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Rodríguez-Ramallo H, Báez-Gutiérrez N, Jaramillo-Ruiz D, Sanfélix-Gimeno G, Villegas-Portero R, Jiménez-Murillo JL, Hernández-Quiles C, Santos-Ramos B. [Translated article] Therapeutic management, adherence, and clinical outcomes of heart failure in Andalucía. ANDALIC Protocol. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00091-6. [PMID: 38926026 DOI: 10.1016/j.farma.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 06/28/2024] Open
Abstract
Heart failure is a prevalent syndrome with high mortality rates, representing a significant economic burden in terms of healthcare. The lack of systematic information about the treatment and adherence of patients with heart failure limits the understanding of these aspects and potentially the improvement of clinical outcomes. OBJECTIVE To describe the clinical characteristics, therapeutic management, adherence, persistence, and clinical results, as well as the association between these variables, in a cohort of patients with heart failure in Andalusia. DESIGN This study will be an observational, population-based, retrospective cohort study. Data of patients discharged from an Andalusian hospital with a diagnosis of heart failure between 2014 and 2023 will be extracted from the Andalusian population health database. ANALYSIS The statistical analysis will incorporate the following strategies: (1) Descriptive analysis of the characteristics of the population cohort, adherence measures, and clinical outcomes. (2) Bivariate analyses to study the association of covariates with adherence, persistence, and clinical results. (3) Multivariate logistic regression and Cox regression analysis including relevant covariates. (4) To evaluate changes over time, multivariate Poisson regression models will be used. By conducting this comprehensive study, we aim to gain valuable insights into the clinical characteristics, treatment management, and adherence of heart failure patients in Andalusia, as well as to identify factors that may influence clinical outcomes. These findings could be critical both for the development of optimised strategies that improve medical care and quality of life of patients and for mitigating the health burden of HF in the region.
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Affiliation(s)
| | - Nerea Báez-Gutiérrez
- Unidad de gestión clínica de farmacia, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Didiana Jaramillo-Ruiz
- Unidad de gestión clínica de farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Gabriel Sanfélix-Gimeno
- Fundación para la Promoción de la Salud e Investigación Biomédica de la Comunidad Valenciana, Valencia, Spain
| | - Román Villegas-Portero
- Subdirección Técnica Asesora de Gestión de la Información (STAGI) del Servicio Andaluz de Salud (SAS), Sevilla, Spain
| | - José Luis Jiménez-Murillo
- Subdirección Técnica Asesora de Gestión de la Información (STAGI) del Servicio Andaluz de Salud (SAS), Sevilla, Spain
| | - Carlos Hernández-Quiles
- Unidad de gestión clínica de Medicina Interna Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Bernardo Santos-Ramos
- Unidad de gestión clínica de farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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2
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Loucera-Muñecas C, Canal-Rivero M, Ruiz-Veguilla M, Carmona R, Bostelmann G, Garrido-Torres N, Dopazo J, Crespo-Facorro B. Aripiprazole as protector against COVID-19 mortality. Sci Rep 2024; 14:12362. [PMID: 38811612 PMCID: PMC11137032 DOI: 10.1038/s41598-024-60297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
The relation of antipsychotics with severe Coronavirus Disease 19 (COVID-19) outcomes is a matter of debate since the beginning of the pandemic. To date, controversial results have been published on this issue. We aimed to prove whether antipsychotics might exert adverse or protective effects against fatal outcomes derived from COVID-19. A population-based retrospective cohort study (January 2020 to November 2020) comprising inpatients (15,968 patients) who were at least 18 years old and had a laboratory-confirmed COVID-19 infection. Two sub-cohorts were delineated, comprising a total of 2536 inpatients: individuals who either had no prescription medication or were prescribed an antipsychotic within the 15 days preceding hospitalization. We conducted survival and odds ratio analyses to assess the association between antipsychotic use and mortality, reporting both unadjusted and covariate-adjusted results. We computed the average treatment effects, using the untreated group as the reference, and the average treatment effect on the treated, focusing solely on the antipsychotic-treated population. Among the eight antipsychotics found to be in use, only aripiprazole showed a significant decrease in the risk of death from COVID-19 [adjusted odds ratio (OR) = 0.86; 95% CI, 0.79-0.93, multiple-testing adjusted p-value < 0.05]. Importantly, these findings were consistent for both covariate-adjusted and unadjusted analyses. Aripiprazole has been shown to have a differentiated beneficial effect in protecting against fatal clinical outcome in COVID-19 infected individuals. We speculate that the differential effect of aripiprazole on controlling immunological pathways and inducible inflammatory enzymes, that are critical in COVID19 illness, may be associated with our findings herein.
