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Calderón-Moreno J, Delgado-Rodriguez MJ, Juárez-Vela R, Tejada-Garrido CI, de Viñaspre-Hernández RR, Burgos-Esteban A, Sánchez-Conde P, Andreu-Fernández V, Gea-Caballero V, Santos-Sanchez JA, Quintana-Diaz M, Andrés-Esteban EM. Approximation to the economic cost of healthcare for hypertensive patients diagnosed with COVID-19. Front Public Health 2024; 12:1333081. [PMID: 38566790 PMCID: PMC10986305 DOI: 10.3389/fpubh.2024.1333081] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Many researchers have focused their studies on hypertension due to its over-representation among COVID-19 patients. Both retrospective and observational studies conducted close to the Wuhan area have reported that hypertension is the most common comorbidity observed in patients affected by COVID-19. Objective Our objective is that patients with arterial hypertension have a worse prognosis in terms of evolution leading to higher costs. Methods A retrospective cross-sectional study was conducted. A total of 3,581 patients from La Paz University Hospital (LPUH) during the period between 15 July 2020 and 31 July 2020 were included in this study. Results It should be noted that 40.71% of the patients were hypertensive. As expected, hypertension was associated with men, among whom we observed a higher prevalence and a higher age (median age of 77 years (IQI: 65-85) versus 52 years (IQI: 37-64), p-value < 0.001). Hypertensive patients had a higher prevalence of dyspnea (52.14% vs. 47.15%, p-value = 0.004) and altered awareness (14.89% vs. 4.30%, p-value <0.001). The non-parametric Kaplan-Meier curve estimates the survival of patients in the two study groups. We can see how patients with hypertension have a higher associated mortality, with the difference being statistically significant, p-value (log-rank) = 0.004. Only for the appearance of complications during hospitalization, the group of hypertensive patients reached the figure of €1,355,901.71 compared to the total of 421,403.48 € for normotensive patients. Conclusion Our study shows the worse clinical evolution of patients with COVID-19 in terms of associated morbidity and mortality. It also shows that the cost of managing patients with hypertension is greater than that of managing normotensive patients.
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Affiliation(s)
| | | | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | | | - Regina Ruiz de Viñaspre-Hernández
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | | | - Pilar Sánchez-Conde
- Faculty of Medicine, University of Salamanca, Salamanca, Spain
- Anesthesia and Resuscitation Service, University Healthcare Complex, Salamanca, Spain
| | | | | | | | - Manuel Quintana-Diaz
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Intensive Care Unit, Hospital La Paz, La Paz, Spain
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Güemes M, Martín-Rivada Á, Arribas MB, Andrés-Esteban EM, Angulo BM, Román JP, Argente J. Endocrine sequelae in 157 pediatric survivors of hematopoietic stem cell transplantation (HSCT). J Endocr Soc 2022; 7:bvac183. [DOI: 10.1210/jendso/bvac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT
Context
Successful rates of hematopoietic stem cell transplantation (HSCT), face paralleled escalation of late endocrine and metabolic effects.
Objective
To characterize these sequelae distinguishing between the underlying pathologies and treatments received.
Design
Retrospective descriptive study in 157 children post-HSCT [hematopoietic pathology (N = 106), solid tumors (N = 40) and rare entities (N = 11)] followed at a single endocrine department between 2009 and 2019. Regression analysis was used to ascertain association.
Results
Of all patients, 58.7% presented at least one endocrine abnormality. Endocrinopathies post HSCT were most frequently developed in lymphoblastic leukemia (60.5% of them), whereas myeloid leukemias had the fewest. 64% of patients presented primary hypogonadism, 52% short stature and 20% obesity. Endocrinopathy was associated with: an older age at HSCT [9.78 years (6.25-12.25) versus 6.78 years (4.06-9.75)] (p < 0.005), pubertal Tanner stage V (p < 0.001), chronic graft versus host disease (GVHD) (p = 0.022) and direct gonadal therapy (p = 0.026). The incidence of endocrinopathies was higher in females (15% more common; p < 0.02) and in patients who received: radiotherapy (18% higher), steroids (17.4% increase), allogenic HSCT (7% higher), thymoglobulin or cyclophosphamide. Those on busulfan presented a 27.5% higher rate of primary hypogonadism (p = 0.003).
Conclusions
Over half of the children surviving HSCT will develop endocrinopathies. Strikingly, obesity has risen to the third most frequent endocrine disruption, mainly due to steroids, and partly adhering to the general population tendency. Lymphoblastic leukemia was the condition with higher rate of endocrine abnormalities. Females, an older age at HSCT, pubertal stage, allogenic transplant, radiotherapy, alkylating drugs and GVHD pose risk factors for endocrine disturbances.
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Affiliation(s)
- María Güemes
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology. Madrid , Spain
- Research Institute “La Princesa”. Madrid , Spain
| | - Álvaro Martín-Rivada
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology. Madrid , Spain
- Research Institute “La Princesa”. Madrid , Spain
| | - Marta Bascuas Arribas
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology. Madrid , Spain
| | | | - Blanca Molina Angulo
- Hospital Infantil Universitario Niño Jesús, Department of Hematoncology and Bone Marrow Transplant. Madrid , Spain
| | - Jesús Pozo Román
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology. Madrid , Spain
- Research Institute “La Princesa”. Madrid , Spain
- Universidad Autónoma de Madrid, Department of Pediatrics , Madrid , Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III. Madrid , Spain
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology. Madrid , Spain
- Research Institute “La Princesa”. Madrid , Spain
- Universidad Autónoma de Madrid, Department of Pediatrics , Madrid , Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III. Madrid , Spain
- IMDEA, Food Institute, CEIUAM+CSI . Madrid , Spain
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Martín-Rivada Á, Guerra-Cantera S, Campillo-Calatayud A, Andrés-Esteban EM, Sánchez Holgado M, Martos-Moreno GÁ, Pozo J, Güemes M, Soriano-Guillén L, Pellicer A, Oxvig C, Frystyk J, Chowen JA, Barrios V, Argente J. Pappalysins and Stanniocalcins and Their Relationship With the Peripheral IGF Axis in Newborns and During Development. J Clin Endocrinol Metab 2022; 107:2912-2924. [PMID: 35902207 DOI: 10.1210/clinem/dgac453] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Pappalysins (PAPP-A, PAPP-A2) modulate body growth by increasing insulin-like growth factor I (IGF-I) bioavailability through cleavage of insulin-like growth factor binding proteins (IGFBPs) and are inhibited by stanniocalcins (STC1, STC2). Normative data on these novel factors, as well as on free IGF-I and uncleaved fractions of IGFBPs, are not well established. OBJECTIVE This work aimed to determine serum concentrations of PAPP-A, PAPP-A2, STC1, and STC2 in relationship with other growth hormone (GH)-IGF axis parameters during development. METHODS Full-term newborns (150; gestational age: 39.30 ± 1.10 weeks), 40 preterm newborns (30.87 ± 3.35 weeks), and 1071 healthy individuals (aged 1-30 years) were included in the study and divided according to their Tanner stages (males and females): I:163 males, 154 females; II:100 males, 75 females; III:83 males, 96 females; IV: 77 males, 86 females; and V:109 males,128 females. RESULTS Serum concentrations of PAPP-A, PAPP-A2, STC1, STC2, IGFBP-2, total IGFBP-4, and total IGFBP-5 were elevated at birth and declined throughout childhood. In postnatal life, PAPP-A2 concentrations decreased progressively in concomitance with the free/total IGF-I ratio; however, stanniocalcin concentrations remained stable. PAPP-A2 concentrations positively correlated with the free/total IGF-I ratio (r = +0.28; P < .001) and negatively with the intact/total IGFBP-3 ratio (r = -0.23; P < .001). PAPP-A concentrations inversely correlated with intact/total IGFBP-4 ratio (r = -0.21; P < .001), with PAPP-A concentrations being lower in females at all ages. Association studies indicate the importance of stanniocalcins and pappalysins in the control of this axis in an age-specific manner. CONCLUSION This study provides reference values of pappalysins and stanniocalcins, which modulate IGF-I activity by changing the concentrations of cleaved and uncleaved IGFBPs.
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Affiliation(s)
- Álvaro Martín-Rivada
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
| | - Santiago Guerra-Cantera
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
| | - Ana Campillo-Calatayud
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
| | | | | | - Gabriel Á Martos-Moreno
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
| | - Jesús Pozo
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
| | - María Güemes
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
| | - Leandro Soriano-Guillén
- Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Fundación Jiménez Díaz, E-28040, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, Hospital Universitario La Paz, E-28046, Madrid, Spain
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, Aarhus University, DK-8000, Aarhus C, Aarhus, Denmark
| | - Jan Frystyk
- Department of Endocrinology, Odense University Hospital & Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Julie A Chowen
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
- IMDEA, Food Institute, CEIUAM+CSI, Cantoblanco, E-28049, Madrid, Spain
| | - Vicente Barrios
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
| | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, Departments of Pediatrics & Pediatric Endocrinology, Research Institute "La Princesa," Department of Pediatrics, Universidad Autónoma de Madrid, E-28009, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, E-28009, Madrid, Spain
- IMDEA, Food Institute, CEIUAM+CSI, Cantoblanco, E-28049, Madrid, Spain
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Juárez-Vela R, García-Erce JA, Gea-Caballero V, Ruiz de Viñaspre-Hernandez R, Santos-Sánchez JÁ, Sánchez-González JL, Andrés-Esteban EM, Czapla M, Tejada CI, Nanwani-Nanwani KL, Serrano-Lázaro A, Quintana-Díaz M. A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154396. [PMID: 35956012 PMCID: PMC9368991 DOI: 10.3390/jcm11154396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
| | - José Antonio García-Erce
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Bank of Blood and Tissue of Navarra, Government of Navarra, 31008 Pamplona, Spain
- Correspondence:
| | - Vicente Gea-Caballero
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Regina Ruiz de Viñaspre-Hernandez
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - José Ángel Santos-Sánchez
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Salamanca Hospital Complex, 37008 Salamanca, Spain
| | | | - Eva María Andrés-Esteban
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Michał Czapla
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Clara Isabel Tejada
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - Kapil Laxman Nanwani-Nanwani
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
| | - Ainhoa Serrano-Lázaro
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Intensive Care Unit, Hospital Clinico de Valencia, 46010 Valencia, Spain
| | - Manuel Quintana-Díaz
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
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5
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Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, Quintana-Díaz M, García-Erce JA. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J Clin Med 2022; 11:jcm11123532. [PMID: 35743602 PMCID: PMC9225042 DOI: 10.3390/jcm11123532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Programme in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Research Institute IdiPaz, 28029 Madrid, Spain;
| | - Eva María Andrés-Esteban
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ivan Santolalla-Arnedo
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
| | | | | | | | - Pilar Marcos-Neira
- Intensive Care Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | | | - Clara Isabel Tejada-Garrido
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
| | | | - Manuel Quintana-Díaz
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Intensive Care Unit, University Hospital of La Paz, 28046 Madrid, Spain;
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
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6
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Calderón-Moreno J, Juárez-Vela R, Delgado-Rodríguez MJ, Quintana-Díaz M, Magallón-Botaya R, Olivan-Blázquez B, Cobos-Rincón A, Santolalla-Arnedo I, Ramírez-Torres CA, Gea-Caballero V, Andrés-Esteban EM. Approximation to the Consumption of Healthcare Resources and the Economic Cost of SARS-CoV-2 Patient Management: A Retrospective Study. Front Public Health 2022; 10:843751. [PMID: 35433597 PMCID: PMC9008573 DOI: 10.3389/fpubh.2022.843751] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/02/2022] [Indexed: 12/05/2022] Open
Abstract
Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is €2373.24. We conclude that a patient with COVID-19 without hospitalization costs €729.79, while the expenses of a hospitalized patient are between €4294.36 and €14440.68, if there is ICU admission.
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Affiliation(s)
- Jesús Calderón-Moreno
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
| | | | - Manuel Quintana-Díaz
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Intensive Care Unit, Research Group Blood Patient Management, IDI-Paz Research Institute, University Hospital “La Paz, ” Madrid, Spain
| | - Rosa Magallón-Botaya
- Primary Care Prevention and Health Promotion Network, Research Unit in Primary Care, IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Olivan-Blázquez
- Department of Psychology and Sociology, Institute for Health Research Aragón (IISA), University of Zaragoza, Zaragoza, Spain
| | - Ana Cobos-Rincón
- Department of Nursing, GRUPAC, University of La Rioja, Logroño, Spain
- *Correspondence: Ana Cobos-Rincón
| | | | | | - Vicente Gea-Caballero
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
- Faculty of Health Sciences, Valencia International University, Valencia, Spain
| | - Eva María Andrés-Esteban
- Business Economics Department, University of Rey Juan Carlos, Madrid, Spain
- Research Group Blood Patient Management, IDI-Paz Research Institute, Madrid, Spain
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7
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Quintana-Diaz M, Nanwani-Nanwani K, Marcos-Neira P, Serrano-Lázaro A, Juarez-Vela R, Andrés-Esteban EM. Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day». Med Intensiva 2022; 46:123-131. [PMID: 34996742 DOI: 10.1016/j.medine.2021.12.006] [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: 05/10/2020] [Revised: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). DESIGN Prospective, cross-sectional, multi-centre study. SCOPE Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. PARTICIPANTS 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7 ± 3.8 and average stay of 10.62 ± 17.49 days. VARIABLES Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. RESULTS Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8 g/dL (95% CI: 6-9-8.5) and 9.8 g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p < 0.001. The transfusion units had a mean of 2.5 ± 2.4 per patient. The most commonly used blood product was red blood cell concentrate (CH) (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p = 0.006). 5.4% (7/129) of patients who received CH died compared to 2.4% (31/1302) who did not (p = 0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. CONCLUSIONS In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish Critical Care Units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.
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Affiliation(s)
- M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - K Nanwani-Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain
| | - P Marcos-Neira
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - A Serrano-Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - R Juarez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain; Universidad de la Rioja, Logroño, La Rioja, Spain.
| | - E M Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
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8
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Juárez-Vela R, Andrés-Esteban EM, Gea-Caballero V, Sánchez-González JL, Marcos-Neira P, Serrano-Lázaro A, Tirado-Anglés G, Ruiz-Rodríguez JC, Durante Á, Santolalla-Arnedo I, García-Erce JA, Quintana-Díaz M. Related Factors of Anemia in Critically Ill Patients: A Prospective Multicenter Study. J Clin Med 2022; 11:jcm11041031. [PMID: 35207301 PMCID: PMC8878830 DOI: 10.3390/jcm11041031] [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: 01/10/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022] Open
Abstract
Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid-base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48-69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51-74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, 28049 Madrid, Spain;
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Eva María Andrés-Esteban
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Vicente Gea-Caballero
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Faculty of Health Sciences, International University of Madrid, 46010 Valencia, Spain
| | | | - Pilar Marcos-Neira
- Intensive Care Unit, Germans Trial I Pujol Hospital, 08916 Badalona, Spain;
| | | | | | - Juan Carlos Ruiz-Rodríguez
- Shock, Organ Dysfunction and Resuscitation Research Group, Intensive Care Department, Vall d’Hebron University Hospital, Vall d’Hebron, 08035 Barcelona, Spain;
| | - Ángela Durante
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
| | - Iván Santolalla-Arnedo
- Department of Nursing, GRUPAC, University of La Rioja, 26004 Logroño, Spain;
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - José Antonio García-Erce
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Blood and Tissue Bank of Navarra, Navarre Health Service, 31015 Pamplona, Spain
- Correspondence: (I.S.-A.); (J.A.G.-E.)
| | - Manuel Quintana-Díaz
- Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain; (E.M.A.-E.); (V.G.-C.); (M.Q.-D.)
- Intensive Care Unit, La Paz University Hospital, 28046 Madrid, Spain
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9
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Andrés-Esteban EM, Quintana-Diaz M, Ramírez-Cervantes KL, Benayas-Peña I, Silva-Obregón A, Magallón-Botaya R, Santolalla-Arnedo I, Juárez-Vela R, Gea-Caballero V. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ 2021; 9:e11260. [PMID: 33954054 PMCID: PMC8051355 DOI: 10.7717/peerj.11260] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background The complications from coronavirus disease 2019 (COVID-19) have been the subject of study in diverse scientific reports. However, many aspects that influence the prognosis of the disease are still unknown, such as frailty, which inherently reduces resistance to disease and makes people more vulnerable. This study aimed to explore the complications of COVID-19 in patients admitted to a third-level hospital and to evaluate the relationship between these complications and frailty. Methods An observational, descriptive, prospective study was performed in 2020. A sample of 254 patients from a database of 3,112 patients admitted to a high-level hospital in Madrid, Spain was analyzed. To assess frailty (independent variable) the Clinical Frailty Scale (CFS) was used. The outcome variables were sociodemographic and clinical, which included complications, length of stay, intensive care unit (ICU) admission and prognosis. Results A total of 13.39% of the patients were pre-frail and 17.32% were frail. Frail individuals had a shorter hospital stay, less ICU admission, higher mortality and delirium, with statistical significance. Conclusion Frailty assessment is a crucial approach in patients with COVID-19, given a higher mortality rate has been demonstrated amongst frail patients. The CFS could be a predictor of mortality in COVID-19.
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Affiliation(s)
- Eva María Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Madrid, Spain
| | - Manuel Quintana-Diaz
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Karen Lizzette Ramírez-Cervantes
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Departamento de Prevención, Asociación Española contra el Cáncer, Madrid, Madrid, Spain
| | | | - Alberto Silva-Obregón
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Guadalajara, Spain
| | - Rosa Magallón-Botaya
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zargoza, Aragón, Spain
| | - Ivan Santolalla-Arnedo
- Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Raúl Juárez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe., Adscript center of Universidad de Valencia., Valencia, Valencia, Spain.,Research Group GREIACC, Health Research Institute La Fe., Valencia, Valencia, Spain
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10
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Quintana-Diaz M, Nanwani-Nanwani K, Marcos-Neira P, Serrano-Lázaro A, Juarez-Vela R, Andrés-Esteban EM. Epidemiology of blood transfusion in the Spanish Critical Care Units: «Transfusion Day». Med Intensiva 2020; 46:S0210-5691(20)30317-X. [PMID: 33087293 DOI: 10.1016/j.medin.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/10/2020] [Revised: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the transfusion practice in the ICUs in Spain, according to national and international recommendations (guidelines). DESIGN Prospective, cross-sectional, multi-centre study. SCOPE Data collection was carried out by means of a questionnaire sent electronically to the Heads of Service of 111 ICUs in Spain. PARTICIPANTS 1,448 patients were included, aged 61.8 (SD 15.7) years, 66.2% male, with an SOFA of 4.7±3.8 and average stay of 10.62±17.49 days. VARIABLES Demographic and clinical variables of the patients were collected, as well as variables related to the transfusion act. RESULTS Of the 1,448 patients, 9.9% received al least one transfusion of any blood product, 3.7% fresh plasma, 3.9% platelets and 8.9% red blood cell concentrate, mainly by analytical criteria (36.2%). Hemoglobin had a mean of 7.8g/dL (95% CI: 6-9-8.5) and 9.8g/dL (95% CI: 8.5-11.2) before and after the transfusion, respectively, p<0.001. The transfusion units had a mean of 2.5±2.4 per patient. The most commonly used blood product was red blood cell concentrate (90.2%). Patients admitted for surgery had a higher transfusion rate (14.4%) than those admitted for medical pathology (8.9%) (p=0.006). 5.4% (7/129) of patients who received red blood cell concentrate died compared to 2.4% (31/1302) who did not (p=0.04). Mortality of transfused patients was higher. The transfusion rate in most of hospitals was 5% to 20%, with 18 hospitals (16.21%) having transfusion rates between 20% and 50%. Hospitals with PBM programs and mass transfusion programs had a lower transfusion rate, although not statistically significant. CONCLUSIONS In this multicenter cross-sectional study, a transfusion prevalence of 9.9% was observed in Spanish critical care units. The most frequent blood product transfused was red blood cells and the main reasons for transfusion were acute anemia with hemodynamic impact and analytical criteria. Mortality of transfused patients was higher.
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Affiliation(s)
- M Quintana-Diaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España
| | - K Nanwani-Nanwani
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España; Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España
| | - P Marcos-Neira
- Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Serrano-Lázaro
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, Valencia, España
| | - R Juarez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad de la Rioja, Logroño, La Rioja, España.
| | - E M Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, España; Universidad Rey Juan Carlos, Madrid, España
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11
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Quintana-Díaz M, Andrés-Esteban EM, Sánchez-Serrano J, Martínez-Virto A, Juárez-Vela R, García-Erce JA. Transfusions in the Emergency department: More than a blood transfusion. Rev Clin Esp 2019; 220:393-399. [PMID: 31744619 DOI: 10.1016/j.rce.2019.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/29/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/17/2022]
Abstract
Increasing haemoglobin and haematocrit levels with blood transfusions has been the gold standard for treating severe anaemia; however, the indication for transfusing concentrated red blood cells is based merely on a few laboratory markers, such as haemoglobin and haematocrit levels, rather than based on the symptoms according to clinical practice guidelines, the implementation of legal regulations and the consensus achieved by the hospitals' transfusion committees. The aim of this multicentre study was to reassess the suitability of the indication for transfusing concentrated red blood cells and the volumes transfused in emergency departments. We established an observational, multicentre, cross-sectional design with 2 participating centres: the La Paz University Hospital and the Hospital of Salamanca. In total, we obtained data from 381 patients, 220 (57.74%) of whom were men with an average age of 71.4±14.0 years and 161 (42.26%) of whom were women with an average age of 75.3±15.3 years (P<.001). The most prevalent underlying diseases in the patients who underwent transfusions were heart disease, which included haemorrhaging due to antiplatelet or anticoagulant therapy (57.7%), haemato-oncologic (15.3%) diseases and neurological disease. Only 54.9% (209/381) of the prescriptions for transfusion were considered appropriate, with significant differences according to the indication.
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Affiliation(s)
- M Quintana-Díaz
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - E M Andrés-Esteban
- Universidad Rey Juan Carlos, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - J Sánchez-Serrano
- Servicio de Urgencias, Hospital Universitario de Salamanca, Instituto de Investigación-IdiPAZ, Salamanca, España
| | - A Martínez-Virto
- Servicio de Urgencias, Hospital Universitario La Paz, Grupo PBM, Instituto de Investigación-IdiPAZ, Madrid, España
| | - R Juárez-Vela
- Universidad de La Rioja, Logroño, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España.
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra (Navarra), Grupo PBM, Instituto de Investigación -IdiPAZ, Madrid, España
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12
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Castellanos-González M, Joven BE, Sánchez J, Andrés-Esteban EM, Vanaclocha-Sebastián F, Romero PO, Díaz RR. Nagelbefall kann bei Patienten mit Psoriasis auf eine Enthesiopathie hinweisen. J Dtsch Dermatol Ges 2016; 14:1102-1108. [PMID: 27879103 DOI: 10.1111/ddg.12989_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/03/2016] [Indexed: 12/01/2022]
Abstract
HINTERGRUND Obwohl subklinische Enthesiopathie ein gut etabliertes diagnostisches Merkmal der Psoriasisarthritis (PsA) ist, wird sie häufig übersehen, da viele Patienten asymptomatisch sind. Gäbe es klinische Hinweise auf das Vorliegen einer Enthesiopathie, würde dies den Klinikern die Möglichkeit eröffnen, eine PsA frühzeitig zu diagnostizieren. MATERIAL UND METHODEN Es wurde eine monozentrische prospektive Studie mit insgesamt 90 Psoriasis-Patienten durchgeführt, um mittels Ultraschall das Vorliegen von Enthesenanomalien zu untersuchen und eine Korrelation mit dem Befall der Nägel festzustellen. ERGEBNISSE Enthesenanomalien wurden bei 23 Patienten (25,5 %) gefunden, von denen 19 (82,6 %) Nagelbefall aufwiesen. Bei 4 Patienten waren die Nägel nicht betroffen. Enthesiopathie lag bei 31,1 % (19/61) der Patienten mit Onychopathie vor, von den Patienten ohne Nagelbefall litten nur 13,8 % (4/29) an Enthesiopathie (p = 0,07). Zwischen dem Target-NAPSI-Score und dem Vorliegen einer Enthesiopathie bestand eine signifikante Korrelation. Eine signifikante Korrelation bestand darüber hinaus auch zwischen dem Vorliegen einer Enthesiopathie und der Anzahl der betroffenen Nägel (p = 0,035). SCHLUSSFOLGERUNGEN Klinische Belege für eine Onychopathie können der Schlüssel für die frühe Diagnose einer Enthesiopathie bei Psoriasis-Patienten sein.
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Affiliation(s)
| | - Beatriz Esther Joven
- Department of Rheumatology, Hospital Universitario, 12 de Octubre, Madrid, Spanien
| | - Julio Sánchez
- Department of Rheumatology, Hospital Universitario, 12 de Octubre, Madrid, Spanien
| | - Eva María Andrés-Esteban
- Research Unit, Clinical, Epidemiology and Public Health CIBER, Hospital Universitario, 12 de Octubre, Madrid, Spanien
| | | | - Pablo Ortiz Romero
- Department of Dermatology and Venereology, Hospital Universitario, 12 de Octubre, Madrid, Spanien
| | - Raquel Rivera Díaz
- Department of Dermatology and Venereology, Hospital Universitario, 12 de Octubre, Madrid, Spanien
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13
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García-Gigorro R, de la Cruz Vigo F, Andrés-Esteban EM, Chacón-Alves S, Morales Varas G, Sánchez-Izquierdo JA, Montejo González JC. Impact on patient outcome of emergency department length of stay prior to ICU admission. Med Intensiva 2016; 41:201-208. [PMID: 27553889 DOI: 10.1016/j.medin.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 04/12/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department. DESIGN A single-center ambispective cohort study was carried out. SETTING A general ICU and Emergency Care Department (ED) of a single University Hospital. PATIENTS We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period. INTERVENTIONS Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h. VARIABLES Demographic, diagnostic, length of stay and mortality data were compared among the groups. RESULTS Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p<0.01). A total of 129 patients (48%) had ED LOS >5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay. CONCLUSIONS A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support.
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Affiliation(s)
- R García-Gigorro
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
| | - F de la Cruz Vigo
- Servicio de Cirugía General, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - E M Andrés-Esteban
- Servicio de Epidemiología e Investigación Clínica, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - S Chacón-Alves
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - G Morales Varas
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - J A Sánchez-Izquierdo
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
| | - J C Montejo González
- Jefe del Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain
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Moreno-Franco B, Peñalvo JL, Andrés-Esteban EM, Malo S, Lallana MJ, Casasnovas JA, León-Latre M. ASSOCIATION BETWEEN DAILY SITTING TIME AND PREVALENT METABOLIC SYNDROME IN AN ADULT WORKING POPULATION: THE AWHS COHORT. NUTR HOSP 2015; 32:2692-700. [PMID: 26667722 DOI: 10.3305/nh.2015.32.6.9806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE the aim of this analysis was to measure the association between daily sitting time and prevalent metabolic syndrome, independently of the physical activity performed. SUBJECTS AND METHODS the Aragon Workers' Health Study cohort consists of 5 865 participants from which a sample of 1 415 male participants (40-55 years old) with completed data at baseline was selected. Sitting time and physical activity were assessed by validated questionnaires, and the socio-demographic, clinical and biochemical covariates needed to diagnose metabolic syndrome were collected as part of the study protocols. Metabolic syndrome was defined according to the modified National Cholesterol Education Program - Adult Treatment Panel III. Multiple linear and logistic regression models were carried out to quantify this association using sitting time categorized into tertiles. RESULTS mean sitting time was 5.78 ± 1.72 h/day, and the prevalence of metabolic syndrome was 19.2%. Comparing participants in the highest (> 6.57 h/day) versus lowest (1.85-4.57 h/day) tertile of sitting time, a positive association was observed for metabolic syndrome (OR 1.77, 95%CI: 1.25-2.49) and triglyceride (OR 1.70, 95%CI: 1.30-2.24), HDL-cholesterol (OR 1.65, 95%CI: 1.06-2.58), waist circumference (OR 1.57, 95%CI: 1.17-2.11) and fasting blood glucose (OR 1.35, 95%CI: 1.03-1.77) criteria, adjusting the level of physical activity. CONCLUSIONS higher sitting time is associated with an increased prevalence of metabolic syndrome independently of physical activity performed. These results could be useful to carry out effective strategies for cardiovascular health promotion especially in workplaces.
