Revista clinica espanola最新文献_第2页

Retraso diagnóstico y oportunidades perdidas en la detección precoz de la fibrilación auricular: estudio transversal 心房颤动早期检测中的延迟诊断和错失良机：一项横断面研究

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.011

F. Richard Espiga , M. Almendro Delia , F. Caballero Martínez , D. Monge Martín , F. Neria Serrano , R. Quirós López

Introduction

We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.

Methods

This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.

Results

A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1-6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.

Conclusions

In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.

引言我们分析了新诊断患者中房颤（AF）延迟诊断的频率及其相关因素。方法这是一项描述性、横断面、多中心研究。通过病历审查和在西班牙心脏病科、内科、初级保健科和急诊科就诊时进行的访谈，收集了新诊断的房颤患者的数据。结果共有 201 名医生参与了研究（64.2% 为心脏病专家，21.4% 为内科医生）。共纳入 948 名患者（58% 为男性；平均年龄 72.8 岁）。41.8%的患者在诊断时被归类为阵发性房颤，30.9%的患者被归类为持续性房颤，27.3%的患者被归类为永久性房颤。37%的患者的诊断是巧合。49.3%的患者被认为是诊断延迟。这种延迟与存在永久性或持续性房颤、年龄较大或瓣膜疾病有关。74.8%的患者在前一年与医疗系统有过一些接触。50.7%的病例可在 1-6 个月前确诊，20.1%的病例可在 6 个月前确诊。54.4%的患者之前出现过与房颤相似的症状。结论在很大一部分心房颤动病例中，诊断存在延误。许多有类似症状的人既不就诊，也不与医疗系统设施联系。因此，丧失了早期诊断的机会。

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引用次数: 0

El receptor soluble para productos finales de glicación avanzada se correlacionó positivamente con la lesión renal con la enfermedad coronaria 高级糖化终产物可溶性受体与冠心病肾损伤呈正相关。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.016

L. Chen , X.-J. Zeng , X.-Y. Guo , J. Liu , F-H. Du , C-X. Guo

Aims

Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end-products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.

Materials and methods

In this cross-sectional study, sRAGE and urinary albumin to creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.

Results

There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR < 30 mg/g) [2.08 ± 0.70 vs. 1.75 ± 0.61 μg/L, P < .05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (r = 0.196, P < .05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [odd ratio = 2.62 (1.12-6.15), P < .05]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543-0.778), P < .01].

Conclusions

Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.

目的血清可溶性高级糖化终产物受体（sRAGE）发生变化的冠心病（CHD）患者会出现微量白蛋白尿，甚至肾功能障碍。然而，sRAGE 在冠心病微量白蛋白尿中的作用仍未确定。材料和方法在这项横断面研究中，对接受冠状动脉造影术的住院 CHD 患者的 sRAGE 和尿白蛋白肌酐比值（uACR）进行了测量，以评估 sRAGE 和 uACR 之间的区别和相关性。结果127 名冠心病患者（平均年龄：63.06 ± 10.93 岁，男性 93 人）的 sRAGE 为 1.83 ± 0.64 μg/L。肾损伤组（uACR ≥ 30 mg/g）的 sRAGE 水平高于无肾损伤组（uACR < 30 mg/g）[2.08±0.70 vs. 1.75±0.61 μg/L，P < .05]。此外，在冠心病患者中，血清 sRAGE 与 uACR 呈显著正相关（r = 0.196，P < .05）。二元逻辑回归表明，sRAGE 是冠心病患者微量白蛋白尿的预测因子[奇异比 = 2.62 (1.12-6.15)，P < .05]。结论血清 sRAGE 与 uACR 呈正相关，可作为预测 CHD 患者早期肾损伤的潜在标志物。

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引用次数: 0

Perspectiva clínica de las miopatías necrotizantes inmunomediadas anti-HMG-Co-A-reductasa: análisis de tres casos 抗-HMG-Co-A 还原酶免疫介导的坏死性坏死性肌病的临床视角：三个病例的分析

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.07.002

J.P. de la Fuente Peñaloza , L. Quintana Cabezas , M.C. Yubini Lagos

引用次数: 0

Anemia de la inflamación y metabolismo del hierro en las enfermedades crónicas 慢性疾病中的炎症性贫血和铁代谢

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.013

S. Conde Díez , R. de las Cuevas Allende , E. Conde García

Anemia of inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient's quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.