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Affiliation(s)
- C Loucera-Muñecas
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Seville, Spain
- Computational Systems Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
| | - M Canal-Rivero
- Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain.
- Centro Investigación Biomédica en Red Salud Mental, CIBERSAM, Madrid, Spain.
- Instituto de Biomedicina de Sevilla (IBiS), HUVR/CSIC/Universidad de Sevilla, Seville, Spain.
| | - M Ruiz-Veguilla
- Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain
- Centro Investigación Biomédica en Red Salud Mental, CIBERSAM, Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), HUVR/CSIC/Universidad de Sevilla, Seville, Spain
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - R Carmona
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Seville, Spain
- Computational Systems Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
| | - G Bostelmann
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Seville, Spain
- Computational Systems Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
| | - N Garrido-Torres
- Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain
- Centro Investigación Biomédica en Red Salud Mental, CIBERSAM, Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), HUVR/CSIC/Universidad de Sevilla, Seville, Spain
| | - J Dopazo
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Seville, Spain
- Computational Systems Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Seville, Spain
- FPS, ELIXIR-Es, Hospital Virgen del Rocío, Seville, Spain
| | - B Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Sevilla, Spain
- Centro Investigación Biomédica en Red Salud Mental, CIBERSAM, Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), HUVR/CSIC/Universidad de Sevilla, Seville, Spain
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
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3
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Rodríguez-Ramallo H, Báez-Gutiérrez N, Jaramillo-Ruiz D, Sanfélix-Gimeno G, Villegas-Portero R, Jiménez-Murillo JL, Hernández-Quiles C, Santos-Ramos B. Therapeutic management, adherence, and clinical outcomes of heart failure in Andalucía. ANDALIC Protocol. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00037-0. [PMID: 38582665 DOI: 10.1016/j.farma.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/08/2024] Open
Abstract
Heart failure is a prevalent syndrome with high mortality rates, representing a significant economic burden in terms of healthcare. The lack of systematic information about the treatment and adherence of patients with heart failure limits the understanding of these aspects and potentially the improvement of clinical outcomes. OBJECTIVE To describe the clinical characteristics, therapeutic management, adherence, persistence and clinical results, as well as the association between these variables, in a cohort of patients with heart failure in Andalusia. DESIGN This study will be an observational, population-based, retrospective cohort study. Data of patients discharged from an Andalusian hospital with a diagnosis of heart failure between 2014 and 2023 will be extracted from the Andalusian population health database. ANALYSIS The statistical analysis will incorporate the following strategies: 1) Descriptive analysis of the characteristics of the population cohort, adherence measures, and clinical outcomes. 2) Bivariate analyses to study the association of covariates with adherence, persistence and clinical results. 3) Multivariate logistic regression and Cox regression analysis including relevant covariates. 4) To evaluate changes over time, multivariate Poisson regression models will be used. By conducting this comprehensive study, we aim to gain valuable insights into the clinical characteristics, treatment management, and adherence of heart failure patients in Andalusia, as well as to identify factors that may influence clinical outcomes. These findings could be critical both for the development of optimized strategies that improve medical care and quality of life of patients and for mitigating the health burden of HF in the region.
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Affiliation(s)
| | - Nerea Báez-Gutiérrez
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Didiana Jaramillo-Ruiz
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Gabriel Sanfélix-Gimeno
- Fundación para la Promoción de la Salud e Investigación Biomédica de la Comunidad Valenciana, Valencia, España
| | - Román Villegas-Portero
- Subdirección Técnica Asesora de Gestión de la Información (STAGI) del Servicio Andaluz de Salud (SAS), Sevilla, España
| | - José Luis Jiménez-Murillo
- Subdirección Técnica Asesora de Gestión de la Información (STAGI) del Servicio Andaluz de Salud (SAS), Sevilla, España
| | - Carlos Hernández-Quiles
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Bernardo Santos-Ramos
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España
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Loucera C, Carmona R, Bostelmann G, Muñoyerro-Muñiz D, Villegas R, Gonzalez-Manzanares R, Dopazo J, Anguita M. Evidence of the association between increased use of direct oral anticoagulants and a reduction in the rate of atrial fibrillation-related stroke and major bleeding at the population level (2012-2019). Med Clin (Barc) 2024; 162:220-227. [PMID: 37989706 DOI: 10.1016/j.medcli.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The introduction of direct-acting oral anticoagulants (DOACs) has shown to decrease atrial fibrillation (AF)-related stroke and bleeding rates in clinical studies, but there is no certain evidence about their effects at the population level. Our aim was to assess changes in AF-related stroke and major bleeding rates between 2012 and 2019 in Andalusia (Spain), and the association between DOACs use and events rates at the population level. METHODS All patients with an AF diagnosis from 2012 to 2019 were identified using the Andalusian Health Population Base, that provides clinical information on all Andalusian people. Annual ischemic and hemorrhagic stroke, major bleeding rates, and used antithrombotic treatments were determined. Marginal hazard ratios (HR) were calculated for each treatment. RESULTS A total of 95,085 patients with an AF diagnosis were identified. Mean age was 76.1±10.2 years (49.7% women). An increase in the use of DOACs was observed throughout the study period in both males and females (p<0.001). The annual rate of ischemic stroke decreased by one third, while that of hemorrhagic stroke and major bleeding decreased 2-3-fold from 2012 to 2019. Marginal HR was lower than 0.50 for DOACs compared to VKA for all ischemic or hemorrhagic events. CONCLUSIONS In this contemporary population-based study using clinical and administrative databases in Andalusia, a significant reduction in the incidence of AF-related ischemic and hemorrhagic stroke and major bleeding was observed between 2012 and 2019. The increased use of DOACs seems to be associated with this reduction.
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Affiliation(s)
- Carlos Loucera
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain; Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, Sevilla, Spain
| | - Rosario Carmona
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain; Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, Sevilla, Spain
| | - Gerrit Bostelmann
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Sevilla, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Sevilla, Spain
| | - Rafael Gonzalez-Manzanares
- Department of Cardiology, Hospital Universitario Reina Sofía, Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Joaquin Dopazo
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain; Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, Sevilla, Spain; FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, Sevilla, Spain
| | - Manuel Anguita
- Department of Cardiology, Hospital Universitario Reina Sofía, Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain.
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Montero-Balosa MC, Limón-Mora JA, Leal-Atienza A, Luque-Romero LG, Aguado-Romeo MJ, Isabel-Gómez R, Molina-López MT. Effectiveness and safety of oral anticoagulant therapy in a real-world cohort with atrial fibrillation: The SIESTA-A study protocol. PLoS One 2023; 18:e0294822. [PMID: 38019815 PMCID: PMC10686507 DOI: 10.1371/journal.pone.0294822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). METHODS AND ANALYSIS Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching.
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Affiliation(s)
- M. C. Montero-Balosa
- Servicio de Farmacia de Atención Primaria, Distrito Aljarafe y Sevilla Norte, Servicio Andaluz de Salud, Sevilla, Spain
| | - J. A. Limón-Mora
- Coordinación de Gestión y Evaluación, Servicio Andaluz de Salud, Sevilla, Spain
| | - A. Leal-Atienza
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Consejería de Salud y Consumo, Sevilla, Spain
| | - L. G. Luque-Romero
- Unidad de Investigación, Distrito Aljarafe y Sevilla Norte, Servicio Andaluz de Salud, Sevilla, Spain
| | - M. J. Aguado-Romeo
- Centro de Transfusión de Tejidos y Células de Sevilla, Red Andaluza de Medicina Transfusional de Tejidos y Células, Consejería de Salud y Consumo, Sevilla, Spain
| | - R. Isabel-Gómez
- Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Consejería de Salud y Consumo, Sevilla, Spain
| | - M. T. Molina-López
- Servicio de Farmacia de Atención Primaria, Distrito Sevilla, Servicio Andaluz de Salud, Sevilla, Spain
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Loucera C, Carmona R, Esteban-Medina M, Bostelmann G, Muñoyerro-Muñiz D, Villegas R, Peña-Chilet M, Dopazo J. Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments. Virol J 2023; 20:226. [PMID: 37803348 PMCID: PMC10559601 DOI: 10.1186/s12985-023-02195-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
PURPOSE Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19. METHODS Using data from a central registry of electronic health records (the Andalusian Population Health Database), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient outcomes, including survival and lymphocyte progression, was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. RESULTS Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality. CONCLUSIONS In this study we have taken advantage of the availability of a regional clinical database to study the effect of drugs, which patients were taking for other indications, on their survival. The large size of the database allowed us to control covariates effectively.
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Affiliation(s)
- Carlos Loucera
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Rosario Carmona
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Marina Esteban-Medina
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Gerrit Bostelmann
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - María Peña-Chilet
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Joaquín Dopazo
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain.
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain.
- FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, Sevilla, Spain.
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7
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Assessing the Impact of SARS-CoV-2 Lineages and Mutations on Patient Survival. Viruses 2022; 14:v14091893. [PMID: 36146700 PMCID: PMC9500738 DOI: 10.3390/v14091893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/29/2022] Open
Abstract
Objectives: More than two years into the COVID-19 pandemic, SARS-CoV-2 still remains a global public health problem. Successive waves of infection have produced new SARS-CoV-2 variants with new mutations for which the impact on COVID-19 severity and patient survival is uncertain. Methods: A total of 764 SARS-CoV-2 genomes, sequenced from COVID-19 patients, hospitalized from 19th February 2020 to 30 April 2021, along with their clinical data, were used for survival analysis. Results: A significant association of B.1.1.7, the alpha lineage, with patient mortality (log hazard ratio (LHR) = 0.51, C.I. = [0.14,0.88]) was found upon adjustment by all the covariates known to affect COVID-19 prognosis. Moreover, survival analysis of mutations in the SARS-CoV-2 genome revealed 27 of them were significantly associated with higher mortality of patients. Most of these mutations were located in the genes coding for the S, ORF8, and N proteins. Conclusions: This study illustrates how a combination of genomic and clinical data can provide solid evidence for the impact of viral lineage on patient survival.
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Barragán-Prieto A, Pérez-Sánchez S, Moniche F, Moyano RV, Delgado F, Martínez-Sánchez P, Moya M, Oropesa JM, Mínguez-Castellanos A, Villegas I, Álvarez Soria MJ, Tamayo Toledo JA, de la Cruz Cosme C, Canto Neguillo R, Herrerías Esteban JM, Montero Cobos DJ, Moreno Muñoz JA, González A, Montaner J. Express improvement of acute stroke care accessibility in large regions using a centralized telestroke network. Eur Stroke J 2022; 7:259-266. [PMID: 36082245 PMCID: PMC9446331 DOI: 10.1177/23969873221101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Acute ischemic stroke therapy has improved in recent decades, decreasing the rates of disability and death among stroke patients. Unfortunately, all health care systems have geographical disparities in infrastructure for stroke patients. A centralized telestroke network might be a low-cost strategy to reduce differences in terms of geographical barriers, equitable access, and quality monitoring across different hospitals. Aims: We aimed to quantify changes in stroke patients’ geographic access to specialized evaluation by neurologists and to intravenous acute stroke reperfusion treatments following the rapid implementation of a centralized telestroke network in the large region of Andalusia (8.5 million inhabitants). Methods: We conducted an observational study using spatial and analytical methods to examine how a centralized telestroke network influences the quality and accessibility of stroke care for a large region. Results: In the pre-implementation period, 5,005,477 (59.72% of the Andalusian population) had access to specialized stroke care in less than 30 min. After the 5-month process of implementing the telestroke network, 7,832,988 (93.5%) inhabitants had an access time of less than 30 min, bridging the gap in acute stroke care in rural hospitals. Conclusions: A centralized telestroke network may be an efficient tool to reduce the differences in stroke care access and quality monitoring across different hospitals, especially in large regions with low population density.
