SeDREno study - prevalence of hospital malnutrition according to GLIM criteria, ten years after the PREDyCES study.

INTRODUCTION: Background & aims: the last large multicenter study on disease-related malnutrition (DRM) in Spain (the PREDyCES study) showed a 23.7 % prevalence of malnutrition, according to the Nutritional Risk Screening (NRS-2002) tool. The main objective of the SeDREno study was to assess the prevalence of hospital malnutrition upon admission, according to GLIM criteria, ten years later. Methods: a cross-sectional, observational, multicenter study in standard clinical practice, conducted in 17 hospitals during a period of five to seven days. Patients were initially screened using the Malnutrition Universal Screening Tool (MUST), and then assessed using the GLIM criteria for diagnosis and severity grading. Results: a total of 2,185 patients, 54.8 % males, mean age 67.1 (17.0) years (50.2 % aged ≥ 70 years), were evaluated. Malnutrition was observed in 29.7 % of patients according to GLIM criteria (12.5 % severe, 17.2 % moderate). In patients ≥ 70 years malnutrition was observed in 34.8 %. The clinical conditions significantly associated with a higher prevalence of malnutrition were dysphagia (47.6 %), cognitive impairment (43.4 %), cancer (39.1 %), gastrointestinal disease (37.7 %), diabetes (34.8 %), and cardiovascular disease (33.4 %). The multivariate analysis revealed that gender, BMI, diabetes, cancer, gastrointestinal disorders, and polypharmacy were the main independent factors associated with DRM. Malnutrition was associated with an increase in length of hospital stay and death (p < 0.001). Conclusions: DRM in admitted patients has increased in Spain in the last 10 years paralleling ageing of the population. In the SeDREno study almost one in three patients are malnourished. A systematic assessment of nutritional status allows early detection and implementation of nutritional interventions to achieve a better clinical outcome.

INTRODUCCIÓN: Antecedentes y objetivos: el último gran estudio multicéntrico sobre desnutrición relacionada con la enfermedad (DRE) en España (el estudio PREDyCES) mostró una prevalencia de desnutrición del 23,7 % según la herramienta Nutritional Risk Screening (NRS-2002). El principal objetivo del estudio SeDREno fue evaluar la prevalencia de la desnutrición hospitalaria al ingreso según los criterios GLIM diez años después. Métodos: estudio transversal, observacional, multicéntrico, según la práctica clínica estándar, realizado en 17 hospitales durante un período de cinco a siete días. Los pacientes fueron evaluados inicialmente con la herramienta de detección universal de desnutrición (MUST) y luego con los criterios GLIM para el diagnóstico de DRE y la clasificación de la gravedad. Resultados: se evaluaron 2185 pacientes, con un 54,8 % de varones una edad media de 67,1 (17,0) años (50,2 % ≥ 70 años). Se observó desnutrición en el 29,7 % de los pacientes según los criterios GLIM (12,5 % grave, 17,2 % moderada). Entre los pacientes ≥ 70 años se observó desnutrición en el 34,8 %. Las condiciones clínicas asociadas significativamente con una mayor prevalencia de desnutrición fueron la disfagia (47,6 %), el deterioro cognitivo (43,4 %), el cáncer (39,1 %), las enfermedades gastrointestinales (37,7 %), la diabetes (34,8 %) y la patología cardiovascular (33,4 %). El análisis multivariante reveló que el sexo, el IMC, la diabetes, el cáncer, los trastornos gastrointestinales y la polimedicación eran los principales factores independientes asociados a la DRE. La desnutrición se asoció a un aumento de la duración de la estancia hospitalaria y la muerte (p < 0,001). Conclusiones: la DRE en pacientes ingresados ha aumentado en España en los últimos 10 años en paralelo con el aumento del envejecimiento de la población. En el estudio SeDREno, casi uno de cada tres pacientes está desnutrido. La evaluación sistemática del estado nutricional permite la detección e implementación precoces de intervenciones nutricionales para lograr un mejor resultado clínico.

