Retrospective study of the effect of vaccination against SARS-CoV-2 in seriously ill patients admitted to an intensive care unit. / Estudio retrospectivo del efecto de la vacunación frente al SARS-CoV-2 en enfermos graves que ingresan en una unidad de cuidados intensivos.

BACKGROUND AND OBJECTIVE: Our study aims to compare the clinical and epidemiological characteristics, length of stay in the ICU, and mortality rates of COVID-19 patients admitted to the ICU who are fully vaccinated, partially vaccinated, or unvaccinated. PATIENTS AND METHODS: Retrospective cohort study (March 2020-March 2022). Patients were classified into unvaccinated, fully vaccinated, and partially vaccinated groups. We initially performed a descriptive analysis of the sample, a multivariable survival analysis adjusting for a Cox regression model, and a 90-day survival analysis using the Kaplan-Meier method for the death time variable. RESULTS: A total of 894 patients were analyzed: 179 with full vaccination, 32 with incomplete vaccination, and 683 were unvaccinated. Vaccinated patients had a lower incidence (10% vs. 21% and 18%) of severe ARDS. The survival curve did not show any differences in the probability of surviving for 90 days among the studied groups (p = 0.898). In the Cox regression analysis, only the need for mechanical ventilation during admission and the value of LDH (per unit of measurement) in the first 24 hours of admission were significantly associated with mortality at 90 days (HR: 5.78; 95% CI: 1.36-24.48); p = 0.01 and HR: 1.01; 95% CI: 1.00-1.02; p = 0.03, respectively. CONCLUSIONS: Patients with severe SARS-CoV-2 disease who are vaccinated against COVID-19 have a lower incidence of severe ARDS and mechanical ventilation than unvaccinated patients.

COVID-19-associated lung weakness (CALW): Systematic review and meta-analysis.

OBJECTIVES: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). DESIGN: Systematic review with meta-analysis. SETTING: Intensive Care Unit (ICU). PARTICIPANTS: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay. INTERVENTIONS: Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD. MAIN VARIABLES OF INTEREST: Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis. RESULTS: Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution. CONCLUSIONS: Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).

Role of statins in clinical evolution of octogenarian patients admitted due to COVID-19. / Papel de las estatinas en la evolución clínica de los pacientes octogenarios ingresados por COVID-19.

INTRODUCTION AND OBJECTIVES: coronavirus disease 2019 (COVID-19) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. MATERIALS AND METHODS: A single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n=129) or not (n=129). RESULTS: In-hospital mortality due to COVID-19 in patients ≥80 years (86.13±4.40) during the first wave was 35.7% (95% CI: 30.1-41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44-0.89]; p=0.008), diabetes (RR 0.61 [0.41-0.92]; p=0.017) and pre-admission treatment with statins (RR 0.58 95% CI [0.41-0.83]; p=0.003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 95% CI [1.04-2.03]; p=0.028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. CONCLUSIONS: In octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.

Multimorbidity and clinical results of a pediatric population with suspected COVID-19 treated in a Mexican hospital / Multimorbilidad y resultados clínicos de una población pediátrica con sospecha de COVID-19 atendida en un hospital mexicano

Resumen Introducción: Datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: El presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.° 1 (HGR C/MF N.° 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: Se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos, 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, 84,7% alcanzaron mejoría y fueron dados de alta, 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2. Conclusiones: Los principales síntomas de la población pediátrica en este estudio fueron fiebre, tos y malestar general. De los niños que fallecieron, 4 presentaron resultado positivo para SARS-CoV-2, no obstante, estos presentaban otras comorbilidades.

Abstract Introduction: Data from several countries around the world suggest that children with COVID-19 may present different and less severe symptoms than adults. However, the epidemiological and clinical patterns in this population group have been unclear. Methods: This is an observational study, with an initial cross-analytical characterization, and with a longitudinal or follow-up component in a group of minors with suspected and or confirmed case of COVID-19, which have outcomes such as improvement, transfer to a higher level of care or death due to respiratory symptoms. The children received medical attention at the Regional General Hospital with Family Medicine No 1 (HGR C / MF No 1), and underwent a Real Time Polymerase Chain Reaction test (RT-PCR). Results: 98 children were studied as suspected cases for COVID-19, who underwent RT-PCR. Of the total 24 were positive and 74 were negatives. The median age was 64.4 months (0 to 203 months), 55 minors were male, 59 children had outpatient management, and of these, 14 had a positive result. Among those who required hospital management (39), 10 children were positive for SARS-CoV-2, 84.7% achieved improvement and were discharged, and four were transferred to a higher level of care hospital. Of the 98 children in the study, 11 died, seven had a negative result and four a positive result for SARS-CoV-2. Conclusions: The main symptoms of the pediatric population in this study were fever, cough and general discomfort. Four of those who died had a positive result for SARS-CoV-2, however, they had other comorbidities.

COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital.

INTRODUCTION: Our work describes the frequency of superinfections in COVID-19 ICU patients and identifies risk factors for its appearance. Second, we evaluated ICU length of stay, in-hospital mortality and analyzed a subgroup of multidrug-resistant microorganisms (MDROs) infections. METHODS: Retrospective study conducted between March and June 2020. Superinfections were defined as appeared ≥48h. Bacterial and fungal infections were included, and sources were ventilator-associated lower respiratory tract infection (VA-LRTI), primary bloodstream infection (BSI), secondary BSI, and urinary tract infection (UTI). We performed a univariate analysis and a multivariate analysis of the risk factors. RESULTS: Two-hundred thirteen patients were included. We documented 174 episodes in 95 (44.6%) patients: 78 VA-LRTI, 66 primary BSI, 9 secondary BSI and 21 UTI. MDROs caused 29.3% of the episodes. The median time from admission to the first episode was 18 days and was longer in MDROs than in non-MDROs (28 vs. 16 days, p<0.01). In multivariate analysis use of corticosteroids (OR 4.9, 95% CI 1.4-16.9, p 0.01), tocilizumab (OR 2.4, 95% CI 1.1-5.9, p 0.03) and broad-spectrum antibiotics within first 7 days of admission (OR 2.5, 95% CI 1.2-5.1, p<0.01) were associated with superinfections. Patients with superinfections presented respect to controls prolonged ICU stay (35 vs. 12 days, p<0.01) but not higher in-hospital mortality (45.3% vs. 39.7%, p 0.13). CONCLUSIONS: Superinfections in ICU patients are frequent in late course of admission. Corticosteroids, tocilizumab, and previous broad-spectrum antibiotics are identified as risk factors for its development.

Influence of meteorological factors on the severity of COVID-19 in Spain: Observational ecological study. / Influencia de los factores meteorológicos en la gravedad de la COVID-19 en España: estudio observacional ecológico.

OBJECTIVES: Evaluating whether meteorological and geographical variables could be associated with the severity of COVID-19 in Spain. METHODS: An ecological study was performed to analyze the influence of meteorological and geographical factors in hospital admissions and deaths due to COVID-19 in the 52 provinces of Spain (24 coastal and 28 inland regions), during the first three pandemic waves. Medical and mortality data were collected from the CarlosIII Health Institute (ISCIII) and meteorological variables were requested to the Spanish State Meteorological Agency (AEMET). RESULTS: Regarding the diagnosed cases it is remarkable that the percentage of patients hospitalized for COVID-19 was lower in the coastal provinces than in the inland ones (8.7±2.6% vs. 11.5±2.6%; P=9.9×10-5). Furthermore, coastal regions registered a lower percentage of mortality than inland regions (2.0±0.6% vs. 3.1±0.8%; P=1.7×10-5). Mean air temperature was inversely correlated both with COVID-19 hospitalizations (Rho: -0.59; P=3.0×10-6) and mortality (Rho: -0.70; P=5.3×10-9). In those provinces with a mean air temperature <10°C mortality by COVID-19 was twice that of those with >16°C. Finally, we found an association between mortality and the location of the province (coastal/inland), altitude, patient age and the average air temperature; the latter was inversely and independently correlated with mortality (non-standardized ß coeff.: -0.24; 95%CI: -0.31 to -0.16; P=2.38×10-8). CONCLUSIONS: The average air temperature was inversely associated with COVID-19 mortality in our country during the first three waves of the pandemic.

COVID-19 and pregnancy. Review and update / COVID-19 and pregnancy. Review and update / COVID-19 y embarazo. Revisión y actualización