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Affiliation(s)
- Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Fernando Delgado
- Department of Interventional Neurorradiology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Miguel Moya
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Juan M Oropesa
- Department of Neurology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | | | | | | | | | - Rafael Canto Neguillo
- Department of Emergency Medicine, Hospital de Alta Resolución Sierra Norte, Sevilla, Spain
| | | | | | | | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Department of Interventional Neurorradiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
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Carmona-Pírez J, Ioakeim-Skoufa I, Gimeno-Miguel A, Poblador-Plou B, González-Rubio F, Muñoyerro-Muñiz D, Rodríguez-Herrera J, Goicoechea-Salazar JA, Prados-Torres A, Villegas-Portero R. Multimorbidity Profiles and Infection Severity in COVID-19 Population Using Network Analysis in the Andalusian Health Population Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073808. [PMID: 35409489 PMCID: PMC8997853 DOI: 10.3390/ijerph19073808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023]
Abstract
Identifying the population at risk of COVID-19 infection severity is a priority for clinicians and health systems. Most studies to date have only focused on the effect of specific disorders on infection severity, without considering that patients usually present multiple chronic diseases and that these conditions tend to group together in the form of multimorbidity patterns. In this large-scale epidemiological study, including primary and hospital care information of 166,242 patients with confirmed COVID-19 infection from the Spanish region of Andalusia, we applied network analysis to identify multimorbidity profiles and analyze their impact on the risk of hospitalization and mortality. Our results showed that multimorbidity was a risk factor for COVID-19 severity and that this risk increased with the morbidity burden. Individuals with advanced cardio-metabolic profiles frequently presented the highest infection severity risk in both sexes. The pattern with the highest severity associated in men was present in almost 28.7% of those aged ≥ 80 years and included associations between cardiovascular, respiratory, and metabolic diseases; age-adjusted odds ratio (OR) 95% confidence interval (1.71 (1.44–2.02)). In women, similar patterns were also associated the most with infection severity, in 7% of 65–79-year-olds (1.44 (1.34–1.54)) and in 29% of ≥80-year-olds (1.35 (1.18–1.53)). Patients with mental health patterns also showed one of the highest risks of COVID-19 severity, especially in women. These findings strongly recommend the implementation of personalized approaches to patients with multimorbidity and SARS-CoV-2 infection, especially in the population with high morbidity burden.
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Affiliation(s)
- Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), 50009 Zaragoza, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-976-765-500 (ext. 5371/5375)
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health, NO-0213 Oslo, Norway
- Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, NO-0213 Oslo, Norway
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), 08009 Barcelona, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), 08009 Barcelona, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Juliana Rodríguez-Herrera
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Juan Antonio Goicoechea-Salazar
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (I.I.-S.); (A.G.-M.); (B.P.-P.); (F.G.-R.); (A.P.-T.)
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, 28029 Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Román Villegas-Portero
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud (SAS), 41071 Seville, Spain; (D.M.-M.); (J.R.-H.); (J.A.G.-S.); (R.V.-P.)
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10
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Loucera C, Peña-Chilet M, Esteban-Medina M, Muñoyerro-Muñiz D, Villegas R, Lopez-Miranda J, Rodriguez-Baño J, Túnez I, Bouillon R, Dopazo J, Quesada Gomez JM. Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients. Sci Rep 2021; 11:23380. [PMID: 34862422 PMCID: PMC8642445 DOI: 10.1038/s41598-021-02701-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 is a major worldwide health problem because of acute respiratory distress syndrome, and mortality. Several lines of evidence have suggested a relationship between the vitamin D endocrine system and severity of COVID-19. We present a survival study on a retrospective cohort of 15,968 patients, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. Based on a central registry of electronic health records (the Andalusian Population Health Database, BPS), prescription of vitamin D or its metabolites within 15-30 days before hospitalization were recorded. The effect of prescription of vitamin D (metabolites) for other indication previous to the hospitalization was studied with respect to patient survival. Kaplan-Meier survival curves and hazard ratios support an association between prescription of these metabolites and patient survival. Such association was stronger for calcifediol (Hazard Ratio, HR = 0.67, with 95% confidence interval, CI, of [0.50-0.91]) than for cholecalciferol (HR = 0.75, with 95% CI of [0.61-0.91]), when prescribed 15 days prior hospitalization. Although the relation is maintained, there is a general decrease of this effect when a longer period of 30 days prior hospitalization is considered (calcifediol HR = 0.73, with 95% CI [0.57-0.95] and cholecalciferol HR = 0.88, with 95% CI [0.75, 1.03]), suggesting that association was stronger when the prescription was closer to the hospitalization.
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Affiliation(s)
- Carlos Loucera
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
| | - María Peña-Chilet
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
- Bioinformatics in Rare Diseases (BiER), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, 41013, Seville, Spain
| | - Marina Esteban-Medina
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Seville, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Seville, Spain
| | - Jose Lopez-Miranda
- Internal Medicine Department, IMIBIC/Reina Sofia University Hospital/University of Cordoba, 14004, Córdoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Jesus Rodriguez-Baño
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
- Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Isaac Túnez
- Departamento de Bioquimica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigacion Biomédica de Córdoba (IMIBIC), 14004, Córdoba, Spain
- G. Técnico de Expertos de Andalucía para Estudios de Suplementos e Intervención Nutricional Frente a Covid-19, SGIDIS, Consejería de Salud y Familias, Junta de Andalucia, Seville, Spain
- Secretaria General de Investigación, Desarrollo e Innovación en Salud, Consejería de Salud y Familias de la Junta de Andalucía, Seville, Spain
| | - Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Herestraat, 3000, Leuven, Belgium
| | - Joaquin Dopazo
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain.
