Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses. Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095). In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders.
[Non-drug treatments for chronic non-malignant pain].
(2022-08-30) Ruiz-Romero, M V; Guerra-Martín, M D; Álvarez-Tellado, L; Sánchez-Villar, E; Arroyo-Rodríguez, A; Sánchez-Gutiérrez, M C
[Poor prognostic factors in patients hospitalized for COVID-19].
(2022-07-01) Blanco-Taboada, A L; Fernández-Ojeda, M R; Castillo-Matus, M M; Galán-Azcona, M D; Salinas-Gutiérrez, J; Ruiz-Romero, M V
The clinical spectrum of COVID-19 varies from no or mild symptoms to pneumonia with fatal complications. The aim of the study was to find predictors of mortality and admission in the intensive care unit (ICU) in patients hospitalized for COVID-19. Retrospective study of a cohort of patients admitted for COVID-19 between March 2020 and February 2021. Demographic, clinical, radiological and laboratory variables were described at admission. Independent predictors of mortality and ICU admission were identified by means of backward stepwise logistic regression and described in terms of odds ratio (OR) and 95% confidence interval (95%CI). A total of 883 patients were included, 51.8% men with a mean age of 68; 1.8% readmissions. 17.6% of patients died (n=154). The independent predictors of mortality were age (OR=1.071; 95%CI: 1.046-1.095), percentage of oxygen saturation (SatO2) (OR=0.938; 95%CI: 0.903-0.974), diastolic blood pressure (DBP, OR= 0.972; 95%CI: 0.955-0.989), creatinine (OR=1.516; 95%CI: 1.088-2.113), INR (OR=1.199; 95%CI: 1.012-1.419) and sodium (OR=1.082; 95%CI: 1.037-1.128). Eight percent of patients were admitted to ICU; the independent predictors were: male sex (OR=2.079; 95%CI: 1.099-3.935), age (OR=0.960; 95%CI: 0.942-0.979), SatO2 (OR=0.925; 95%CI: 0.889-0.962), creatinine (OR=1.551; 95%CI: 1.118-2.152) and C-reactive protein (CRP, OR=1.003; 95%CI: 1.000-1.007). The identification of independent predictors of mortality (age, SatO2, DBP, creatinine, INR, sodium) and ICU admission (sex, age, SatO2, creatinine, and CRP) allowed for the stratification of patients to adapt clinical care protocols to these findings, thereby improving medical decisions.
Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study.
(2022-02-19) Bassetti, Matteo; Vena, Antonio; Giacobbe, Daniele R; Trucchi, Cecilia; Ansaldi, Filippo; Antonelli, Massimo; Adamkova, Vaclava; Alicino, Cristiano; Almyroudi, Maria-Panagiota; Atchade, Enora; Azzini, Anna M; Brugnaro, Pierluigi; Carannante, Novella; Peghin, Maddalena; Berruti, Marco; Carnelutti, Alessia; Castaldo, Nadia; Corcione, Silvia; Cortegiani, Andrea; Dimopoulos, George; Dubler, Simon; García-Garmendia, José L; Girardis, Massimo; Cornely, Oliver A; Ianniruberto, Stefano; Kullberg, Bart Jan; Lagrou, Katrien; Lebihan, Clement; Luzzati, Roberto; Malbrain, Manu; Merelli, Maria; Marques, Ana J; Martin-Loeches, Ignacio; Mesini, Alessio; Paiva, José-Artur; Raineri, Santi Maurizio; Rautemaa-Richardson, Riina; Schouten, Jeroen; Spapen, Herbert; Tasioudis, Polychronis; Timsit, Jean-François; Tisa, Valentino; Tumbarello, Mario; Van den Berg, Charlotte H S B; Veber, Benoit; Venditti, Mario; Voiriot, Guillaume; Wauters, Joost; Zappella, Nathalie; Montravers, Philippe; from the Study Group for Infections in Critically Ill Patients (ESGCIP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candida spp. may be responsible for up to 10-30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. We performed a case-control study in 26 European ICUs during the period January 2015-December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65-72.82, p = 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98-21.99, p = 0.002), abdominal drain (OR 6.58; 95% CI 1.73-25.06, p = 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04-17.46, p = 0.04) or antibiotics (OR 3.78; 95% CI 1.32-10.52, p = 0.01) were independently associated with IAC. Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.
