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}
The effective implementation of the FGM contributes to achieving glycemic control, reducing hypoglycemic and hyperglycemic decompensations as well as enhancing patient self-management and improving their perception of quality of life. The aim of our study was to evaluate the glycemic control in type 2 diabetes patients after having implemented FGM in clinical practice.
Material and methods
Current patients with type 2 diabetes treated in our unit were monitored (FGM). A Structured Therapeutic Education Program was carried out and glycemic control variables were compared at the start and after 3 months of treatment.
Results
A total of 36 patients were included (mean age of 67.8 ± 12.4 years, 36.11% female, diabetes duration 21.5 ± 2.12 years and a previous median glycated hemoglobine of 7.55%). Comparing the baseline data and the measures at 3 months, it was found a decrease in both glucose management indicator (GMI) (0.15% [0.40;0.30], P 0,537) and the coefficient of variation (CV) (1,42 ± 4,66%, P 0,07), as well as an increase in time in range (TIR) (3,44 ± 14.72%, P 0,169). Furthermore, a decrease in time in hyperglycemia > 250 mg/dl was observed (2,00% [−6,50;0,00] P 0,001).
Conclusion
FGM has led to a favorable advance in the management and glycemic control in patients with type 2 diabetes.
引言：女性生殖器切割的有效实施有助于实现血糖控制，减少低血糖和高血糖失代偿，增强患者自我管理，提高患者对生活质量的感知。本研究的目的是评估2型糖尿病患者在临床实践中实施女性生殖器切割后的血糖控制情况。材料和方法：对目前在我单位治疗的2型糖尿病患者进行FGM监测。进行了结构化治疗教育计划，并在治疗开始和治疗3个月后比较血糖控制变量。结果：共纳入36例患者（平均年龄67.8±12.4岁，女性36.11%，糖尿病病程21.5±2.12年，既往糖化血红蛋白中位数为7.55%）。将基线数据与3个月时的测量数据进行比较，发现血糖管理指标（GMI） （0.15% [0.40;0.30], P 0.537）和变异系数（CV）（1.42±4.66%,P 0.007）下降，时间范围（TIR）（3.44±14.72%,P 0.169）增加。此外，观察到在250mg/dl时高血糖时间减少（2,00% [-6,50;0,000]P,001）。结论：女性生殖器切割在2型糖尿病患者的治疗和血糖控制方面取得了良好的进展。
{"title":"Impacto del inicio de la monitorización flash de glucosa (MFG) en los parámetros de control glucémico de pacientes adultos con diabetes mellitus tipo 2","authors":"Carmela Manrique Mutiozábal , Amaia Legarreta Alday , Zuria Alba Muñoz , Eunate Sánchez Uribe , Ainara Deusto Puertas , Santos Zorrozúa Borja , Maria Luisa Antuñano López , Teresa Ruiz de Azúa Arteche , Estela Benito Martínez , Ester Caballero Renilla , Maite Guimón Bardesi","doi":"10.1016/j.medcli.2025.107255","DOIUrl":"10.1016/j.medcli.2025.107255","url":null,"abstract":"<div><h3>Introduction</h3><div>The effective implementation of the FGM contributes to achieving glycemic control, reducing hypoglycemic and hyperglycemic decompensations as well as enhancing patient self-management and improving their perception of quality of life. The aim of our study was to evaluate the glycemic control in type 2 diabetes patients after having implemented FGM in clinical practice.</div></div><div><h3>Material and methods</h3><div>Current patients with type 2 diabetes treated in our unit were monitored (FGM). A Structured Therapeutic Education Program was carried out and glycemic control variables were compared at the start and after 3 months of treatment.</div></div><div><h3>Results</h3><div>A total of 36 patients were included (mean age of 67.8<!--> <!-->±<!--> <!-->12.4 years, 36.11% female, diabetes duration 21.5<!--> <!-->±<!--> <!-->2.12 years and a previous median glycated hemoglobine of 7.55%). Comparing the baseline data and the measures at 3 months, it was found a decrease in both glucose management indicator (GMI) (0.15% [0.40;0.30], <em>P</em> 0,537) and the coefficient of variation (CV) (1,42<!--> <!-->±<!--> <!-->4,66%, <em>P</em> 0,07), as well as an increase in time in range (TIR) (3,44<!--> <!-->±<!--> <!-->14.72%, <em>P</em> 0,169). Furthermore, a decrease in time in hyperglycemia ><!--> <!-->250<!--> <!-->mg/dl was observed (2,00% [−6,50;0,00] <em>P</em> 0,001).</div></div><div><h3>Conclusion</h3><div>FGM has led to a favorable advance in the management and glycemic control in patients with type 2 diabetes.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107255"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934107","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.2025.107265
Rayden Iglesias , Josep M. Badia , Emili Vela , David Monterde , Juan Carlos Yébenes
Bacskground
Sepsis patients are becoming progressively older and frailer and often require chronic medication. Comorbidities and long-term pharmacological treatments may influence survival outcomes in sepsis. This study aimed to evaluate the association between baseline health status, chronic medication use, and in-hospital mortality among ICU-admitted patients with sepsis.
