PublicationProtective effects of melatonin on changes occurring in the experimental autoimmune encephalomyelitis model of multiple sclerosis.(2022-01-11) Escribano, Begoña María; Muñoz-Jurado, A; Caballero-Villarraso, J; Valdelvira, M E; Giraldo, A I; Paz-Rojas, E; Gascón, F; Santamaría, A; Agüera, E; Túnez, IsaacMelatonin has been related to the pathophysiology of multiple sclerosis (MS), and its anti-inflammatory and immunomodulatory properties have been proved in numerous neurodegenerative diseases. This study aimed to find out whether a melatonin supplement in MS is able to act as a benefit to its clinical status, i.e. oxidative stress, inflammation and indirect biomarkers of bacterial dysbiosis, lipopolysaccharide (LPS) and LPS-binding protein (LBP), verifying its therapeutic potential and its possible clinical use in patients with MS. The animal MS model, experimental autoimmune encephalomyelitis (EAE), was employed whereby 25 male Dark Agouti rats (5 animals per group) were divided into: a control group (not manipulated); a control+vehicle group; a control+melatonin group; an EAE group; an EAE+melatonin group. Melatonin was administered daily for 51 days, at a dose of 1 mg/kg body weight/i.p., once a day, five days a week. The results from the administration of melatonin demonstrated an improvement in clinical status, a diminution in oxidative stress and inflammation, as well as in bacterial dysbiosis. Melatonin could play an effective role against MS, either alone or as a therapy combined with traditional agents. PublicationPredictive 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 SAMIUCThe 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. PublicationProne Position in COVID-19 Patients With Severe Acute Respiratory Distress Syndrome Receiving Conventional Oxygen Therapy: A Retrospective Study.(2021-06-06) Loureiro-Amigo, Jose; Suárez-Carantoña, Cecilia; Oriol, Isabel; Sánchez-Díaz, Cristina; Coloma-Conde, Ana; Manzano-Espinosa, Luis; Rubio-Rivas, Manuel; Otero-Perpiñá, Barbara; Ferreiro-Mazón Jenaro, María Mercedes; Coduras-Erdozain, Ainara; Garcia-Klepzig, José Luis; Vargas-Parra, Derly; Pesqueira-Fontán, Paula M; Fiteni-Mera, Isabel; García-García, Gema María; Jiménez-Torres, José; Rodríguez-Cortés, Pablo; Costo-Muriel, Clara; Arnalich-Fernández, Francisco; Artero, Arturo; Carrasco-Sánchez, Francisco Javier; Escobar-Sevilla, Joaquín; Alcalá-Pedrajas, José Nicolás; Gómez-Huelgas, Ricardo; Ramos-Rincón, José-Manuel; SEMI-COVID-19 Network PublicationSafety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19.(2022-05-02) Jacob, Javier; Albert-Casado, Arantxa; Del-Castillo, Juan G; Llorens-Soriano, Pere; Jiménez-Hernández, Sonia; Burillo-Putze, Guillermo; Martín-Martínez, Alfonso; Martín-Sánchez, Francisco J; García-Lamberechts, Eric J; Piñera-Salmerón, Pascual; Alquézar-Arbé, Aitor; Ferre-Losa, Carles; Juan-Gómez, María Á; Serrano-Lázaro, Leticia; Noceda-Bermejo, José; Salido-Mota, Manuel; Fortuny-Bayarri, María J; González-Tejera, Matilde; Ferreras-Amez, José M; Díaz-Fernández, Elena; Quero-Motto, Eva; Peiró-Gómez, Ana; Martín-Mojarro, Enrique; Llopis-Roca, Ferran; Huerta-García, Arturo; Pedraza-García, Jorge; Meléndez-Cálix, Napoleón; Brazó-Aznar, José V; Cano-Cano, María J; Miró, ÓscarInformation is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality. PublicationActivity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial.(2022-04-16) Muñoz-Alcaraz, María Nieves; Jiménez-Vílchez, Antonio José; Santamaría-Peláez, Mirian; Pérula-de Torres, Luis A; Olmo-Carmona, María Victoria; Muñoz-García, María Teresa; Jorge-Gutiérrez, Presentación; Serrano-Merino, Jesús; Romero-Rodríguez, Esperanza; Rodríguez-Elena, Lorena; Refusta-Ainaga, Raquel; Lahoz-Sánchez, María Pilar; Miró-Palacios, Belén; Medrano-Cid, Mayra; Magallón-Botaya, Rosa; Mínguez-Mínguez, Luis A; González-Santos, Josefa; González-Bernal, Jerónimo JLymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb's functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η2 ≤ 0.080). In the rest of the variables, no significant differences were found. TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance. PublicationImpact of Activity-Oriented Propioceptive Antiedema Therapy on the Health-Related Quality of Life of Women with Upper-Limb Lymphedema Secondary to Breast Cancer-A Randomized Clinical Trial.(2022-03-28) Muñoz-Alcaraz, María Nieves; Pérula-de Torres, Luis A; Jiménez-Vílchez, Antonio José; Rodríguez-Fernández, Paula; Olmo-Carmona, María Victoria; Muñoz-García, María Teresa; Jorge-Gutiérrez, Presentación; Serrano-Merino, Jesús; Romero-Rodríguez, Esperanza; Rodríguez-Elena, Lorena; Refusta-Ainaga, Raquel; Lahoz-Sánchez, María Pilar; Miró-Palacios, Belén; Medrano-Cid, Mayra; Magallón-Botaya, Rosa; Santamaría-Peláez, Mirian; Mínguez-Mínguez, Luis A; González-Bernal, Jerónimo JAlterations derived from lymphedema in the upper-limb secondary to breast cancer-related lymphedema (BCRL) decrease the health-related quality of life (HRQoL), but there is limited evidence of the impact of the different interventions on it. The aim of this research was to compare the effect of conventional treatment with another treatment based on Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) on HRQoL in women diagnosed with BCRL. A prospective clinical study was designed with two parallel arms. The study population consisted of women diagnosed with BCRL in stage I and II, belonging to different institutions in Córdoba and Aragon, Spain. Sociodemographic and HRQoL-related variables, pain, tightness, heaviness and functionality were obtained before and after treatments. 51 women participated in the study, 25 received the conventional treatment and 26 the TAPA, with a mean age of 59.24 ± 9.55 years. HRQoL was significantly related to upper-limb function and pain on the participants' affected side. In addition, covariance analysis (ANCOVA) showed that the TAPA treatment interfered less in the performance of activities of daily life and produced significant improvements in the social dimension of HRQoL. the non-use of compressive elements in the rehabilitative treatment of the BCRL that is proposed with TAPA improves aspects such as self-image and participation in social and recreational activities. PublicationCancer Impacts Prognosis on Mortality in Patients with Acute Heart Failure: Analysis of the EPICTER Study.(2022-01-24) Méndez-Bailón, Manuel; Lorenzo-Villalba, Noel; Romero-Correa, Miriam; Guisado-Espartero, Esther; González-Soler, Juan; Rugeles-Niño, Jessica; Sebastián-Leza, Angel; Ceresuela-Eito, Luis; Romaní-Costa, Verónica; Quesada-Simón, Angustias; Soler-Rangel, Llanos; Herrero-Domingo, Almudena; Díez-García, Luis; Alcalá-Pedrajas, José; Villalonga-Comas, María; Andrès, Emmanuel; Gudiñ-Aguirre, Diego; Formiga, Francesc; Aramburu-Bodas, Oscar; Arias-Jiménez, Jose; Salamanca-Bautista, Prado; On Behalf Of Epicter Study Group,Heart failure (HF) and cancer are currently the leading causes of death worldwide, with an increasing incidence with age. Little is known about the treatment received and the prognosis of patients with acute HF and a prior cancer diagnosis. to determine the clinical characteristics, palliative treatment received, and prognostic impact of patients with acute HF