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Morales-Cano D, Barreira B, Callejo M, Olivencia MA, Ferruelo A, Milara J, Lorente JÁ, Moreno L, Cogolludo Á, Perez-Vizcaino F. Comparative analysis of antiproliferative and vasodilator effects of drugs for pulmonary hypertension: Extensive in vitro study in rats and human. Vascul Pharmacol 2024; 155:107371. [PMID: 38599357 DOI: 10.1016/j.vph.2024.107371] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/12/2024]
Abstract
An effective pulmonary hypertension (PH) treatment should combine antiproliferative and vasodilator effects. We characterized a wide-range of drugs comparing their anti-proliferative vs vasodilator effects in human and rat pulmonary artery smooth muscle cells (PASMC). Key findings: 1) Approved PH drugs (PDE5 inhibitors, sGC stimulators and PGI2 agonists) are preferential vasodilators. 2) cGMP stimulators were more effective in cells derived from hypertensive rats. 3) Nifedipine acted equally as vasodilator and antiproliferative. 4) quercetin and imatinib were potent dual vasodilator/antiproliferative drugs. 5) Tacrolimus and levosimendan lacked antiproliferative effects. 6) Forskolin, pinacidil and hydroxyfasudil were more effective as antiproliferative in human cells.
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Affiliation(s)
- Daniel Morales-Cano
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Bianca Barreira
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - María Callejo
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Miguel A Olivencia
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Antonio Ferruelo
- Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Department of Critical Care, Hospital Universitario de Getafe, 28905 Madrid, Spain
| | - Javier Milara
- Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Pharmacy Unit, University General Hospital Consortium, 46014 Valencia, Spain
| | - José Ángel Lorente
- Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Department of Critical Care, Hospital Universitario de Getafe, 28905 Madrid, Spain
| | - Laura Moreno
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Ángel Cogolludo
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain
| | - Francisco Perez-Vizcaino
- Department of Pharmacology and Toxicology, School of Medicine, University Complutense of Madrid, 28040 Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain.
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Tejerina EE, Gonçalves G, Gómez-Mediavilla K, Jaramillo C, Jiménez J, Frutos-Vivar F, Lorente JÁ, Thuissard IJ, Andreu-Vázquez C. The effect of age on clinical outcomes in critically ill brain-injured patients. Acta Neurol Belg 2023; 123:1709-1715. [PMID: 35737277 DOI: 10.1007/s13760-022-01987-0] [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: 02/26/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE We studied the impact of age on survival and functional recovery in brain-injured patients. METHODS We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3-6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes. RESULTS We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3-6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73-7.74, p < 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95-7.08, p < 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70-11.28, p < 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34-6.42, p < 0.001]. CONCLUSION Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.
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Affiliation(s)
- Eva E Tejerina
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain.
| | | | | | | | | | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain
| | - José Ángel Lorente
- Hospital Universitario de Getafe and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Intensive Care Unit, Carretera de Toledo, km 12.5, 28905, Getafe, Spain
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3
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Galli F, Bindo F, Motos A, Fernández-Barat L, Barbeta E, Gabarrús A, Ceccato A, Bermejo-Martin JF, Ferrer R, Riera J, Peñuelas O, Lorente JÁ, de Gonzalo-Calvo D, Menéndez R, Gonzalez J, Misuraca S, Palomeque A, Amaya-Villar R, Añón JM, Balan Mariño A, Barberà C, Barberán J, Blandino Ortiz A, Bustamante-Munguira E, Caballero J, Cantón-Bulnes ML, Carbajales Pérez C, Carbonell N, Catalán-González M, de Frutos R, Franco N, Galbán C, Lopez Lago A, Gumucio-Sanguino VD, de la Torre MDC, Díaz E, Estella Á, Gallego Curto E, García-Garmendia JL, Gómez JM, Huerta A, Jorge García RN, Loza-Vázquez A, Marin-Corral J, Martin Delgado MC, Martínez de la Gándara A, Martínez Varela I, Lopez Messa J, M Albaiceta G, Nieto MT, Novo MA, Peñasco Y, Pérez-García F, Pozo-Laderas JC, Ricart P, Sagredo V, Sánchez-Miralles A, Sancho Chinesta S, Roche-Campo F, Socias L, Solé-Violan J, Suarez-Sipmann F, Tamayo Lomas L, Trenado J, Úbeda A, Valdivia LJ, Vidal P, Boado MV, Rodríguez A, Antonelli M, Blasi F, Barbé F, Torres A. Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients. Intensive Care Med 2023; 49:934-945. [PMID: 37507573 PMCID: PMC10425511 DOI: 10.1007/s00134-023-07161-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. METHODS We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. RESULTS Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. CONCLUSION Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.