炎症性贫血的起因是免疫系统被激活，细胞因子随之释放，导致血色素升高，造成低铁蛋白血症，并因缺铁而抑制红细胞生成。贫血通常为轻度/中度、正常红细胞/正常虹膜色素沉着，是继缺铁性贫血之后发病率最高的一种贫血，在慢性病患者、老年人和住院病人中最为常见。贫血会影响患者的生活质量，并对生存产生负面影响。治疗的目的应是改善基础疾病，纠正贫血。静脉注射铁剂、促红细胞生成素和脯氨酰羟化酶抑制剂是目前治疗的基础，但未来的治疗将针对血红素，因为血红素是造成贫血的最终原因。

引用次数: 0

Resumen ejecutivo de la reflexión estratégica de la Sociedad Española de Medicina Interna 2025-2029 para garantizar la asistencia integral a la persona enferma en un Sistema Nacional de Salud de alto valor 西班牙内科医学会 2025-2029 年战略思考执行摘要，以确保在高价值的国家卫生系统中为病人提供全面护理。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.08.001

J. Carretero Gómez , M.M. Chimeno Viñas , J.M. Porcel Pérez , M. Méndez Bailón , P. Pérez Martínez , M.T. Herranz Marín , F.J. Elola Somoza , en nombre de los miembros de los comités para el proceso de reflexión estratégica de la SEMI

Aims

To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).

Methods

Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.

Results

The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.

Conclusions

SEMI seeks to be a key player in the transformation of the Spanish healthcare system.

目的为西班牙内科学会（SEMI）的政策和活动设计一个战略框架。结果西班牙内科学会的座右铭改为 "为患者提供全面护理"。确定了七项战略方针：为医疗系统的转型做出贡献；参与大学教学；保证为患者提供全面的医疗服务；为内科住院医师和内科医生提供在21世纪医疗领域执业的技能；促进内科研究和科学证据的产生；结合技术创新和数字工具；将SEMI定位为医疗政策的示范机构。

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引用次数: 0

Resultados de la implementación del proyecto DP-TRANSFERS en Cataluña: un método traslacional para mejorar el cribado y la prevención de la diabetes en atención primaria 在加泰罗尼亚实施 DP-TRANSFERS 项目的结果：在初级保健中改进糖尿病筛查和预防的转化方法。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-11-01 DOI: 10.1016/j.rce.2024.06.017

J.J. Cabré , F. Barrio , J. Vizcaíno , A. Martínez , T. Mur , R. Sagarra , S. Dalmau

Introduction

DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.

Objective

Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.

Methodology

Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC >11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.

Results

The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2,381 subjects screened, 1,713 participated in the basic module, with 1,186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second.

The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference.

Conclusions

The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.

简介：DP-TRANSFERS 是一项生活方式干预转化项目，遵循 DE-PLAN-CAT 研究中描述的先前方案。筛查后，干预包括基本模块和持续模块。按照群组（医疗中心）进行分层，从2016年至2020年对代表性样本（中心、专业人员和参与者）进行评估（FINDRISC>11和/或糖尿病前期）。结果123个中心中有95个可行，647名专业人员中有343名参与了干预。在筛选出的 2381 名受试者中，1713 人参加了基础模块，其中 1186 人完成了第一年的学习，776 人完成了第二年的学习。双变量分析表明，受糖尿病影响的受试者在以下方面存在差异：之前的血糖状况、A1c、高密度脂蛋白胆固醇、FINDRISC 评分和对地中海饮食的坚持程度，以及在研究开始和结束时体重、体重指数和腹围的差异。结论与之前估计的标准化干预相比，强化干预大大降低了糖尿病的发病率（23.6%）。以下因素起到了保护作用：较好的血糖状况、较低的基线风险、较高的高密度脂蛋白胆固醇，或在研究期间实现了体重或腹围的减少。