Efecto de la aplicación del programa Patient blood management en el abordaje de las artroplastias de cadera y rodilla programada / Effect of the application of the "Patient blood management" programme on the approach to elective hip and knee arthroplasties

ANTECEDENTES Y OBJETIVOS: Los programas de Patient blood management (PBM) han demostrado su valor en la mejora continua de la práctica asistencial, gracias a la revisión sistemática de resultados y a su actualización dinámica y multidisciplinar, de acuerdo con las nuevas evidencias clínicas. Nuestro objetivo es demostrar la efectividad y seguridad de protocolos sencillos, aplicables en hospitales de segundo nivel. PACIENTES Y MÉTODOS: Se han analizado retrospectivamente 702 pacientes intervenidos de artroplastia programada desde 2011 hasta 2018. Durante este periodo se ha registrado en la historia clínica de los pacientes la evolución transfusional y el manejo de la anemia y el sangrado. RESULTADOS: Fases y tasas de transfusión: año 2011-2012 «Programa autodonación universal»: 62,4%; año 2013 «inicio optimización de hemoglobina preoperatoria y retirada autodonación universal» 22,5%; año 2015 «suspensión del uso de recuperadores y los drenajes» 13,2%; y año 2017 «inicio de uso de ácido tranexámico (ATX)» 3,6%. Se ha conseguido una reducción significativa de la tasa y el número de concentrados de hematíes transfundidos (p < 0,001) y de la estancia media hospitalaria (de 8 a 6 días) (p < 0,001). En los modelos multivariantes los pacientes transfundidos tienen 0,5 días más de estancia y se observa una tendencia a la reducción en complicaciones, siendo menores en los pacientes que reciben ATX (OR 0,44). CONCLUSIÓN: Un programa PBM sencillo, progresivo y multidisciplinar, con reevaluación continuada, ha permitido reducir la transfusión y la estancia media hospitalaria en un hospital de segundo nivel

BACKGROUND AND OBJECTIVES: The "Patient Blood Management" (PBM) programmes have demonstrated their value in the continuous improvement of care practice, due to continuous systematic reviewing of results and their dynamic and multidisciplinary updating in accordance with new clinical evidence. Our goal is to demonstrate the effectiveness of simple protocols, applicable in second level hospitals. PATIENTS AND METHODS: 702 patients undergoing scheduled arthroplasty from 2011 to 2018 were retrospectively analysed. During this period, the evolution of transfusion rates and anaemia and bleeding management were recorded in the patients' computerised clinical histories. RESULTS: Stages and transfusion rates were: Year 2011-2012, "Universal self-donation programme": 62.4%; year 2013, "Optimization of preoperative haemoglobin and universal self-donation withdrawal", 22.5%; year 2015, "Stopping the use of cell-savers and drains", 13.2%; and year 2017, "Introduction of routine tranexamic acid", 3.6%. A significant reduction in the transfusion rate and volume (P<.001) and the average hospital stay (8 to 6 days) (P<.001) was achieved. In multivariate models, transfused patients have a .5-day stay and there is a trend towards a reduction in complications, being fewer in patients receiving tranexamic acid (OR .44). CONCLUSION: A simple progressive and multidisciplinary PBM programme, with continued re-evaluation, has allowed a reduction in transfusion rates and average hospital stay

Effect of the application of the "Patient blood management" programme on the approach to elective hip and knee arthroplasties. / Efecto de la aplicación del programa Patient blood management en el abordaje de las artroplastias de cadera y rodilla programada.

BACKGROUND AND OBJECTIVES: The "Patient Blood Management" (PBM) programmes have demonstrated their value in the continuous improvement of care practice, due to continuous systematic reviewing of results and their dynamic and multidisciplinary updating in accordance with new clinical evidence. Our goal is to demonstrate the effectiveness of simple protocols, applicable in second level hospitals. PATIENTS AND METHODS: 702 patients undergoing scheduled arthroplasty from 2011 to 2018 were retrospectively analysed. During this period, the evolution of transfusion rates and anaemia and bleeding management were recorded in the patients' computerised clinical histories. RESULTS: Stages and transfusion rates were: Year 2011-2012, "Universal self-donation programme": 62.4%; year 2013, "Optimization of preoperative haemoglobin and universal self-donation withdrawal", 22.5%; year 2015, "Stopping the use of cell-savers and drains", 13.2%; and year 2017, "Introduction of routine tranexamic acid", 3.6%. A significant reduction in the transfusion rate and volume (P<.001) and the average hospital stay (8 to 6 days) (P<.001) was achieved. In multivariate models, transfused patients have a .5-day stay and there is a trend towards a reduction in complications, being fewer in patients receiving tranexamic acid (OR .44). CONCLUSION: A simple progressive and multidisciplinary PBM programme, with continued re-evaluation, has allowed a reduction in transfusion rates and average hospital stay.

N-terminal pro-B-type natriuretic peptide predicts the burden of pulmonary embolism.

