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1.
J Clin Transl Res ; 9(2): 59-68, 2023 Apr 28.
Artículo en Inglés | MEDLINE | ID: covidwho-2295154

RESUMEN

Background and Aim: We aimed to develop a clinical prediction model for pulmonary thrombosis (PT) diagnosis in hospitalized COVID-19 patients. Methods: Non-intensive care unit hospitalized COVID-19 patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected PT were included in the study. Demographic, clinical, analytical, and radiological variables as potential factors associated with the presence of PT were selected. Multivariable Cox regression analysis to develop a score for estimating the pre-test probability of PT was performed. The score was internally validated by bootstrap analysis. Results: Among the 271 patients who underwent a CTPA, 132 patients (48.7%) had PT. Heart rate >100 bpm (OR = 4.63 [95% CI: 2.30-9.34]; P < 0.001), respiratory rate >22 bpm (OR = 5.21 [95% CI: 2.00-13.54]; P < 0.001), RALE score ≥4 (OR = 3.24 [95% CI: 1.66-6.32]; P < 0.001), C-reactive protein (CRP) >100 mg/L (OR = 2.10 [95% CI: 0.95-4.63]; P = 0.067), and D-dimer >3.000 ng/mL (OR = 6.86 [95% CI: 3.54-13.28]; P < 0.001) at the time of suspected PT were independent predictors of thrombosis. Using these variables, we constructed a nomogram (CRP, Heart rate, D-dimer, RALE score, and respiratory rate [CHEDDAR score]) for estimating the pre-test probability of PT. The score showed a high predictive accuracy (area under the receiver-operating characteristics curve = 0.877; 95% CI: 0.83-0.92). A score lower than 182 points on the nomogram confers a low probability for PT with a negative predictive value of 92%. Conclusions: CHEDDAR score can be used to estimate the pre-test probability of PT in hospitalized COVID-19 patients outside the intensive care unit. Relevance for Patients: Developing a new clinical prediction model for PT diagnosis in COVID-19 may help in the triage of patients, and limit unnecessary exposure to radiation and the risk of nephrotoxicity due to iodinated contrast.

3.
Rev Clin Esp ; 2022 Aug 05.
Artículo en Español | MEDLINE | ID: covidwho-2230078

RESUMEN

BACKGROUND AND OBJECTIVE: Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. METHODS: A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. RESULTS: Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000 ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. CONCLUSIONS: Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.

4.
Med Clin (Engl Ed) ; 160(3): 137-138, 2023 Feb 10.
Artículo en Inglés | MEDLINE | ID: covidwho-2165697
5.
Revista clinica espanola ; 2022.
Artículo en Español | EuropePMC | ID: covidwho-1980491

RESUMEN

Antecedentes y objetivo: Las escalas de predicción clínica para embolia de pulmón (EP) determinan la probabilidad pretest y valoran la necesidad de las pruebas para estos pacientes. La infección por coronavirus se asocia a un mayor riesgo de EP aumentando su gravedad y confiriendo un peor pronóstico. La patogénesis de la EP parece ser diferente en pacientes con y sin infección por SARS-CoV-2. Esta revisión sistemática pretende conocer, revisando la bibliografía disponible, la utilidad de los modelos predictivos desarrollados para EP en pacientes con COVID-19. Métodos: Se realizó una búsqueda bibliográfica en las bases de datos de PubMed, Scopus y EMBASE, incluyendo todos los estudios que comunican datos relacionados con la aplicación de escalas de predicción clínica para EP en pacientes con COVID-19. La calidad de los estudios se evaluó con la escala Newcastle-Ottawa para estudios no aleatorizados. Resultados: Se incluyeron 13 estudios de cohortes que evaluaron cinco modelos predictivos (escala de Wells, puntuación de Ginebra, algoritmo YEARS y las reglas de decisión clínica PERC y PEGeD). Las diversas escalas se aplicaron en 1.187 pacientes con COVID-19. En general, los modelos tuvieron una capacidad predictiva limitada. La escala de Wells de dos categorías con probabilidad clínica baja (o improbable) en combinación con un dímero D <3000 ng/mL o con una ecografía pulmonar a pie de cama normal mostraron una adecuada correlación para excluir la EP. Conclusión: Nuestra revisión sistemática sugiere que las escalas de predicción disponibles para EP desarrolladas en población general no son aplicables a los pacientes con COVID-19 por lo que, de momento, no se recomienda su uso en la práctica clínica como única herramienta de cribado diagnóstico. Se necesitan nuevas escalas de probabilidad clínica para EP validadas en estos pacientes.

6.
J Gerontol A Biol Sci Med Sci ; 76(8): e127-e132, 2021 07 13.
Artículo en Inglés | MEDLINE | ID: covidwho-1132488

RESUMEN

BACKGROUND: The most susceptible population group to critical and fatal coronavirus disease 2019 (COVID-19) is older adults. In severe acute respiratory syndrome coronavirus 2 infection, the host immune response is thought to play a key role in the pathophysiological effects of lung damage. Therefore, corticosteroid therapy could modulate inflammation-mediated pulmonary injury and thereby reduce progression to severe respiratory failure and death. The aim of this study was to analyze the safety and clinical efficacy of corticosteroid therapy in older adults with severe COVID-19 pneumonia. METHOD: We reviewed the clinical records of confirmed COVID-19 patients aged 75 years or older admitted to our hospital over a 3-month period (March 1-May 31, 2020). A total of 143 patients were included in the study cohort. From 2 April, 2020, in accordance with World Health Organization guidance on COVID-19, our hospital protocol added corticosteroid for COVID-19 treatment. We compared in-hospital mortality among patients with critical COVID-19 who received corticosteroids therapy and those who did not. RESULTS: In total, 88 patients (61.5%) were treated with corticosteroids, and 55 patients (38.4%) were not. Both groups were similar in baseline characteristics. The median age was 85 years (interquartile range: 82-89), and 61.5% (88/143) were male. In-hospital mortality was lower in the corticosteroid group (68.2%) compared with patients in the noncorticosteroid group (81.8%). Treatment with corticosteroids was an independent survival factor (hazard ratio: 0.61; 95% CI: 0.41-0.93; p = .006). CONCLUSIONS: In critically ill older adults with COVID-19 pneumonia, the use of corticosteroid treatment resulted in lower mortality without severe adverse events.


Asunto(s)
Corticoesteroides/uso terapéutico , Tratamiento Farmacológico de COVID-19 , Mortalidad Hospitalaria/tendencias , Hospitalización , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Insuficiencia Respiratoria/fisiopatología , Estudios Retrospectivos , SARS-CoV-2
7.
J Ultrasound Med ; 40(7): 1411-1416, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-813317

RESUMEN

OBJECTIVES: Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE. METHODS: In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound. RESULTS: The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 µg/dL (interquartile range, 80,000-1210 µg/dL) versus 5310 µg/dL (P < .05). CONCLUSIONS: Our study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.


Asunto(s)
COVID-19 , Embolia Pulmonar , Trombosis , Trombosis de la Vena , Femenino , Humanos , Incidencia , Inflamación , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/epidemiología , Factores de Riesgo , SARS-CoV-2 , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología
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