Correction: Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885.
(2022-09-30) Chaparro, María; Garre, Ana; Núñez Ortiz, Andrea; Diz-Lois Palomares, María Teresa; Rodríguez, Cristina; Riestra, Sabino; Vela, Milagros; Benítez, José Manuel; Fernández Salgado, Estela; Sánchez Rodríguez, Eugenia; Hernández, Vicent; Ferreiro-Iglesias, Rocío; Ponferrada Díaz, Ángel; Barrio, Jesús; Huguet, José María; Sicilia, Beatriz; Martín-Arranz, María Dolores; Calvet, Xavier; Ginard, Daniel; Alonso-Abreu, Inmaculada; Fernández-Salazar, Luis; Varela Trastoy, Pilar; Rivero, Montserrat; Vera-Mendoza, Isabel; Vega, Pablo; Navarro, Pablo; Sierra, Mónica; Cabriada, José Luis; Aguas, Mariam; Vicente, Raquel; Navarro-Llavat, Mercè; Echarri, Ana; Gomollón, Fernando; Guerra Del Río, Elena; Piñero, Concepción; Casanova, María José; Spicakova, Katerina; Ortiz de Zarate, Jone; Torrella Cortés, Emilio; Gutiérrez, Ana; Alonso-Galán, Horacio; Hernández-Martínez, Álvaro; Marrero, José Miguel; Lorente Poyatos, Rufo; Calafat, Margalida; Martí Romero, Lidia; Robledo, Pilar; Bosch, Orencio; Jiménez, Nuria; Esteve Comas, María; Duque, José María; Fuentes Coronel, Ana María; Josefa Sampedro, Manuela; Sesé Abizanda, Eva; Herreros Martínez, Belén; Pozzati, Liliana; Fernández Rosáenz, Hipólito; Crespo Suarez, Belén; López Serrano, Pilar; Lucendo, Alfredo J; Muñoz Vicente, Margarita; Bermejo, Fernando; Ramírez Palanca, José Joaquín; Menacho, Margarita; Carmona, Amalia; Camargo, Raquel; Torra Alsina, Sandra; Maroto, Nuria; Nerín de la Puerta, Juan; Castro, Elena; Marín-Jiménez, Ignacio; Botella, Belén; Sapiña, Amparo; Cruz, Noelia; Forcelledo, José Luis F; Bouhmidi, Abdel; Castaño-Milla, Carlos; Opio, Verónica; Nicolás, Isabel; Kutz, Marcos; Abraldes Bechiarelli, Alfredo; Gordillo, Jordi; Ber, Yolanda; Torres Domínguez, Yolanda; Novella Durán, María Teresa; Rodríguez Mondéjar, Silvia; Martínez-Cerezo, Francisco J; Kolle, Lilyan; Sabat, Miriam; Ledezma, Cesar; Iyo, Eduardo; Roncero, Óscar; Irisarri, Rebeca; Lluis, Laia; Blázquez Gómez, Isabel; Zapata, Eva María; José Alcalá, María; Martínez Pascual, Cristina; Montealegre, María; Mata, Laura; Monrobel, Ana; Hernández Camba, Alejandro; Hernández, Luis; Tejada, María; Mir, Alberto; Galve, María Luisa; Soler, Marta; Hervías, Daniel; Gómez-Valero, José Antonio; Barreiro-de Acosta, Manuel; Rodríguez-Artalejo, Fernando; García-Esquinas, Esther; Gisbert, Javier P; On Behalf Of The EpidemIBD Study Group Of Geteccu,
The authors wish to make the following corrections to this paper [...].
Impact of Systemic Comorbidities on Ocular Hypertension and Open-Angle Glaucoma, in a Population from Spain and Portugal.
