Pub Date : 2025-10-01DOI: 10.1016/j.rce.2025.502357
C. Morales Indiano , A. Herraiz Ruiz , P. Marcos Neira , R. Roig Pineda , B. Catalán Eraso , A. Martínez Iribarren , A. Leis Sestayo , F. Arméstar Rodríguez
Background
The incidence and mortality of sepsis remain high in the intensive care units (ICU). WBC, CRP and PCT are frequently used as tools for sepsis detection; however, none of them is specific to sepsis. The aim of the current study was to evaluate whether monocyte distribution width (MDW) is useful for early sepsis detection in critically ill patients.
Methods
Prospective cohort study was conducted in a critical care unit. MDW, CRP, PCT and WBC were evaluated for sepsis detection at the time of intensive care unit admission.
Results
There were 344 critically ill patients enrolled consecutively and categorized as no sepsis (200), sepsis (76) and septic shock (68). MDW in patients with sepsis diagnoses in ICU was notably higher than non-sepsis group (29.7 [24.7-35.7] vs 20.4 [18.6-22.7]; P < .001) under the assumption of no mean difference between the groups. Compared to other parameters, MDW was the best to discriminate sepsis from all other conditions (area under curve [AUC]: 0.877; 95% CI: 0.841 0.914), sensitivity 80.6, specificity 84.5 at a cut-off point of 24. MDW adjusted for age, sex and SOFA score was associated with mortality (OR: 1.056; 95% CI: 1.004-1.09; P < .01).
Conclusion
The measurement of MDW is a tool that can help in the early diagnosis of sepsis in ICU settings and its value is a factor associated with the prognosis of septic patients.
背景：脓毒症在重症监护病房（ICU）的发病率和死亡率仍然很高。WBC、CRP和PCT常被用作脓毒症的检测工具；然而，它们都不是针对败血症的。本研究的目的是评估单核细胞分布宽度（MDW）是否对危重患者的早期脓毒症检测有用。方法前瞻性队列研究在某重症监护病房进行。在重症监护病房入院时，评估MDW、CRP、PCT和WBC以检测败血症。结果连续入组344例危重患者，分为无脓毒症（200例）、脓毒症（76例）和感染性休克（68例）。在假定组间无平均差异的情况下，ICU诊断为脓毒症患者的MDW显著高于非脓毒症组（29.7 [24.7-35.7]vs 20.4 [18.6-22.7]; P < .001）。与其他参数相比，MDW最能区分脓毒症与所有其他疾病（曲线下面积[AUC]: 0.877; 95% CI: 0.841 0.914），在截断点24时敏感性80.6，特异性84.5。经年龄、性别和SOFA评分调整的MDW与死亡率相关（OR: 1.056; 95% CI: 1.004-1.09; P < 0.01）。结论MDW的测定有助于ICU脓毒症的早期诊断，是影响脓毒症患者预后的重要因素。
{"title":"Utilidad de la amplitud de distribución de monocitos en el diagnóstico de sepsis en pacientes críticos","authors":"C. Morales Indiano , A. Herraiz Ruiz , P. Marcos Neira , R. Roig Pineda , B. Catalán Eraso , A. Martínez Iribarren , A. Leis Sestayo , F. Arméstar Rodríguez","doi":"10.1016/j.rce.2025.502357","DOIUrl":"10.1016/j.rce.2025.502357","url":null,"abstract":"<div><h3>Background</h3><div>The incidence and mortality of sepsis remain high in the intensive care units (ICU). WBC, CRP and PCT are frequently used as tools for sepsis detection; however, none of them is specific to sepsis. The aim of the current study was to evaluate whether monocyte distribution width (MDW) is useful for early sepsis detection in critically ill patients.</div></div><div><h3>Methods</h3><div>Prospective cohort study was conducted in a critical care unit. MDW, CRP, PCT and WBC were evaluated for sepsis detection at the time of intensive care unit admission.</div></div><div><h3>Results</h3><div>There were 344 critically ill patients enrolled consecutively and categorized as no sepsis (200), sepsis (76) and septic shock (68). MDW in patients with sepsis diagnoses in ICU was notably higher than non-sepsis group (29.7 [24.7-35.7] vs 20.4 [18.6-22.7]; <em>P</em> <!--><<!--> <!-->.001) under the assumption of no mean difference between the groups. Compared to other parameters, MDW was the best to discriminate sepsis from all other conditions (area under curve [AUC]: 0.877; 95%<!--> <!-->CI: 0.841 0.914), sensitivity 80.6, specificity 84.5 at a cut-off point of 24. MDW adjusted for age, sex and SOFA score was associated with mortality (OR: 1.056; 95%<!--> <!-->CI: 1.004-1.09; <em>P</em> <!--><<!--> <!-->.01).</div></div><div><h3>Conclusion</h3><div>The measurement of MDW is a tool that can help in the early diagnosis of sepsis in ICU settings and its value is a factor associated with the prognosis of septic patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502357"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189778","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 : 2025-10-01DOI: 10.1016/j.rce.2025.502351
N. Correa-Ventura
Background
Non-celiac gluten sensitivity (NCGS) is characterized by a combination of intestinal and extra-intestinal symptoms triggered by gluten consumption, without evidence of celiac disease or wheat allergy. Anemia, as an extra-intestinal manifestation, has been little studied in this context.