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Affiliation(s)
- Flavia Galli
- Department of Intensive Care, Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bindo
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Anna Motos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laia Fernández-Barat
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Enric Barbeta
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Gabarrús
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Adrián Ceccato
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Center, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Intensive Care Unit, Grupo Quironsalud, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Jesús F Bermejo-Martin
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Jordi Riera
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
- Dept. of Bioengineering, Universidad Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Rosario Menéndez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Jessica Gonzalez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sofia Misuraca
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Andrea Palomeque
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rosario Amaya-Villar
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain
| | - José Manuel Añón
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | - José Barberán
- Hospital Universitario HM Montepríncipe, Facultad HM Hospitales de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain
| | - Aaron Blandino Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Intensive Care Unit, and Emergency Medicine, Universidad de Alcalá, Madrid, Spain
| | - Elena Bustamante-Munguira
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Jesús Caballero
- Critical Intensive Medicine Department, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida, Lleida, Spain
| | | | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico Universitario, Valencia, Spain
| | | | - Raul de Frutos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Spain
| | | | - Cristóbal Galbán
- Department of Critical Care Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago, Spain
| | - Ana Lopez Lago
- Department of Critical Care Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago, Spain
| | - Víctor D Gumucio-Sanguino
- Department of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Emilio Díaz
- Department of Medicine, Critical Care Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Ángel Estella
- Department of Medicine, Intensive Care Unit University Hospital of Jerez, University of Cádiz, INIBiCA, Cádiz, Spain
| | - Elena Gallego Curto
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | | | - Ana Loza-Vázquez
- Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Seville, Spain
| | | | | | | | | | | | - Guillermo M Albaiceta
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Mariana Andrea Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Illes Balears, Palma, Spain
| | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Facultad de Medicina, Departamento de Biomedicina y Biotecnología, Hospital Universitario Príncipe de Asturias - Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Pozo-Laderas
- UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain
| | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain
| | | | - Angel Sánchez-Miralles
- Intensive Care Unit, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Susana Sancho Chinesta
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ferran Roche-Campo
- Hospital Verge de la Cinta, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Illes Balears, Palma, Spain
| | - Jordi Solé-Violan
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Department, Hospital Universitario de GC Dr. Negrín, Universidad Fernando Pessoa Canarias, Las Palmas, Gran Canaria, Spain
| | | | - Luis Tamayo Lomas
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - José Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Alejandro Úbeda
- Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain
| | | | - Pablo Vidal
- Complexo Hospitalario Universitario de Ourense, Orense, Spain
| | | | - Alejandro Rodríguez
- Critical Care Department, Hospital Universitario Joan XXIII, CIBERES, Rovira & Virgili University, IISPV, Tarragona, Spain
| | - Massimo Antonelli
- Department of Intensive Care, Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Ferran Barbé
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Antoni Torres
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.
- Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
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4
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Riera J, Barbeta E, Tormos A, Mellado-Artigas R, Ceccato A, Motos A, Fernández-Barat L, Ferrer R, García-Gasulla D, Peñuelas O, Lorente JÁ, Menéndez R, Roca O, Palomeque A, Ferrando C, Solé-Violán J, Novo M, Boado MV, Tamayo L, Estella Á, Galban C, Trenado J, Huerta A, Loza A, Aguilera L, García Garmendia JL, Barberà C, Gumucio V, Socias L, Franco N, Valdivia LJ, Vidal P, Sagredo V, Ruiz-García ÁL, Martínez Varela I, López J, Pozo JC, Nieto M, Gómez JM, Blandino A, Valledor M, Bustamante-Munguira E, Sánchez-Miralles Á, Peñasco Y, Barberán J, Ubeda A, Amaya-Villar R, Martín MC, Jorge R, Caballero J, Marin J, Añón JM, Suárez Sipmann F, Albaiceta GM, Castellanos-Ortega Á, Adell-Serrano B, Catalán M, Martínez de la Gándara A, Ricart P, Carbajales C, Rodríguez A, Díaz E, de la Torre MC, Gallego E, Cantón-Bulnes L, Carbonell N, González J, de Gonzalo-Calvo D, Barbé F, Torres A. Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic: a matched analysis. Eur Respir J 2023; 61:13993003.01426-2022. [PMID: 36396142 PMCID: PMC9686319 DOI: 10.1183/13993003.01426-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with coronavirus disease 2019 (COVID-19)-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior noninvasive respiratory support on outcomes. METHODS This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICUs) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of ICU admission. Propensity score matching was used to achieve a balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different time-point (48 h from ICU admission) for early and delayed intubation. RESULTS Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After propensity score matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%; p=0.01), ICU mortality (25.7% versus 36.1%; p=0.007) and 90-day mortality (30.9% versus 40.2%; p=0.02) compared with the early intubation group. Very similar findings were observed when we used a 48-h time-point for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth waves, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (HFNC) (n=294) who were intubated earlier. The subgroup of patients undergoing noninvasive ventilation (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. CONCLUSIONS In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received HFNC.