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引用次数: 0

La amiloidosis cardiaca empeora el pronóstico en los pacientes con insuficiencia cardiaca: hallazgos del estudio PREVAMIC 心脏淀粉样变性会加重心力衰竭患者的预后：PREVAMIC 研究的发现

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.06.006

R. Ruiz Hueso , P. Salamanca Bautista , M.A. Quesada Simón , S. Yun , A. Conde Martel , J.L. Morales Rull , I. Fiteni Mera , D. Abad Pérez , I. Páez Rubio , Ó. Aramburu Bodas , en representación del grupo de trabajo PREVAMIC

Background and objectives

Cardiac amyloidosis (CA) is a common pathology in elderly patients that usually presents as heart failure (HF). However, it is not clear whether CA associated with HF has a worse prognosis compared with HF due to other etiologies.

Material and methods

Prospective, observational cohort study that recruited patients ≥65 years of age with HF in 30 Spanish centers. The cohort was divided according to whether the patients had AC or not. Patients were followed for 1 year.

Results

A total of 484 patients were included in the analysis. The population was elderly (median 86 years) and 49% were women CA was present in 23.8% of the included patients. In the CA group, there was a lower prevalence of diabetes mellitus and valvular disease. At one year of follow-up, mortality was significantly more frequent in patients with CA compared to those without (33.0 vs.14.9%, p < 0.001). However, there were no differences between both groups in visits to the emergency room or readmissions. In the multivariate analysis, the variables that were shown to predict all-cause mortality at one year of follow-up were chronic kidney disease (HR 1.75 (1.01-3.05) p = 0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) p < 0.001), confusion (HR 2.05 (1.01-4.17), p = 0.048), and the presence of CA (HR 1.77 (1.11-2.84), p = 0.017).

Conclusion

The presence of CA in elderly patients with HF is related to a worse prognosis at one year of follow-up. Early diagnosis of the pathology and multidisciplinary management can help improve patient outcomes.

背景和目的心脏淀粉样变性（CA）是老年患者的一种常见病症，通常表现为心力衰竭（HF）。然而，与其他病因引起的心力衰竭相比，与心力衰竭相关的心脏淀粉样变性是否预后更差，目前尚不清楚。根据患者是否患有交流性心脏病对队列进行了划分。结果共有 484 名患者纳入分析。研究对象为老年人（中位数为 86 岁），49% 为女性，23.8% 的患者患有冠心病。在CA组中，糖尿病和瓣膜病的发病率较低。随访一年后，CA患者的死亡率明显高于非CA患者（33.0% vs.14.9%, p <0.001）。不过，两组患者在急诊就诊和再入院方面没有差异。在多变量分析中，可预测随访一年后全因死亡率的变量是慢性肾病（HR 1.75 (1.01-3.05) p = 0.045）、NT-proBNP 水平（HR 2.51 (1.46-4.30) p < 0.001）、精神错乱（HR 2.05 (1.01-4.17)，p = 0.048）和CA的存在（HR 1.77 (1.11-2.84)，p = 0.017）。早期病理诊断和多学科治疗有助于改善患者的预后。

