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Gutiérrez-Rojas Á, Tung-Chen Y, Hernández-Montero E, Eisenhofer AA, Diego I. Point-of-care Ultrasound Diagnosis of Gastric Outlet Obstruction Syndrome. J Med Ultrasound 2023; 31:48-50. [PMID: 37180627 PMCID: PMC10173836 DOI: 10.4103/jmu.jmu_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/20/2021] [Accepted: 12/22/2021] [Indexed: 05/16/2023] Open
Abstract
Gastric Outlet Obstruction (GOO) is a clinical syndrome characterized by postprandial vomiting, epigastric pain, and abdominal distension due to mechanical or motility disorders. The suspicion will mainly rely on abdominal radiological imaging (computed tomography, barium studies) that might not be widely available or even be contraindicated. We report a 65-year-old male who developed progressive epigastralgia, anorexia, and vomiting. Physical examination revealed mild abdominal distension and epigastric tenderness on deep palpation. With the presumptive diagnosis of gastric outlet obstruction, an abdominal point-of-care ultrasound (POCUS) was performed and showed impaired gastric emptying and a "target sign." A gastroscopic exploration confirmed inflammatory pyloric stenosis due to coexisting antral and duodenal ulcers. POCUS could play an essential role in the easy ultrasonographic diagnosis of gastroparesis, helping to differentiate from other causes of obstruction and even raise suspicion in the diagnosis of pyloric stenosis as a consequence of a GGO. POCUS may serve as a first-line imaging test that can raise suspicion of this difficult to diagnose and probably underreported disease.
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Affiliation(s)
- Ángela Gutiérrez-Rojas
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Yale Tung-Chen
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
- Address for correspondence: Dr. Yale Tung-Chen, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. Department of Medicine, Universidad Alfonso X El Sabio, Calle Joaquín Rodrigo 1. 28222, Majadahconda, Madrid, Spain. E-mail:
| | - Esther Hernández-Montero
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ane Andrés Eisenhofer
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Itziar Diego
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Moreno-Torres V, Royuela A, Gutiérrez-Rojas Á, Mills P. Author's response: "Red blood cell distribution width as a prognostic factor in sepsis: A new use for a classical parameter". J Crit Care 2022; 72:154135. [PMID: 36050199 DOI: 10.1016/j.jcrc.2022.154135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain.
| | - Ana Royuela
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, CIBERESP, Madrid, Spain, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Patricia Mills
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
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Moreno-Torres V, Castejón R, Martínez-Urbistondo M, Gutiérrez-Rojas Á, Vázquez-Comendador J, Tutor P, Durán-Del Campo P, Mellor-Pita S, Rosado S, Vargas-Núñez JA. Serum cytokines to predict systemic lupus erythematosus clinical and serological activity. Clin Transl Sci 2022; 15:1676-1686. [PMID: 35478259 PMCID: PMC9283738 DOI: 10.1111/cts.13283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 12/22/2022] Open
Abstract
We aimed to explore the role of interleukin (IL)-6, interferon-gamma (IFNγ), IL-10, and tumor necrosis factor (TNF) as predictors of systemic lupus erythematosus (SLE) clinical and serological activity, and their correlation with the treatment received. We performed a retrospective analysis of 77 patients with SLE according to the 2012 Systemic Lupus International Collaborative Clinics (SLICC) criteria. The outcomes were serological activity (SA), active disease (AD), complete remission (CR), the low-disease activity state (LDAS), and immunosuppressive treatment. SA was present in 17.1%, AD in 17.3%, CR in 13%, and LDAS in 64.9% of patients. IL-6 values were higher in patients in SA, in AD, in those receiving steroids alone, and in patients without CR or LDAS (p < 0.05). IFNγ was associated with anti-double stranded DNA (dsDNA) antibodies positivity and immunosuppression, whereas IL-10 values were higher in patients with CR (p < 0.05). The IL6-IFN product was able to predict anti-double stranded DNA (anti-dsDNA) antibodies positivity (area under the receiver operating characteristic curve [AUC-ROC] = 0.705, 95% confidence interval [CI] 0.563-0.847), SA (AUC-ROC = 0.720, 95% CI 0.542-0.899), AD (AUC-ROC = 0.701, 95% CI 0.520-0.882), steroid treatment (AUC-ROC = 0.751, 95% CI 0.622-0.879), and the absence of LDAS (AUC-ROC = 0.700, 95% CI 0.558-0.834). The IL6-IFN/IL10 ratio predicted AD (AUC-ROC = 0.742, 955 CI 0.540-0.944), steroid treatment (AUC-ROC = 0.721, 95% CI 0.572-0.870), and the absence of LDAS (AUC-ROC = 0.694, 95% CI 0.536-0.853). In conclusion, IL-6, IL-10, and IFNγ might help to assess SLE serological and clinical activity. Their combination in the IL-6-IFN product and the IL-6xIFN to IL-10 ratio results in novel tools to determine and predict SA, AD, and LDAS. Prompt detection of SLE activity might allow a rapid intervention to avoid established or chronic damage.
