Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Pneumon ; : 6, 2021.
Article in English | Web of Science | ID: covidwho-1551958

ABSTRACT

INTRODUCTION COVID-19 disproportionately impacts patients aged >= 80 years, yet few studies have focused on this population. We aimed to investigate the clinical characteristics and outcomes of very elderly patients with COVID-19 across three consecutive waves in Spain. METHODS We retrospectively evaluated very elderly patients admitted with COVID-19 to a university hospital in Barcelona, Spain, across the three first waves. Main outcomes were ICU admission and 30-day mortality. RESULTS From March 2020 to February 2021, 3105 patients diagnosed with COVID-19 were admitted. Of these, 655 (21%) were very elderly patients, 50% were female and median age was 86 (83;89) years. ICU admission and ICU-mortality rates were 11% and 42%, respectively;male sex, respiratory rate >= 25 breaths/min, LDH >= 337.5 U/L and C-reactive protein >= 11.5 mg/dL were significantly associated with ICU admission in the multivariable analysis. Overall, 30-day mortality was 34%. The ICU admission rate was significantly higher during the first wave compared to the third wave (16% vs 8%;p=0.009), whereas no significant differences in 30-day mortality were found between waves (p=0.107). CONCLUSIONS We observed an increase in the percentage of very elderly patients admitted to the ICU during the three first pandemic peaks. ICU admission more likely occurs in very elderly male patients with higher respiratory rate, with elevate LDH and C-reactive protein. Overall, our 30-day mortality rate was lower compared to other series globally.

2.
Rev Esp Quimioter ; 34 Suppl 1: 72-75, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1449590

ABSTRACT

Invasive fungal infection often complicates patients with severe viral infection, especially those admitted to critical care units. Severe SARS-CoV-2 infection has been no exception and a significant association with Aspergillus spp. has been documented, resulting in high patient mortality. In this summary we describe the clinical presentation, the underlying diseases most commonly linked with this association, radiological manifestations and therapeutic management of CAPA.


Subject(s)
COVID-19 , Mycoses , Aspergillus , Humans , Intensive Care Units , Mycoses/drug therapy , SARS-CoV-2
3.
Rev Esp Quimioter ; 34(4): 337-341, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1317435

ABSTRACT

OBJECTIVE: The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS: Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS: The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS: Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.


Subject(s)
Antibodies, Monoclonal/therapeutic use , COVID-19/drug therapy , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , C-Reactive Protein/analysis , COVID-19/mortality , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , Disease Progression , Female , Humans , Hypertension/complications , Interleukin-6/antagonists & inhibitors , Interleukin-6/blood , Male , Middle Aged , Retrospective Studies , Salvage Therapy , Treatment Outcome
4.
Rev Esp Quimioter ; 34(3): 238-244, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1173137

ABSTRACT

OBJECTIVE: In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. METHODS: A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. RESULTS: A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. CONCLUSIONS: Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , Bed Occupancy , COVID-19/immunology , Female , Humans , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2
5.
Rev Esp Quimioter ; 34(2): 136-140, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1119722

ABSTRACT

OBJECTIVE: Controversial results on remdesivir efficacy have been reported. We aimed to report our real-life experience with the use of remdesivir from its availability in Spain. METHODS: We performed a descriptive study of all patients admitted for ≥48 hours with confirmed COVID-19 who received remdesivir between the 1st of July and the 30th of September 2020. RESULTS: A total of 123 patients out of 242 admitted with COVID-19 at our hospital (50.8%) received remdesivir. Median age was 58 years, 61% were males and 56.9 % received at least one anti-inflammatory treatment. No adverse events requiring remdesivir discontinuation were reported. The need of intensive care unit admission, mechanical ventilation and 30-days mortality were 19.5%, 7.3% and 4.1%, respectively. CONCLUSIONS: In our real-life experience, the use of remdesivir in hospitalized patients with COVID-19 was associated with a low mortality rate and good safety profile.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Inpatients , Adenosine Monophosphate/therapeutic use , Aged , Alanine/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/mortality , Cohort Studies , Dexamethasone/therapeutic use , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Respiration, Artificial/statistics & numerical data , Spain/epidemiology , Treatment Outcome
6.
Revista Iberoamericana De Micologia ; 37(2):41-46, 2020.
Article in English | Web of Science | ID: covidwho-974532

ABSTRACT

Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy. (C) 2020 Asociacion Espanola de Micologia. Published by Elsevier Espana, S.L.U. All rights reserved.

SELECTION OF CITATIONS
SEARCH DETAIL
...