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Affiliation(s)
- Jordi Riera
- Critical Care Department, Hospital Universitari Vall d'Hebron, SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- These authors contributed equally to this work
| | - Enric Barbeta
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- These authors contributed equally to this work
| | - Adrián Tormos
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Ricard Mellado-Artigas
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Adrián Ceccato
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
- Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Motos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
| | - Laia Fernández-Barat
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
| | - Ricard Ferrer
- Critical Care Department, Hospital Universitari Vall d'Hebron, SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Oscar Peñuelas
- Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | | | - Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Oriol Roca
- Critical Care Department, Hospital Universitari Vall d'Hebron, SODIR, Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Palomeque
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Respiratory Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Surgical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Solé-Violán
- Critical Care Department, Hospital Dr Negrín Gran Canaria, Universidad Fernando Pessoa, Las Palmas, Spain
| | - Mariana Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Luis Tamayo
- Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Ángel Estella
- Departamento Medicina, Facultad Medicina, Universidad de Cádiz, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - Cristóbal Galban
- Department of Medicine, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - Josep Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | - Ana Loza
- Hospital Virgen de Valme, Sevilla, Spain
| | | | | | | | - Víctor Gumucio
- Department of Intensive Care, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | | | - Pablo Vidal
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Ángela Leonor Ruiz-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Departamento de Biomedicina y Biotecnología, Universidad de Alcalá de Henares, Madrid, Spain
| | | | - Juan López
- Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Juan Carlos Pozo
- UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain
| | - Maite Nieto
- Hospital Universitario de Segovia, Segovia, Spain
| | - José M Gómez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aaron Blandino
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Ángel Sánchez-Miralles
- Servicio de Medicina Intensiva, Hospital Universitario Sant Joan d'Alacant, Alicante, Spain
| | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José Barberán
- Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain
| | - Alejandro Ubeda
- Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain
| | - Rosario Amaya-Villar
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Sevilla, Spain
| | - María Cruz Martín
- Hospital Universitario Torrejón, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ruth Jorge
- Intensive Care Department, Hospital Nuestra Señora de Gracia, Zaragoza, Spain
| | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Judith Marin
- Critical Care Department, Hospital del Mar-IMIM, Barcelona, Spain
| | | | | | - Guillermo M Albaiceta
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Spain
| | | | | | - Mercedes Catalán
- Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain
| | | | | | - Emili Díaz
- Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
- Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | | | - Elena Gallego
- Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - David de Gonzalo-Calvo
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Ferran Barbé
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Antoni Torres
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Respiratory Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
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5
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González J, de Batlle J, Benítez ID, Torres G, Santisteve S, Targa AD, Gort-Paniello C, Moncusí-Moix A, Aguilà M, Seck F, Ceccato A, Ferrer R, Motos A, Riera J, Fernández L, Menéndez R, Lorente JÁ, Peñuelas O, Garcia-Gasulla D, Peñasco Y, Ricart P, Abril Palomares E, Aguilera L, Rodríguez A, Boado Varela MV, Beteré B, Pozo-Laderas JC, Solé-Violan J, Salvador-Adell I, Novo MA, Barberán J, Amaya Villar R, Garnacho-Montero J, Gómez JM, Blandino Ortiz A, Tamayo Lomas L, Úbeda A, Catalán-González M, Sánchez-Miralles A, Martínez Varela I, Jorge García RN, Franco N, Gumucio-Sanguino VD, Bustamante-Munguira E, Valdivia LJ, Caballero J, Gallego E, Rodríguez C, Castellanos-Ortega Á, Trenado J, Marin-Corral J, Albaiceta GM, de la Torre MDC, Loza-Vázquez A, Vidal P, Añón JM, Carbajales Pérez C, Sagredo V, Carbonell N, Socias L, Barberà C, Estella A, Diaz E, de Gonzalo-Calvo D, Torres A, Barbé F. Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients. Arch Bronconeumol 2023; 59:205-215. [PMID: 36690515 PMCID: PMC9824938 DOI: 10.1016/j.arbres.2022.12.017] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. METHODS Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. RESULTS The median [p25-p75] time from discharge to follow-up was 3.57 [2.77-4.92] months. Median age was 60 [53-67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18-2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37-1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18-1.63)), urea (OR: 1.16 (0.97-1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73-1.06)). Bacterial pneumonia (1.62 (1.11-2.35)) and duration of ventilation (NIMV (1.23 (1.06-1.42), IMV (1.21 (1.01-1.45)) and prone positioning (1.17 (0.98-1.39)) were associated with fibrotic lesions. CONCLUSION Age and CLD, reflecting patients' baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.
