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Mellor-Pita S, Tutor-Ureta P, Velasco P, Plaza A, Diego I, Vázquez-Comendador J, Vionnet AP, Durán-del Campo P, Moreno-Torres V, Vargas JA, Castejon R. IgA Anti-β2-Glycoprotein I Antibodies as Markers of Thrombosis and Severity in COVID-19 Patients. Viruses 2024; 16:1071. [PMID: 39066233 PMCID: PMC11281419 DOI: 10.3390/v16071071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Patients with COVID-19 may develop a hypercoagulable state due to tissue and endothelial injury, produced by an unbalanced immune response. Therefore, an increased number of thromboembolic events has been reported in these patients. The aim of this study is to investigate the presence of antiphospholipid antibodies (aPL) in COVID-19 patients, their role in the development of thrombosis and their relationship with the severity of the disease. In this retrospective study, serum samples from 159 COVID-19 patients and 80 healthy donors were analysed for the presence of aPL. A total of 29 patients (18.2%) and 14 healthy donors (17.5%) were positive for aPL. Nineteen COVID-19 patients (12%) but no healthy donor presented a positive percentage of the IgA isotype aPL. IgA anti-β2-glycoprotein I antibodies (anti-β2GPI) were the most frequent type (6.3%) in patients but was not detected in any healthy donor. The positivity of this antibody was found to be significantly elevated in patients with thromboembolic events (25% vs. 5%, p = 0.029); in fact, patients with positive IgA anti-β2GPI had an incidence of thrombosis over six times higher than those who had normal antibody concentrations [OR (CI 95%) of 6.67 (1.5-30.2), p = 0.014]. Additionally, patients with moderate-severe disease presented a higher aPL positivity than patients with mild disease according to the Brescia (p = 0.029) and CURB-65 (p = 0.011) severity scales. A multivariate analysis showed that positivity for IgA anti-β2GPI is significantly associated with disease severity measured by CURB-65 [OR (CI 95%) 17.8 (1.7-187), p = 0.0016]. In conclusion, COVID-19 patients have a significantly higher positive percentage of the IgA isotype aPL than healthy donors. IgA anti-β2GPI antibodies were the most frequently detected aPL in COVID-19 patients and were associated with thrombosis and severe COVID-19 and are thus proposed as a possible marker to identify high-risk patients.
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Affiliation(s)
- Susana Mellor-Pita
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
- Department of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Pablo Tutor-Ureta
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
- Department of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Paula Velasco
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
| | - Aresio Plaza
- Department of Immunology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (A.P.); (A.P.V.)
| | - Itziar Diego
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
| | - José Vázquez-Comendador
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
| | - Ana Paula Vionnet
- Department of Immunology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (A.P.); (A.P.V.)
| | - Pedro Durán-del Campo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
| | - Víctor Moreno-Torres
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
| | - Juan Antonio Vargas
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
- Department of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Raquel Castejon
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, IDIPHIM (Puerta de Hierro University Hospital Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain; (S.M.-P.); (P.T.-U.); (P.V.); (I.D.); (J.V.-C.); (P.D.-d.C.); (V.M.-T.); (J.A.V.)
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Rischall A, Olson A. SOHO State of the Art Updates and Next Questions | CTLs for Infections Following Stem Cell Transplantation. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:340-347. [PMID: 38267354 DOI: 10.1016/j.clml.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
Allogeneic hematopoietic stem cell transplantation (AHSCT) is an important modality in the treatment of acute leukemia and other hematologic disorders. The post-transplant period is associated with prolonged periods of impaired immune function. Delayed T-cell immune reconstitution is correlated with increased risk of viral, bacterial, and fungal infections. This risk increases with high intensity inductions regimens often required for alternative donor sources. Current therapies for prophylaxis and treatment of these infections are limited by poor efficacy and significant toxicity. Adoptive cell therapy with cytotoxic T lymphocytes (CTL) has proven to be both efficacious and safe in the management of post-transplant viral infections. Recent advances have led to faster production of CTLs and broadened applications for their use. In particular, the generation of third party CTLs has helped ameliorate the problems related to donor availability and product generation time. In this review we aim to describe both the history of CTL use and current advances in the field.