RESUMEN Objetivo . Buscar toda la información y evidencia disponible sobre el SARS-CoV-2 -que surgió en estos primeros 4 meses de 2020y el embarazo. Metodología . Revisión sistemática en las bases de datos PubMed y Google Scholar, hasta el 25 de abril de 2020. Se buscó artículos publicados relacionados con mujeres embarazadas infectadas con SARS-CoV-2. No hubo restricción de idioma. La búsqueda se extendió a las referencias de los artículos encontrados. Resultados . La enfermedad COVID-19 en mujeres embarazadas se caracteriza porque más del 90% de las pacientes evoluciona en forma leve, 2% requiere ingresar a las unidades de cuidados intensivos. Una muerte materna ha sido reportada. La prematuridad es alrededor de 25%, con predominio de recién nacidos prematuros tardíos; aproximadamente el 9% se complica con rotura prematura de membranas; la mortalidad perinatal es baja o similar a la de la población general y no se ha demostrado la transmisión vertical. Conclusiones . Los ginecólogos obstetras deben prepararse para atender cada vez más casos con COVID-19 y, por lo tanto, es necesario tener su conocimiento. La enfermedad evoluciona de la misma manera que en las no embarazadas, genera mayor prematuridad, no se ha demostrado la transmisión vertical, pero hay altas posibilidades de transmisión horizontal durante el parto vaginal.

ABSTRACT Objective : To search for all the information and available evidence on infection with SARS-CoV-2, a virus that appeared during the first 4 months of 2020, and pregnancy. Methods : Systematic review in PubMed and Google Scholar databases until April 25, 2020. We searched for published articles related to pregnant women infected with SARS-CoV-2. There was no language restriction. The search was extended to the references of the articles found. Results : In pregnant women with COVID-19, more than 90% of patients evolve mildly, 2% require intensive care. One maternal death has been reported. Prematurity occurs in approximately 25% of the cases, with predominance of late preterm infants; premature rupture of membranes presents in about 9%. Perinatal mortality is lower or similar to that of the general population, and vertical transmission has not been shown. Conclusions : Obstetrician-gynecologists must prepare to attend more cases with COVID-19 and therefore they need to know this disease. COVID-19 progresses similarly in pregnant and non-pregnant women, although it is associated to prematurity. While vertical transmission has not been demonstrated, horizontal transmission during vaginal birth is very likely.

Impact of the COVID-19 pandemic in mortality due to respiratory diseases: A comparative analysis of 2021 and 2020 vs 2019 in Spain.

INTRODUCTION: We previously reported an increase in respiratory mortality in 2020 in Spain after COVID-19. It is unclear if this rise is sustained in the longer-term. We aimed to determine whether respiratory mortality in 2021 in Spain returned to pre-pandemic levels. MATERIAL AND METHODS: In an observational, large study using official National Institute of Statistics data, we explored deaths due to respiratory diseases, that is, all causes of death by the standard WHO list of diseases of the respiratory system plus COVID-19, tuberculosis and lung cancer. Using the latest available official data of Spain, we analyzed changes in the mortality pattern in Spain from January 2019 to December 2021. We endorsed STROBE guidance for observational research. RESULTS: There were 98,714 deaths due to respiratory diseases in 2021 in Spain, corresponding to 21.9% of all deaths, becoming second in the ranking of causes of death. Respiratory diseases mortality in Spain has not returned to pre-pandemic levels in 2021, still with an increase of 30.3% (95% CI 30.2-30.4) compared to rates in 2019. All respiratory-specific causes of death decreased in 2021, except for lung cancer, that increased in women and decreased in men compared to 2019 (both p<0.05). In a multivariate analysis some established risk factors for respiratory diseases mortality were confirmed, such as male gender and older age; further, an association with reduced mortality in rural Spain was observed, still with a large geographical variability. CONCLUSIONS: The COVID-19 pandemic has had a lasting impact on deaths due to respiratory diseases and certain specific causes of death in 2021, and it has disproportionately affected certain regions.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists.

BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Liver injury due to COVID-19 in critically ill adult patients. A retrospective study.

INTRODUCTION AND AIM: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. MATERIALS AND METHODS: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. RESULTS: Gamma glutamyl transferase (GGT) levels were elevated (p = 0.032), as were those of AST (p = 0.011) and ALT (p = 0.021). The patients were stratified into age groups: 18-35, 36-50, and > 50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. CONCLUSIONS: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed.

Influence of influenza vaccine and comorbidity on the evolution of hospitalized COVID-19 patients. / Influencia de la vacunación antigripal y la comorbilidad en la evolución de los pacientes hospitalizados por COVID-19.