(2022-09-25) Garcia-Villanueva, Carolina; Milla, Elena; Bolarin, José M; García-Medina, José J; Cruz-Espinosa, Javier; Benítez-Del-Castillo, Javier; Salgado-Borges, José; Hernández-Martínez, Francisco J; Bendala-Tufanisco, Elena; Andrés-Blasco, Irene; Gallego-Martinez, Alex; Zanón-Moreno, Vicente C; Pinazo-Durán, María Dolores
Open-angle glaucoma (OAG), the most prevalent clinical type of glaucoma, is still the main cause of irreversible blindness worldwide. OAG is a neurodegenerative illness for which the most important risk factor is elevated intraocular pressure (IOP). Many questions remain unanswered about OAG, such as whether nutritional or toxic habits, other personal characteristics, and/or systemic diseases influence the course of glaucoma. As such, in this study, we performed a multicenter analytical, observational, case-control study of 412 participants of both sexes, aged 40-80 years, that were classified as having ocular hypertension (OHT) or OAG. Our primary endpoint was to investigate the relationship between specific lifestyle habits; anthropometric and endocrine-metabolic, cardiovascular, and respiratory events; and commonly used psychochemicals, with the presence of OHT or OAG in an ophthalmologic population from Spain and Portugal. Demographic, epidemiological, and ocular/systemic clinical data were recorded from all participants. Data were analyzed using the R Statistics v4.1.2 and RStudio v2021.09.1 programs. The mean age was 62 ± 15 years, with 67-80 years old comprising the largest subgroup sample of participants in both study groups. The central corneal thickness (ultrasound pachymetry)-adjusted IOP (Goldman tonometry) in each eye was 20.46 ± 2.35 and 20.1 ± 2.73 mmHg for the OHT individuals, and 15.8 ± 3.83 and 16.94 ± 3.86 mmHg for the OAG patients, with significant differences between groups (both p = 0.001). The highest prevalence of the surveyed characteristics in both groups was for overweight/obesity and daily coffee consumption, followed by psychochemical drug intake, migraine, and peripheral vasospasm. Our data show that overweight/obesity, migraine, asthma, and smoking are major risk factors for conversion from OHT to OAG in this Spanish and Portuguese population.
Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs-Analysis of the EPICTER Study.
(2022-06-27) Méndez-Bailón, Manuel; Lorenzo-Villalba, Noel; Romero-Correa, Miriam; Josa-Laorden, Claudia; Inglada-Galiana, Luis; Menor-Campos, Eva; Gómez-Aguirre, Noelia; Clemente-Sarasa, Carolina; Salas-Campos, Rosario; García-Redecillas, Carmen; Asenjo-Martínez, María; Trullàs, Joan Carles; Cortés-Rodríguez, Begoña; de la Guerra-Acebal, Carla; Serrado Iglesias, Ana; Aparicio-Santos, Reyes; Formiga, Francesc; Andrès, Emmanuel; Aramburu-Bodas, Oscar; Salamanca-Bautista, Prado; On Behalf Of Epicter Study Group,
Introduction: There are studies that evaluate the association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality in elderly patients with acute and advanced HF and the clinical manifestations and management from a palliative point of view. Methods: The EPICTER study (“Epidemiological survey of advanced heart failure”) is a cross-sectional, multicenter project that consecutively collected patients admitted for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF
ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome.
(2021-12-31) Martin-Loeches, Ignacio; Motos, Anna; Menéndez, Rosario; Gabarrús, Albert; González, Jessica; Fernández-Barat, Laia; Ceccato, Adrián; Pérez-Arnal, Raquel; García-Gasulla, Dario; Ferrer, Ricard; Riera, Jordi; Lorente, José Ángel; Peñuelas, Óscar; Bermejo-Martin, Jesús F; de Gonzalo-Calvo, David; Rodríguez, Alejandro; Barbé, Ferran; Aguilera, Luciano; Amaya-Villar, Rosario; Barberà, Carme; Barberán, José; Blandino Ortiz, Aaron; Bustamante-Munguira, Elena; Caballero, Jesús; Carbajales, Cristina; Carbonell, Nieves; Catalán-González, Mercedes; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D; de la Torre, Maria Del Carmen; Díaz, Emili; Gallego, Elena; García Garmendia, José Luis; Garnacho-Montero, José; Gómez, José M; Jorge García, Ruth Noemí; Loza-Vázquez, Ana; Marín-Corral, Judith; Martínez de la Gándara, Amalia; Martínez Varela, Ignacio; Lopez Messa, Juan; Albaiceta, Guillermo M; Novo, Mariana Andrea; Peñasco, Yhivian; Ricart, Pilar; Urrelo-Cerrón, Luis; Sánchez-Miralles, Angel; Sancho Chinesta, Susana; Socias, Lorenzo; Solé-Violan, Jordi; Tamayo Lomas, Luis; Vidal, Pablo; Torres, Antoni
Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.
