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Flores A, Garcia-Tornel A, Seró L, Ustrell X, Requena M, Pellisé A, Rodriguez P, Monterde A, Lara L, Gonzalez-de-Echavarri JM, Molina CA, Doncel-Moriano A, Dorado L, Cardona P, Cánovas D, Krupinski J, Más N, Purroy F, Zaragoza-Brunet J, Palomeras E, Cocho D, Garcia J, Colom C, Silva Y, Gomez-Cocho M, Jiménez X, Ros-Roig J, Abilleira S, Pérez de la Ossa N, Ribo M. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis. J Neurointerv Surg 2024; 16:143-150. [PMID: 37068936 DOI: 10.1136/jnis-2023-020125] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
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Affiliation(s)
- Alan Flores
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | | | - Laia Seró
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Xavier Ustrell
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Pellisé
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Paula Rodriguez
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Angela Monterde
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Lidia Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Jose María Gonzalez-de-Echavarri
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Doncel-Moriano
- Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Pedro Cardona
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | | | - Natalia Más
- Department of Neurology, Hospital Althaia, Manresa, Manresa, Catalunya, Spain
| | | | - Jose Zaragoza-Brunet
- Stroke Unit, Department of Neurology, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Ernesto Palomeras
- Department of Neurology, Hospital de Mataró, Mataro, Catalunya, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Granollers, Catalunya, Spain
| | - Jessica Garcia
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedes, Catalunya, Spain
| | - Carla Colom
- Department of Neurology, Hospital Universitario de Igualada, Igualada, Catalunya, Spain
| | - Yolanda Silva
- Neurology Department, Stroke Unit, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | - Manuel Gomez-Cocho
- Department of Neurology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Josep Ros-Roig
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sonia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
- Catalan Stroke Program, Barcelona, Spain
| | - Marc Ribo
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Terceño M, Bashir S, Puig J, I-Estadella JD, Murias E, Jiménez JM, Díaz EG, Monso JF, Bravo-Rey I, Romero V, Werner M, López-Rueda A, Román LS, Anadaluz JB, Doncel-Moriano A, Rosati S, Pérez-García C, Remollo S, Caamaño IR, Aixut S, Chaparro OSC, Garcia JMS, Porto-Álvarez J, Mendez-Cendón JC, Rayon-Aledo JC, Aguilar Y, Parrilla G, Castaño M, Serena J, Silva Y. Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry. AJNR Am J Neuroradiol 2023; 44:1275-1281. [PMID: 37827717 PMCID: PMC10631533 DOI: 10.3174/ajnr.a8003] [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: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. MATERIALS AND METHODS Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. RESULTS A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. CONCLUSIONS In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.
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Affiliation(s)
- Mikel Terceño
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Saima Bashir
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Josep Puig
- Department of Radiology (J.P.), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Josep Daunis- I-Estadella
- Department of Computer Science (J.D.-I.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eduardo Murias
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jose María Jiménez
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eva González Díaz
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Jon Fondevila Monso
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Isabel Bravo-Rey
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Veredas Romero
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Mariano Werner
- Neurointerventional Department CDI (M.W.), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Luis San Román
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Jordi Blasco Anadaluz
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | | | - Santiago Rosati
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Isabel Rodríguez Caamaño
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Sonia Aixut
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Sabino Chirife Chaparro
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jacobo Porto-Álvarez
- Department of Neuroradiology (J.P.-A.), Complexo Hospitalario Universitario de Santiago de, Compostela, Galicia, Spain
| | - Jose Carlos Mendez-Cendón
- Interventional Neuroradiology Unit (J.C.M.-C.), Department of Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Jose Carlos Rayon-Aledo
- Department of Interventional Neuroradiology (J.C.R.-A.), Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Yeray Aguilar
- Department of Radiology (Y.A.), Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Guillermo Parrilla
- Department of Interventional Neuroradiology (G.P.), Department of Radiology, Hospital Clínico Universitario Virgen de la, Murcia, Spain
| | - Miguel Castaño
- Department of Interventional Neuroradiology (M.S.), Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Joaquín Serena
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Yolanda Silva
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
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Bodro M, Compta Y, Llansó L, Esteller D, Doncel-Moriano A, Mesa A, Rodríguez A, Sarto J, Martínez-Hernandez E, Vlagea A, Egri N, Filella X, Morales-Ruiz M, Yagüe J, Soriano Á, Graus F, García F. Increased CSF levels of IL-1β, IL-6, and ACE in SARS-CoV-2-associated encephalitis. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/5/e821. [PMID: 32611761 PMCID: PMC7357418 DOI: 10.1212/nxi.0000000000000821] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Marta Bodro
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain.
| | - Yaroslau Compta
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain.
| | - Laura Llansó
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Diana Esteller
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Antonio Doncel-Moriano
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Alex Mesa
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Alejandro Rodríguez
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Jordi Sarto
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Eugenia Martínez-Hernandez
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Alexandru Vlagea
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Natalia Egri
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Xavier Filella
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Manuel Morales-Ruiz
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Jordi Yagüe
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Álex Soriano
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Francesc Graus
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
| | - Felipe García
- From the Infectious Diseases Service (M.B., Á.S., F. García), Hospital Clínic de Barcelona, Catalonia; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (M.B., Y.C., X.F., M.M.-R., J.Y., Á.S., F. Graus, F. García), Barcelona, Catalonia; Department of Medicine (M.B., Y.C., Á.S., F. García), Universitat de Barcelona, Catalonia; Neurology Service (Y.C., L.L., D.E., A.D.-M., A.R., J.S.), Hospital Clínic de Barcelona, Catalonia; Institut de Neurociències (Y.C.), Maria de Maeztu excellence center, Universitat de Barcelona, Catalonia; Endocrinology and Nutricion Service (A.M.), Hospital Clínic de Barcelona, Catalonia; Immunology Service (A.V., N.E., J.Y.), Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Functional Unit of Clinical Immunology, Hospital Sant Joan de Déu & Hospital Clínic, Barcelona, Catalonia; CDB (X.F., M.M.-R.), Hospital Clínic de Barcelona, Barcelona, Catalonia; and Department of Biomedicine (M.M.-R.), Universitat de Barcelona; CIBERehd; Catalonia, Spain
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