BACKGROUND AND OBJECTIVE: The COVID-19 coronavirus disease outbreak is evolving around the world. The aim of this study is to evaluate the association between influenza vaccination and the risk of mortality in hospitalized COVID-19 patients, as well as other risk factors. MATERIALS AND METHODS: Retrospective observational study. This study was conducted among hospitalized patients with COVID-19 at Hospital La Mancha Centro between March 5 and 25, 2020. Information on influenza vaccination was extracted from electronic medical records. We used a multivariate logistic regression to explore the association between influenza vaccination and mortality from COVID and other risk factors. RESULTS: 410 patients were included. Influenza vaccine had no effect among COVID-19 hospitalized patients [OR: 1.55 (95%CI: 0.96 - 2.48; p=0.071)]. Increasing hospital mortality was associated with older age [OR: 1.05 (95% CI 1.02-1.07), per year increase; p<0.001)], Charlson ≥3 [OR: 1.84 (95%CI: 1.07-3.15, p=0.027)] and heart failure on admission [OR: 6 (IC95%: 1.6 - 21.7; p=0.007)] CONCLUSIONS: Influenza vaccine had no effect among COVID-19 hospitalized patients. The risk factors identified were older age, higher comorbidity and heart failure on admission.

Mortality risk factors in patients with SARS-CoV-2 infection and atrial fibrillation: Data from the SEMI-COVID-19 registry. / Factores de riesgo de mortalidad en pacientes con infección por SARS-CoV-2 y fibrilación auricular: datos del registro SEMI-COVID-19.

INTRODUCTION: Atrial fibrillation and associated comorbidities pose a risk factor for mortality, morbidity and development of complications in patients admitted for COVID-19. OBJECTIVES: To describe the clinical, epidemiological, radiological and analytical characteristics of patients with atrial fibrillation admitted for COVID-19 in Spain. Secondarily, we aim to identify those variables associated with mortality and poor prognosis of COVID-19 in patients with atrial fibrillation. METHODS: Retrospective, observational, multicenter, nationwide, retrospective study of patients hospitalized for COVID-19 from March 1 to October 1, 2020. Data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) in which 150 Spanish hospitals participate. RESULTS: Between March 1 and October 1, 2020, data from a total of 16,461 patients were entered into the SEMI-COVID-19 registry. 1816 (11%) had a history of atrial fibrillation and the number of deaths among AF patients amounted to 738 (41%). Regarding clinical characteristics, deceased patients were admitted with a higher heart rate (88.38 vs. 84.95; P>0.01), with a higher percentage of respiratory failure (67.2 vs. 20.1%; P<0.01) and high tachypnea (58 vs. 30%; P<0.01). The comorbidities that presented statistically significant differences in the deceased group were: age, hypertension and diabetes with target organ involvement. There was also a higher prevalence of a history of cardiovascular disease in the deceased. On multivariate analysis, DOACs treatment had a protective role for mortality (OR: 0.597; CI: 0.402-0.888; P=0.011). CONCLUSIONS: Previous treatment with DOACs and DOACs treatment during admission seem to have a protective role in patients with atrial fibrillation, although this fact should be verified in prospective studies.

Timeline analysis of IgA and IgG levels in Covid-19 hospitalized patients according to the clinical outcome / Análise temporal das concentrações de IgA e IgG em pacientes hospitalizados com Covid-19 de acordo com o desfecho clínico

ABSTRACT Introduction: Studies suggest the association between antibody production and the severity of coronavirus disease 2019 (Covid-19). Objectives: To evaluate the concentrations of immunoglobulins class A (IgA) and class G (IgG) during the hospitalization period of Covid-19 patients according to the outcome (survival vs death). Materials and methods: Patients with severe acute respiratory syndrome of coronavirus 2 (Sars-CoV-2) infection confirmed by reverse transcriptase reaction followed by polymerase chain reaction (RT-PCR) were included in this prospective study. Samples were obtained weekly during the follow-up of individuals, considering symptom onset. Titers of anti-Sars-CoV-2 IgA and IgG were measured using a commercial immunoassay. Correlations between IgA/IgG and cycle threshold (Ct) values for N1 and N2 target genes were also assessed. Results: We studied 55 Covid-19 patients (59.7±16.2 years, 63.6% male), of which 28 (50.9%) died. We observed IgA and IgG positivity (IgA+ and IgG+) in 90.9% and 80% of patients, respectively. The highest IgA+ frequency was observed at weeks 2 and 3 and the highest IgG+ at weeks 3 and 4. It is important to note that patients who died presented lower IgA titers in the first two weeks (p < 0.05); however, a significant increase in IgA levels was observed in the subsequent weeks. Lastly, we identified that significant correlations between Ct values and immunoglobulins levels, both IgA and IgG were correlated with Ct N2 in patients who died. Conclusion: Our results suggest that lower IgA titers in early Covid-19, which is associated with lower Ct values, may indicate patients at higher risk for death.

