Pub Date : 2026-02-01Epub Date: 2026-01-17DOI: 10.1016/j.medcli.2025.107314
Irene Casado López, Francisco Javier Teigell Muñoz, José Manuel Casas Rojo, María Mateos González, Alba Hernández Piriz, Pilar Cubo Romano
Objective
To evaluate the prognostic value of the PROFUND index for predicting all-cause mortality during hospitalization or within three months after discharge in patients hospitalized due to COPD exacerbation, as well as predicting readmissions within three months.
Method
An observational, retrospective, single-center study that included all patients hospitalized between January and December 2022 due to COPD exacerbation.
Results
The analysis included 172 patients. Half of the patients (50.6%) were multimorbid. These patients were older, had greater baseline dyspnea, a higher degree of obstruction, greater dependency for basic daily living activities, a higher PROFUND index, and were at higher risk of readmission within three months and in-hospital mortality (P<.05). There was a 35.98% readmission rate within three months, mostly due to a new COPD exacerbation (86%), an in-hospital mortality rate of 3.4%, and a three-month mortality rate of 5.2%. A high PROFUND index (≥7) was significantly associated with increased mortality during hospitalization or within the first 3 months after discharge (OR: 33; 95% CI: 3.9-273.4; P=.001) and a higher risk of hospital readmission for any cause (OR: 4.91; 95% CI: 1.99-12.13; P=.0003). The variables most influencing mortality were severe dyspnea, anemia, confusional syndrome, and functional impairment (Barthel index < 60).
Conclusion
The PROFUND index could be a good predictor of mortality and readmission risk in patients hospitalized due to a COPD exacerbation.
{"title":"Valor pronóstico del índice PROFUND en pacientes con enfermedad pulmonar obstructiva crónica tras agudización","authors":"Irene Casado López, Francisco Javier Teigell Muñoz, José Manuel Casas Rojo, María Mateos González, Alba Hernández Piriz, Pilar Cubo Romano","doi":"10.1016/j.medcli.2025.107314","DOIUrl":"10.1016/j.medcli.2025.107314","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the prognostic value of the PROFUND index for predicting all-cause mortality during hospitalization or within three months after discharge in patients hospitalized due to COPD exacerbation, as well as predicting readmissions within three months.</div></div><div><h3>Method</h3><div>An observational, retrospective, single-center study that included all patients hospitalized between January and December 2022 due to COPD exacerbation.</div></div><div><h3>Results</h3><div>The analysis included 172 patients. Half of the patients (50.6%) were multimorbid. These patients were older, had greater baseline dyspnea, a higher degree of obstruction, greater dependency for basic daily living activities, a higher PROFUND index, and were at higher risk of readmission within three months and in-hospital mortality (<em>P</em><.05). There was a 35.98% readmission rate within three months, mostly due to a new COPD exacerbation (86%), an in-hospital mortality rate of 3.4%, and a three-month mortality rate of 5.2%. A high PROFUND index (≥7) was significantly associated with increased mortality during hospitalization or within the first 3 months after discharge (OR: 33; 95% CI: 3.9-273.4; <em>P</em>=.001) and a higher risk of hospital readmission for any cause (OR: 4.91; 95% CI: 1.99-12.13; <em>P</em>=.0003). The variables most influencing mortality were severe dyspnea, anemia, confusional syndrome, and functional impairment (Barthel index <<!--> <!-->60).</div></div><div><h3>Conclusion</h3><div>The PROFUND index could be a good predictor of mortality and readmission risk in patients hospitalized due to a COPD exacerbation.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107314"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107286
María Teresa Pérez-Gracia, Lara Martínez-Celdrán, Clara Más-Comes
Hepatitis E, caused by the hepatitis E virus (HEV), represents an emerging global public health problem, constituting one of the main causes of acute viral hepatitis. Since its first description, it has been considered a disease with an epidemiological pattern linked to the consumption of contaminated water and food, and with a higher prevalence in geographical areas with poor socio-sanitary conditions. According to WHO estimates, around 2 billion people, representing a quarter of the world's population, live in areas where HEV is endemic and are therefore at risk of infection. Improvements in diagnostic techniques have provided the data necessary to demonstrate that in developed countries, HEV infection is common, indigenous and has a different epidemiological pattern, associated with contact with domestic animals, especially pigs. Another interesting aspect is that HEV can cause chronic hepatitis in transplant and immunocompromised patients.
