Comorbilidades asociadas a mortalidad o enfermedad severa en pacientes hospitalizados con COVID-19 / Comorbidities associated with mortality or severe disease in hospitalized patients with COVID-19

Objetivo: Conocer las comorbilidades de los pacientes hospitalizados con COVID-19 e identificar cuales se asocian a mayor severidad y/o mortalidad intrahospitalaria. Métodos: Estudio de cohortes retrospectivo en el que se incluyeron todos los pacientes ingresados con COVID-19 desde 1 de marzo del 2020 hasta el 31 mayo de 2020. Se realizó un análisis descriptivo de las comorbilidades y se vio cuales se asocian a una mayor mortalidad intrahospitalaria y/o severidad de la enfermedad mediante un modelo de regresión logística binaria. Resultados: Un total de 336 pacientes fueron incluidos en el estudio de los cuales 52 (15,5%) fallecieron durante el ingreso. Un 58% eran varones, la edad media fue 66 años y el índice Charlson fue de 1. En el análisis multivariante se identificaron como comorbilidades asociadas a mortalidad la edad > 65 años (OR 2,65; p 0,021), el sexo masculino (OR 3,26; p 0,004), la enfermedad cardiovascular ateroesclerótica (OR 2,11; p<0,040) y no ateroesclerótica (OR 6,40; p<0,001) y la neoplasia (OR 5,09; p<0,001). Se asociaron a mayor severidad de la COVID-19 la edad> 65 años (OR 1,87; p 0,033), el sexo masculino (OR 2,86; p <0,001), la obesidad (OR 1,82; p 0,034) y SAOS (OR 5,26; p 0,006). Conclusiones: La enfermedad cardiovascular previa y la neoplasia se asocian a mortalidad intrahospitalaria mientras que la obesidad y el SAOS se asocian a severidad de la enfermedad en pacientes hospitalizados con COVID-19. La edad >65 años y el sexo masculino se asocian a una mayor severidad y mortalidad intrahospitalaria. (AU)

Objective: To evaluate the comorbidities in hospitalized patients with COVID-19 and identify which ones are associated with severe COVID-19 disease and/or in-hospital mortality. Methods: A retrospective cohort study was performed. All patients admitted with confirmed COVID-19 from March 1, 2020 to May 31, 2020 were included. A descriptive analysis of comorbidities was made. We evaluated what comorbidities are associated with in-hospital mortality and/or severe COVID-19 disease using a binary logistic regression model. Results: A total of 336 patients were included in the study: 52 (15,5%) died during hospitalization. Mean age was 66 + 14 years, 58% were men and the Charlson Comorbidity Index was 1. In multivariate analysis, age >65 years (HR 2,65; p 0,021), male sex (HR 3,26; p 0,004), atherosclerotic cardiovascular disease (HR 2,11; p 0,040), non-atherosclerotic cardiovascular disease (HR 6,40; p<0,001) and malignancy (HR 5,09; p< 0,001), were identified as comorbidities associated with in hospital-mortality. Age >65 years (HR 1,87; p 0,033), male sex (HR 2,86; p<0,001), obesity (HR 1,82; p 0,034) and obstructive sleep apnea (HR 5,26; p 0,006) were associated with severe COVID-19 disease. Conclusions: Previous cardiovascular disease and malignancy are risk factors of in-hospital mortality while obesity and obstructive sleep apnea are associated with severe COVID-19 disease in hospitalized patients. Age >65 years and male sex are associated with both. (AU)

Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.