RESUMEN Introducción: Los estudios sugieren una asociación entre la producción de anticuerpos y la gravedad de la enfermedad por coronavirus 2019 (Covid-19). Objetivos: Evaluar las concentraciones de inmunoglobulinas clase A (IgA) y clase G (IgG) durante la hospitalización de pacientes con Covid-19 según el desenlace (supervivencia vs muerte). Materiales y métodos: Se incluyeron en este estudio prospectivo pacientes con síndrome respiratorio agudo severo de infección por coronavirus 2 (Sars-CoV-2) confirmado por la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Las muestras se obtuvieron semanalmente durante el seguimiento de los individuos, considerando la aparición de los síntomas. Los títulos de IgA e IgG anti-Sars-CoV-2 se midieron usando un inmunoensayo comercial. También se evaluaron las correlaciones entre IgA/IgG y los valores de los umbrales de ciclo [cycle threshold (Ct)] para los genes N1 y N2. Resultados: Se estudiaron 55 pacientes Covid-19 (59,7 ± 16,2 años, 63,6% varones), de los cuales 28 (50,9%) fallecieron. Observamos positividad de IgA e IgG (IgA+ e IgG+) en el 90,9% y el 80% de los pacientes, respectivamente. La frecuencia más alta de IgA+ se observó en las semanas dos y tres y la IgG + más alta en las semanas tres y cuatro. Es importante señalar que los pacientes que fallecieron presentaron títulos de IgA más bajos en las dos primeras semanas (p < 0,05); sin embargo, se observó un aumento significativo en los niveles de IgA en las semanas siguientes. Conclusión: Identificamos correlaciones significativas entre los valores de Ct y los niveles de Ig, tanto IgA como IgG se correlacionaron con Ct N2 en los pacientes que fallecieron. Nuestros resultados sugieren que los títulos de IgA más bajos en Covid-19 temprano, que se asocia con valores de Ct más bajos, pueden indicar que los pacientes tienen un mayor riesgo de muerte.

RESUMO Introdução: Estudos sugerem a associação entre a produção de anticorpos e a gravidade da coronavirus disease 2019 (Covid-19). Objetivos: Avaliar as concentrações de imunoglobulinas da classe A (IgA) e da classe G (IgG) durante a internação de pacientes com Covid-19 de acordo com o desfecho (sobrevida vs óbito). Materiais e métodos: Pacientes com infecção pela síndrome respiratória aguda grave do coronavírus 2 (Sars-CoV-2) confirmada por reação da transcriptase reversa seguida de reação em cadeia da polimerase (RT-PCR) foram incluídos neste estudo prospectivo. As amostras foram obtidas semanalmente durante o acompanhamento dos indivíduos, considerando o início dos sintomas. Os títulos de IgA e IgG anti-Sars-CoV-2 foram mensurados por meio de um imunoensaio comercial. Correlações entre IgA/IgG e valores de limiar de detecção [cycle thresholds (Ct)] para os genes alvos N1 e N2 também foram avaliadas. Resultados: Estudamos 55 pacientes com Covid-19 (59,7 ± 6,2 anos; 63,6% do sexo masculino); destes, 28 (50,9%) morreram. Observamos positividade para IgA e IgG (IgA+/IgG+) em 90,9% e 80% dos pacientes, respectivamente. A maior frequência de IgA+ foi verificada nas semanas 2 e 3, e a maior frequência de IgG+, nas semanas 3 e 4. É importante observar que os pacientes que morreram apresentaram títulos de IgA mais baixos nas primeiras duas semanas (p < 0,05); no entanto, um aumento significativo na concentração de IgA foi observado nas semanas subsequentes. Por fim, identificamos correlações significativas entre os valores de Ct e imunoglobulinas; tanto IgA quanto IgG foram correlacionadas com Ct N2 em pacientes que morreram. Conclusão: Nossos resultados sugerem que títulos mais baixos de IgA no início da Covid-19 - que estão associados a valores mais baixos de Ct - podem indicar pacientes com risco elevado de evoluir para óbito.

The role of corticosteroids in patients hospitalized for COVID-19 at Mexico general Hospital.

OBJECTIVE: To compare the evolution of hospitalized patients infected with SARS-CoV-2 who received corticosteroid-based treatment versus patients who received standard therapy. METHOD: Retrospective, observational, and analytical study. Clinical records were collected from the different intensive care units, and data were obtained from confirmed COVID-19 patients over 18 years of age who were hospitalized. The population was divided into two groups: patients who received corticosteroid treatment, and those who received standard therapy. RESULTS: A total of 1603 patients were admitted to hospital, and of these 984 (62.9%) were discharged due to death. The main result was the identification by odds ratio (OR: 4.68; 95% confidence interval [95% CI]: 3.75-5.83; p = 0.001) as risk for death to the use of systemic steroids, as well as the use of invasive mechanical ventilation (OR: 2.26; 95% CI: 1.80-2.82; p < 0.001). The male gender was the most affected with 1051 (65.6%) patients. Mean age was 56 years (± 14). CONCLUSIONS: Corticosteroid use was associated with poor prognosis in patients hospitalized for COVID-19 compared to those receiving standard therapy.

OBJETIVO: Comparar la evolución de los pacientes hospitalizados infectados por SARS-CoV-2 que recibieron tratamiento a base de corticoesteroides frente a los pacientes que recibieron la terapia estándar. MÉTODO: Estudio de tipo retrospectivo, observacional y analítico. Se recolectaron los expedientes clínicos de las diferentes unidades de terapia intensiva y se obtuvieron datos de los pacientes confirmados de COVID-19, mayores de 18 años, que estuvieron hospitalizados. Se dividió la población en dos grupos: pacientes que recibieron tratamiento con corticoesteroides y pacientes que recibieron terapia estándar. RESULTADOS: De un total de 1603 pacientes ingresados a hospitalización, 984 (62.9%) fallecieron. El resultado principal fue la identificación mediante razón de momios (odds ratio [OR]: 4.68; intervalo de confianza del 95% [IC95%]: 3.75-5.83; p = 0.001) como riesgo para defunción con uso de esteroides sistémicos, así como con uso de ventilación mecánica invasiva (OR: 2.26; IC95%: 1.80-2.82; p < 0.001). El sexo masculino fue el más afectado, con 1051 (65.6%) pacientes. La media de edad fue de 56 años (± 14). CONCLUSIONES: El uso de corticoesteroides se asoció con mal pronóstico en los pacientes hospitalizados por COVID-19, en comparación con los que recibieron la terapia estándar.

Effect of Parenteral Corticosteroids in Mortality from Severe Covid-19 / Efecto de los Corticoides Parenterales en la Mortalidad por Covid-19 Severo

Introducción. La infección causada por el SARS-CoV-2 puede producir un cuadro inflamatorio severo, sepsis, falla respiratoria, disfunción orgánica, y muerte. Es plausible fisiopatológicamente, que los corticoides sean una opción terapéutica razonable para Covid-19. Sin embargo, la evidencia del efecto benéfico de los corticoides sobre la mortalidad no es categórica. Objetivo: determinar si existe evidencia que avale el uso de corticoides parenterales en Covid-19 grave y Síndrome de Distrés Respiratorio Agudo (SDRA). Material y método: Este estudio se desarrolló en concordancia con la guía PRIMA. Según la estrategia PICO, nuestra Población fueron los pacientes con Covid-19 grave y/o SRDA; la Intervención, el uso de corticoides parenterales; el Comparador, los pacientes con Covid-19 severo con tratamiento estándar (sin corticoides); y el Outcome, la mortalidad y otros resultados clínicos. La búsqueda se realizó en las bases de datos PubMed, Medline, Cochrane, Embase, y LILACS usando los términos relacionados con nuestra pregunta PICO, entre el de 01 enero al 31 de agosto del 2020. Se logró recopilar un total de 287 artículos, de los que finalmente se seleccionaron 9 que cumplieron con los criterios PICO y de selección. Resultados: Según nuestro estudio, los corticoides parenterales reducen la mortalidad en pacientes con Covid-19 severo y SRDA[OR 0.83 (IC 95% 0.63-1.08)]. Conclusión: la revisión sistemática muestra que los corticoides parenterales podrían disminuir la mortalidad de pacientes con Covid-19 severo y ARDS.

Introduction. Infections caused by SARS-CoV-2 may produce a severe inflammatory response,sepsis, respiratory failure, organ dysfunction, and death. From a pathophysiological point of view, it is plausible that glucocorticoids could be a reasonable therapeutic option for Covid-19. However, the evidence supporting the benefit of corticosteroids on mortality and other clinical outcomes is no tconclusive. Objective: determinate if there exist evidence supporting corticosteroids therapy in patients with severe Covid-19 and Acute Respiratory Distress Syndrome (ARDS). Material and method: This study was performed in concordance with PRISMA guidelines. According to the PICO strategy, Population were patients with severe Covid-19 and/or ARDS; Intervention, parenteral corticosteroid administration; Comparator, patients with severe Covid-19 and/or ARDS with standard treatment (without corticosteroids); and Outcome, mortality and other clinical outcomes. Search strategy was performed in the data bases PubMed, Medline, Cochrane, Embase, and LILACS, using terms related with the PICO question; from January 1 to august 31 (2020). A total of 287 articles were initially retrieved. Of these, we finally selected only 9 article which fulfilled with PICO and selection criteria. Results: According to our study, parenteral corticosteroids reduce mortality in patients with Severe Covid-19 and/or ARDS [OR 0.83 (IC 95% 0.63-1.08)]. Conclusion: the systematic review shows that parenteral corticosteroids could reduce the mortality of patients with severe Covid-19 and ARDS.

Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort.

OBJECTIVES: Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. METHODS: Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. RESULTS: From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS>15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR]=3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR=1.303, CI 1.137-1.493), and with 28-days mortality (OR=1.024, CI 1.006-1.042). LUS>15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS≤7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS>20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917). CONCLUSIONS: LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS≤7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS>15 would be the point which better discriminates mild from severe disease.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. METHODS: 93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. RESULTS: CKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. CONCLUSION: We report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.

Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19.

INTRODUCTION: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with Covid-19. OBJECTIVE: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with Acute Respiratory Distress Syndrome and clinical trial of Covid-19 treated in intensive care units. METHODOLOGY: A systematized bibliographic review was carried out in the Pubmed, Cuiden, Lilacs, Medline, Cinahl and Google Scholar databases, using MeSH terms (Adult Respiratory Distress Syndrome, Mechanical Ventilation, Prone Position, Nitric Oxide, Extracorporeal Membrane Oxygenation, Nursing Care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. RESULTS: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and 1 cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is ECMO, with the care provided by qualified and trained nursing staff being very important. CONCLUSION: Mortality from Covid-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.

Trends in COVID-19-related in-hospital mortality in women and men.

INTRODUCTION: Whether political, scientific and medical development in a country is associated with better clinical results according to gender in patients with COVID-19 has not yet been clearly elucidated. OBJECTIVE: To determine the trends of COVID-19-related in-hospital mortality in women and men from March 2020 to February 2022. METHODS: Clinical data of all patients with COVID-19 cared for at 21 Spanish hospitals were used, both of those who were discharged and of those who died during hospitalization. The association between hospital length of stay and mortality was analyzed with logistic regression models. RESULTS: Out of 7,974 patients that were included, 3,234 were women; 928 patients died. A significant decreasing trend in mortality was identified. When the analysis was carried out by gender, no significant mortality trend was found in women (OR = 0.96 [0.90-1.03], p = 0.239), while in men there was a significant decreasing trend identified (OR = 0.87 [0.82-0.92], p < 0.001). CONCLUSION: Health policies, together with clinical and preventive interventions, may explain these results. Response to treatment and behavioral differences may explain why mortality does not decrease for women.

INTRODUCCIÓN: Todavía no se comprende si el desarrollo político, científico y médico en un país se asocia a mejores resultados clínicos de los pacientes con COVID-19 según el sexo. OBJETIVO: Determinar las tendencias de mortalidad hospitalaria asociada a COVID-19 en mujeres y hombres entre marzo de 2020 y febrero de 2022. MÉTODOS: Se utilizaron los datos clínicos de todos los pacientes con COVID-19 atendidos en 21 hospitales españoles, tanto de quienes fueron dados de alta como de quienes fallecieron durante el ingreso. La asociación entre la fecha del ingreso y la mortalidad se analizó con modelos de regresión logística. RESULTADOS: Fueron incluidos 7974 pacientes, de los cuales 3234 fueron mujeres y 928 fallecieron. Se encontró una tendencia significativa y decreciente en la mortalidad según avanzaba la fecha del ingreso. Cuando el análisis se realizó por sexos, no se halló una tendencia significativa en las mujeres (RM = 0.96 [0.90-1.03], p = 0.239), pero sí en los hombres (RM = 0.87 [0.82-0.92], p < 0.001). CONCLUSIÓN: Las políticas de salud, junto con las intervenciones clínicas y preventivas, pueden dar cuenta de los resultados. Diferencias en la respuesta al tratamiento o en los comportamientos pueden explicar por qué la mortalidad no disminuye en las mujeres.

