ABSTRACT
Objectives: To assess the impact of the COVID-19 pandemic on the activity of clinical laboratories in Spain. Methods: A descriptive, observational, retrospective, multicenter study. Results: Between March and December 2020, there was a statistically significant decrease in the number of test requests (-17.7%, p=<0.001) and total tests performed (-18.3%, p<0.001) with respect to the same period in 2019. A decrease was observed in the number of requests from primary care (-37.4%) (p<0.001) and in the number of foecal occult blood (-45.8%); qualitative urine (-30.1%); PSA (-28.5%); TSH (-27.8%); total cholesterol (-27.2%) and HbA1c (-24.7%) tests performed, p<0.001. A significant increase was found in the number of requests from ICUs (76.6%, p<0.001) and number of IL-6 (+22,350.9), D-dimer (+617.2%), troponin (+46.8%) and arterial blood gas (+3.9%) tests carried out, p<0.001. During the first months of 2021, there were significant changes in the number of requests for qualitative urine (-8.7%, p<0.001), PSA (-6.3%, p=0.009), IL-6 (+66,269.2, p<0.001), D-dimer (+603.6%, p<0.001), troponin (+28.7%, p<0.001), arterial blood gas (+26,2%, p=0.014) and ferritin (+16.0%, p=0.002) tests performed. Conclusions: There were changes in the origin and number of test requested to clinical laboratories in Spain. The number of requests for the evaluation and monitoring of COVID-19 patients increased, whereas requests for the control of non-COVID patients and for population screening decreased. Long-term analysis reveals that the volume of tests performed for the control of chronic diseases returned to normal over time, whereas the increase observed in the volume of tests performed for the management of COVID-19 patients is maintained.
ABSTRACT
La perforación vascular con resultado de hidrotórax es una complicación poco frecuente de la colocación de un catéter venoso central. Debe sospecharse en aquellos pacientes con catéter venoso central en vena subclavia o yugular interna y derrame pleural con insuficiencia respiratoria y/o inestabilidad hemodinámica. Las pruebas radiológicas junto con una correcta interpretación de los resultados analíticos son clave para la realización de un diagnóstico rápido que evite complicaciones futuras. Se presenta el caso clínico de una lactante de un mes y 10 días que ingresa en unidad de cuidados intensivos tras cirugía cardiaca. Al ingreso en esta unidad se mantiene ventilación mecánica y catéter venoso central en vena yugular derecha, cuya correcta posición había sido comprobada mediante radiografía de tórax. A las 5-6 horas posteriores, se constata oliguria con hipotensión y aumento del débito por drenaje pleural, sospechando insuficiencia cardiaca. Dada la no mejoría clínica tras el tratamiento con fármacos vasoactivos, se realiza drenaje torácico para descartar quilotórax. Los resultados obtenidos tras el análisis del líquido pleural en el laboratorio de bioquímica clínica hacen sospechar de una posible contaminación con suero glucosalino, por lo que rápidamente es advertido al clínico solicitante. Ante esta situación se decide realizar una radiografía de tórax con contraste yodado, donde se evidencia extravasación del contenido de la vía central a cavidad pleural, con resultado de hidrotórax, procediendo a la retirada inmediata de dicha vía. La evolución posterior fue favorable y no hubo nuevas complicaciones (AU)
Hydrothorax as a result of vascular perforation is a rare complication of central venous catheter (CVC) and should be suspected in patients with subclavian or internal jugular vein catheterism as well as pleural effusion with respiratory failure and/or hemodynamic instability. A proper interpretation of the analytical results, in addition to radiological findings, is crucial for an early diagnosis that may avoid future complications. In this article we present a clinical case of an infant, aged one month and 10 days, who was admitted to the ICU after a cardiac surgery. Once in the ICU, mechanical ventilation and right jugular vein catheterism are maintained; the proper CVC placement had been previously verified by chest X-ray. After 5-6 hours the patient began to suffer from oliguria with hypotension and increased debt by pleural drainage, suspecting heart failure. There was no clinical improvement after treatment with vasoactive drugs so chest drainage was performed to discard chylotorax. The clinical biochemistry laboratory conducted a pleural fluid analysis. The results suggested contamination with glucosaline solution. Such results were reported to the applicant physician. According to the clinical situation a chest X-ray with iodinated contrast was performed evidencing an extravasation of the content of the CVC to pleural cavity, resulting in hydrothorax. The CVC was immediately removed. The subsequent evolution was favorable and there were no further complications (AU)