{"title":"Virus de la hepatitis E: un problema de salud pública emergente","authors":"María Teresa Pérez-Gracia, Lara Martínez-Celdrán, Clara Más-Comes","doi":"10.1016/j.medcli.2025.107286","DOIUrl":"10.1016/j.medcli.2025.107286","url":null,"abstract":"<div><div>Hepatitis E, caused by the hepatitis E virus (HEV), represents an emerging global public health problem, constituting one of the main causes of acute viral hepatitis. Since its first description, it has been considered a disease with an epidemiological pattern linked to the consumption of contaminated water and food, and with a higher prevalence in geographical areas with poor socio-sanitary conditions. According to WHO estimates, around 2 billion people, representing a quarter of the world's population, live in areas where HEV is endemic and are therefore at risk of infection. Improvements in diagnostic techniques have provided the data necessary to demonstrate that in developed countries, HEV infection is common, indigenous and has a different epidemiological pattern, associated with contact with domestic animals, especially pigs. Another interesting aspect is that HEV can cause chronic hepatitis in transplant and immunocompromised patients.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107286"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Monitorización terapéutica de golimumab en práctica de la vida real: hacia un tratamiento personalizado en la colitis ulcerosa (CU)","authors":"Paulina Núñez , Francisca Carvajal , Rodrigo Quera , Fodda Chelech","doi":"10.1016/j.medcli.2025.107330","DOIUrl":"10.1016/j.medcli.2025.107330","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 2","pages":"Article 107330"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-07DOI: 10.1016/j.medcli.2025.107279
Rafael Dal-Ré , Elena García-Méndez , Ignacio Mahillo-Fernández
{"title":"Características de los ensayos clínicos no farmacológicos financiados por el Instituto de Salud Carlos III completados en 2009-2024","authors":"Rafael Dal-Ré , Elena García-Méndez , Ignacio Mahillo-Fernández","doi":"10.1016/j.medcli.2025.107279","DOIUrl":"10.1016/j.medcli.2025.107279","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107279"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-07DOI: 10.1016/j.medcli.2025.107260
José Antonio García Erce , Ingrid Magnolia Parra Salinas
{"title":"Uso racional de las inmunoglobulinas","authors":"José Antonio García Erce , Ingrid Magnolia Parra Salinas","doi":"10.1016/j.medcli.2025.107260","DOIUrl":"10.1016/j.medcli.2025.107260","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107260"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-07DOI: 10.1016/j.medcli.2025.107256
Ignacio Gallo , Gloria Heredia , Rafael Gonzalez-Manzanares , Cristina Urbano , Diana Ladera , Luis Carlos Maestre , Inmaculada Osuna , Francesco Costa , Javier Suarez de Lezo , Francisco Hidalgo , Jorge Perea , Miguel Romero , Manuel Pan , Soledad Ojeda
Aims
This study aimed to evaluate the efficacy and safety of ticagrelor-based dual antiplatelet therapy (DAPT) compared to clopidogrel-based DAPT in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI) in a real-world setting.
Methods and results
This was a retrospective, single-centre study including consecutive CCS patients discharged on DAPT after elective PCI between 2019 and 2022. Propensity score matching (PSM) was performed to account for confounding factors, including clinical, angiographic, and procedural variables. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included the individual components of MACE and major bleeding, A total of 1236 patients were included, 731 treated with ticagrelor and 505 with clopidogrel. Before matching, ticagrelor prescription was associated with higher thrombotic risk and lower bleeding risk profile. PSM resulted in 351 pairs. Ticagrelor was associated with a lower 1-year incidence of MACE (2.3% vs. 6.6%; HR 0.34, 95% CI 0.15–0.76; p = 0.008) and all-cause mortality (2.3% vs. 5.1%; HR 0.43, 95% CI 0.19–0.99; p = 0.049). No significant differences were observed in non-fatal myocardial infarction, non-fatal stroke, or major bleeding.