Methods
Retrospective population-based cohort study of ICU adult patients diagnosed with sepsis. The influence of baseline health status, measured using the adjusted morbidity groups (GMA) score, along with the effect of chronic medication use on post-sepsis survival was analysed. Pre-admission medication exposure was determined from outpatient prescription data for the eight months prior to admission. Multivariate logistic regression identified independent predictors of mortality.
Results
Twelve thousand ninety-five ICU-admitted patients with a diagnosis of sepsis were identified in the Catalan population database for 2018–2019. The cohort had a mean age of 68.2 years; high comorbidity burden (GMA: 33.2), high dependency on health services; and elevated baseline health expenditures. In 73.5% of cases infection was present at admission. The overall in-hospital mortality rate was 36.4%. Non-survivors exhibited higher comorbidity levels and greater medication use. In multivariate analysis, prior statin use was independently associated with reduced mortality (OR 0.794; 95% CI 0.723–0.872), whereas corticosteroids were linked to increased mortality (OR 1.321; 95% CI 1.108–1.575).
Conclusion
Comorbidities and chronic medication use significantly influence sepsis survival. Statin use prior to admission was associated with reduced mortality, whereas corticosteroid use correlated with worse outcomes. The GMA score may enhance predictive models, improving resource allocation and clinical decision-making in hospitals. ClinicalTrials.gov: NCT06354452.
背景：脓毒症患者逐渐变老和虚弱，通常需要慢性药物治疗。合并症和长期药物治疗可能影响脓毒症的生存结果。本研究旨在评估icu收治的脓毒症患者的基线健康状况、慢性药物使用和住院死亡率之间的关系。方法：对诊断为脓毒症的ICU成年患者进行回顾性人群队列研究。使用调整发病率组（GMA）评分测量基线健康状况的影响，以及慢性药物使用对脓毒症后生存的影响进行了分析。根据入院前8个月的门诊处方数据确定入院前药物暴露情况。多变量逻辑回归确定了死亡率的独立预测因子。结果：2018-2019年，在加泰罗尼亚人口数据库中发现了1295名被诊断为败血症的icu住院患者。该队列的平均年龄为68.2岁；合并症负担高（GMA: 33.2），高度依赖保健服务；基线卫生支出升高。73.5%的病例入院时存在感染。住院总死亡率为36.4%。非幸存者表现出更高的合并症水平和更多的药物使用。在多变量分析中，既往使用他汀类药物与死亡率降低独立相关（OR 0.794; 95% CI 0.723-0.872），而皮质类固醇与死亡率增加相关（OR 1.321; 95% CI 1.108-1.575）。结论：合并症和慢性用药显著影响脓毒症患者的生存。入院前使用他汀类药物与降低死亡率相关，而使用皮质类固醇则与较差的结果相关。GMA评分可以增强预测模型，改善医院的资源配置和临床决策。Clinicaltrials: gov: NCT06354452。
{"title":"Influence of comorbidities and chronic medications on ICU mortality in sepsis: A population-based cohort study of 12,095 patients","authors":"Rayden Iglesias , Josep M. Badia , Emili Vela , David Monterde , Juan Carlos Yébenes","doi":"10.1016/j.medcli.2025.107265","DOIUrl":"10.1016/j.medcli.2025.107265","url":null,"abstract":"<div><h3>Bacskground</h3><div>Sepsis patients are becoming progressively older and frailer and often require chronic medication. Comorbidities and long-term pharmacological treatments may influence survival outcomes in sepsis. This study aimed to evaluate the association between baseline health status, chronic medication use, and in-hospital mortality among ICU-admitted patients with sepsis.</div></div><div><h3>Methods</h3><div>Retrospective population-based cohort study of ICU adult patients diagnosed with sepsis. The influence of baseline health status, measured using the adjusted morbidity groups (GMA) score, along with the effect of chronic medication use on post-sepsis survival was analysed. Pre-admission medication exposure was determined from outpatient prescription data for the eight months prior to admission. Multivariate logistic regression identified independent predictors of mortality.</div></div><div><h3>Results</h3><div>Twelve thousand ninety-five ICU-admitted patients with a diagnosis of sepsis were identified in the Catalan population database for 2018–2019. The cohort had a mean age of 68.2 years; high comorbidity burden (GMA: 33.2), high dependency on health services; and elevated baseline health expenditures. In 73.5% of cases infection was present at admission. The overall in-hospital mortality rate was 36.4%. Non-survivors exhibited higher comorbidity levels and greater medication use. In multivariate analysis, prior statin use was independently associated with reduced mortality (OR 0.794; 95% CI 0.723–0.872), whereas corticosteroids were linked to increased mortality (OR 1.321; 95% CI 1.108–1.575).</div></div><div><h3>Conclusion</h3><div>Comorbidities and chronic medication use significantly influence sepsis survival. Statin use prior to admission was associated with reduced mortality, whereas corticosteroid use correlated with worse outcomes. The GMA score may enhance predictive models, improving resource allocation and clinical decision-making in hospitals. ClinicalTrials.gov: <span><span>NCT06354452</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107265"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934137","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.2025.107272