{"title":"La amiloidosis cardiaca empeora el pronóstico en los pacientes con insuficiencia cardiaca: hallazgos del estudio PREVAMIC","authors":"R. Ruiz Hueso , P. Salamanca Bautista , M.A. Quesada Simón , S. Yun , A. Conde Martel , J.L. Morales Rull , I. Fiteni Mera , D. Abad Pérez , I. Páez Rubio , Ó. Aramburu Bodas , en representación del grupo de trabajo PREVAMIC","doi":"10.1016/j.rce.2024.06.006","DOIUrl":"10.1016/j.rce.2024.06.006","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Cardiac amyloidosis (CA) is a common pathology in elderly patients that usually presents as heart failure (HF). However, it is not clear whether CA associated with HF has a worse prognosis compared with HF due to other etiologies.</div></div><div><h3>Material and methods</h3><div>Prospective, observational cohort study that recruited patients ≥65 years of age with HF in 30 Spanish centers. The cohort was divided according to whether the patients had AC or not. Patients were followed for 1 year.</div></div><div><h3>Results</h3><div>A total of 484 patients were included in the analysis. The population was elderly (median 86 years) and 49% were women CA was present in 23.8% of the included patients. In the CA group, there was a lower prevalence of diabetes mellitus and valvular disease. At one year of follow-up, mortality was significantly more frequent in patients with CA compared to those without (33.0 vs.14.9%, p<0.001). However, there were no differences between both groups in visits to the emergency room or readmissions. In the multivariate analysis, the variables that were shown to predict all-cause mortality at one year of follow-up were chronic kidney disease (HR 1.75 (1.01-3.05) p0.045), NT-proBNP levels (HR 2.51 (1.46-4.30) p<0.001), confusion (HR 2.05 (1.01-4.17), p0.048), and the presence of CA (HR 1.77 (1.11-2.84), p0.017).</div></div><div><h3>Conclusion</h3><div>The presence of CA in elderly patients with HF is related to a worse prognosis at one year of follow-up. Early diagnosis of the pathology and multidisciplinary management can help improve patient outcomes.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 8","pages":"Pages 494-502"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417146","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}

引用次数: 0

Pneumocystis jirovecii en la enfermedad humana, ¿sólo neumonía? 人类疾病中的肺孢子虫，仅仅是肺炎吗？

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.07.001

E.J. Calderón , V. Friaza

引用次数: 0

El registro RICA-2: diseño y características basales de los primeros 1.000 pacientes RICA-2 登记：首批 1,000 名患者的设计和基线特征

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.06.010

J.C. Trullàs , M.C. Moreno-García , V. Mittelbrunn-Alquézar , A. Conde-Martel , L. Soler-Rangel , M. Montero-Pérez-Barquero , J. Casado , M. Sánchez-Marteles , J.C. Arévalo-Lorido , J. Pérez-Silvestre , en representación de los investigadores del registro RICA-2

Background and objective

Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry.

Methods

Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with de novo HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities.

Results

RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition.

Conclusion

The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine.

背景和目的心力衰竭（HF）是一种流行性综合征，也是入院治疗的主要原因之一。患者登记提供了真实世界的临床实践信息，是临床试验的补充。RICA-2 是西班牙内科医学会的一个登记处。其主要目的是了解在内科接受治疗的高血压患者的临床和流行病学特征以及预后因素。本研究旨在介绍 RICA-2 的设计、首批纳入的 1000 名患者的基线特征及其与 RICA 登记历史队列的比较。方法对符合以下纳入标准的心房颤动患者进行观察性、多中心和前瞻性研究：年龄等于或大于18岁，根据欧洲指南诊断为心房颤动，未明确纳入失代偿期或稳定期，新发心房颤动或慢性心房颤动患者，无论左心室射血分数、病因和合并症如何。合并症负担高于 RICA 登记（夏尔森合并症指数为 5 分），以慢性失代偿性心房颤动（74%）、高血压病因（39%）和射血分数保留（52%）为主。结论：RICA-2 代表了一个当代患者群组，将为我们提供内科治疗的急慢性心房颤动患者的临床、流行病学和预后信息。