Main objective
To synthesize the available evidence on the association between NCGS and anemia.
Secondary objective
To evaluate studies applying the Salerno criteria as a diagnostic method.
Methods
Between November and December 2024, a search for scientific articles was conducted in the PubMed, Scopus, and Google Scholar databases, using the following terms: «anemia AND non-celiac gluten sensitivity»; «non-celiac gluten sensitivity AND clinical manifestations»; «non-celiac gluten sensitivity AND Salerno Experts.» Studies were included that either reported data on anemia in NCGS and/or used the Salerno criteria for the diagnosis of NCGS. The methodological quality of observational studies was assessed using the STROBE checklist, and the review was structured according to PRISMA 2020.
Results
A total of 18 studies were selected. The frequency of anemia in patients with NCGS ranged from 15% to 43%. Improvement in hemoglobin levels was reported after a gluten-free diet. Only 6 studies were developed according to the Salerno criteria.
Conclusions
NCGS should be considered in the differential diagnosis of anemia. The methodological quality of studies needs to be improved, ideally through double-blind controlled trials applying the Salerno criteria.
{"title":"Anemia en la sensibilidad al gluten no celíaca: una revisión sistemática","authors":"N. Correa-Ventura","doi":"10.1016/j.rce.2025.502351","DOIUrl":"10.1016/j.rce.2025.502351","url":null,"abstract":"<div><h3>Background</h3><div>Non-celiac gluten sensitivity (NCGS) is characterized by a combination of intestinal and extra-intestinal symptoms triggered by gluten consumption, without evidence of celiac disease or wheat allergy. Anemia, as an extra-intestinal manifestation, has been little studied in this context.</div></div><div><h3>Main objective</h3><div>To synthesize the available evidence on the association between NCGS and anemia.</div></div><div><h3>Secondary objective</h3><div>To evaluate studies applying the Salerno criteria as a diagnostic method.</div></div><div><h3>Methods</h3><div>Between November and December 2024, a search for scientific articles was conducted in the PubMed, Scopus, and Google Scholar databases, using the following terms: «anemia AND non-celiac gluten sensitivity»; «non-celiac gluten sensitivity AND clinical manifestations»; «non-celiac gluten sensitivity AND Salerno Experts.» Studies were included that either reported data on anemia in NCGS and/or used the Salerno criteria for the diagnosis of NCGS. The methodological quality of observational studies was assessed using the STROBE checklist, and the review was structured according to PRISMA 2020.</div></div><div><h3>Results</h3><div>A total of 18 studies were selected. The frequency of anemia in patients with NCGS ranged from 15% to 43%. Improvement in hemoglobin levels was reported after a gluten-free diet. Only 6 studies were developed according to the Salerno criteria.</div></div><div><h3>Conclusions</h3><div>NCGS should be considered in the differential diagnosis of anemia. The methodological quality of studies needs to be improved, ideally through double-blind controlled trials applying the Salerno criteria.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502351"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189782","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 : 2025-10-01DOI: 10.1016/j.rce.2025.502338
J.A. Riancho , M. Martín Millán , P. Peris , G. Martínez , en nombre de la Comisión de Redacción de las Guías de Osteoporosis de la SEIOMM
Introduction
Osteoporosis is a highly prevalent condition. SEIOMM has published guidelines for managing these patients in 2022. The recent introduction of a new drug in Europe, abaloparatide, makes it advisable to consider its role among therapeutic options.
Objective and results
This article summarizes the existing information on the efficacy and safety of abaloparatide and it updates the therapeutic algorithms proposed in the guidelines.
Conclusion
Abaloparatide is an osteoanabolic drug with efficacy and safety similar to teriparatide. It represents a new option for treating patients with severe osteoporosis and a very high risk of fracture.
{"title":"Actualización de las guías de manejo de la osteoporosis de la SEIOMM: abaloparatida","authors":"J.A. Riancho , M. Martín Millán , P. Peris , G. Martínez , en nombre de la Comisión de Redacción de las Guías de Osteoporosis de la SEIOMM","doi":"10.1016/j.rce.2025.502338","DOIUrl":"10.1016/j.rce.2025.502338","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoporosis is a highly prevalent condition. SEIOMM has published guidelines for managing these patients in 2022. The recent introduction of a new drug in Europe, abaloparatide, makes it advisable to consider its role among therapeutic options.</div></div><div><h3>Objective and results</h3><div>This article summarizes the existing information on the efficacy and safety of abaloparatide and it updates the therapeutic algorithms proposed in the guidelines.</div></div><div><h3>Conclusion</h3><div>Abaloparatide is an osteoanabolic drug with efficacy and safety similar to teriparatide. It represents a new option for treating patients with severe osteoporosis and a very high risk of fracture.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502338"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189784","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 : 2025-10-01DOI: 10.1016/j.rce.2025.502355
P. Pérez-Martínez , E. Porras-Pérez , J.L. Romero-Cabrera
{"title":"El poder del comedor escolar como herramienta de salud: sinergias entre la política pública y el programa E-DUCASS","authors":"P. Pérez-Martínez , E. Porras-Pérez , J.L. Romero-Cabrera","doi":"10.1016/j.rce.2025.502355","DOIUrl":"10.1016/j.rce.2025.502355","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502355"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189635","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502331
C. Guan , Z. Gu , J. Sun , W. Zhu , M. Ye
Background
The triglyceride-glucose (TyG) index is derived from a combination of fasting plasma glucose and triglyceride levels, making it a reliable indicator of insulin resistance. Prior studies have established a significant connection between insulin resistance and Alzheimer's disease (AD). Nevertheless, the relationship between the trajectory of the TyG index and AD onset is still not clearly understood.
Methods
This longitudinal prospective cohort study derived data from the Framingham Heart Study Offspring cohort. A total of 2,170 participants without AD at baseline were included and were prospectively followed until 2018. Groups of participants with comparable TyG index trajectories were identified through the application of latent class growth mixture modeling analysis.
Results
A cohort of 163 participants were diagnosed with AD during the follow-up. The incidence of AD in the low, moderate, and high trajectory groups was 0.38, 0.66, and 0.68 per 100 person-years respectively. Compared to the low trajectory group, both the moderate trajectory (hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.04-2.25) and high trajectory groups (HR = 1.90, 95% CI: 1.09-3.31) exhibited an elevated risk of developing AD. These results remained consistent after adjusting for multiple covariates (moderate: HR = 1.53, 95% CI: 1.02-2.29; high: HR = 1.84, 95% CI: 1.03-3.27, respectively).
Conclusion
Higher TyG index trajectories exhibit a notable correlation with the development of AD. Early and continuous monitoring of the TyG index in individuals identified as high-risk for AD may help implement timely prevention measures.
{"title":"Relación entre las trayectorias del TyG y la enfermedad de Alzheimer: datos del Estudio de Framingham","authors":"C. Guan , Z. Gu , J. Sun , W. Zhu , M. Ye","doi":"10.1016/j.rce.2025.502331","DOIUrl":"10.1016/j.rce.2025.502331","url":null,"abstract":"<div><h3>Background</h3><div>The triglyceride-glucose (TyG) index is derived from a combination of fasting plasma glucose and triglyceride levels, making it a reliable indicator of insulin resistance. Prior studies have established a significant connection between insulin resistance and Alzheimer's disease (AD). Nevertheless, the relationship between the trajectory of the TyG index and AD onset is still not clearly understood.</div></div><div><h3>Methods</h3><div>This longitudinal prospective cohort study derived data from the Framingham Heart Study Offspring cohort. A total of 2,170 participants without AD at baseline were included and were prospectively followed until 2018. Groups of participants with comparable TyG index trajectories were identified through the application of latent class growth mixture modeling analysis.</div></div><div><h3>Results</h3><div>A cohort of 163 participants were diagnosed with AD during the follow-up. The incidence of AD in the low, moderate, and high trajectory groups was 0.38, 0.66, and 0.68 per 100 person-years respectively. Compared to the low trajectory group, both the moderate trajectory (hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.04-2.25) and high trajectory groups (HR<!--> <!-->=<!--> <!-->1.90, 95%<!--> <!-->CI: 1.09-3.31) exhibited an elevated risk of developing AD. These results remained consistent after adjusting for multiple covariates (moderate: HR<!--> <!-->=<!--> <!-->1.53, 95%<!--> <!-->CI: 1.02-2.29; high: HR<!--> <!-->=<!--> <!-->1.84, 95%<!--> <!-->CI: 1.03-3.27, respectively).</div></div><div><h3>Conclusion</h3><div>Higher TyG index trajectories exhibit a notable correlation with the development of AD. Early and continuous monitoring of the TyG index in individuals identified as high-risk for AD may help implement timely prevention measures.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502331"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779801","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502330
Ó. Porto Fuentes , A. Muela Molinero , M.B. Alonso Ortiz
Patients with chronic obstructive pulmonary disease (COPD) are more vulnerable to infections that may favor disease progression. Vaccination in COPD is an effective intervention that helps reduce infectious exacerbations, as well as associated morbidity and mortality.
In recent years, the use of new vaccines has become widespread, not only targeting specific infections but also contributing to long-lasting immunity and slowing the process of immune aging (immunosenescence).
Current clinical practice guidelines recommend the administration of six vaccines (against Streptococcus pneumoniae, influenza virus, SARS-CoV-2, respiratory syncytial virus, Bordetella pertussis, and varicella-zoster virus) for all COPD patients.
However, vaccination rates in many countries still fall short of the established targets. Therefore, it is crucial to design a specific vaccination schedule tailored for COPD patients.
{"title":"Vacunación en la enfermedad pulmonar obstructiva crónica (EPOC): evidencia científica y estrategias para reducir riesgos","authors":"Ó. Porto Fuentes , A. Muela Molinero , M.B. Alonso Ortiz","doi":"10.1016/j.rce.2025.502330","DOIUrl":"10.1016/j.rce.2025.502330","url":null,"abstract":"<div><div>Patients with chronic obstructive pulmonary disease (COPD) are more vulnerable to infections that may favor disease progression. Vaccination in COPD is an effective intervention that helps reduce infectious exacerbations, as well as associated morbidity and mortality.</div><div>In recent years, the use of new vaccines has become widespread, not only targeting specific infections but also contributing to long-lasting immunity and slowing the process of immune aging (immunosenescence).</div><div>Current clinical practice guidelines recommend the administration of six vaccines (against <em>Streptococcus pneumoniae</em>, influenza virus, SARS-CoV-2, respiratory syncytial virus, <em>Bordetella pertussis</em>, and varicella-zoster virus) for all COPD patients.</div><div>However, vaccination rates in many countries still fall short of the established targets. Therefore, it is crucial to design a specific vaccination schedule tailored for COPD patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502330"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779630","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502329
R. Triviño-Caballero , J. Franco , L. Sordo
Background/objective
The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.
Materials and methods
Cross-sectional knowledge, attitudes, and practices model study. A total of 434 active general practitioners working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.
Results
Of the general practitioners surveyed, 46.3% practised in Madrid; 75.2% were women, with an average age of 47; 84.8% had received training in bioethics; 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices; 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR = 2.98; 95% CI 1.16-5.34), those with religious beliefs (aOR = 5.23; 95% CI 2.78-9.80), and those opposed to MAID (aOR = 12.63; 95% CI 5.80-27.50).
Conclusions
The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.
背景/目的《安乐死管理法》规定了良心拒服兵役的权利。但是，几乎没有任何关于行使这种权利或反对理由的资料。本研究的目的是确定关于在初级保健中提供死亡医疗援助（MAID）的CO的知识、态度和做法，这是大多数提供医疗援助的护理水平。材料和方法横断面知识、态度和实践模型研究。通过自我填写的问卷，对在西班牙各地保健中心工作的434名在职全科医生进行了关于同性婚姻的知识、态度和做法的调查。对每个领域的回答进行了描述性分析，然后进行了多变量分析，以确定与反对或考虑这样做有关的因素。结果接受调查的全科医生中，46.3%在马德里执业；75.2%为女性，平均年龄47岁；接受过生命伦理学培训的占84.8%；54.9%的人表示知道法律，只有29%的人正确回答有关临终护理中一氧化碳的问题；35%的人反对或考虑反对。马德里执业者的反对率较高(aOR = 2.98；95% CI 1.16-5.34)，有宗教信仰的人(aOR = 5.23；95% CI 2.78-9.80)，反对MAID的患者(aOR = 12.63；95% ci 5.80-27.50)。反对的主要原因是道德和情感，尽管其他背景因素也会出现。鉴于对人们可以反对的做法的高度无知，需要改进培训和机构参与，以便负责任的做法和保证MAID。
{"title":"Objeción de conciencia a la prestación de ayuda para morir: conocimientos, actitudes y prácticas en atención primaria","authors":"R. Triviño-Caballero , J. Franco , L. Sordo","doi":"10.1016/j.rce.2025.502329","DOIUrl":"10.1016/j.rce.2025.502329","url":null,"abstract":"<div><h3>Background/objective</h3><div>The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.</div></div><div><h3>Materials and methods</h3><div>Cross-sectional knowledge, attitudes, and practices model study. A total of 434 active general practitioners working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.</div></div><div><h3>Results</h3><div>Of the general practitioners surveyed, 46.3% practised in Madrid; 75.2% were women, with an average age of 47; 84.8% had received training in bioethics; 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices; 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR<!--> <!-->=<!--> <!-->2.98; 95% CI 1.16-5.34), those with religious beliefs (aOR<!--> <!-->=<!--> <!-->5.23; 95% CI 2.78-9.80), and those opposed to MAID (aOR<!--> <!-->=<!--> <!-->12.63; 95% CI 5.80-27.50).</div></div><div><h3>Conclusions</h3><div>The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502329"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779959","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502332
A. Campos Sáenz de Santamaría , A. Alcaine Otín , S. Crespo Aznarez , C. Josa Laorden , L. Esterellas Sánchez , M. Sánchez Marteles , V. Garcés Horna , Z. Albines Fiestas , I. Giménez López , J. Rubio Gracia
Background
Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).
Methods
Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.
Results
A total of 100 patients were included (mean age 86 ± 8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥ 2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1 year (OR 2.52, 95% CI: 1.02-6.26, P = .046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (P < .001).
Conclusions
Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.
{"title":"Análisis multimodal de la congestión y utilidad pronóstica del protocolo VExUS en pacientes hospitalizados por insuficiencia cardiaca en un hospital terciario","authors":"A. Campos Sáenz de Santamaría , A. Alcaine Otín , S. Crespo Aznarez , C. Josa Laorden , L. Esterellas Sánchez , M. Sánchez Marteles , V. Garcés Horna , Z. Albines Fiestas , I. Giménez López , J. Rubio Gracia","doi":"10.1016/j.rce.2025.502332","DOIUrl":"10.1016/j.rce.2025.502332","url":null,"abstract":"<div><h3>Background</h3><div>Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).</div></div><div><h3>Methods</h3><div>Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.</div></div><div><h3>Results</h3><div>A total of 100 patients were included (mean age 86<!--> <!-->±<!--> <!-->8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥<!--> <!-->2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1<!--> <!-->year (OR 2.52, 95%<!--> <!-->CI: 1.02-6.26, <em>P</em> <!-->=<!--> <!-->.046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (<em>P</em> <!--><<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502332"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779961","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502337
S. Carrasco-Molina , Á. Robles-Marhuenda , J.J. Ríos-Blanco , Y. Tung-Chen
{"title":"Contrarréplica: comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada»","authors":"S. Carrasco-Molina , Á. Robles-Marhuenda , J.J. Ríos-Blanco , Y. Tung-Chen","doi":"10.1016/j.rce.2025.502337","DOIUrl":"10.1016/j.rce.2025.502337","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502337"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779962","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 : 2025-08-01DOI: 10.1016/j.rce.2025.502334
J.A. Mariz
{"title":"Comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada»","authors":"J.A. Mariz","doi":"10.1016/j.rce.2025.502334","DOIUrl":"10.1016/j.rce.2025.502334","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502334"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779632","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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