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Affiliation(s)
- Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jordi de Batlle
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D. Benítez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Adriano D.S. Targa
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Maria Aguilà
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Fatty Seck
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Critical Care Center, ParcTaulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d’Hebron Hospital Universitari, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Anna Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Riera
- Intensive Care Department, Vall d’Hebron Hospital Universitari, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laia Fernández
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - José Ángel Lorente
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid, Spain
| | - Oscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid, Spain
| | | | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain
| | | | - Luciano Aguilera
- Servicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Spain
| | | | | | - Belén Beteré
- Servicio de Análisis Clínicos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Juan Carlos Pozo-Laderas
- UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain
| | - Jordi Solé-Violan
- Critical Care Department, Hospital Dr. Negrín Gran Canaria, Universidad Fernando Pessoa, Las Palmas, Gran Canaria, Canarias, Spain
| | | | - Mariana Andrea Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - José Barberán
- Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain
| | - Rosario Amaya Villar
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Sevilla, Spain
| | - José Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José M. Gómez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aaron Blandino Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis Tamayo Lomas
- Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Alejandro Úbeda
- Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain
| | | | | | | | | | | | - Víctor D. Gumucio-Sanguino
- Department of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Elena Gallego
- Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | | | - Josep Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Guillermo M. Albaiceta
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Spain
| | | | - Ana Loza-Vázquez
- Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Pablo Vidal
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Jose M. Añón
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain
| | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | | | - Angel Estella
- Intensive Care Unit, University Hospital of Jerez, Medicine Department University of Cadiz, INiBICA, Spain
| | - Emili Diaz
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain,CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain,Corresponding author
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Cilloniz C, Pericàs JM, Motos A, Gabarrús A, Ferrer R, Menéndez R, Riera J, García-Gasulla D, Peñuelas O, Fernández-Barat L, Ángel Lorente J, de Gonzalo-Calvo D, Barbé F, Torres A. Hyperglycemia in Acute Critically Ill COVID-19 Patients. Arch Bronconeumol 2023; 59:51-56. [PMID: 36167740 PMCID: PMC9461233 DOI: 10.1016/j.arbres.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Corresponding authors
| | - Juan M. Pericàs
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research (VHIR), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain,Infectious Disease Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anna Motos
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)
| | - Ricard Ferrer
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, Barcelona, Spain
| | - Rosario Menéndez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Jordi Riera
- Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, Barcelona, Spain
| | | | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid, Spain
| | - Laia Fernández-Barat
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid, Spain
| | - David de Gonzalo-Calvo
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Ferran Barbé
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB),CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain,Corresponding authors
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7
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Benítez ID, de Batlle J, Torres G, González J, de Gonzalo-Calvo D, Targa AD, Gort-Paniello C, Moncusí-Moix A, Ceccato A, Fernández-Barat L, Ferrer R, Garcia-Gasulla D, Menéndez R, Motos A, Peñuelas O, Riera J, Bermejo-Martin JF, Peñasco Y, Ricart P, Martin Delgado MC, Aguilera L, Rodríguez A, Boado Varela MV, Suarez-Sipmann F, Pozo-Laderas JC, Solé-Violan J, Nieto M, Novo MA, Barberán J, Amaya Villar R, Garnacho-Montero J, García-Garmendia JL, Gómez JM, Lorente JÁ, Blandino Ortiz A, Tamayo Lomas L, López-Ramos E, Úbeda A, Catalán-González M, Sánchez-Miralles A, Martínez Varela I, Jorge García RN, Franco N, Gumucio-Sanguino VD, Huerta Garcia A, Bustamante-Munguira E, Valdivia LJ, Caballero J, Gallego E, Martínez de la Gándara A, Castellanos-Ortega Á, Trenado J, Marin-Corral J, Albaiceta GM, de la Torre MDC, Loza-Vázquez A, Vidal P, Lopez Messa J, Añón JM, Carbajales Pérez C, Sagredo V, Bofill N, Carbonell N, Socias L, Barberà C, Estella A, Valledor Mendez M, Diaz E, López Lago A, Torres A, Barbé F. Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study. Lancet Reg Health Eur 2022; 18:100422. [PMID: 35655660 PMCID: PMC9148543 DOI: 10.1016/j.lanepe.2022.100422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Funding ISCIII, UNESPA, CIBERES, FEDER, ESF.