Carolina Peixe , José Vicente Rocha , Maria Inês Alexandre
{"title":"Severe hyperglycemia induced by alpelisib in breast cancer: A call for early monitoring","authors":"Carolina Peixe , José Vicente Rocha , Maria Inês Alexandre","doi":"10.1016/j.medcli.2025.107272","DOIUrl":"10.1016/j.medcli.2025.107272","url":null,"abstract":"","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107272"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933971","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.2025.107244
Halil Kazanasmaz, Fırat Gündoğmuş, Ender Can Eroğlu, Mukaddes Kalyoncu
Purpose
This study aimed to assess the diagnostic value of serum amyloid A (SAA) levels during attacks of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.
Methods
A retrospective analysis was conducted on the medical records of 51 children diagnosed with PFAPA and 51 control patients. Serum levels of SAA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the neutrophil-to-lymphocyte ratio (NLR) were measured.
Results
The median SAA levels were significantly higher in the PFAPA group than in controls (p < 0.05). ROC analysis revealed that SAA had a sensitivity of 100% and a specificity of 96.1% at a cutoff value of ≥12.43 mg/L, outperforming CRP and ESR in diagnostic accuracy. While CRP and ESR had high sensitivities (90.2% and 90%, respectively), their specificities were lower (96% and 58.8%, respectively). Moreover, the high positive predictive value of SAA underscores its potential role as a reliable marker for the differential diagnosis of PFAPA.
Conclusion
SAA is a highly sensitive and specific marker for PFAPA attack, showing greater diagnostic accuracy compared to CRP and ESR. These findings suggest that SAA can serve as a valuable biomarker in the differential diagnosis of PFAPA.
{"title":"Serum amyloid A as predictive factor in PFAPA syndrome attack","authors":"Halil Kazanasmaz, Fırat Gündoğmuş, Ender Can Eroğlu, Mukaddes Kalyoncu","doi":"10.1016/j.medcli.2025.107244","DOIUrl":"10.1016/j.medcli.2025.107244","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to assess the diagnostic value of serum amyloid A (SAA) levels during attacks of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the medical records of 51 children diagnosed with PFAPA and 51 control patients. Serum levels of SAA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the neutrophil-to-lymphocyte ratio (NLR) were measured.</div></div><div><h3>Results</h3><div>The median SAA levels were significantly higher in the PFAPA group than in controls (<em>p</em> <!--><<!--> <!-->0.05). ROC analysis revealed that SAA had a sensitivity of 100% and a specificity of 96.1% at a cutoff value of ≥12.43<!--> <!-->mg/L, outperforming CRP and ESR in diagnostic accuracy. While CRP and ESR had high sensitivities (90.2% and 90%, respectively), their specificities were lower (96% and 58.8%, respectively). Moreover, the high positive predictive value of SAA underscores its potential role as a reliable marker for the differential diagnosis of PFAPA.</div></div><div><h3>Conclusion</h3><div>SAA is a highly sensitive and specific marker for PFAPA attack, showing greater diagnostic accuracy compared to CRP and ESR. These findings suggest that SAA can serve as a valuable biomarker in the differential diagnosis of PFAPA.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"166 1","pages":"Article 107244"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933976","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}
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