Factors associated with mortality in critically ill patients with COVID-19 / Fatores associados à mortalidade em pacientes críticos com COVID-19 / Factores asociados a la mortalidad en pacientes críticos con COVID-19

Background and objectives: COVID-19 is a life-threatening disease. Recognizing the main characteristics of the disease and its main complications will help future interventions, care, and management of health services since territorial and population diversities directly influence health outcomes. Our main objective is to describe the clinical characteristics, outcomes, and factors associated with mortality of patients with COVID-19 admitted to the intensive care unit of a public and tertiary hospital. Methods: Cohort study, conducted from March 1 to September 30, 2020. Poisson regression was performed to investigate the variables of hospital treatment as potential risk factors for in-hospital mortality. Results: Of the 283 eligible patients in this study, the hospital mortality rate was of 41.7% (n=118). The most common outcomes were acute respiratory distress syndrome, nosocomial infection, and septic shock. Factors independently associated with increased risk of death were age greater than 51 years old (RR=1.7, 95%CI=1.0-2.8), especially over 70 years old (RR=2.9, 95%CI=1.7-2.8), current smoker (RR=1.8, 95%CI=1.1-2.9), requiring the use of inotrope (RR=1.4, 95%CI=1.0-2.0), and presenting potassium greater than 5.0 mEq/l on admission (RR=1.3, 95%CI=1.0-1.7). Conclusion: Mortality was associated with older age, being a current smoker, inotrope use, and presenting potassium greater than 5.0 on hospital admission.(AU)

Justificativa e objetivos: A COVID-19 é uma doença ameaçadora à vida. Reconhecer as características da doença e suas principais complicações nesta população auxiliará em futuras intervenções, cuidados e gestão dos serviços de saúde, uma vez que a diversidade territorial e populacional influencia diretamente nos resultados de saúde. O objetivo principal do presente estudo é descrever as características clínicas, desfechos e fatores associados à mortalidade de pacientes com COVID-19 internados na unidade de terapia intensiva de um hospital público e terciário. Métodos: Estudo de coorte, realizado de 1º de março a 30 de setembro de 2020. Foi realizada regressão de Poisson para investigar variáveis de apresentação hospitalar como potenciais fatores de risco para mortalidade intra-hospitalar. Resultados: Dos 283 pacientes elegíveis neste estudo, o dado de mortalidade hospitalar foi de 41,7% (n=118). Os desfechos mais comuns foram síndrome do desconforto respiratório agudo, infecção hospitalar e choque séptico. Os fatores independentemente associados ao aumento do risco de morte foram idade superior a 51 anos (RR=1,7, IC 95%=1,0-2,8), principalmente acima de 70 anos (RR=2,9, IC 95%=1,7-2,8), tabagismo atual (RR=1,8, IC 95%=1,1-2,9), necessidade de inotrópico (RR=1,4, IC 95%=1,0-2,0) e potássio maior que 5,0 mEq/l (RR=1,3, IC 95%=1,0- 1.7) na admissão. Conclusão: A mortalidade esteve associada à idade avançada, tabagismo atual, uso de inotrópicos e potássio maior que 5,0 na admissão hospitalar.(AU)

Justificación y objetivos: La COVID-19 es una enfermedad potencialmente mortal. Reconocer las características de la enfermedad y sus principales complicaciones en esta población ayudará a futuras intervenciones, atención y gestión de los servicios de salud, ya que las diversidades territoriales y poblacionales influyen directamente en los resultados de salud. El objetivo principal de este estudio es describir las características clínicas, los resultados y los factores asociados a la mortalidad de los pacientes con COVID-19 ingresados en la unidad de cuidados intensivos de un hospital público y de tercer nivel. Métodos: Estudio de cohorte, realizado del 1 de marzo al 30 de septiembre de 2020. Se realizó regresión de Poisson para investigar variables en la presentación hospitalaria como potenciales factores de riesgo para la mortalidad intrahospitalaria. Resultados: De los 283 pacientes elegibles en este estudio, el 41,7% (n=118) tuvo mortalidad hospitalaria. Los desenlaces más comunes fueron síndrome de dificultad respiratoria aguda, infección nosocomial y shock séptico. Los factores independientemente asociados a mayor riesgo de muerte fueron edad mayor de 51 años (RR=1,7, IC95%=1,0-2,8), especialmente mayores de 70 años (RR=2,9, IC95%=1,7-2,8), tabaquismo actual (RR=1,8, IC95%=1,1-2,9), necesidad de inotrópico (RR=1,4, IC95%=1,0-2,0) y potasio mayor que 5,0 mEq/l (RR=1,3, IC95%=1,0-1,7). Conclusión: La mortalidad estuvo asociada a la edad avanzada, tabaquismo actual, uso de inotrópico y potasio mayor a 5,0 en la admisión hospitalaria.(AU)