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Torres A, Motos A, Ceccato A, Bermejo-Martin J, de Gonzalo-Calvo D, Pérez R, Barroso M, Pascual IZ, Gonzalez J, Fernández-Barat L, Ferrer R, Riera J, García-Gasulla D, Peñuelas O, Lorente JÁ, Almansa R, Menéndez R, Kiarostami K, Canseco J, Villar RA, Añón JM, Mariño AB, Barberà C, Barberán J, Ortiz AB, Boado MV, Bustamante-Munguira E, Caballero J, Cantón-Bulnes ML, Pérez CC, Carbonell N, Catalán-González M, de Frutos R, Franco N, Galbán C, Gumucio-Sanguino VD, Torre MDCDL, Díaz E, Estella Á, Gallego E, Garmendia JLG, Gómez JM, Huerta A, García RNJ, Loza-Vázquez A, Marin-Corral J, Delgado MCM, Gándara AMDL, Varela IM, Messa JL, Albaiceta GM, Nieto M, Novo MA, Peñasco Y, Pérez-García F, Pozo-Laderas JC, Ricart P, Sagredo V, Sánchez-Miralles Á, Chinesta SS, Serra-Fortuny M, Socias L, Solé-Violan J, Suárez-Sipmann F, Lomas LT, Trenado J, Úbeda A, Valdivia LJ, Vidal P, Barbé F. Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units. Arch Bronconeumol 2022; 58 Suppl 1:22-31. [PMID: 35491287 PMCID: PMC9012512 DOI: 10.1016/j.arbres.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. METHODS CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. RESULTS This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. CONCLUSIONS We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs.
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Affiliation(s)
- Antoni Torres
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Anna Motos
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Adrián Ceccato
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jesús Bermejo-Martin
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - David de Gonzalo-Calvo
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Raquel Pérez
- Barcelona Supercomputing Centre (BSC), Barcelona, Spain
| | - Marta Barroso
- Barcelona Supercomputing Centre (BSC), Barcelona, Spain
| | | | - Jessica Gonzalez
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain; Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain; Barcelona Supercomputing Centre (BSC), Barcelona, Spain; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Laia Fernández-Barat
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Jordi Riera
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | - Raquel Almansa
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rosario Menéndez
- Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Kasra Kiarostami
- Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joan Canseco
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Department of Pneumology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rosario Amaya Villar
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Sevilla, Spain
| | - José M Añón
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | | | - José Barberán
- Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain
| | - Aaron Blandino Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Elena Bustamante-Munguira
- Department of Intensive Care Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | | | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain
| | | | - Raúl de Frutos
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | | | - Cristóbal Galbán
- Department of Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Víctor D Gumucio-Sanguino
- Department of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Emili Díaz
- Critical Care Department, Corporació Sanitària Parc Taulí, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Ángel Estella
- Departamento de Medicina, Facultad de Medicina, Universidad de Cádiz, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | - Elena Gallego
- Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | | | - José M Gómez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Emergency Department, Clínica Sagrada Família, Barcelona, Spain
| | | | - Ana Loza-Vázquez
- Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | | | | | | | - Guillermo M Albaiceta
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Maite Nieto
- Hospital Universitario de Segovia, Segovia, Spain
| | - Mariana Andrea Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Felipe Pérez-García
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Departamento de Biomedicina y Biotecnología, Universidad de Alcalá de Henares, Madrid, Spain
| | - Juan Carlos Pozo-Laderas
- UGC-Medicina Intensiva, Hospital Universitario Reina Sofía, Instituto Maimónides IMIBIC, Córdoba, Spain
| | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain
| | | | | | - Susana Sancho Chinesta
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | - Jordi Solé-Violan
- Critical Care Department, Hospital de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | | | - Luis Tamayo Lomas
- Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - José Trenado
- Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Alejandro Úbeda
- Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Cádiz, Spain
| | | | - Pablo Vidal
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Ferran Barbé
- CIBER de Enfermedades Respiratorias (CIBERES), Spain; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
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Motos A, López-Gavín A, Riera J, Ceccato A, Fernández-Barat L, Bermejo-Martin JF, Ferrer R, de Gonzalo-Calvo D, Menéndez R, Pérez-Arnal R, García-Gasulla D, Rodriguez A, Peñuelas O, Ángel Lorente J, Almansa R, Gabarrus A, Marin-Corral J, Ricart P, Roche-Campo F, Sancho Chinesta S, Socias L, Barbé F, Torres A. Higher frequency of comorbidities in fully vaccinated patients admitted to ICU due to severe COVID-19: a prospective, multicenter, observational study. Eur Respir J 2021; 59:13993003.02275-2021. [PMID: 34824059 PMCID: PMC8620090 DOI: 10.1183/13993003.02275-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/13/2021] [Indexed: 01/11/2023]
Abstract
The coronavirus disease 2019 (COVID-19) vaccination campaign in Spain began on 27 December 2020 [1]. To date, more than 36 million people have been fully vaccinated, with most of the population, namely 25.3 million people (69.1%), receiving BNT 162b2 (Pfizer/BioNTech) [1]. With respect to other vaccines and figures, 4.8 million (13.2%) people have received AZD1222 (Oxford/AstraZeneca); 4.5 million (12.3%) mRNA-1273 (Moderna); and 2.0 million (5.4%) JNJ-78436735 (Janssen) [1]. Severe COVID-19 disease requiring ICU admission is possible in the fully vaccinated population, especially in those with immunocompromised status and other comorbidities. Interventions to improve vaccine response might be necessary in this population.https://bit.ly/3Fw6vCP
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Affiliation(s)
- Anna Motos
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain.,AM and ALG equally contributed to the manuscript
| | - Alexandre López-Gavín
- Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain.,AM and ALG equally contributed to the manuscript
| | - Jordi Riera
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Adrián Ceccato
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Laia Fernández-Barat
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jesús F Bermejo-Martin
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Gerencia Regional de Salud de Castilla y León, Spain
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - David de Gonzalo-Calvo
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Rosario Menéndez
- Pulmonary Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | | | | | - Oscar Peñuelas
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid; Spain
| | - José Ángel Lorente
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Hospital Universitario de Getafe, Madrid; Universidad Europea, Madrid; Spain
| | - Raquel Almansa
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Gerencia Regional de Salud de Castilla y León, Spain
| | - Albert Gabarrus
- Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain
| | - Ferran Roche-Campo
- Critical Care Department, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | - Susana Sancho Chinesta
- Servicio de medicina intensiva. Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | - Ferran Barbé
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria; IRBLleida, Lleida, Spain
| | - Antoni Torres
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Barcelona, Spain .,Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain.,AM and ALG equally contributed to the manuscript
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Peñuelas O, Keough E, López-Rodríguez L, Carriedo D, Gonçalves G, Barreiro E, Lorente JÁ. Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill. Intensive Care Med Exp 2019; 7:48. [PMID: 31346802 PMCID: PMC6658639 DOI: 10.1186/s40635-019-0259-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023] Open
Abstract
Mechanical ventilation [MV] is a life-saving technique delivered to critically ill patients incapable of adequately ventilating and/or oxygenating due to respiratory or other disease processes. This necessarily invasive support however could potentially result in important iatrogenic complications. Even brief periods of MV may result in diaphragm weakness [i.e., ventilator-induced diaphragm dysfunction [VIDD]], which may be associated with difficulty weaning from the ventilator as well as mortality. This suggests that VIDD could potentially have a major impact on clinical practice through worse clinical outcomes and healthcare resource use. Recent translational investigations have identified that VIDD is mainly characterized by alterations resulting in a major decline of diaphragmatic contractile force together with atrophy of diaphragm muscle fibers. However, the signaling mechanisms responsible for VIDD have not been fully established. In this paper, we summarize the current understanding of the pathophysiological pathways underlying VIDD and highlight the diagnostic approach, as well as novel and experimental therapeutic options.
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Affiliation(s)
- Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain. .,Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.
| | - Elena Keough
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Lucía López-Rodríguez
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Gesly Gonçalves
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Esther Barreiro
- Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.,Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department [CEXS], Barcelona, Spain.,Universitat Pompeu Fabra [UPF], Barcelona Biomedical Research Park [PRBB], Barcelona, Spain
| | - José Ángel Lorente
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.,Universidad Europea, Madrid, Spain
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Tejerina EE, Abril E, Padilla R, Rodríguez Ruíz C, Ballen A, Frutos-Vivar F, Lorente JÁ, Esteban A. Invasive aspergillosis in critically ill patients: An autopsy study. Mycoses 2019; 62:673-679. [PMID: 31177621 DOI: 10.1111/myc.12927] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 03/18/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/29/2023]
Abstract
Autopsy studies show that IA is among the most commonly missed diagnoses in critically ill patients. And, because of lack of unequivocal diagnostic criteria, a timely diagnosis remains challenging. We investigate the epidemiology of and the clinical risk factors for IA in critically ill patients. We conducted a retrospective, observational study of all consecutive ICU patients with evidence of IA in the postmortem examination. During the period of the study (25 years), 893 postmortem examinations were performed in the ICU. Twenty-five patients (2.8%) were diagnosed with IA in autopsy. Only ten (40%) were classified as IA ante-mortem, based on the initiation of antifungal treatment. The most common comorbid conditions were corticosteroid treatment (n = 14, 56%), chronic obstructive pulmonary disease (COPD) (n = 11, 44%), immunosuppression (n = 6, 24%) and haematological malignancy (n = 5, 20%). Twenty-three patients (92%) had three or more risk factors for IA. Critically ill patients with pulmonary infiltrates, treated with high doses intravenous corticosteroids (even for a short period of time), particularly COPD patients who developed worsening respiratory insufficiency despite appropriate treatment were at the highest risk of IA.