and a history of solid tumor. The EPICTER study ("Epidemiological survey of advanced heart failure") is a cross-sectional, multicenter project that consecutively collected patients admitted for acute HF in 74 Spanish hospitals. Patients were classified into two groups according to whether they met criteria for acute HF with and without solid cancer, and the groups were subsequently compared. A multivariable logistic regression analysis was conducted, using the forward stepwise method. A Kaplan-Meier survival analysis was performed to evaluate the impact of solid tumor on prognosis in patients with acute HF. A total of 3127 patients were included, of which 394 patients (13%) had a prior diagnosis of some type of solid cancer. Patients with a history of cancer presented a greater frequency of weight loss at admission: 18% vs. 12% (p = 0.030). In the cancer group, functional impairment was noted more frequently: 43% vs. 35%, p = 0.039). Patients with a history of solid cancer more frequently presented with acute HF with preserved ejection fraction (65% vs. 58%, p = 0.048) than reduced or mildly reduced. In-hospital and 6-month follow-up mortality was 31% (110/357) in patients with solid cancer vs. 26% (637/2466), p = 0.046. Our investigation demonstrates that in-hospital mortality and mortality during 6-month follow-up in patients with acute HF were higher in those subjects with a history of concomitant solid tumor cancer diagnosis. PublicationClusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry.(2022-03-02) Rubio-Rivas, Manuel; Mora-Luján, José María; Formiga, Francesc; Corrales González, Miguel Ángel; García Andreu, María Del Mar; Moreno-Torres, Víctor; García García, Gema María; Alcalá Pedrajas, José N; Boixeda, Ramon; Pérez-Lluna, Leticia; Cortés-Rodríguez, Begoña; Mella-Pérez, Carmen; Navas Alcántara, María de la Sierra; López Reboiro, Manuel Lorenzo; Alfaro-Lara, Verónica; Pérez-Martín, Santiago; Martín-Oterino, José Ángel; Gracia Gutiérrez, Anyuli; Martín-Urda Díez-Canseco, Anabel; Comas Casanova, Pere; Pérez García, Cristina; Varona, José F; Gómez-Huelgas, Ricardo; Antón-Santos, Juan-Miguel; Lumbreras-Bermejo, Carlos; SEMI-COVID-19 NetworkUncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. They were included in the Spanish SEMI-COVID-19 registry from March 1, 2020 to May 1, 2021. The primary outcome was in-hospital mortality. Hierarchical cluster analysis identified 7 clusters. C1 is characterized by lymphopenia, C2 by elevated ferritin, and C3 by elevated LDH. C4 is characterized by lymphopenia plus elevated CRP and LDH and frequently also ferritin. C5 is defined by elevated CRP, and C6 by elevated ferritin and D-dimer, and frequently also elevated CRP and LDH. Finally, C7 is characterized by an elevated D-dimer. The clusters with the highest in-hospital mortality were C4, C6, and C7 (17.4% vs. 18% vs. 15.6% vs. 36.8% vs. 17.5% vs. 39.3% vs. 26.4%). Inflammation clusters were found as independent factors for in-hospital mortality. In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters: C2 (OR = 1.30, p = 0.001), C3 (OR = 1.14, p = 0.178), C4 (OR = 2.28, p PublicationDoes admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry.(2021-11-29) Formiga, Francesc; Rubio-Rivas, Manuel; Mora-Luján, José María; Escudero, Samara Campos; Martinez, Rosa Fernandez Madera; Mendez-Bailón, Manuel; Campo, Pedro Durán-Del; Pérez, Andrea Riaño; García-Sánchez, Francisco-Javier; Alcalá-Pedrajas, José Nicolás; Hernández, Sergio Arnedo; Milian, Almudena Hernández; Díez, Ana Latorre; Sánchez, Ricardo Gil; Boixeda, Ramon; Vicente, Julio; Cortes, Begoña; Pérez, Carmen Mella; Espartero, María Esther Guisado; Castro, José López; Suárez, Santiago Rodríguez; Varona, Jose F; Gomez-Huelgas, Ricardo; Ramos-Rincón, Jose Manuel; SEMI-COVID-19 SEMI-COVID-19 NetworkAcetylsalicylic acid (ASA) is widely used in the treatment and prevention of cardiovascular disorders. Our objective is to evaluate its possible protective role, not only in mortality but also in other aspects such as inflammation, symptomatic thrombosis, and intensive care unit (ICU) admission in hospitalized COVID-19 patients. We realized an observational retrospective cohort study of 20,641 patients with COVID-19 pneumonia collected and followed-up from Mar 1st, 2020 to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Propensity score matching (PSM) was performed to determine whether treatment with ASA affected outcomes in COVID-19 patients. On hospital admission, 3291 (15.9%) patients were receiving ASA. After PSM, 3291 patients exposed to ASA and 2885 not-exposed patients were analyzed. In-hospital mortality was higher in the ASA group (30.4 vs. 16.9%, p PublicationSpanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards.(2022-11-01) Montoya-Garcia, Maria Jose; Carbonell-Abella, Cristina; Cancio-Trujillo, Jose Manuel; Moro-Álvarez, Maria Jesus; Mora-Fernández, Jesus; Izquierdo-Avino, Rafael; Nogues, Xavier; Mesa-Ramos, Manuel; San Segundo-Mozo, Rosa Maria; Calero-Muñoz, Elena; Naves-Diaz, Manuel; Olmo-Montes, F Jesus; Duaso, Enric; GRUPO REFRA-FLSREFRA-FLS is a new registry in Spain aimed at identifying individuals over 50 years of age with a fragility fracture. Using this registry, we found hip fracture is the most prevalent fracture. Treatment for osteoporosis was 87.7%, with 65.3% adherence. REFRA-FLS provides fundamental data in the study of fragility fractures. Fragility fractures are a growing public health concern in modern-aged societies. Fracture Liaison Services (FLS) have been shown to successfully lower rates of secondary fractures. A new registry (REFRA-FLS) has been created to monitor quality indicators of FLS units in Spain and to explore the occurrence and characteristic of fragility fractures identified by these centers. We conducted a prospective cohort study based on fragility fractures recorded in the REFRA-FLS registry. Participants were individuals 50 years or above who suffered a low energy fragility fracture identified by the 10 participating FLS units during the study period. The type of FLS unit, the characteristics of the individuals at baseline, along with patient outcomes as quality indicators among those who completed 1 year of follow-up were analyzed. A total of 2965 patients and 3067 fragility fractures were identified, and the most frequent locations were hip (n = 1709, 55.7%) and spine (n = 492, 16.0%). A total of 43 refractures (4.5%) and 46 deaths (4.9%) were observed among 948 individuals in the follow-up analyses. Time from fracture to evaluation was less than 3 months in 76.7% of individuals. Osteoporosis treatment was prescribed in 87.7%, and adherence was 65.3% in Morisky-Green test. Our results provide a comprehensive picture of fragility fractures identified in FLS units from Spain. Overall, quality indicators are satisfactory although a much higher use of DXA would be desirable. As the registry grows with the incorporation of new FLS units and longer follow-up, incoming analyses will provide valuable insight. PublicationWHO Ordinal Scale and Inflammation Risk Categories in COVID-19. Comparative Study of the Severity Scales.