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Affiliation(s)
- Belén Moreno-Franco
- Cardiovascular Prevention Unit, Instituto Aragonés de Ciencias de la Salud (IACS), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain. Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain..
| | - José Luis Peñalvo
- Department of Epidemiology, Atherothrombosis and Cardiovascular Imaging, Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. School of Nutrition Science and Policy, Tufts University. Boston, Massachusetts..
| | | | - Sara Malo
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain..
| | | | - José Antonio Casasnovas
- Cardiovascular Prevention Unit, Instituto Aragonés de Ciencias de la Salud (IACS), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain. Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain..
| | - Montserrat León-Latre
- Cardiovascular Prevention Unit, Instituto Aragonés de Ciencias de la Salud (IACS), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain..
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Pretell-Mazzini J, Rodriguez-Vega V, Muñoz-Ledesma J, Andrés-Esteban EM, Marti-Ciruelos R, González-López JL, Curto- De la Mano A. Complications and associated risk factors at screw removal in slipped capital femoral epiphysis treated by cannulated stainless steel screws. J Child Orthop 2012; 6:285-9. [PMID: 23904894 PMCID: PMC3425694 DOI: 10.1007/s11832-012-0425-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 07/09/2012] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of our study is to report our complication rate and analyze the associated risk factors when removing cannulated stainless steel screws for SCFE fixation. METHODS This was a multicenter retrospective study of patients who underwent removal of cannulated stainless steel screws after a mean time of 2.03 years of implantation. Thirty-two patients were included (38 hips) with a mean of 13.7 years of age during screw removal surgery. The mean post-removal follow up time was 1.6 years. In all cases the removal of screws was done systematically. Demographic data, possible risk factors related to removal failure, as well as post-removal complications such as post-removal fractures, infections and scar issues were recorded. RESULTS A removal failure rate of 15.79 % (6/38) was found. The removal surgical time was longer than the initial fixation time but without statistical significance (70.78 vs 61.84 m, p = 0.196). However, the duration of screw implantation (r (2): 7.09; IC: 1.12-13.06) and screw head bony coverage (r (2): 21.32; IC: 5.58-37.06) were both related to this prolonged time. Multivariant analysis revealed that a fully threaded cannulated screw had the lowest removal failure risk (OR: 0.3; IC: 0.14-0.61). There were no postremoval complications recorded. CONCLUSIONS We recommend to use full threaded cannulated stainless steel screws and to perform the procedure as soon as the physis are closed to decrease the surgical time. It is a safe procedure based on a low rate of complications such as post-removal fractures, infection and scar issues.
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Affiliation(s)
- Juan Pretell-Mazzini
- />Pediatric Orthopaedic Division, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Victor Rodriguez-Vega
- />Pediatric Orthopaedic Division, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Jorge Muñoz-Ledesma
- />Pediatric Orthopaedic Division, Hospital Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Eva María Andrés-Esteban
- />Research Unit, Clinical Epidemiology, 12 de Octubre Hospital, Epidemiology and Public Health CIBER, Avd De Cordoba s/n, 28041 Madrid, Spain
| | - Rafael Marti-Ciruelos
- />Pediatric Orthopaedic Division, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - José Luis González-López
- />Pediatric Orthopaedic Division, Hospital Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Angel Curto- De la Mano
- />Pediatric Orthopaedic Division, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
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