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Affiliation(s)
- Ariel Rischall
- Department of Medical Oncology, The University of Texas Medical Branch, Galveston, TX
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Kempaiah P, Libertin CR, Chitale RA, Naeyma I, Pleqi V, Sheele JM, Iandiorio MJ, Hoogesteijn AL, Caulfield TR, Rivas AL. Decoding Immuno-Competence: A Novel Analysis of Complete Blood Cell Count Data in COVID-19 Outcomes. Biomedicines 2024; 12:871. [PMID: 38672225 PMCID: PMC11048687 DOI: 10.3390/biomedicines12040871] [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: 02/10/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND While 'immuno-competence' is a well-known term, it lacks an operational definition. To address this omission, this study explored whether the temporal and structured data of the complete blood cell count (CBC) can rapidly estimate immuno-competence. To this end, one or more ratios that included data on all monocytes, lymphocytes and neutrophils were investigated. MATERIALS AND METHODS Longitudinal CBC data collected from 101 COVID-19 patients (291 observations) were analyzed. Dynamics were estimated with several approaches, which included non-structured (the classic CBC format) and structured data. Structured data were assessed as complex ratios that capture multicellular interactions among leukocytes. In comparing survivors with non-survivors, the hypothesis that immuno-competence may exhibit feedback-like (oscillatory or cyclic) responses was tested. RESULTS While non-structured data did not distinguish survivors from non-survivors, structured data revealed immunological and statistical differences between outcomes: while survivors exhibited oscillatory data patterns, non-survivors did not. In survivors, many variables (including IL-6, hemoglobin and several complex indicators) showed values above or below the levels observed on day 1 of the hospitalization period, displaying L-shaped data distributions (positive kurtosis). In contrast, non-survivors did not exhibit kurtosis. Three immunologically defined data subsets included only survivors. Because information was based on visual patterns generated in real time, this method can, potentially, provide information rapidly. DISCUSSION The hypothesis that immuno-competence expresses feedback-like loops when immunological data are structured was not rejected. This function seemed to be impaired in immuno-suppressed individuals. While this method rapidly informs, it is only a guide that, to be confirmed, requires additional tests. Despite this limitation, the fact that three protective (survival-associated) immunological data subsets were observed since day 1 supports many clinical decisions, including the early and personalized prognosis and identification of targets that immunomodulatory therapies could pursue. Because it extracts more information from the same data, structured data may replace the century-old format of the CBC.
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Affiliation(s)
- Prakasha Kempaiah
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA; (P.K.); (V.P.)
| | | | - Rohit A. Chitale
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Islam Naeyma
- Department of Neuroscience, Division of QHS Computational Biology, Mayo Clinic, Jacksonville, FL 32224, USA; (I.N.); (T.R.C.)
| | - Vasili Pleqi
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL 32224, USA; (P.K.); (V.P.)
| | | | - Michelle J. Iandiorio
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA;
| | | | - Thomas R. Caulfield
- Department of Neuroscience, Division of QHS Computational Biology, Mayo Clinic, Jacksonville, FL 32224, USA; (I.N.); (T.R.C.)
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ariel L. Rivas
- Center for Global Health, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
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Moreno-Torres V, Martínez-Urbistondo M, Calderón-Parra J, de Mendoza C, Soriano V. COVID-19 mortality amongst the immunosuppresed. J Infect 2024; 88:106137. [PMID: 38479495 DOI: 10.1016/j.jinf.2024.106137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Víctor Moreno-Torres
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain; Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain.