(2022-04-08) Rubio-Rivas, Manuel; Mora-Luján, José María; Formiga, Francesc; Arévalo-Cañas, Coral; Lebrón Ramos, Juan Manuel; Villalba García, María Victoria; Fonseca Aizpuru, Eva Mª; Díez-Manglano, Jesús; Arnalich Fernández, Francisco; Romero Cabrera, Juan Luis; García García, Gema María; Pesqueira Fontan, Paula M; Vargas Núñez, Juan Antonio; Freire Castro, Santiago Jesús; Loureiro Amigo, José; Pascual Pérez, Maria de Los Reyes; Alcalá Pedrajas, José N; Encinas-Sánchez, Daniel; Mella Pérez, Carmen; Ena, Javier; Gracia Gutiérrez, Anyuli; Esteban Giner, María José; Varona, José F; Millán Núñez-Cortés, Jesús; Casas-Rojo, José-Manuel; SEMI-COVID-19 NetworkThe WHO ordinal severity scale has been used to predict mortality and guide trials in COVID-19. However, it has its limitations. The present study aims to compare three classificatory and predictive models: the WHO ordinal severity scale, the model based on inflammation grades, and the hybrid model. Retrospective cohort study with patient data collected and followed up from March 1, 2020, to May 1, 2021, from the nationwide SEMI-COVID-19 Registry. The primary study outcome was in-hospital mortality. As this was a hospital-based study, the patients included corresponded to categories 3 to 7 of the WHO ordinal scale. Categories 6 and 7 were grouped in the same category. A total of 17,225 patients were included in the study. Patients classified as high risk in each of the WHO categories according to the degree of inflammation were as follows: 63.8% vs. 79.9% vs. 90.2% vs. 95.1% (p The present study proposes a new severity grading scale for COVID-19 hospitalized patients. In our opinion, it is the most informative, representative, and predictive scale in COVID-19 patients to date. PublicationDifferences 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).(2022-06-30) Ramos-Rincon, Jose-Manuel; Cobos-Palacios, Lidia; López-Sampalo, Almudena; Ricci, Michele; Rubio-Rivas, Manel; Nuñez-Rodriguez, Maria-Victoria; Miranda-Godoy, Rodrigo; García-Leoni, Maria-Eugenia; Fernández-Madera-Martínez, Rosa; García-García, Gema-María; Beato-Perez, Jose-Luis; Monge-Monge, Daniel; Asín-Samper, Uxua; Bustamante-Vega, Marta; Rábago-Lorite, Isabel; Freire-Castro, Santiago-Jesús; Miramontes-González, Jose-Pablo; Magallanes-Gamboa, Jeffrey-Oskar; Alcalá-Pedrajas, José-Nicolás; García-Gómez, Miriam; Cano-Llorente, Verónica; Carrasco-Sánchez, Francisco-Javier; Martinez-Carrilero, Jesús; Antón-Santos, Juan-Miguel; Gómez-Huelgas, Ricardo; SEMI-COVID-19 NetworkOld 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. 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). 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 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. PublicationCoronavirus disease 2019 hospitalization outcomes in persons with and without HIV in Spain.(2022) Olalla-Sierra, Julián; Martín-Escalante, María Dolores; García-Alegría, Javier; Rubio-Rivas, Manuel; de Miguel-Campo, Borja; Zurita-Etayo, María; Arbones-Fernández, Laia; Alcalá-Pedrajas, José N; Roldán-Silvestre, Alicia; Cortés-Rodríguez, Begoña; Casas-Rojo, José Manuel; Núñez-Cortés, Jesús Millán; SEMI-COVID-19 NetworkTo compare coronavirus disease 2019 (COVID-19) hospitalization outcomes between persons with and without HIV. Retrospective observational cohort study in 150 hospitals in Spain. Patients admitted from 1 March to 8 October 2020 with COVID-19 diagnosis confirmed by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 positive) PCR test in respiratory tract samples. The primary data source was the COVID-19 Sociedad Española de Medicina Interna's registry (SEMI-COVID-19). Demographics, comorbidities, vital signs, laboratory parameters, and clinical severity as well as treatments received