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Affiliation(s)
- Victor Moreno-Torres
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Raquel Castejón
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - María Martínez-Urbistondo
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Jose Vázquez-Comendador
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pablo Tutor
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pedro Durán-Del Campo
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Mellor-Pita
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvia Rosado
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan-Antonio Vargas-Núñez
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Ramos-Martínez A, Serrano-Martínez F, Pintos I, Valencia-Alijo Á, Gutiérrez-Rojas Á, Cítores MJ, Ortiz-Balbuena J, Royuela A, Martínez-Ruiz R, Sánchez-Romero I, Asensio Á, Múñez E, Plaza A. Effective definition of low humoral response to Clostridioides difficile infection. Anaerobe 2021; 72:102475. [PMID: 34752901 DOI: 10.1016/j.anaerobe.2021.102475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Determination of the humoral response to Clostridioides difficile (CD) toxins could be of great value in the management of patients with CD infection (CDI). METHODS A prospective study was conducted on the clinical characteristics and humoral response in patients with CDI. Determination of ELISA IgG CD anti-toxin B (tgcBiomics, Germany) was performed. The following dilutions were planned for each patient, 1:100, 1: 200, 1: 400, 1: 800: 1: 1600. A significant concentration of antibody was considered to be present in each dilution if an optical density 0.2 units higher than the negative control of the technique was evident. RESULTS Eighty-five patients were included during the study period, November 2018-February 2020. The median age was 73 years (interquartile range: 62.5-85 years), with female predominance (45 patients, 52.9%). Thirty-nine patients (45.9%) had a severe infection. Seven patients (8.2%) had suffered an episode of CDI in the previous three months. Seventeen patients (20%) had one or more recurrent episodes during the three-month follow-up: No patient died during admission or required surgery for severe-complicated infection. The incidence of recurrence in patients with no antibody detected at 1:400 dilution was 25.4% (16 patients) while it was 4.3% (one patient) in patients with antibody present at that dilution (p = 0.03). Liver cirrhosis was associated with higher humoral response against CD. CONCLUSIONS Antibodies IgG CD anti-toxin B detection at a dilution of 1:400, using a B ELISA technique, effectively identified patients at increased risk of recurrence. This information could help assist in the management of patients.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas. Departamento de Medicina Interna, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Universidad Autónoma de Madrid, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Francisco Serrano-Martínez
- Departamento de Inmunología, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Ilduara Pintos
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Ángela Valencia-Alijo
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Ángela Gutiérrez-Rojas
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - María Jesús Cítores
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Jorge Ortiz-Balbuena
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Rocío Martínez-Ruiz
- Departamento de Microbiología, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Isabel Sánchez-Romero
- Departamento de Microbiología, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Ángel Asensio
- Departamento de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Elena Múñez
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
| | - Aresio Plaza
- Departamento de Inmunología, Hospital Universitario Puerta de Hierro, Joaquín Rodrigo 2, 2822, Majadahonda, Madrid, Spain.
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Ortiz-Balbuena J, Royuela A, Calderón-Parra J, Martínez-Ruiz R, Asensio-Vegas Á, Múñez E, Valencia-Alijo Á, Gutiérrez-Rojas Á, Ussetti P, Cuervas-Mons V, Segovia-Cubero J, Portolés-Pérez J, Ramos-Martínez A. Risk Factors for Clostridioides Difficile Diarrhea In Solid Organ Transplantation Recipients. Transplant Proc 2021; 53:2826-2832. [PMID: 34772488 DOI: 10.1016/j.transproceed.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited knowledge about risk factors for Clostridioides difficile infection (CDI) and recurrent CDI in solid organ transplant (SOT) recipients. METHODS A case-control study of CDI in SOT recipients compared with controls (SOT recipients who did not present CDI). RESULTS Sixty-seven patients from 1089 SOT recipients (6.2%) suffered at least one episode of CDI. The mean age was 55 ± 12 years and 20 cases (69%) were men. The accumulated incidence was 8% in liver transplantation, 6.2% in lung transplantation, 5.4% in heart transplantation, and 4.7% in kidney transplantation. Twenty-nine cases (43.3%) were diagnosed during the first 3 months after SOT. Forty-one cases (61.2%) were hospital acquired. Thirty-one patients with CDI presented with mild-moderate infection (46.3%), 30 patients with severe infection (44.8%), and 6 patients with severe-complicated disease (9%). Independent variables found to be related with CDI were hospitalization in the previous 3 months (odds ratio: 2.99; [95% confidence interval 1.21-7.37]) and the use of quinolones in the previous month (odds ratio: 3.71 [95% confidence interval 1.16-11.8]). Eleven patients (16.4%) had at least one recurrence of CDI. Previous treatment with amoxicillin-clavulanate, severe-complicated index episode, and high serum creatinine were associated with recurrent CDI in the univariant analysis CONCLUSIONS: Liver transplant recipients presented the highest incidence of CDI among SOT recipients. Risk factors for CDI were hospitalization in the previous 3 months and the use of quinolones in the previous month.