Supplementation with a Highly Concentrated Docosahexaenoic Acid (DHA) in Non-Proliferative Diabetic Retinopathy: A 2-Year Randomized Double-Blind Placebo-Controlled Study.
(2022-01-05) Piñas García, Purificación; Hernández Martínez, Francisco Javier; Aznárez López, Núria; Castillón Torre, Luis; Tena Sempere, Mª Eugenia
We assessed the effect of a 2-year supplementation with a highly concentrated docosahexaenoic acid (DHA) product with antioxidant activity on non-proliferative diabetic retinopathy (NPDR) in a randomized double-blind placebo-controlled study. A total of 170 patients with diabetes were randomly assigned to the DHA group (n = 83) or the placebo group (n = 87). NPDR was diagnosed using non-contact slit lamp biomicroscopy examination, and classified into mild, moderate, and severe stages. Patients in the DHA group received a high rich DHA triglyceride (1050 mg/day) nutritional supplement, and those in the placebo group received olive oil capsules. The percentages of mild NPDR increased from 61.7% at baseline to 75.7% at the end of the study in the DHA group, and from 61.9% to 73.1% in the placebo group. Moderate NPDR stages decreased from 35.1% at baseline to 18.7% at the end of the study in the DHA group, and from 36.8% to 26.0% in the placebo group. In the DHA group, there were five eyes with severe NPDR at baseline, which increased to one more at the end of the study. In the placebo group, of two eyes with severe NPDR at baseline, one eye remained at the end of the study. Changes in visual acuity were not found. There were improvements in the serum levels of HbA1c in both groups, but significant differences between the DHA and the placebo groups were not found. In this study, the use of a DHA triglyceride nutraceutical supplement for 2 years did not appear to influence the slowing of the progression of NPDR.
Clinical and Psychological Factors Associated with Addiction and Compensatory Use of Facebook Among Patients with Inflammatory Bowel Disease: A Cross-Sectional Study.
(2022-02-11) Cury, Giovana Signorelli Astolfi; Takamune, Debora Mayumi; Herrerias, Giedre Soares Prates; Rivera-Sequeiros, Adriana; de Barros, Jaqueline Ribeiro; Baima, Julio Pinheiro; Saad-Hossne, Rogerio; Sassaki, Ligia Yukie
Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient's quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients. This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale. The patient group included 54 patients with Crohn's disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients: R = 0.22; p = 0.03; controls: R = 0.34; p = 0.0006) and inversely related to self-esteem scale (patients: R = -0.27; p = 0.006; controls: R = -0.37; p = 0.0001). Facebook addiction showed an inverse correlation with self-esteem (patients: R = -0.32; p = 0.001; controls: R = -0.24; p = 0.02) and quality of life (patients: IBDQ score, R = -0.30; p = 0.003; controls: SF-36 score, R = -0.29; p = 0.004). The use of Facebook was not different between study groups. Psychological aspects such as depression and low self-esteem were associated with the compensatory use of Facebook in both groups, which may be related to unsatisfactory personal aspects of social interaction.
Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.
(2022-06-21) Torres, Antoni; Motos, Ana; Cillóniz, Catia; Ceccato, Adrián; Fernández-Barat, Laia; Gabarrús, Albert; Bermejo-Martin, Jesús; Ferrer, Ricard; Riera, Jordi; Pérez-Arnal, Raquel; García-Gasulla, Dario; Peñuelas, Oscar; Lorente, José Ángel; de Gonzalo-Calvo, David; Almansa, Raquel; Menéndez, Rosario; Palomeque, Andrea; Villar, Rosario Amaya; Añón, José M; Balan Mariño, Ana; Barberà, Carme; Barberán, José; Blandino Ortiz, Aaron; Boado, Maria Victoria; Bustamante-Munguira, Elena; Caballero, Jesús; Cantón-Bulnes, María Luisa; Carbajales Pérez, Cristina; Carbonell, Nieves; Catalán-González, Mercedes; de Frutos, Raul; Franco, Nieves; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D; de la Torre, Maria Del Carmen; Díaz, Emili; Estella, Ángel; Gallego, Elena; García Garmendia, José Luis; Gómez, José M; Huerta, Arturo; García, Ruth Noemí Jorge; Loza-Vázquez, Ana; Marin-Corral, Judith; Martin Delgado, María Cruz; Martínez de la Gándara, Amalia; Martínez Varela, Ignacio; López Messa, Juan; Albaiceta, Guillermo M; Nieto, Maite; Novo, Mariana Andrea; Peñasco, Yhivian; Pérez-García, Felipe; Pozo-Laderas, Juan Carlos; Ricart, Pilar; Sagredo, Victor; Sánchez-Miralles, Angel; Sancho Chinesta, Susana; Serra-Fortuny, Mireia; Socias, Lorenzo; Solé-Violan, Jordi; Suarez-Sipmann, Fernando; Tamayo Lomas, Luis; Trenado, José; Úbeda, Alejandro; Valdivia, Luis Jorge; Vidal, Pablo; Barbé, Ferran; CIBERESUCICOVID Project Investigators
Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment ( Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.
A neuroimaging study of pleasant and unpleasant olfactory perceptions of virgin olive oil
(Consejo superior investigaciones cientificas-csic, 2016-10-01) Vivancosa, J.; Tena, N.; Morales, M. T.; Aparicio, R.; Garcia-Gonzalez, D. L.; [Vivancosa, J.] Hosp San Juan Dios, Avda San Juan de Dios S-N, E-41930 Bormujos, Spain; [Tena, N.] CSIC, Inst Grasa, Bdg 46 Campus Univ Pablo de Olavide, E-41013 Seville, Spain; [Aparicio, R.] CSIC, Inst Grasa, Bdg 46 Campus Univ Pablo de Olavide, E-41013 Seville, Spain; [Garcia-Gonzalez, D. L.] CSIC, Inst Grasa, Bdg 46 Campus Univ Pablo de Olavide, E-41013 Seville, Spain; [Morales, M. T.] Univ Seville, Dept Analyt Chem, C Prof Garcia Gonzalez 2, E-41012 Seville, Spain; State Secretariat for Research, Development and Innovation (Ramon y Cajal Program)
Functional magnetic resonance imaging (fMRI) has been used to collect information from neurons that receive direct input from olfactory bulbs when subjects smell virgin olive oil. The pleasant aroma of three extra virgin olive oils (var. Royal, Arbequina and Picual) and three virgin olive oils with sensory defects (rancid, fusty and winey/vinegary) were presented to 14 subjects while a fMRI scan acquired data from the brain activity. Data were subjected to a two-sample t test analysis, which allows a better interpretation of results particularly when data are studied across different subjects. Most of the activations, which were located in the frontal lobe, are related to the olfactory task regardless of the hedonic component of perception (e.g. Brodmann areas 10, 11). Comparing the samples with pleasant and unpleasant aromas, differences were found at the anterior cingulate gyrus (Brodmann area 32), at the temporal lobe (Brodmann area 38), and inferior frontal gyrus (Brodmann area 47), while intense aromas activated Brodmann area 6. The actual perceptions described by the subjects and the concentration of the odorant compounds in the samples were considered in the interpretation of the results.
Viral detection and serological response critically ill patients with SARS-CoV-2. Implications for isolation withdrawal
(Elsevier espana slu, 2020-12-01) Garcia Garmendia, J. L.; Ramirez Arcos, M.; Barrero Almodovar, A. E.; Chavez Caballero, M.; Jorge Amigo, V.; Serrano Martino, M. C.; [Garcia Garmendia, J. L.] Hosp San Juan Dios Aljarafe, Serv Cuidados Crit & Urgencias, Unidad Cuidados Intens, Seville, Spain; [Barrero Almodovar, A. E.] Hosp San Juan Dios Aljarafe, Serv Cuidados Crit & Urgencias, Unidad Cuidados Intens, Seville, Spain; [Jorge Amigo, V.] Hosp San Juan Dios Aljarafe, Serv Cuidados Crit & Urgencias, Unidad Cuidados Intens, Seville, Spain; [Ramirez Arcos, M.] Hosp San Juan Dios Aljarafe, Serv Lab, Unidad Microbiol, Seville, Spain; [Chavez Caballero, M.] Hosp San Juan Dios Aljarafe, Serv Lab, Unidad Microbiol, Seville, Spain; [Serrano Martino, M. C.] Hosp San Juan Dios Aljarafe, Serv Lab, Unidad Microbiol, Seville, Spain
Impact of fluconazole susceptibility on the outcome of patients with candidaemia: data from a population-based surveillance
(Elsevier sci ltd, 2017-09-01) Fernandez-Ruiz, M.; Guinea, J.; Lora-Pablos, D.; Zaragoza, O.; Puig-Asensio, M.; Almirante, B.; Cuenca-Estrella, M.; Aguado, J. M.; CANDIPOP Project; GEIH-GEMICOMED SEIMC; REIPI; [Fernandez-Ruiz, M.] Univ Complutense, Inst Invest Hosp Octubre i 12 12, Hosp Univ Octubre 12, Unit Infect Dis, Madrid, Spain; [Aguado, J. M.] Univ Complutense, Inst Invest Hosp Octubre i 12 12, Hosp Univ Octubre 12, Unit Infect Dis, Madrid, Spain; [Guinea, J.] Univ Complutense, Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid, Spain; [Lora-Pablos, D.] Hosp Univ Octubre 12, Inst Invest Hosp Octubre i 12 12, Unit Clin Res, Madrid, Spain; [Lora-Pablos, D.] CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain; [Zaragoza, O.] Inst Salud Carlos III, Spanish Natl Ctr Microbiol, Dept Mycol, Madrid, Spain; [Cuenca-Estrella, M.] Inst Salud Carlos III, Spanish Natl Ctr Microbiol, Dept Mycol, Madrid, Spain; [Puig-Asensio, M.] Univ Autonoma Barcelona, Dept Med, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain; [Almirante, B.] Univ Autonoma Barcelona, Dept Med, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain; Gilead; MSD; Astellas; Pfizer; Fundacion SEIMC-GESIDA; Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III - European Development Regional Fund (ERDF) 'A Way to Achieve Europe'); Spanish Network for the Research in Infectious Diseases; Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III; Astellas Pharma; MICOLAB; Mutua Madrilena Foundation; Spanish Health Research Fund (FIS); Gilead Sciences; Merck Sharp Dohme; Hickma Pharmaceutica; United Medical; Instituto de Salud Carlos III; bioMerieux; Schering Plough; Soria Melguizo SA; Ferrer International; Europea Union; ALBAN program; Spanish Agency for International Cooperation; Spanish Ministry of Culture and Education; Spanish Health Research Fund; Instituto de Salud Carlos III (Spanish Ministry of Economy and Competitiveness); Ramon Areces Foundation; Mutua Madrileria Foundation
Objectives: The clinical correlation of fluconazole antifungal susceptibility testing (AST) for Candida isolates and its integration with pharmacokinetics/pharmacodynamics (PK/PD) parameters is unclear. We analysed the impact of fluconazole minimum inhibitory concentration (MIC) values, 24-hour area under the concentration-time curve (AUC24) and AUC24/MIC ratio on the outcome of candidemic patients.Methods: We included 257 episodes of candidaemia treated with fluconazole monotherapy for >= 72 hours from a population-based surveillance conducted in 29 hospitals (CANDIPOP Project). AST was centrally performed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) microdilution methods. Primary outcome was clinical failure (30-day mortality and/or persistent candidaemia for >= 72 hours from initiation of therapy). Secondary outcomes included early (3-7 days) and late (3-30 days) mortality.Results: Rates of clinical failure, early and late mortality among evaluable episodes were 32.3% (80/248), 3.1% (8/257) and 23.4% (59/248). There was no relationship between