BACKGROUND: In acute pulmonary embolism (PE), brain natriuretic peptides are markers of right ventricular dysfunction and they could point out the size of the occluded pulmonary vessel. METHODS: N-terminal pro-B-type natriuretic peptide (BNP) was measured in 93 consecutive outpatients diagnosed with acute PE by means of helical computed tomography. Central PE was diagnosed when thrombotic material was seen in the main trunk or right or left main branches of the pulmonary artery, and peripheral PE was diagnosed when thrombi were seen exclusively in segmental or subsegmental arteries. RESULTS: Central PE occurred in 51 (55%) patients and peripheral PE in 42 (45%). Plasma level of pro-BNP greater than 500 ng/L was independently associated with central PE. The area under the receiver operating characteristic curve was 0.753 (CI 95% 0.700-0.806), sensitivity 0.82 (CI 95% 0.69-0.91), specificity 0.67 (CI 95% 0.50-0.79), positive predictive value 0.75 (CI 95% 0.61-0.85), and negative predictive value 0.76 (CI 95% 0.58-0.87). Six (6%) patients died, 3 from PE, 2 from brain hemorrhage, and 1 from advanced gallbladder cancer. N-terminal pro-BNP level was greater than 500 ng/L in all patients who died. The area under receiver operating characteristic curve for death was 0.712 (CI 95% 0.635-0.789), sensitivity 0.10 (CI 95% 0.04-0.22), specificity 1 (CI 95% 0.88-1), positive predictive value 1 (CI 95% 0.51-1), and negative predictive value 0.42 (CI 95% 0.32-0.53). CONCLUSIONS: Preliminary data suggest that N-terminal pro-BNP levels higher than 500 ng/L could serve as indicator of the burden of PE and perhaps as a predictor of death.

[Prognostic significance of the hepatopulmonary syndrome in liver cirrhosis]. / Significado pronóstico del síndrome hepatopulmonar en la cirrosis hepática.

BACKGROUND AND OBJECTIVE: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. PATIENTS AND METHOD: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. RESULTS: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. CONCLUSIONS: The coexistence of HPS worsens the prognosis in liver cirrhosis.

Significado pronóstico del síndrome hepatopulmonar en la cirrosis hepática / Prognostic significance of the hepatopulmonary syndrome in liver cirrhosis

Fundamento y objetivo: El significado pronóstico del síndrome hepatopulmonar (SHP) se ha estudiado en pocas ocasiones. Pacientes y método: Observación de la supervivencia de 32 pacientes cirróticos, 14 (44%) de ellos con SHP y 18 con intercambio gasesoso normal (IGN), y estudio de los factores asociados. Resultados: Durante una media (desviación estándar) de 56 (27) meses fallecieron 9 pacientes (riesgo relativo de 0,64) del grupo SHP y 4 (riesgo relativo de 0,22) de los pacientes con IGN (odds ratio = 6,42; p < 0,01; intervalo de confianza del 95%, 0,04-0,80). Los pacientes con SHP fallecieron una media de 44 (31) meses tras la inclusión y los pacientes con IGN, 65 (21) meses tras la inclusión (p < 0,05). No todos los fallecimientos estuvieron relacionados con enfermedad hepática o disfunción pulmonar. Los factores asociados a mortalidad fueron el grado de shunt pulmonar y los valores plasmáticos de renina, mientras que el volumen plasmático y la capacidad de difusión de monóxido de carbono fueron factores de protección. Conclusiones: El SHP empeora el pronóstico de la cirrosis hepática

Background and objective: The prognosis of hepatopulmonary syndrome (HPS) has been only rarely investigated. Patients and method: We investigated the survival of 32 cirrhotic patients, 14 (44%) with HPS and 18 with a normal gaseous exchange (NGE), and the associated factors. Results: During a mean (standard deviation) of 56 (27) months, 9 patients in the HPS group (relative risk: 0.64) and 4 patients in the NGE group (relative risk: 0.22) died. The odds ratio was 6.42 (p < 0.01; 95% confidence interval, 0.04-0.80). Patients in the HPS group died after 44 (31) months, while patients in the NGE group died 65 (21) months after inclusion (p < 0.05). Overall, 46% of deaths were liver related. Factors associated with death were the right to left shunting and the increased plasmatic renin levels. Of note, the plasmatic volume and diffusing capacity were protective. Conclusions: The coexistence of HPS worsens the prognosis in liver cirrhosis