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Affiliation(s)
- Jorge Ortiz-Balbuena
- Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rocío Martínez-Ruiz
- Departamento de Microbiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ángel Asensio-Vegas
- Departamento de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elena Múñez
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ángela Valencia-Alijo
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Piedad Ussetti
- Departamento de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Valentín Cuervas-Mons
- Unidad de Trasplante Hepático, Departamento de Medicina Interna, Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - José Portolés-Pérez
- Departamento de Nefrología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro, Madrid, Spain.
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Moreno-Torres V, Royuela A, Tarín C, Castejón R, Gutiérrez-Rojas Á, Durán-del Campo P, Mellor-Pita S, Tutor-Ureta P, Sánchez E, Martínez-Urbistondo M, de Mendoza C, Vargas-Núñez JA, Ruiz-Irastorza G. Impact of cardiovascular risk factors in antiphospholipid syndrome: an observational study from the Spanish national registry. Clin Exp Rheumatol 2021; 40:2161-2166. [DOI: 10.55563/clinexprheumatol/h2tkx3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Víctor Moreno-Torres
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Ana Royuela
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, CIBERESP, Madrid, Spain
| | - Carlos Tarín
- Basic Medical Sciences, Faculty of Medicine, Universidad CEU San Pablo, Madrid, Spain
| | - Raquel Castejón
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pedro Durán-del Campo
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Mellor-Pita
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pablo Tutor-Ureta
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Enrique Sánchez
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - María Martínez-Urbistondo
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Carmen de Mendoza
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan-Antonio Vargas-Núñez
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, BioCruces Bizkaia Health Research Institute, UPV/EHU, Bizkaia, Spain
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Martínez-Urbistondo M, Gutiérrez-Rojas Á, Andrés A, Gutiérrez I, Escudero G, García S, Gutiérrez A, Sánchez E, Herráiz J, De La Fuente S, Callejas A, De Mendoza C, Moreno-Torres V. Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients. J Clin Med 2021; 10:jcm10163595. [PMID: 34441891 PMCID: PMC8396991 DOI: 10.3390/jcm10163595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/08/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background. Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. Methods. We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. Results. A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. Conclusion. Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.
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Escudero-Sánchez R, Valencia-Alijo A, Cuéllar Tovar S, Merino-de Lucas E, García Fernández S, Gutiérrez-Rojas Á, Ramos-Martínez A, Salavert Lletí M, Castro Hernández I, Giner L, Cobo J. Real-life experience with fidaxomicin in Clostridioides difficile infection: a multicentre cohort study on 244 episodes. Infection 2021; 49:475-482. [PMID: 33417171 DOI: 10.1007/s15010-020-01567-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
The high cost of fidaxomicin has restricted its use despite the benefit of a lower Clostridioides difficile infection (CDI) recurrence rate at 4 weeks of follow-up. This short follow-up represents the main limitation of pivotal clinical trials of fidaxomicin, and some recent studies question its benefits over vancomycin. Moreover, the main risk factors of recurrence after treatment with fidaxomicin remain unknown. We designed a multicentre retrospective cohort study among four Spanish hospitals to assess the efficacy of fidaxomicin in real life and to investigate risk factors of fidaxomicin failure at weeks 8 and 12. Two-hundred forty-four patients were included. Fidaxomicin was used in 96 patients (39.3%) for a first episode of CDI, in 95 patients (38.9%) for a second episode, and in 53 patients (21.7%) for a third or subsequent episode. Patients treated with fidaxomicin in a first episode were younger (59.9 years vs 73.5 years), but they had more severe episodes (52.1% vs. 32.4%). The recurrence rates for patients treated in the first episode were 6.5% and 9.7% at weeks 8 and 12, respectively. Recurrence rates increased for patients treated at second or ulterior episodes (16.3% and 26.4% at week 8, respectively). Age greater than or equal to 85 years and having had a previous episode of CDI were identified as recurrence risk factors at weeks 8 and 12. We conclude that the outcomes with fidaxomicin in real life are at least as good as those observed in clinical trials despite a more demanding evaluation. Be it 85 years of age or older, and the use after a first episode appears to be independent factors of CDI recurrence after treatment with fidaxomicin.
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Affiliation(s)
- Rosa Escudero-Sánchez
- Infectious Disease Department, University Hospital Ramon Y Cajal, Ctra. Colmenar Viejo, Km 9,1. Zip code 28034, Madrid, Spain. .,Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain.
| | - Angela Valencia-Alijo
- Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | - Sergio García Fernández
- Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain.,Microbiology Department, University Hospital Ramón Y Cajal, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | - Livia Giner
- Internal Medicine Department, University Hospital General de Alicante, Alicante, Spain
| | - Javier Cobo
- Infectious Disease Department, University Hospital Ramon Y Cajal, Ctra. Colmenar Viejo, Km 9,1. Zip code 28034, Madrid, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Madrid, Spain
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