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain.
- Bioinformatics in Rare Diseases (BiER), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, 41013, Seville, Spain.
- FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain.
| | - Jose Manuel Quesada Gomez
- Instituto Maimónides de Investigacion Biomédica de Córdoba (IMIBIC), 14004, Córdoba, Spain.
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Hospital Universitario Reina Sofía, Universidad de Córdoba, Menéndez Pidal s/n, 14004, Córdoba, Spain.
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11
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Dopazo J, Maya-Miles D, García F, Lorusso N, Calleja MÁ, Pareja MJ, López-Miranda J, Rodríguez-Baño J, Padillo J, Túnez I, Romero-Gómez M. Implementing Personalized Medicine in COVID-19 in Andalusia: An Opportunity to Transform the Healthcare System. J Pers Med 2021; 11:475. [PMID: 34073493 PMCID: PMC8226500 DOI: 10.3390/jpm11060475] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic represents an unprecedented opportunity to exploit the advantages of personalized medicine for the prevention, diagnosis, treatment, surveillance and management of a new challenge in public health. COVID-19 infection is highly variable, ranging from asymptomatic infections to severe, life-threatening manifestations. Personalized medicine can play a key role in elucidating individual susceptibility to the infection as well as inter-individual variability in clinical course, prognosis and response to treatment. Integrating personalized medicine into clinical practice can also transform health care by enabling the design of preventive and therapeutic strategies tailored to individual profiles, improving the detection of outbreaks or defining transmission patterns at an increasingly local level. SARS-CoV2 genome sequencing, together with the assessment of specific patient genetic variants, will support clinical decision-makers and ultimately better ways to fight this disease. Additionally, it would facilitate a better stratification and selection of patients for clinical trials, thus increasing the likelihood of obtaining positive results. Lastly, defining a national strategy to implement in clinical practice all available tools of personalized medicine in COVID-19 could be challenging but linked to a positive transformation of the health care system. In this review, we provide an update of the achievements, promises, and challenges of personalized medicine in the fight against COVID-19 from susceptibility to natural history and response to therapy, as well as from surveillance to control measures and vaccination. We also discuss strategies to facilitate the adoption of this new paradigm for medical and public health measures during and after the pandemic in health care systems.
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Affiliation(s)
- Joaquín Dopazo
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Área de Bioinformática, Fundación progreso y Salud, Junta de Andalucía, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Douglas Maya-Miles
- Instituto de Biomedicina de Sevilla (HUVR/HUVM/CSIC/US), 41013 Sevilla, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
| | - Federico García
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, 18012 Granada, Spain
| | - Nicola Lorusso
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Dirección General de Salud Pública, Consejería de Salud y Familias, Junta de Andalucía, Spain
| | - Miguel Ángel Calleja
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Servicio de Farmacia, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
| | - María Jesús Pareja
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Hospital Universitario de Valme, 41014 Sevilla, Spain
| | - José López-Miranda
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, 14071 Córdoba, Spain
| | - Jesús Rodríguez-Baño
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Instituto de Biomedicina de Sevilla (HUVR/HUVM/CSIC/US), 41013 Sevilla, Spain;
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Javier Padillo
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Instituto de Biomedicina de Sevilla (HUVR/HUVM/CSIC/US), 41013 Sevilla, Spain;
- Departamento de Cirugía, Universidad de Sevilla, 41009 Sevilla, Spain
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Isaac Túnez
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Departamento de Bioquímica, Universidad de Córdoba, 14071 Córdoba, Spain
- Secretaría General de Investigación, Desarrollo e Innovación en Salud, Consejería de Salud y Familias de la Junta de Andalucía, 41020 Sevilla, Spain
| | - Manuel Romero-Gómez
- GT MP Covid-19. SGIDIS, Consejería de Salud y Familias, Junta de Andalucía, Spain; (J.D.); (F.G.); (N.L.); (M.Á.C.); (M.J.P.); (J.L.-M.); (J.R.-B.); (J.P.)
- Instituto de Biomedicina de Sevilla (HUVR/HUVM/CSIC/US), 41013 Sevilla, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
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