| | - María Martínez-Urbistondo
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Jorge Calderón-Parra
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - Vicente Soriano
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain
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Stella C, Berardi C, Chiarito A, Gennenzi V, Postorino S, Settanni D, Cesarano M, Xhemalaj R, Tanzarella ES, Cutuli SL, Grieco DL, Conti G, Antonelli M, De Pascale G. Clinical features and 28-day mortality predictors of vaccinated patients admitted to a COVID-19 ICU hub in Italy. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:47. [PMID: 37957713 PMCID: PMC10644635 DOI: 10.1186/s44158-023-00130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND COVID-19 vaccination has been proved to be effective in preventing hospitalization and illness progression, even though data on mortality of vaccinated patients in the intensive care unit (ICU) are conflicting. The aim of this study was to investigate the characteristics of vaccinated patients admitted to ICU according to their immunization cycle and to outline the risk factors for 28-day mortality. This observational study included adult patients admitted to ICU for acute respiratory failure (ARF) due to SARS-CoV-2 and who had received at least one dose of vaccine. RESULTS Fully vaccination was defined as a complete primary cycle from < 120 days or a booster dose from > 14 days. All the other patients were named partially vaccinated. One-hundred sixty patients (91 fully and 69 partially vaccinated) resulted eligible, showing a 28-day mortality rate of 51.9%. Compared to partially vaccinated, fully vaccinated were younger (69 [60-77.5] vs. 74 [66-79] years, p 0.029), more frequently immunocompromised (39.56% vs. 14.39%, p 0.003), and affected by at least one comorbidity (90.11% vs 78.26%, p 0.045), mainly chronic kidney disease (CKD) (36.26% vs 20.29%, p 0.035). At multivariable analysis, independent predictors of 28-day mortality were as follows: older age [OR 1.05 (CI 95% 1.01-1.08), p 0.005], history of chronic obstructive pulmonary disease (COPD) [OR 3.05 (CI 95% 1.28-7.30), p 0.012], immunosuppression [OR 3.70 (CI 95% 1.63-8.40), p 0.002], and admission respiratory and hemodynamic status [PaO2/FiO2 and septic shock: OR 0.99 (CI 95% 0.98-0.99), p 0.009 and 2.74 (CI 95% 1.16-6.48), p 0.022, respectively]. CONCLUSIONS Despite a full vaccination cycle, severe COVID-19 may occur in patients with relevant comorbidities, especially immunosuppression and CKD. Regardless the immunization status, predisposing conditions (i.e., older age, COPD, and immunosuppression) and a severe clinical presentation were predictors of 28-day mortality.
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Affiliation(s)
- Claudia Stella
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cecilia Berardi
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annalisa Chiarito
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Gennenzi
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Postorino
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Donatella Settanni
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Melania Cesarano
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rikardo Xhemalaj
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa Sofia Tanzarella
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Lucio Cutuli
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Dell'Emergenza, Anestesiologiche E Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Moreno-Torres V, Soriano V. Response to: Prognostic factors in hospitalized HIV-positive patients with COVID-19: correspondence. QJM 2023; 116:721-722. [PMID: 37216907 DOI: 10.1093/qjmed/hcad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- V Moreno-Torres
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 1, Majadahonda, 28222 Madrid, Spain
| | - V Soriano
- UNIR Health Sciences School and Medical Center, Calle García Martín 21, Pozuelo de Alarcón, 28224 Madrid, Spain
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Moreno-Torres V, Martínez-Urbistondo M, Calderón-Parra J, Mills P, Muñoz-Serrano A, Arias-Milla A, Benítez L, Aguilar-Pérez M, Múñez-Rubio E, Ramos-Martínez A, Fernández-Cruz A, Cuervas-Mons V, de Mendoza C. COVID-19 in hospitalized solid organ transplant recipients in a nationwide registry study. Int J Infect Dis 2023; 134:154-159. [PMID: 37321473 PMCID: PMC10264329 DOI: 10.1016/j.ijid.2023.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES Underlying immunodeficiency has been associated with worse clinical presentation and increased mortality in patients with COVID-19. We evaluated the mortality of solid organ transplant (SOT) recipients (SOTR) hospitalized in Spain due to COVID-19. METHODS Nationwide, retrospective, observational analysis of all adults hospitalized because of COVID-19 in Spain during 2020. Stratification was made according to SOT status. The National Registry of Hospital Discharges was used, using the International Classification of Diseases, 10th revision coding list. RESULTS Of the 117,694 adults hospitalized during this period, 491 were SOTR: kidney 390 (79.4%), liver 59 (12%), lung 27 (5.5%), and heart 19 (3.9%). Overall, the mortality of SOTR was 13.8%. After adjustment for baseline characteristics, SOTR was not associated with higher mortality risk (odds ratio [OR] = 0.79, 95% confidence interval [CI] 0.60-1.03). However, lung transplantation was an independent factor related to mortality (OR = 3.26, 95% CI 1.33-7.43), while kidney, liver, and heart transplantation were not. Being a lung transplant recipient was the strongest prognostic factor in SOT patients (OR = 5.12, 95% CI 1.88-13.98). CONCLUSION This nationwide study supports that the COVID-19 mortality rate in SOTR in Spain during 2020 did not differ from the general population, except for lung transplant recipients, who presented worse outcomes. Efforts should be focused on the optimal management of lung transplant recipients with COVID-19.
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Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; Universidad Internacional de La Rioja (UNIR) Health Sciences School, Madrid, Spain.
| | | | - Jorge Calderón-Parra
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
| | - Patricia Mills
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Alejandro Muñoz-Serrano
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ana Arias-Milla
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Laura Benítez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Myriam Aguilar-Pérez
- Pneumology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Elena Múñez-Rubio
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Valentín Cuervas-Mons
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; University Study Centre (CEU) San Pablo, University, Madrid, Spain
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Blazoski C, Kirupaharan P, Hilton R, Leong R, Baram M. Outcomes of extracorporeal membrane oxygenation in immunosuppressed vs. Immunocompetent patients. Heart Lung 2023; 58:179-184. [PMID: 36535131 DOI: 10.1016/j.hrtlng.2022.12.003] [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: 07/07/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Immunosuppressed hosts represent a growing group of patients who suffer acute respiratory failure and may be considered for therapies such as extracorporeal membrane oxygenation (ECMO). OBJECTIVES We conducted this retrospective study to determine whether acutely or chronically immunosuppressed patients placed on ECMO for cardiac and/or respiratory failure in our institution have different outcomes than immunocompetent patients placed on ECMO in our institution. METHODS Adult patients placed on ECMO between June 31, 2010 and July 7, 2021 were identified within an IRB-approved database. Data was retrospectively extracted from the database and patients' medical records. Patients who survived ECMO decannulation were sub-grouped by the presence of acute or chronic immunosuppression, defined by the use of high-dose steroids or immunosuppressive agents for greater than four weeks prior to ECMO initiation. We analyzed and compared baseline characteristics and clinical outcomes using chi-squared tests for categorical variables and a one-way analysis of variance (ANOVA) for continuous variables. RESULTS 385 patients were included in this study, with 39 identified as chronically immunosuppressed, 49 as acutely immunosuppressed, and 297 as immunocompetent. There was no statistical difference in ECMO survival (respectively 54%, 59%, 65% p = 0.359) or 30-day survival (33%, 51%, 48% p = 0.149) for chronically immunosuppressed, acutely immunosuppressed, and immunocompetent, respectively. There were significant differences in rates of pre-ECMO COVID infection (p<0.001), coronary artery disease (p<0.001), smoking (p = 0.003), and acute kidney injury (p = 0.032). Acutely immunosuppressed patients had the highest rates of new infections during ECMO (p = 0.006). CONCLUSION When compared to immunocompetent patients, both acutely and chronically immunosuppressed patients had no significant difference in ECMO survival or 30-day survival. Acutely immunosuppressed patients had less comorbidities than chronically immunosuppressed patients, but they were more commonly infected during ECMO. ECMO may still be a valuable tool in appropriately selected patients with refractory respiratory or cardiac failure.
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Affiliation(s)
- Cameron Blazoski
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Palestine, United States
| | - Pradhab Kirupaharan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Palestine, United States
| | - Robert Hilton
- Department of Medicine, Thomas Jefferson University, Philadelphia, Palestine, United States
| | - Ron Leong
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA
| | - Michael Baram
- Department of Medicine, Thomas Jefferson University, Philadelphia, Palestine, United States.