during admission, treatment duration, ICU admission, use of invasive mechanical ventilation, and death were recorded. Factors associated with mortality and the composite of ICU admission, invasive mechanical ventilation, and death, were analyzed. Data from 16 563 admissions were collected, 98 (0.59%) of which were of persons with HIV infection. These patients were younger, the percentage of male patients was higher, and their Charlson comorbidity index was also higher. Rates of mortality and composite outcome of ICU admission, invasive mechanical ventilation or death were lower among patients with HIV infection. In the logistic regression analysis, HIV infection was associated with an adjusted odds ratio of 0.53 [95% confidence interval (CI) 0.29-0.96] for the composite outcome. HIV infection was associated with a lower probability of ICU admission, invasive mechanical ventilation, or death. PublicationClinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain.(2022) Ramos-Rincón, José-Manuel; Bernabeu-Wittel, Máximo; Fiteni-Mera, Isabel; López-Sampalo, Almudena; López-Ríos, Carmen; García-Andreu, María-Del-Mar; Mancebo-Sevilla, Juan-José; Jiménez-Juan, Carlos; Matía-Sanz, Marta; López-Quirantes, Pablo; Rubio-Rivas, Manuel; Paredes-Ruiz, Diana; González-San-Narciso, Candela; González-Vega, Rocío; Sanz-Espinosa, Pablo; Hernández-Milián, Almudena; Gonzalez-Noya, Amara; Gil-Sánchez, Ricardo; Boixeda, Ramon; Alcalá-Pedrajas, José-Nicolás; Palop-Cervera, Marta; Cortés-Rodríguez, Begoña; Guisado-Espartero, María-Esther; Mella-Pérez, Carmen; Gómez-Huelgas, Ricardo; SEMI-COVID-19 NetworkCOVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19. PublicationAngiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19.(2021-06-15) Roy-Vallejo, Emilia; Sánchez Purificación, Aquilino; Torres Peña, José David; Sánchez Moreno, Beatriz; Arnalich, Francisco; García Blanco, María José; López Miranda, José; Romero-Cabrera, Juan Luis; Herrero Gil, Carmen Rosario; Bascunana, José; Rubio-Rivas, Manuel; Pintos Otero, Sara; Martínez Sempere, Verónica; Ballano Rodríguez-Solís, Jesús; Gil Sánchez, Ricardo; Luque Del Pino, Jairo; González Noya, Amara; Navas-Alcántara, María Sierra; Cortés Rodríguez, Begoña; Alcalá, José Nicolás; Suárez-Lombraña, Ana; Andrés Soler, Jorge; Gómez-Huelgas, Ricardo; Casas-Rojo, José Manuel; Millán Núñez-Cortés, Jesús; On Behalf Of The Semi-Covid-Network,Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p PublicationCardiometabolic Therapy and Mortality in Very Old Patients With Diabetes Hospitalized due to COVID-19.(2021) Ramos-Rincón, Jose Manuel; Pérez-Belmonte, Luis M; Carrasco-Sánchez, Francisco Javier; Jansen-Chaparro, Sergio; De-Sousa-Baena, Mercedes; Bueno-Fonseca, José; Pérez-Aguilar, Maria; Arévalo-Cañas, Coral; Bacete Cebrian, Marta; Méndez-Bailón, Manuel; Fiteni Mera, Isabel; González García, Andrés; Navarro Romero, Francisco; Tuñón de Almeida, Carlota; Muñiz Nicolás, Gemma; González Noya, Amara; Hernández Milian, Almudena; García García, Gema María; Alcalá Pedrajas, José Nicolás; Herrero García, Virginia; Corral-Gudino, Luis; Comas Casanova, Pere; Meijide Míguez, Héctor; Casas-Rojo, José Manuel; Gómez-Huelgas, Ricardo; SEMI-COVID-19 NetworkThe effects of cardiometabolic drugs on the prognosis of diabetic patients with COVID-19, especially very old patients, are not well known. This work was aimed to analyze the association between preadmission cardiometabolic therapy (antidiabetic, antiaggregant, antihypertensive, and lipid-lowering drugs) and in-hospital mortality among patients ≥80 years with type 2 diabetes mellitus (T2DM) hospitalized for COVID-19. We conducted