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Affiliation(s)
- Eva E Tejerina
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - Elena Abril
- Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Spain
| | - Rebeca Padilla
- Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Spain
| | | | - Aida Ballen
- Department of Pathology, Hospital Universitario de Getafe, Getafe, Spain
| | - Fernando Frutos-Vivar
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - José Ángel Lorente
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - Andrés Esteban
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
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Izquierdo-García JL, Nin N, Cardinal-Fernandez P, Ruiz-Cabello J, Lorente JÁ. Metabolomic profile of acute respiratory distress syndrome of different etiologies. Intensive Care Med 2019; 45:1318-1320. [PMID: 31087114 PMCID: PMC7095478 DOI: 10.1007/s00134-019-05634-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/16/2022]
Affiliation(s)
- José Luis Izquierdo-García
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain. .,Centro de Investigación Cooperativa en Biomateriales, CIC biomaGUNE, Paseo Miramón 182, 20014, Donostia-San Sebastián, Spain. .,Departamento de Química-Física II, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
| | - Nicolás Nin
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Hospital Español, Montevideo, Uruguay
| | - Pablo Cardinal-Fernandez
- Emergency Department, Fundacion de Investigacion HM, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Jesús Ruiz-Cabello
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Centro de Investigación Cooperativa en Biomateriales, CIC biomaGUNE, Paseo Miramón 182, 20014, Donostia-San Sebastián, Spain.,Departamento de Química-Física II, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Department of Critical Care, Hospital Universitario de Getafe, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
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Herrero R, Prados L, Ferruelo A, Puig F, Pandolfi R, Guillamat-Prats R, Moreno L, Matute-Bello G, Artigas A, Esteban A, Lorente JÁ. Fas activation alters tight junction proteins in acute lung injury. Thorax 2018; 74:69-82. [PMID: 30385692 DOI: 10.1136/thoraxjnl-2018-211535] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 01/15/2018] [Revised: 09/11/2018] [Accepted: 10/15/2018] [Indexed: 01/11/2023]
Abstract
Background:The acute respiratory distress syndrome (ARDS) is characterized by protein-rich oedema in the alveolar spaces, a feature in which Fas-mediated apoptosis of the alveolar epithelium has been involved. Objective:To determine whether Fas activation increases protein permeability by mechanisms involving disruption of the paracellular tight junction (TJ) proteins in the pulmonary alveoli. Methods: Protein permeability and the expression of TJ proteins were assessed in vivo in wild-type and Fas-deficient lpr mice 16 hours after the intratracheal instillation of recombinant human soluble Fas ligand (rh-sFasL), and at different time points in vitro in human pulmonary alveolar epithelial cells (HPAEpiC) exposed to rh-sFasL Results:Activation of the Fas pathway increased protein permeability in mouse lungs and altered the expression of the TJ proteins occludin and zonula occludens-1 in the alveolar-capillary membrane in vivo and in human alveolar epithelial cell monolayers in vitro. Blockade of caspase-3, but not inhibition of tyrosine kinase dependent pathways, prevented the alterations in TJ protein expression and permeability induced by the Fas/FasL system in human alveolar cell monolayers in vitro. We also observed that both the Fas-induced increase of protein permeability and disruption of TJ proteins occurred before cell death could be detected in the cell monolayers in vitro. Conclusion:Targeting caspase pathways could prevent the disruption of TJs and reduce the formation of lung oedema in the early stages of ARDS.