Conclusion
In this cohort of patients with CCS undergoing PCI, ticagrelor was associated with a lower incidence of MACE at 1-year follow-up compared to clopidogrel, without an increase in major bleeding. Dedicated randomised controlled trials are needed to confirm these findings.
目的：本研究旨在评估基于替格洛的双重抗血小板治疗（DAPT）与基于氯吡格雷的双重抗血小板治疗（DAPT）在现实世界中接受选择性经皮冠状动脉介入治疗（PCI）的慢性冠状动脉综合征（CCS）患者的疗效和安全性。方法和结果：这是一项回顾性的单中心研究，包括2019年至2022年期间在选择性PCI术后连续行DAPT出院的CCS患者。采用倾向评分匹配（PSM）来解释混杂因素，包括临床、血管造影和程序变量。主要终点是1年随访期间主要不良心血管事件（MACE）的发生率，定义为全因死亡、非致死性心肌梗死和非致死性卒中的综合发生率。次要终点包括MACE的个体成分和大出血，共纳入1236例患者，替格瑞洛治疗731例，氯吡格雷治疗505例。配对前，替格瑞洛处方与较高的血栓形成风险和较低的出血风险相关。PSM结果为351对。替格瑞洛与较低的1年MACE发生率（2.3%比6.6%;HR 0.34, 95% CI 0.15-0.76; p=0.008）和全因死亡率（2.3%比5.1%;HR 0.43, 95% CI 0.19-0.99; p=0.049）相关。在非致死性心肌梗死、非致死性卒中或大出血方面没有观察到显著差异。结论：在接受PCI的CCS患者队列中，与氯吡格雷相比，替格瑞洛与1年随访时MACE发生率较低相关，且未增加大出血。需要专门的随机对照试验来证实这些发现。
{"title":"Ticagrelor versus clopidogrel in patients with chronic coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis","authors":"Ignacio Gallo , Gloria Heredia , Rafael Gonzalez-Manzanares , Cristina Urbano , Diana Ladera , Luis Carlos Maestre , Inmaculada Osuna , Francesco Costa , Javier Suarez de Lezo , Francisco Hidalgo , Jorge Perea , Miguel Romero , Manuel Pan , Soledad Ojeda","doi":"10.1016/j.medcli.2025.107256","DOIUrl":"10.1016/j.medcli.2025.107256","url":null,"abstract":"<div><h3>Aims</h3><div>This study aimed to evaluate the efficacy and safety of ticagrelor-based dual antiplatelet therapy (DAPT) compared to clopidogrel-based DAPT in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI) in a real-world setting.</div></div><div><h3>Methods and results</h3><div>This was a retrospective, single-centre study including consecutive CCS patients discharged on DAPT after elective PCI between 2019 and 2022. Propensity score matching (PSM) was performed to account for confounding factors, including clinical, angiographic, and procedural variables. The primary endpoint was the incidence of major adverse cardiovascular events (MACE) at 1-year follow-up, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. Secondary endpoints included the individual components of MACE and major bleeding, A total of 1236 patients were included, 731 treated with ticagrelor and 505 with clopidogrel. Before matching, ticagrelor prescription was associated with higher thrombotic risk and lower bleeding risk profile. PSM resulted in 351 pairs. Ticagrelor was associated with a lower 1-year incidence of MACE (2.3% vs. 6.6%; HR 0.34, 95% CI 0.15–0.76; <em>p</em> <!-->=<!--> <!-->0.008) and all-cause mortality (2.3% vs. 5.1%; HR 0.43, 95% CI 0.19–0.99; <em>p</em> <!-->=<!--> <!-->0.049). No significant differences were observed in non-fatal myocardial infarction, non-fatal stroke, or major bleeding.</div></div><div><h3>Conclusion</h3><div>In this cohort of patients with CCS undergoing PCI, ticagrelor was associated with a lower incidence of MACE at 1-year follow-up compared to clopidogrel, without an increase in major bleeding. Dedicated randomised controlled trials are needed to confirm these findings.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107256"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107292
Inmaculada Arostegui , Josep Roma Millan , Nora Amama-BenHassun , Erik Cobo Valeri
{"title":"Retos de los estudios con datos reales: causalidad, intervención y reproducibilidad","authors":"Inmaculada Arostegui , Josep Roma Millan , Nora Amama-BenHassun , Erik Cobo Valeri","doi":"10.1016/j.medcli.2025.107292","DOIUrl":"10.1016/j.medcli.2025.107292","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107292"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-13DOI: 10.1016/j.medcli.2025.107303
Walter Masson , Gonzalo Fernandez-Villar , Solange Martinez-Elhelou , Fernando Garagoli , María Belen Sánchez , María Josefina Etchevers , Rodolfo Pizarro , María Josefina Sobrero
Background and aims
Elevated lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular risk and have been implicated in various inflammatory conditions. However, evidence regarding the role of Lp(a) in patients with inflammatory bowel disease (IBD) remains limited. This study aimed to evaluate Lp(a) levels in a group of patients with IBD.
Methods
A cross-sectional study was conducted involving patients with IBD actively followed by a multidisciplinary team. As part of routine care, patients with cardiovascular risk factors were systematically referred for comprehensive cardiology evaluation. For comparison, a control group matched for age and sex in a 2:1 ratio was randomly selected from the hospital database.
Results
Seventy-eight patients with IBD and 156 controls (mean age 56.1 years; 59% male) were included. Among patients with IBD, 56.4% had ulcerative colitis and 43.6% Crohn's disease. The IBD group showed a non-significant trend toward higher Lp(a) levels compared to controls (median [IQR]: 19.1 [5.9–71.3] vs. 17.5 [7.0–39.0] mg/dL; p = 0.274). A significantly greater proportion of IBD patients had high-risk Lp(a) levels (>50 mg/dL) than controls (35.9% vs. 19.2%; p = 0.02). Additionally, IBD patients with Lp(a) > 50 mg/dL exhibited a non-significant trend toward higher inflammatory marker values.
Conclusion
A substantial proportion of IBD patients exhibited elevated Lp(a) levels. Given its inflammatory, prothrombotic, and proatherogenic properties, Lp(a) may contribute to the increased cardiovascular risk observed in this population.
背景和目的脂蛋白(a) [Lp(a)]水平升高与心血管风险增加有关，并与各种炎症有关。然而，关于Lp(a)在炎症性肠病（IBD）患者中的作用的证据仍然有限。本研究旨在评估一组IBD患者的Lp(a)水平。方法对IBD患者进行横断面研究，由多学科团队积极随访。作为常规护理的一部分，系统地转介有心血管危险因素的患者进行全面的心脏病学评估。为了进行比较，从医院数据库中随机选择年龄和性别比例为2:1的对照组。结果纳入78例IBD患者和156例对照组（平均年龄56.1岁，男性59%）。在IBD患者中，56.4%患有溃疡性结肠炎，43.6%患有克罗恩病。与对照组相比，IBD组Lp(a)水平升高的趋势不显著（中位数[IQR]: 19.1 [5.9-71.3] vs. 17.5 [7.0-39.0] mg/dL; p = 0.274）。IBD患者高危脂蛋白(A)水平（50 mg/dL）的比例明显高于对照组（35.9% vs. 19.2%; p = 0.02）。此外，Lp(a) >； 50 mg/dL的IBD患者炎症标志物值升高的趋势不显著。结论相当比例的IBD患者出现Lp(a)水平升高。鉴于其炎症性、血栓性和致动脉粥样硬化性，Lp(a)可能导致该人群心血管风险增加。
{"title":"Prevalence of elevated lipoprotein(a) in individuals with inflammatory bowel disease: Potential implications for cardiovascular risk","authors":"Walter Masson , Gonzalo Fernandez-Villar , Solange Martinez-Elhelou , Fernando Garagoli , María Belen Sánchez , María Josefina Etchevers , Rodolfo Pizarro , María Josefina Sobrero","doi":"10.1016/j.medcli.2025.107303","DOIUrl":"10.1016/j.medcli.2025.107303","url":null,"abstract":"<div><h3>Background and aims</h3><div>Elevated lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular risk and have been implicated in various inflammatory conditions. However, evidence regarding the role of Lp(a) in patients with inflammatory bowel disease (IBD) remains limited. This study aimed to evaluate Lp(a) levels in a group of patients with IBD.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted involving patients with IBD actively followed by a multidisciplinary team. As part of routine care, patients with cardiovascular risk factors were systematically referred for comprehensive cardiology evaluation. For comparison, a control group matched for age and sex in a 2:1 ratio was randomly selected from the hospital database.</div></div><div><h3>Results</h3><div>Seventy-eight patients with IBD and 156 controls (mean age 56.1 years; 59% male) were included. Among patients with IBD, 56.4% had ulcerative colitis and 43.6% Crohn's disease. The IBD group showed a non-significant trend toward higher Lp(a) levels compared to controls (median [IQR]: 19.1 [5.9–71.3] vs. 17.5 [7.0–39.0]<!--> <!-->mg/dL; <em>p</em> <!-->=<!--> <!-->0.274). A significantly greater proportion of IBD patients had high-risk Lp(a) levels (>50<!--> <!-->mg/dL) than controls (35.9% vs. 19.2%; <em>p</em> <!-->=<!--> <!-->0.02). Additionally, IBD patients with Lp(a)<!--> <!-->><!--> <!-->50<!--> <!-->mg/dL exhibited a non-significant trend toward higher inflammatory marker values.</div></div><div><h3>Conclusion</h3><div>A substantial proportion of IBD patients exhibited elevated Lp(a) levels. Given its inflammatory, prothrombotic, and proatherogenic properties, Lp(a) may contribute to the increased cardiovascular risk observed in this population.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107303"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-14DOI: 10.1016/j.medcli.2025.107252
María Florencia Pilia , Irene Sansano , Diego Varona , Marina Sánchez , David Espejo , Mario Culebras , Xavier Muñoz , Iñigo Ojanguren , Santiago Ramón y Cajal
Background
In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to evaluate the prognostic value of histopathological patterns, cellular senescence, and lymphatic proliferation in patients with post-COVID-19 ILD.
Methods
This prospective observational study of patients hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia and presenting respiratory symptoms, radiological alterations, and pulmonary function test impairment during the 3-month follow-up visit after discharge. Lung cryobiopsies were performed, and the histopathological findings and expression of senescence and lymphatic proliferation (P16 and D2-40) were analyzed.
Results
Between March 2020 and February 2021, 4332 patients were hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia, and 1403 were visited in the Respiratory Clinic 3 months after discharge. The first 66 patients presenting with respiratory symptoms, radiological alterations, and decreased pulmonary function tests during the post hospitalization follow-up underwent cryobiopsy for diagnostic purposes. Multivariate regression showed that Masson bodies in the 3-month cryobiopsy were related to a higher forced vital capacity at 6 months whereas higher expression of senescence and lymphatic proliferation markers, such as P-16 and D2-40, in the histological samples were related to decreased carbon monoxide transfer test values at 6 months.
Conclusion
Cellular senescence and lymphatic proliferation in lung tissue are associated with impaired gas exchange in mid-term follow-up, suggesting their potential as prognostic markers in post-COVID-19 ILD.
{"title":"Prognostic value of senescence, lymphatic proliferation, and histology in post-COVID-19 interstitial lung disease","authors":"María Florencia Pilia , Irene Sansano , Diego Varona , Marina Sánchez , David Espejo , Mario Culebras , Xavier Muñoz , Iñigo Ojanguren , Santiago Ramón y Cajal","doi":"10.1016/j.medcli.2025.107252","DOIUrl":"10.1016/j.medcli.2025.107252","url":null,"abstract":"<div><h3>Background</h3><div>In a subset of patients, interstitial lung disease (ILD) sequelae following COVID-19 pneumonia persist beyond 6 months after hospital discharge. However, the underlying pathophysiological mechanisms remain poorly understood. This study aimed to evaluate the prognostic value of histopathological patterns, cellular senescence, and lymphatic proliferation in patients with post-COVID-19 ILD.</div></div><div><h3>Methods</h3><div>This prospective observational study of patients hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia and presenting respiratory symptoms, radiological alterations, and pulmonary function test impairment during the 3-month follow-up visit after discharge. Lung cryobiopsies were performed, and the histopathological findings and expression of senescence and lymphatic proliferation (P16 and D2-40) were analyzed.</div></div><div><h3>Results</h3><div>Between March 2020 and February 2021, 4332 patients were hospitalized at Vall d’Hebron University Hospital due to COVID-19 pneumonia, and 1403 were visited in the Respiratory Clinic 3 months after discharge. The first 66 patients presenting with respiratory symptoms, radiological alterations, and decreased pulmonary function tests during the post hospitalization follow-up underwent cryobiopsy for diagnostic purposes. Multivariate regression showed that Masson bodies in the 3-month cryobiopsy were related to a higher forced vital capacity at 6 months whereas higher expression of senescence and lymphatic proliferation markers, such as P-16 and D2-40, in the histological samples were related to decreased carbon monoxide transfer test values at 6 months.</div></div><div><h3>Conclusion</h3><div>Cellular senescence and lymphatic proliferation in lung tissue are associated with impaired gas exchange in mid-term follow-up, suggesting their potential as prognostic markers in post-COVID-19 ILD.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107252"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-13DOI: 10.1016/j.medcli.2025.107247
Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo
Background and objectives
Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).
Methods
We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.
Results
One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.
Conclusions
Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.
{"title":"Initiation and titration of guideline-directed medical therapy during hospitalization for acute decompensation of heart failure with reduced ejection fraction","authors":"Sandra Valdivielso Moré , Núria Farré , Neus Badosa , Núria Rodríguez de Francisco , Laia Carla Belarte-Tornero , Ronald O. Morales Murillo , Joan Vime-Jubany , Miren Vicente Elcano , Juan Jose Ochoa Segarra , Pilar Ruiz-Rodriguez , Ana María Linás-Alonso , Felicidad Martinez-Medina , Beatriz Vaquerizo Montilla , Sonia Ruiz-Bustillo","doi":"10.1016/j.medcli.2025.107247","DOIUrl":"10.1016/j.medcli.2025.107247","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Heart failure with reduced ejection fraction (HFrEF) is a leading cause of morbidity and mortality worldwide. Initiating or maintaining guideline-directed medical therapy (GDMT) during hospitalization is crucial, as early intervention can significantly influence the prognosis. GDMT includes renin–angiotensin–aldosterone system inhibitors (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNI) and mineralocorticoid receptor antagonist (MRA)), beta-blockers and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Our objective was to evaluate the percentage of patients achieving quadruple therapy during hospitalization, document reasons for non-achievement, and describe outcomes in special subgroups (chronic kidney disease (CKD) or advanced age).</div></div><div><h3>Methods</h3><div>We conducted a prospective single-center study from September 2021 to February 2024, including patients hospitalized for acute decompensated HFrEF with ejection fraction ≤40% treated by the heart failure unit (HFU) of our hospital.</div></div><div><h3>Results</h3><div>One hundred ninety-six patients were included, with a mean age of 69.2 years. Common comorbidities included hypertension (70.4%), diabetes (41.8%) and CKD (35.2%). The median hospital stay was 8 days. At discharge, ACEI/ARB/ARNI were prescribed in 92.9% of patients, beta-blockers in 88.8%, MRA in 68.9%, and SGLT2i in 91.8%. A remarkable 58.2% of patients received quadruple therapy.</div></div><div><h3>Conclusions</h3><div>Our study highlights the tolerability and safety of GDMT initiation and titration in hospitalized patients with HFrEF. A substantial proportion of patients were successfully managed with quadruple therapy at discharge, including those with chronic kidney disease (CKD) or advanced age. The main limiting factors were hypotension, renal function deterioration, and electrolyte imbalances.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107247"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号