a nationwide, multicenter, observational study in patients ≥80 years with T2DM hospitalized for COVID-19 between March 1 and May 29, 2020. The primary outcome measure was in-hospital mortality. A multivariate logistic regression analysis was performed to assess the association between preadmission cardiometabolic therapy and in-hospital mortality. Of the 2 763 patients ≥80 years old hospitalized due to COVID-19, 790 (28.6%) had T2DM. Of these patients, 385 (48.7%) died during admission. On the multivariate analysis, the use of dipeptidyl peptidase-4 inhibitors (adjusted odds ratio [AOR] 0.502, 95% confidence interval [CI]: 0.309-0.815, p = .005) and angiotensin receptor blockers (AOR 0.454, 95% CI: 0.274-0.759, p = .003) were independent protectors against in-hospital mortality, whereas the use of acetylsalicylic acid was associated with higher in-hospital mortality (AOR 1.761, 95% CI: 1.092-2.842, p = .020). Other antidiabetic drugs, angiotensin-converting enzyme inhibitors, and statins showed neutral association with in-hospital mortality. We found important differences between cardiometabolic drugs and in-hospital mortality in older patients with T2DM hospitalized for COVID-19. Preadmission treatment with dipeptidyl peptidase-4 inhibitors and angiotensin receptor blockers could reduce in-hospital mortality; other antidiabetic drugs, angiotensin-converting enzyme inhibitors, and statins seem to have a neutral effect; and acetylsalicylic acid could be associated with excess mortality. PublicationIncidence, clinical characteristics, risk factors and outcomes of meningoencephalitis in patients with COVID-19.(2021-03-09) Fragiel, Marcos; Miró, Òscar; Llorens, Pere; Jiménez, Sònia; Piñera Salmerón, Pascual; Burillo-Putze, Guillermo; Martín, Alfonso; Martín-Sánchez, Francisco Javier; García Lamberechts, Eric Jorge; Jacob, Javier; Alquézar-Arbé, Aitor; Llopis-Roca, Ferran; Pedraza García, Jorge; Calvo López, Ricardo; Maza Vera, María Teresa; Lucas-Imbernón, Francisco Javier; González Martinez, Félix; Juárez, Ricardo; Expósito Rodriguez, Marcos; Martinez Bautista, Beatriz Maria; Niembro Valdés, Ana Patricia; Sanchez Nicolas, Jose Andres; Ferreras Amez, José María; Porta-Etessam, Jesús; Calvo, Elpidio; González Del Castillo, Juan; Spanish Investigators on Emergency Situations TeAm (SIESTA) networkWe investigated the incidence, clinical characteristics, risk factors, and outcome of meningoencephalitis (ME) in patients with COVID-19 attending emergency departments (ED), before hospitalization. We retrospectively reviewed all COVID patients diagnosed with ME in 61 Spanish EDs (20% of Spanish EDs, COVID-ME) during the COVID pandemic. We formed two control groups: non-COVID patients with ME (non-COVID-ME) and COVID patients without ME (COVID-non-ME). Unadjusted comparisons between cases and controls were performed regarding 57 baseline and clinical characteristics and 4 outcomes. Cerebrospinal fluid (CSF) biochemical and serologic findings of COVID-ME and non-COVID-ME were also investigated. We identified 29 ME in 71,904 patients with COVID-19 attending EDs (0.40‰, 95%CI=0.27-0.58). This incidence was higher than that observed in non-COVID patients (150/1,358,134, 0.11‰, 95%CI=0.09-0.13; OR=3.65, 95%CI=2.45-5.44). With respect to non-COVID-ME, COVID-ME more frequently had dyspnea and chest X-ray abnormalities, and neck stiffness was less frequent (OR=0.3, 95%CI=0.1-0.9). In 69.0% of COVID-ME, CSF cells were predominantly lymphocytes, and SARS-CoV-2 antigen was detected by RT-PCR in 1 patient. The clinical characteristics associated with a higher risk of presenting ME in COVID patients