Revista Espanola De Quimioterapia最新文献

Objective: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED).

Methods: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV).

Results: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%.

Conclusions: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

Recipients of solid organ transplants (SOT) are at higher risk of infection by SARS-CoV-2 virus especially due to chronic immunosuppression therapy and frequent multiple comorbid conditions. COVID-19 is a potentially life-threatening disease in SOT recipients, with an increased likelihood of progressing to severe disease, with the need of hospitalization, admission to the intensive care unit (ICU) and mechanical ventilatory support. This article presents an updated review of different aspects related to the outcome of COVID-19 in SOT recipients. In nvaccinated SOT recipients, COVID-19 is associated with a high mortality rate, in-patient care and ICU admission, and impaired graft function or rejection in severe disease. In vaccinated SOT recipients even after full vaccination, there is a reduction of the risk of mortality, but the course of COVID-19 may continue to be severe, influenced by the time from transplant, the net state of immunosuppression and having suffered graft rejection or dysfunction. SOT recipients develop lower immunity from mRNA vaccines with suboptimal response. Treatment with mAbs provides favorable outcomes in non-hospitalized SOT recipients at high risk for severe disease, with lower rates of hospitalization, emergency department visits, ICU care, progression to severe disease, and death. However, broad vaccination and therapeutic options are required, particularly in light of the tendency of the SARS-CoV-2 virus to adapt and evade both natural and vaccine-induced immunity.

Objective: Home Hospitalization (HH) is an alternative hospitalization modality that can be very useful in times of health stress such as the COVID-19 pandemic. This paper includes the management of patients admitted with COVID-19 in HH in two county spanish hospitals for two years.

Methods: A descriptive, observational and retrospective study of all patients admitted at HH with a diagnosis of COVID-19 disease was carried out. Subsequently, further analysis was carried out to characterize the patients who died in HH or 30 days after discharge and another to compare the management between the first phase of the study (2020) and the second one (2021 and part of 2022).

Results: A total of 167 patients were recruited. A 52.1% moved to watch that the recovery continued compared to 40.7% in which it was done to watch that they did not worsen. The patients who died in HAD were older (mean 87.5 years), more comorbid and more likely to have do-not resucitate orders (DNR) in case of cardiac arrest (85%). In the second phase of the study, older patients, more comorbid patients and with a greater degree of DNR orders were admitted than those admitted throughout 2020.

Conclusions: HAD is a useful resource to increase the resilience of health systems in cases of stress such as the disease caused by COVID-19. The development and growth of existing units, as well as the creation of new ones where they do not exist, could be a basic tool for the medicine of the future.