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Yadav S, Senapati S, Kulkarni SS, Singh JP. A SERS based clinical study on HIV-1 viral load quantification and determination of disease prognosis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 239:112629. [PMID: 36577167 DOI: 10.1016/j.jphotobiol.2022.112629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
In resource limited settings, a cost-effective point-of-care diagnostic testing possessing the characteristics of detecting the minimum viral load of a malady like human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS) is a pressing priority. The present work describes a novel, rapid and field-deployable method using surface enhanced Raman spectroscopy (SERS) for detection and prognosis of HIV positive clinical samples, in seven different viral load ranges varying between 200 and 1 million copies/ml. A relationship between the increasing and decreasing intensity peaks of HIV-1 was also established for quantitation efficacy of the handheld tool. Three different types of SERS substrates: single arm Ag nanorods, double arm Ag nanorods and Au sputtered single arm Ag nanorods were used and the obtained data was compared for the three substrates. It was demonstrated that maximum enhancement was obtained for Au sputtered Ag nanorods. Rigorous coupled wave analysis (RCWA) simulations were performed to study the 'hotspots' in three different SERS substrates. Further, to explore the utility of our platform and to differentiate between the clade specific X4 and R5 tropism, their corresponding SERS spectra were studied using HIV-1 strains belonging to four different HIV-1 subtypes (A, B, C and D) which showed a clear distinction, implying the usefulness of the platform in understanding the disease prognosis. Statistical analysis of the obtained SERS spectra using principal component analysis (PCA) showed good agreement with the experimental results, confirming the ability of SERS platform to quantitate HIV-1 viral load and distinguish HIV-1 strains on the basis of their SERS spectra.
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Affiliation(s)
- Sarjana Yadav
- Department of Physics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Sneha Senapati
- School of Interdisciplinary Research (SIRe), Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
| | - Smita S Kulkarni
- Division of Virology, ICMR-National AIDS Research Institute, Bhosari, Pune 413404, India.
| | - J P Singh
- Department of Physics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
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10
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Freise NF, Gliga S, Fischer J, Lübke N, Lutterbeck M, Schöler M, Bölke E, Orth HM, Feldt T, Roemmele C, Wilke D, Schneider J, Wille K, Hohmann C, Strauss R, Hower M, Ruf A, Schubert J, Isberner N, Stecher M, Pilgram L, Vehreschild JJ, Hanses F, Luedde T, Jensen B, Jung N, Göpel S, Westhoff T, Hohenstein B, Rothfuss K, Rieg S, Ruethrich MM, Rupp J, Hanses F, Luedde T, Jensen B. Convalescent plasma treatment for SARS-CoV-2 infected high-risk patients: a matched pair analysis to the LEOSS cohort. Sci Rep 2022; 12:19035. [PMID: 36351986 PMCID: PMC9643921 DOI: 10.1038/s41598-022-23200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Establishing the optimal treatment for COVID-19 patients remains challenging. Specifically, immunocompromised and pre-diseased patients are at high risk for severe disease course and face limited therapeutic options. Convalescent plasma (CP) has been considered as therapeutic approach, but reliable data are lacking, especially for high-risk patients. We performed a retrospective analysis of 55 hospitalized COVID-19 patients from University Hospital Duesseldorf (UKD) at high risk for disease progression, in a substantial proportion due to immunosuppression from cancer, solid organ transplantation, autoimmune disease, dialysis. A matched-pairs analysis (1:4) was performed with 220 patients from the Lean European Open Survey on SARS-CoV-2-infected Patients (LEOSS) who were treated or not treated with CP. Both cohorts had high mortality (UKD 41.8%, LEOSS 34.1%). A matched-pairs analysis showed no significant effect on mortality. CP administration before the formation of pulmonary infiltrates showed the lowest mortality in both cohorts (10%), whereas mortality in the complicated phase was 27.8%. CP administration during the critical phase revealed the highest mortality: UKD 60.9%, LEOSS 48.3%. In our cohort of COVID-19 patients with severe comorbidities CP did not significantly reduce mortality in a retrospective matched-pairs analysis. However, our data supports the concept that a reduction in mortality is achievable by early CP administration.
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Affiliation(s)
- Noemi F. Freise
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Smaranda Gliga
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Johannes Fischer
- grid.411327.20000 0001 2176 9917Department for Transfusion Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Nadine Lübke
- grid.411327.20000 0001 2176 9917Institute of Virology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Matthias Lutterbeck
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Miriam Schöler
- grid.411327.20000 0001 2176 9917Heinrich Heine University, Duesseldorf, Germany
| | - Edwin Bölke
- grid.411327.20000 0001 2176 9917Department of Radiotherapy and Radio Oncology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Hans Martin Orth
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Torsten Feldt
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Christoph Roemmele
- grid.419801.50000 0000 9312 0220Department of Internal Medicine III, Gastroenterology and Infectious Diseases, University Hospital Augsburg, Augsburg, Germany
| | - Dominik Wilke
- grid.412282.f0000 0001 1091 2917University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jochen Schneider
- grid.6936.a0000000123222966Technical University of Munich, Munich, Germany
| | - Kai Wille
- grid.5570.70000 0004 0490 981XJohannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
| | - Christian Hohmann
- grid.419807.30000 0004 0636 7065Department of Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany
| | - Richard Strauss
- grid.411668.c0000 0000 9935 6525University Hospital Erlangen, Erlangen, Germany
| | - Martin Hower
- grid.473616.10000 0001 2200 2697Department of Internal Medicine, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Andreas Ruf
- grid.419594.40000 0004 0391 0800Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Nora Isberner
- grid.411760.50000 0001 1378 7891Department of Internal Medicine II, Division of Infectious Diseases, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Melanie Stecher
- grid.6190.e0000 0000 8580 3777Faculty of Medicine, University Clinics, Department I of Internal Medicine, University of Cologne, Cologne, Germany ,grid.452463.2German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Lisa Pilgram
- grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany ,grid.411088.40000 0004 0578 8220Center for Internal Medicine, Medical Department 2, Hematology, Oncology and Infectious Diseases, University Hospital of Frankfurt, Frankfurt, Germany
| | - Jörg J. Vehreschild
- grid.6190.e0000 0000 8580 3777Faculty of Medicine, University Clinics, Department I of Internal Medicine, University of Cologne, Cologne, Germany ,grid.452463.2German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany ,grid.411088.40000 0004 0578 8220Center for Internal Medicine, Medical Department 2, Hematology, Oncology and Infectious Diseases, University Hospital of Frankfurt, Frankfurt, Germany
| | | | - Frank Hanses
- grid.411941.80000 0000 9194 7179Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Tom Luedde
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Björn Jensen
- grid.411327.20000 0001 2176 9917Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
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11
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Abstract
Immunocompromised hosts, which encompass a diverse population of persons with malignancies, human immunodeficiency virus disease, solid organ, and hematologic transplants, autoimmune diseases, and primary immunodeficiencies, bear a significant burden of the morbidity and mortality due to coronavirus disease-2019 (COVID-19). Immunocompromised patients who develop COVID-19 have a more severe illness, higher hospitalization rates, and higher mortality rates than immunocompetent patients. There are no well-defined treatment strategies that are specific to immunocompromised patients and vaccines, monoclonal antibodies, and convalescent plasma are variably effective. This review focuses on the specific impact of COVID-19 in immunocompromised patients and the gaps in knowledge that require further study.
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12
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Effects of lymphocyte and neutrophil counts and their time courses on mortality in patients with postoperative pneumonia. Sci Rep 2022; 12:14564. [PMID: 36028549 PMCID: PMC9411836 DOI: 10.1038/s41598-022-18794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022] Open
Abstract
The prognostic significance of absolute lymphocyte count (ALC) and absolute neutrophil count (ANC) remains unclear in patients with postoperative pneumonia (POP). The study objectives were to investigate the prognostic effects of ALC and ANC in POP patients, and to evaluate the time courses of ALC and ANC during hospitalization. This post-hoc analysis of a single-center prospective observational study evaluated consecutive POP patients, and comparatively analyzed community-acquired pneumonia (CAP) patients to highlight features of POP. In total, 228 POP patients and 1027 CAP patients were assessed. Severe lymphopenia (ALC < 500 cells/μL) at diagnosis was associated with worse 90-day survival in both types of pneumonia. In POP patients, neutrophilia (ANC > 7500 cells/μL) was associated with better survival, whereas CAP patients with neutrophilia tended to have a lower survival rate. Prolonged lymphopenia and delayed increase in neutrophils were characteristic time-course changes of non-survivors in POP. The time courses of ALC and ANC between survivors and non-survivors in POP trended differently from those in CAP. Our study showed that ALC and ANC at pneumonia diagnosis can serve as prognostic factors in POP patients. Differences in time-course changes of ALC and ANC between survivors and non-survivors may provide important information for future immunological research in pneumonia.