{"title":"El registro RICA-2: diseño y características basales de los primeros 1.000 pacientes","authors":"J.C. Trullàs , M.C. Moreno-García , V. Mittelbrunn-Alquézar , A. Conde-Martel , L. Soler-Rangel , M. Montero-Pérez-Barquero , J. Casado , M. Sánchez-Marteles , J.C. Arévalo-Lorido , J. Pérez-Silvestre , en representación de los investigadores del registro RICA-2","doi":"10.1016/j.rce.2024.06.010","DOIUrl":"10.1016/j.rce.2024.06.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry.</div></div><div><h3>Methods</h3><div>Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with <em>de novo</em> HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities.</div></div><div><h3>Results</h3><div>RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition.</div></div><div><h3>Conclusion</h3><div>The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 8","pages":"Pages 522-533"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417249","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}

引用次数: 0

Factores de riesgo de mortalidad en pacientes con enfermedad del coronavirus 2019 con hipoxemia silente 2019 年冠状病毒病无声低氧血症患者死亡的风险因素

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-10-01 DOI: 10.1016/j.rce.2024.06.004

B. Ximenes Braz , G. Cavalcante Meneses , G.B. da Silva Junior , A.M. Costa Martins , A.F. de S. Mourão Feitosa , G.C. Lima Chagas , E. De Francesco Daher

Objective

To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia.

Material and methods

Retrospective cohort study of hospitalized patients with SARS due to COVID-19 and silent hypoxemia at admission, in Brazil, from January to June 2021. The primary outcome of interest was in-hospital death. Multivariable logistic regression analysis was performed.

Results

Of 46,102 patients, the mean age was 59 ± 16 years, and 41.6% were female. During hospitalization, 13,149 patients died. Compared to survivors, non-survivors were older (mean age, 66 vs. 56 years; P < 0.001), less frequently female (43.6% vs. 40.9%; P < 0.001), and more likely to have comorbidities (74.3% vs. 56.8%; P < 0.001). Non-survivors had higher needs for invasive mechanical ventilation (42.4% vs 6.6%; P < 0.001) and intensive care unit admission (56.9% vs 20%; P < 0.001) compared to survivors. In the multivariable regression analysis, advanced age (OR: 1.04; 95%CI: 1.037-1.04), presence of comorbidities (OR: 1.54; 95%CI: 1.47-1.62), cough (OR: 0.74; 95%CI: 0.71-0.79), respiratory distress (OR: 1.32; 95%CI: 1.26-1.38), and need for non-invasive respiratory support (OR: 0.37; 95%CI: 0.35-0.40) remained independently associated with death.

Conclusions

Advanced age, presence of comorbidities, and respiratory distress were independent risk factors for mortality, while cough and requirement for non-invasive respiratory support were independent protective factors against mortality in hospitalized patients with SARS due to COVID-19 with silent hypoxemia at presentation.

材料和方法对 2021 年 1 月至 6 月期间巴西因 COVID-19 感染严重急性呼吸系统综合征（SARS）且入院时出现无声低氧血症的住院患者进行回顾性队列研究。主要研究结果为住院死亡。结果在 46 102 名患者中，平均年龄为 59 ± 16 岁，女性占 41.6%。住院期间，13149 名患者死亡。与幸存者相比，非幸存者年龄更大（平均年龄为 66 岁对 56 岁；P < 0.001），女性更少（43.6% 对 40.9%；P < 0.001），更有可能患有合并症（74.3% 对 56.8%；P < 0.001）。与存活者相比，非存活者对有创机械通气（42.4% 对 6.6%；P <；0.001）和入住重症监护室（56.9% 对 20%；P <；0.001）的需求更高。在多变量回归分析中，高龄（OR：1.04；95%CI：1.037-1.04）、合并症（OR：1.54；95%CI：1.47-1.62）、咳嗽（OR：0.74；95%CI：0.71-0.79）、呼吸困难（OR：1.32；95%CI：1.26-1.38）和需要无创呼吸支持（OR：0.37；95%CI：0.35-0.40）仍然与死亡独立相关。结论对于因COVID-19引起的SARS住院病人来说，高龄、合并症和呼吸窘迫是导致死亡的独立危险因素，而咳嗽和需要无创呼吸支持则是导致死亡的独立保护因素。

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引用次数: 0