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Affiliation(s)
- Raquel Herrero
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - Lucia Prados
- Laboratory of Biochemistry, Hospital Universitario de Getafe, Madrid, Spain
| | - Antonio Ferruelo
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain
| | - Ferranda Puig
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Critical Care Center, Corporació Sanitària i Universitària Parc Taul, Institut d' Investigació i Innovació Parc Taulí, Barcelona, Spain
| | - Rachele Pandolfi
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Guillamat-Prats
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Critical Care Center, Corporació Sanitària i Universitària Parc Taul, Institut d' Investigació i Innovació Parc Taulí, Barcelona, Spain
| | - Laura Moreno
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Gustavo Matute-Bello
- Center for Lung Biology, Division of Pulmonary and Critical Care Medicine, Department of Medicine, and the Medical Research Service of the VA Puget Sound Healthcare System., University of Washington, Seattle, Washington, USA
| | - Antonio Artigas
- Critical Care Center, Corporació Sanitària i Universitària Parc Taul, Institut d' Investigació i Innovació Parc Taulí, Barcelona, Spain
| | - Andres Esteban
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Universidad Europea, Madrid, Spain
| | - José Ángel Lorente
- CIBER de Enfermedades Respiratorias, Instituto de Investigación Carlos III, Madrid, Spain.,Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain.,Universidad Europea, Madrid, Spain
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14
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Abstract
We evaluate the evolution over time of discrepancies between clinical diagnoses and postmortem findings in critically ill patients and assess the factors associated with these discrepancies. We conducted a prospective study of all consecutive patients who underwent autopsy in a medical-surgical intensive care unit (ICU) between January 2008 and December 2015. Among 7655 patients admitted to our ICU, 671 (8.8%) died. Clinical autopsy was performed in 215 (32%) patients. Major missed diagnoses were noted in 38 patients (17.7%). Eighteen patients (8.4%) had class I discrepancies, and 20 patients (9.3%) had class II discrepancies. The most frequently missed diagnoses were invasive aspergillosis, intestinal ischemia, myocardial infarction, cancer, and intra-abdominal abscesses. We did not find a statistically significant correlation between any premortem factor, including age, sex, severity of illness, length of hospital stay before ICU admission, length of ICU stay before death, duration of mechanical ventilation, or admitting unit, and the level of agreement between clinical and pathological diagnosis. In the last decades, the discrepancies between clinical and autopsy diagnoses persisted despite advances in medical skills and technology. Specific clinical entities such as invasive aspergillosis, mesenteric ischemia, myocardial infarction, intra-abdominal abscesses, and neoplastic diseases remain a diagnostic challenge in critically ill patients. Clinical level of diagnostic certainty does not increase with specific premortem characteristics.
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Affiliation(s)
- Eva E Tejerina
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28905 Getafe, Madrid, Spain.
| | - Rebeca Padilla
- Intensive Care Unit, Hospital Universitario de Getafe, 28905 Getafe, Madrid, Spain
| | - Elena Abril
- Intensive Care Unit, Hospital Universitario de Getafe, 28905 Getafe, Madrid, Spain
| | - Fernando Frutos-Vivar
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28905 Getafe, Madrid, Spain
| | - Aida Ballen
- Department of Pathology, Hospital Universitario de Getafe, 28905 Getafe, Madrid, Spain
| | | | - José Ángel Lorente
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28905 Getafe, Madrid, Spain
| | - Andrés Esteban
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28905 Getafe, Madrid, Spain
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15
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Pandolfi R, Barreira B, Moreno E, Lara-Acedo V, Morales-Cano D, Martínez-Ramas A, de Olaiz Navarro B, Herrero R, Lorente JÁ, Cogolludo Á, Pérez-Vizcaíno F, Moreno L. Role of acid sphingomyelinase and IL-6 as mediators of endotoxin-induced pulmonary vascular dysfunction. Thorax 2016; 72:460-471. [DOI: 10.1136/thoraxjnl-2015-208067] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/23/2016] [Accepted: 07/07/2016] [Indexed: 11/04/2022]
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16
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Ferruelo A, Olaiz B, Herrero R, Lopez E, Esteban A, Lorente JÁ. Mirna interference in human pulmonary alveolar epithelial cells (HPAEPIC) undergoing cyclic stretch and in ex vivo ventilated and perfused rat lungs. Intensive Care Med Exp 2015. [PMCID: PMC4796451 DOI: 10.1186/2197-425x-3-s1-a566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Lorente JÁ, Blanch L, Esteban A. Ebola virus: understanding the 2014 outbreak. Arch Bronconeumol 2015; 51:59-60. [PMID: 25595937 DOI: 10.1016/j.arbres.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- José Ángel Lorente
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Hospital Universitario de Getafe, Getafe, Madrid, España; Universidad Europea, Madrid, España.
| | - Lluis Blanch
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Critical Care Center, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España
| | - Andrés Esteban
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Hospital Universitario de Getafe, Getafe, Madrid, España
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