ABSTRACT
INTRODUCTION: Several multidimensional indices have been proposed to predict mortality in chronic obstructive pulmonary disease (COPD). The BODEX index is simple and easy to use for this purpose in all clinical settings. Only a few prognostic indices have integrated oxygenation variables, with measurement methods that are not practical for real life clinical practice in all settings. OBJECTIVES: To develop and externally validate a new prognostic index (BODEXS90) that combines the variables included in BODEX index with rest peripheral oxygen saturation measured with finger oximetry (SpO2) to predict all-cause mortality in stable COPD. METHOD: Observational, non-intervention, multicenter historic cohort study. The BODEXS90 index was developed in a derivation cohort and externally validated in a validation cohort. Calibration of the index was carried out using Hosmer-Lemeshow test. The discrimination capacity of BODEXS90 and BODEX were compared by means of receiver-operating characteristics curves. Modelling of the index was carried out by crude and adjusted Cox regression analysis. RESULTS: The derivation and validation cohorts included 787 and 1179 subjects, respectively. SpO2 predicted all cause-mortality independently of BODEX index. Discrimination capacity of BODEXS90 to predict the outcome was significantly higher than that of BODEX, particularly for more severely affected patients, both in the derivation and in the validation cohorts. CONCLUSIONS: The new index is potentially useful for designing clinical decision-making algorithms in stable COPD.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Humans , Prognosis , Cohort Studies , Lung , OximetryABSTRACT
INTRODUCTION AND OBJECTIVES: Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS: In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS: 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION: BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.
Subject(s)
Diabetes Insipidus/diagnosis , Polydipsia/etiology , Polyuria/etiology , Adult , Humans , MaleABSTRACT
Con el objetivo de comparar su situación analítica, calidad de vida y morbilidad, se realiza un estudio caso-control con 52 pacientes con más de 9 meses de tratamiento previo con hemodiálisis convencional o de alto flujo (HD), que pasan a hemodia-filtración en línea (HDF), por un periodo igual o superior al mismo tiempo. Las determinaciones analíticas demuestran una mejoría significativa de: Hb (p<0.01), Ca, P, Ca x P, Urea pre, Kt/V y URR (p<0.001), y una mejoría en PCR, Colesterol, Triglicéridos y iPTH, aunque no significativa. En cuanto a los criterios para medir la calidad de vida, se obtienen: un aumento no significativo del peso en HDF, que si se compara para el subgrupo de edad inferior a 55 años, adquiere significación estadística (p< 0.01). De igual forma ocurre con la IMC, si bien, en este último subgrupo, es mayor la significancia (p<0.001). La TAC de urea aumenta significativamente, así como la ganancia de peso interdiálisis. La nPCR es mayor, pero sin valor estadístico. Las cifras de TA, aunque menores en el espacio de tiempo de tratamiento con HDF en línea, no adquieren significación. Hay que destacar el descenso de ingresos y complicaciones en la etapa de HDF en línea. La HDF en línea es una técnica de tratamiento de la insuficiencia renal crónica que mejora la dosis de diálisis que reciben los pacientes, su calidad de vida y disminuye la morbilidad
With the aim of comparing their test results, quality of life and morbility, a case history control study was carried out on 52 patients with more than 9 months of prior treatment with conventional or high-flow haemodialysis (HD), who then switched to online haemodiafiltration (HDF) for a period of similar or longer duration. Test results show a significant improvement in: Hb(p<0.01), Ca, P, Ca x P, Urea pre, Kt/V and URR(p<0.001), and an improvement in CRP, Cholesterol, Triglycerides and iPTH, although not significant. In relation to the quality of life evaluation, the following results were obtained: an insignificant increase in weight in HDF, which if compared for the under-55 age group, acquires statistical significance (p< 0.01). The same occurs with the BMI, although the significance is greater in the age group mentioned(p<0.001). The TAC of urea increased significantly, as did interdialysis weight gain. The nCRP was higher, but without statistical value. Blood pressure figures, although lower throughout the on-line HDF treatment, were not significant. The drop in admissions and complications during the online HDF stage is notable. Online HDF is a technique for the treatment of chronic renal failure that improves the dose of dialysis patients receive, their quality of life, and reduces morbility
Subject(s)
Male , Female , Humans , Renal Insufficiency, Chronic/nursing , Renal Insufficiency, Chronic/therapy , Renal Dialysis/methods , Renal Dialysis/nursing , Hemofiltration , Quality of Life , Morbidity , Case-Control StudiesABSTRACT
The plasmatic levels of TSH in 2 group of diabetic patients (7 decompensated and 8 decompensated, but in treatment) were measured at 9:30 and 23:30 hours. The mean glycemia levels were of 280 +/- 45 and 150 +/- 30 mg/dl (p less than 0.0005). There was no significant difference between daily TSH and nocturnal TSH in any of the groups, but there was a tendency for the nocturnal TSH to be higher in decompensated patients. There was no difference when comparing the TSH of the first group to the TSH of the 2nd group. The mean TSH N/TSH D was superior by 1 (1.36 in decompensated and 1,095 in treated patients). The correlation between glycemia and TSH D was negligible in all groups. The data suggests the tendency that the circadian rhythm of TSH in maintained in diabetes decompensation with shorter rhythm registered in treated patients. This shows a certain normality in the suprahypophysary area in charge of the rhythm and is similar to the minor liberation of TSH after TRH stimulus that other authors have described as happening in the decompensation of diabetes mellitus.