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13
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Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study. Viruses 2022; 14:v14081631. [PMID: 35893696 PMCID: PMC9394472 DOI: 10.3390/v14081631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to evaluate the clinical outcome of Systemic Autoimmune Diseases (SADs) patients hospitalized with COVID-19 in Spain, before the introduction of SARS-CoV-2 vaccines. A nationwide, retrospective and observational analysis of the patients admitted during 2020, based on the ICD10 codes in the National Registry of Hospital Discharges, was performed. Among 117,694 patients, only 892 (0.8%) presented any type of SAD before COVID-19-related admission: Sjogren’s Syndrome constituted 25%, Systemic Vasculitides 21%, Systemic Lupus Erythematosus 19%, Sarcoidosis 17%, Systemic Sclerosis 11%, Mixed and Undifferentiated Connective Tissue Disease 4%, Behçet’s Disease 4% and Inflammatory Myopathies 2%. The in-hospital mortality rate was higher in SAD individuals (20% vs. 16%, p < 0.001). After adjustment by baseline conditions, SADs were not associated with a higher mortality risk (OR = 0.93, 95% CI 0.78−1.11). Mortality in the SADs patients was determined by age (OR = 1.05, 95% CI 1.04−1.07), heart failure (OR = 1.67, 95% CI 1.10−2.49), chronic kidney disease (OR = 1.29, 95% CI 1.05−1.59) and liver disease (OR = 1.97, 95% CI 1.13−3.44). In conclusion, the higher COVID-19 mortality rate seen in SADs patients hospitalized in Spain in 2020 was related to the higher burden of comorbidities, secondary to direct organ damage and sequelae of their condition. Whilst further studies should evaluate the impact of baseline immunosuppression on COVID-19 outcomes in this population, efforts should be focused on the optimal management of SAD to minimize the impact of the organ damage that has been shown to determine COVID-19 prognosis.
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14
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Calderón-Parra J, Cuervas-Mons V, Moreno-Torres V, Rubio-Rivas M, Blas PAD, Pinilla-Llorente B, Helguera-Amezua C, Jiménez-García N, Pesqueira-Fontan PM, Méndez-Bailón M, Artero A, Gilabert N, Ibánez-Estéllez F, Freire-Castro SJ, Lumbreras-Bermejo C, Antón-Santos JM. Influence of chronic corticosteroids and calcineurin inhibitors on COVID-19 clinical outcomes: Analysis of a nationwide registry. Int J Infect Dis 2021; 116:51-58. [PMID: 34971824 PMCID: PMC8713429 DOI: 10.1016/j.ijid.2021.12.327] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To analyze whether subgroups of immunosuppressive (IS) medications confer different outcomes in COVID-19. METHODS Multicenter retrospective cohort of consecutive immunosuppressed patients (ISP) hospitalized with COVID-19 from March to July 2020. The primary outcome was in-hospital mortality. A propensity score-matched (PSM) model comparing ISP and non-ISP was planned, as well as specific PSM models comparing individual IS medications associated with mortality. RESULTS Out of 16,647 patients, 868 (5.2%) were on chronic IS therapy prior to admission and were considered ISP. In the PSM model, ISP had greater in-hospital mortality (OR 1.25, 95%CI 0.99-1.62), which was related to a worse outcome associated with chronic corticoids (OR 1.89, 95%CI 1.43-2.49). Other IS drugs had no repercussion on mortality risk (including calcineurin inhibitors (CNI), OR 1.19, 95% CI 0.65-2.20). In the pre-planned specific PSM model within patients on chronic IS treatment before admission, corticosteroids were associated with an increased risk of mortality (OR 2.34, 95%CI 1.43-3.82). CONCLUSIONS Chronic IS therapies pose a heterogeneous group of drugs with different risk profiles for severe COVID-19 and death. Chronic systemic corticosteroid is associated with increased mortality. On the contrary, CNI and other IS treatments prior to admission do not seem to convey different outcomes.
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Affiliation(s)
- Jorge Calderón-Parra
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda (Madrid).
| | - Valentín Cuervas-Mons
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda (Madrid); Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain. IDIPHISA-(Madrid).
| | - Victor Moreno-Torres
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda (Madrid).
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, H. Univ. de Bellvitge. L'Hospitalet de Llobregat (Barcelona).
| | | | | | | | | | | | | | - Arturo Artero
- Department of Internal Medicine, H. Universitario Dr. Peset (Valencia).
| | - Noemí Gilabert
- Department of Internal Medicine, H. U. La Princesa (Madrid).
| | - Fátima Ibánez-Estéllez
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda (Madrid).
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