fluconazole MIC values or PK/PD parameters and clinical failure. Although MIC values >= 2 mg/L by EUCAST (positive predictive value 32.1%, negative predictive value 68.7%) and >= 0.5 mg/L by CLSI (positive predictive value 34.8%, negative predictive value 74.4%) appeared to be optimal for predicting clinical failure, no significant associations remained after multivariate adjustment (odds ratio 1.67; 95% confidence interval 0.48-5.79; p 0.423). Lack of association was consistent for alternative thresholds (including proposed clinical breakpoints). The only association found for secondary outcomes was between an AUC24/MIC ratio >400 h by CLSI and early mortality (odds ratio 0.18; 95% confidence interval 0.04-0.98; p 0.026).Conclusions: High fluconazole MIC values did not negatively impact outcome of patients with candidaemia treated with fluconazole. No effect of PK/PD targets on the risk of clinical failure was found. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score-derived analysis of a population-based, multicentre prospective cohort
(Elsevier sci ltd, 2016-08-01) Lopez-Cortes, L. E.; Almirante, B.; Cuenca-Estrella, M.; Garnacho-Montero, J.; Padilla, B.; Puig-Asensio, M.; Ruiz-Camps, I.; Rodriguez-Bano, J.; CANDIPOP Project GEIH-GEMICOMED; [Lopez-Cortes, L. E.] Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain; [Rodriguez-Bano, J.] Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain; [Lopez-Cortes, L. E.] Hosp Univ Virgen del Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain; [Rodriguez-Bano, J.] Hosp Univ Virgen del Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain; [Almirante, B.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain; [Puig-Asensio, M.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain; [Ruiz-Camps, I.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain; [Cuenca-Estrella, M.] Inst Salud Carlos III, Spanish Natl Ctr Microbiol, Dept Micol, Madrid, Spain; [Garnacho-Montero, J.] Hosp Univ Virgen Macarena, Unidad Clin Cuidados Intens, Seville, Spain; [Padilla, B.] Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid, Spain; [Rodriguez-Bano, J.] Univ Seville, Dept Med, Seville, Spain; Gilead Sciences; Pfizer; Instituto de Salud Carlos III; Astellas Pharma; bioMerieux; Merck Sharp and Dohme; Schering Plough; Soria Melguizo SA; Ferrer International; European Union; ALBAN programme; Spanish Agency for International Cooperation; Spanish Ministry of Culture and Education; Spanish Health Research Fund; Ramon Areces Foundation; Mutua Madrilena Foundation
We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17e0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41-1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia. L.E. Lopez-Cortes, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients.
(2021-09-13) Torres, Antoni; Motos, Anna; Riera, Jordi; Fernández-Barat, Laia; Ceccato, Adrián; Pérez-Arnal, Raquel; García-Gasulla, Dario; Peñuelas, Oscar; Lorente, José Angel; Rodriguez, Alejandro; de Gonzalo-Calvo, David; Almansa, Raquel; Gabarrús, Albert; Menéndez, Rosario; Bermejo-Martin, Jesús F; Ferrer, Ricard; Amaya Villar, Rosario; Añón, José M; Barberà, Carme; Barberán, José; Blandino Ortiz, Aaron; Bustamante-Munguira, Elena; Caballero, Jesús; Carbajales, Cristina; Carbonell, Nieves; Catalán-González, Mercedes; Galbán, Cristóbal; Gumucio-Sanguino, Víctor D; de la Torre, Maria Del Carmen; Díaz, Emili; Estella, Ángel; Gallego, Elena; García Garmendia, José Luis; Garnacho-Montero, José; Gómez, José M; Huerta, Arturo; Jorge García, Ruth Noemí; Loza-Vázquez, Ana; Marin-Corral, Judith; Martínez de la Gándara, Amalia; Martínez Varela, Ignacio; López Messa, Juan; M Albaiceta, Guillermo; Novo, Mariana Andrea; Peñasco, Yhivian; Pozo-Laderas, Juan Carlos; Ricart, Pilar; Salvador-Adell, Inmaculada; Sánchez-Miralles, Angel; Sancho Chinesta, Susana; Socias, Lorenzo; Solé-Violan, Jordi; Suares Sipmann, Fernando; Tamayo Lomas, Luis; Trenado, José; Barbé, Ferran; CIBERESUCICOVID Project (COV20/00110, ISCIII)
Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.

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