were vomiting (OR=3.7, 95%CI=1.4-10.2), headache (OR=24.7, 95%CI=10.2-60.1), and altered mental status (OR=12.9, 95%CI=6.6-25.0). COVID-ME patients had a higher in-hospital mortality than non-COVID-ME patients (OR=2.26; 95%CI=1.04-4.48), and a higher need for hospitalization (OR=8.02; 95%CI=1.19-66.7) and intensive care admission (OR=5.89; 95%CI=3.12-11.14) than COVID-non-ME patients. ME is an unusual form of COVID presentation ( PublicationLiver Enzymes Correlate With Metabolic Syndrome, Inflammation, and Endothelial Dysfunction in Prepubertal Children With Obesity.(2021-02-16) Valle-Martos, Rosario; Valle, Miguel; Martos, Rosario; Cañete, Ramón; Jiménez-Reina, Luis; Cañete, María DoloresBackground: Metabolic syndrome (MetS) can start in children with obesity at very young ages. Non-alcoholic fatty liver disease (NAFLD) is considered to be the hepatic component of metabolic syndrome. If left untreated, the clinical course of NAFLD can be progressive and can become chronic if not detected at an early stage. Objective: We aimed to quantify the differences in liver enzymes between prepubertal children with obesity and children with normal weight to determine any associations between them and parameters related to MetS, adipokines, or markers of endothelial dysfunction and inflammation. Methods: This cross-sectional study included 54 prepuberal children with obesity (aged 6-9 years) and 54 children with normal weight, matched by age and sex. Liver enzymes, C-reactive protein (CRP), interleukin-6, soluble intercellular adhesion molecule-1 (sICAM-1), adipokines, and parameters related to metabolic syndrome (MetS) were all measured. Results: Alanine aminotransferase (ALT) levels, serum butyryl cholinesterase (BChE), leptin, CRP, sICAM-1, triglycerides, blood pressure, and homeostasis model assessment for insulin resistance were significantly higher in children with obesity, while Apolipoprotein A-1, HDL-cholesterol, and adiponectin were significantly lower. In the children with obesity group, ALT and BChE levels correlated with anthropometric measurements, insulin resistance, and lipid parameters, leptin, interleukin-6, CRP, and sICAM-1 while BChE levels negatively correlated with adiponectin. Conclusions: Compared to children with normal weight, prepubertal children with obesity had elevated values for liver enzymes, leptin, markers of insulin resistance, inflammation, and endothelial dysfunction, and variables associated with MetS. There was also a correlation between these disorders and liver enzyme levels. PublicationFrequency of five cardiovascular/hemostatic entities as primary manifestations of SARS-CoV-2 infection: Results of the UMC-19-S2.(2021-01-30) Miró, Òscar; Llorens, Pere; Jiménez, Sònia; Piñera, Pascual; Burillo-Putze, Guillermo; Martín, Alfonso; Martín-Sánchez, Francisco Javier; González Del Castillo, Juan; Spanish Investigators on Emergency Situations TeAm (SIESTA) network PublicationValue-Based Healthcare in Ostomies.(2020-08-13) Montesinos Gálvez, Ana C; Jódar Sánchez, Francisco; Alcántara Moreno, Carmen; Pérez Fernández, Antonio J; Benítez García, Rosario; Coca López, Mercedes; Bienvenido Ramírez, María Paz; Cabrera López, Monserrat; Vázquez Burrero, Luisa; Jurado Berja, Pilar; Sánchez García, Raquel; Cebrián, Josefa Martín; Hervas García, María Luz; López Fernández, Remedios; Pérez Jiménez, Claudia; Reyes Vico, María Antonia; Vargas Villegas, Ana Belén; García-Agua Soler, Nuria; García Ruiz, Antonio JIn order to achieve significant improvements in quality, cost, and accessibility (the health "iron triangle"), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient.