GADECCU 2022 Guideline for the treatment of Ulcerative Colitis. Adaptation and updating of the GETECCU 2020 Guideline. / Guía GADECCU 2022 para el tratamiento de la colitis ulcerosa. Adaptación y actualización de la Guía GETECCU 2020.

INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory disease that compromises the colon, affecting the quality of life of individuals of any age. In practice, there is a wide spectrum of clinical situations. The advances made in the physio pathogenesis of UC have allowed the development of new, more effective and safer therapeutic agents. OBJECTIVES: To update and expand the evaluation of the efficacy and safety of relevant treatments for remission induction and maintenance after a mild, moderate or severe flare of UC. RECIPIENTS: Gastroenterologists, coloproctologists, general practitioners, family physicians and others health professionals, interested in the treatment of UC. METHODOLOGY: GADECCU authorities obtained authorization from GETECCU to adapt and update the GETECCU 2020 Guide for the treatment of UC. Prepared with GRADE methodology. A team was formed that included authors, a panel of experts, a nurse and a patient, methodological experts, and external reviewers. GRADE methodology was used with the new information. RESULTS: A 118-page document was prepared with the 44 GADECCU 2022 recommendations, for different clinical situations and therapeutic options, according to levels of evidence. A section was added with the new molecules that are about to be available. CONCLUSIONS: This guideline has been made in order to facilitate decision-making regarding the treatment of UC, adapting and updating the guide prepared by GETECCU in the year 2020.

Telemedicine Improves Access to Hepatology Consultation with High Patient Satisfaction.

AIMS: Telemedicine between health care providers could be useful for improving the access to hepatology consultations, which is challenging in some regions. The primary objective of this study was to estimate the proportion of consultations that were resolved through a telemedicine program. Additionally, we evaluated patient satisfaction with this strategy. METHODS: Consecutive telemedicine consultations made by non-hepatologist health care providers from different regions of Argentina to a specialty hepatology team were included. Participants and hepatologists used e-mail, teleconference systems, WhatsApp, or telephone to interact, depending on their preferences. Consultations were considered to be resolved through telemedicine when a diagnosis and an adequate follow-up were achieved without the need to refer the patient to a hepatologist or other specialist. Patient satisfaction with telemedicine was evaluated using the Patient Satisfaction Questionnaire Short Form and Telemedicine Satisfaction Questionnaire. RESULTS: A total of 200 telemedicine consultations made by 24 physicians from 10 different provinces of Argentina were evaluated, of which 145 (73%; 95% CI: 66%-79%) were resolved through telemedicine. Practitioners specialities were as follows: family physicians, internists, gastroenterologists, infectious diseases, and obstetrics. The most frequent final diagnoses for those patients whose consultation was resolved through telemedicine were non-alcoholic fatty liver disease, viral hepatitis, and benign hepatic lesions. A high degree of patient satisfaction with telemedicine was observed in both questionnaires. CONCLUSIONS: Our results show the effectiveness of telemedicine in hepatology, with high resolution rate of consultations and rapid access to experts' assessment. Additionally, a high degree of patient satisfaction was observed using prevalidated questionnaires.

[Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy.] / Factores relacionados al paciente que afectan la limpieza del colon previo a la colonoscopia.

INTRODUCTION: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. OBJECTIVES: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. MATERIALS AND METHODS: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. RESULTS: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. CONCLUSIONS: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.

Risk of colorectal neoplasia in patients with celiac disease: a multicenter study.

BACKGROUND AND AIMS: The association of celiac disease with colorectal neoplasia is controversial. The aim of this study was to determine the risk of colorectal neoplasia among patients with celiac disease. METHODS: We carried out a multicenter, retrospective case-control study, within four community hospitals. Celiac disease patients with a complete colonoscopy were regarded as cases and those without celiac disease as controls. For each case, two controls matched for age, sex, indication for colonoscopy and colorectal cancer family history, were randomly selected. The main outcome evaluated was risk of colorectal polyps, adenomas, advanced neoplastic lesions and cancer. RESULTS: We identified 118 patients with celiac disease and 236 controls. The risk of polyps, adenomas and advanced neoplastic lesions was similar in both groups (OR 1.25, CI 0.71-2.18, p=0.40; OR 1.39, CI 0.73-2.63, p=0.31; and OR 1.00, CI 0.26-3.72, p=1.00, respectively). On multivariate analysis, age >75 years old, and first-grade CRC family history were associated with adenomas (OR 2.68 CI 1.03-6.98, OR 6.68 CI 1.03-47.98 respectively) and advanced neoplastic lesions (OR 15.03, CI 2.88-78.3; OR 6.46 CI 1.23-33.79, respectively). With respect to celiac disease characteristic, a low adherence to a gluten free diet was independently associated with the presence of adenomas (OR 6.78 CI 1.39-33.20 p=0.01). CONCLUSIONS: Celiac disease was not associated with an increased risk of colorectal neoplasia. Nonadherence to a strict gluten free diet was associated with the presence of adenomas. Further studies addressing celiac disease characteristics are needed to confirm this observation.

[Predominance of constipation in subjects with hydrogen-consuming intestinal flora]. / Tendencia al estreñimiento en sujetos que presentan predominio de microorganismos intestinales consumidores de hidrógeno.

INTRODUCTION: There is growing evidence that a disorder in intestinal microbiota would contribute to the development of symptoms in irritable bowel syndrome (IBS) patients. In a subgroup, a remarkably low hydrogen production in lactulose breath test (LBT) is observed. We presume in these patients a predominance of hydrogen consuming gut flora. OBJECTIVE: [corrected] Describe the clinical presentation of lBS patients with low hydrogen production and to compare their cathartic pattern against those with high hydrogen excretion. MATERIALS AND METHODS: A case-control study was designed. IBS outpatients were included. A validated questionnaire was delivered (IBSSS) in order to assess their symptoms and a LBT was performed. The cathartic pattern was compared between those with low and high hydrogen production on LBT. RESULTS: One hundred and ten patients were included and 15 of them (13.6%) had low hydrogen production on LBT, which would be compatible with the presence of hydrogen-consuming gut flora. In this group, 11 patients (73.33%) were constipated In contrast, only 30 patients (31.58%) in the high or normal hydrogen production group were constipated [OR 5.95 (95% confidence interval 1.75-20.25; P = 0.03)]. CONCLUSION: IBS patients with low hydrogen production on lactulose breath test were 6 times more frequently constipated.

[Variation of intestinal fermentative profile after sequential therapy with rifaximin/probiotics]. / Variaciones del perfil fermentativo intestinal frente al uso de un esquema terapéutico secuencial: rifaximina/probiótico.

INTRODUCTION: There is evidence suggesting that intestinal microbiota plays a role in the development of irritable bowel syndrome. Its activity can be indirectly assessed using the lactulose breath test. Antibiotics like rifaximin or probiotics can be used as therapeutic options for patients with irritable bowel syndrome. Our purpose was to evaluate the efficacy of a sequential treatment with rifaximin and probiotics in these patients. MATERIAL AND METHODS: We prospectively evaluated patients with diagnosis of irritable bowel syndrome according to Rome III criteria. Included patients had to fill in a questionnaire in order to assess their symptoms severity. A lactulose breath test was also performed in each case and a curve with the results of hydrogen concentration and time was elaborated. Then, the area under the curve was calculated After initial evaluation, patients received a seven-day treatment with rifaximin, followed by a ten-day course of probiotics. Thirty days after completion of treatment a new lactulose breath test along with a questionnaire were performed. RESULTS: We included 15 patients and 93% experienced a significant improvement of their symptoms as well as a significant reduction of the lactulose breath test values. CONCLUSION: Sequential treatment with rifaximin/probiotics seems to be effective for symptom and fermentative profile improvement in irritable bowel syndrome patients.

[Frequency of bacterial overgrowth in patients with clinical lactose intolerance]. / Frecuencia de sobrecrecimiento bacteriano en pacientes con intolerancia clínica a la lactosa.

INTRODUCTION: Some patients complain of digestive symptoms related to diary products intake. This intolerance could be associated with an intestinal bacterial overgrowth or an increased fermentative intestinal profile and not due to lactose malabsorption. OBJECTIVE: To estimate the prevalence of bacterial overgrowth in subjects with digestive symptoms related to diary products intolerance. MATERIAL AND METHODS: Patients who had performed hydrogen breath test due to chronic functional distension syndrome (Rome III) were analyzed. Thirty of them (22 female, average age 52 years) complained of symptoms related to diary products intake. All subjects completed a nutritional survey that allowed to assess the degree of tolerance to milk products and performed the hydrogen breath test with lactulose as substrate. Bacterial overgrowth was considered when baseline values were over 15 parts per million (ppm), values before 80 minutes were greater than 20 ppm or values of area under the curve were greater than 3,000 ppm/min in the 180 studied minutes. RESULTS: Fifty four patients were analyzed. Thirty of them showed moderate, important or severe clinical milk intolerance. Of these patients, 23 (77%), had a positive breath hydrogen test according to used criteria. CONCLUSIONS: The prevalence of small bowel bacterial overgrowth or an increased fermentative intestinal profile among individuals who complain of symptoms related to diary products is high and this fact should be considered in order to avoid empirical restrictive diets.

Hemoglobin concentration variations over time in general medical inpatients.

BACKGROUND: A decrease in hemoglobin concentration [Hb] with no apparent cause is frequently observed in critically ill patients. Scarce information is available about this situation in general ward-admitted patients (GWAP). OBJECTIVES: To describe [Hb] variation with no obvious cause in GWAP, and to estimate the prevalence and predictors of patients with [Hb] decreases > or =1.5 g/dL. DESIGN, SETTING AND PATIENTS: Prospective, observational study in internal medicine GWAP, carried out at two teaching hospitals in Buenos Aires, Argentina. Patients with a history of, or admitted for diseases associated with decreases in [Hb], as well as those with length of stay less than three days, were excluded. MEASUREMENTS: Upon hospitalization, complete personal and clinical data were recorded. Furthermore, Katz index, APACHE II acute physiology score (APS) and Charlson score were calculated. [Hb] and hematocrit (HCT) were also assessed during hospitalization. RESULTS: A total of 338 patients were evaluated, 131 were included. A mean [Hb] decrease of 0.71 g/dL was observed between admission and discharge (P < 0.001; 95% CI, 0.47-0.97). Forty-five percent of the included patients had decreases in [Hb] > or = 1.5 g/dL. This was associated with a higher APS, a higher [Hb] at admission, and a discharge diagnosis of infectious or gastrointestinal disease. No bleeding episodes were observed. CONCLUSIONS: An [Hb] decrease was frequently observed during GWAP hospitalization with no evident blood loss. Even though this decrease has multiple causes, the severity of the acute illness seems to play a major role.

Limitaciones de esfuerzos terapéuticos: Resultados de un registro prospectivo en una sala de clínica médica / Limitation of life-sustaining treatment: A prospective study developed in a clinical ward

El objetivo de este trabajo fue describir el proceso de limitación de los esfuerzos terapéuticos (LET) en los pacientes internados en una sala general. Para ello se realizó un estudio prospectivo descriptivo, desarrollado en la sala de internación general de un hospital universitario. Fueron evaluados pacientes que tuviesen alguna LET, asistidos por el servicio de clínica médica en un período de 60 días consecutivos. Durante el mismo se hospitalizaron 402 pacientes, 62 (15%) tuvieron algún tipo de LET. Este último grupo estaba compuesto por un 66% de mujeres, la mediana de edad fue de 86 años (78-90) y de la duración de hospitalización de 12 días (8-18). La mala calidad de vida fue la causa más frecuente de LET (69%). Se brindó información acerca de las limitaciones a 43 familias (69%) y 8 pacientes (13%). En la decisión participaron el médico de cabecera (50%), médicos de planta (50%), residentes (40%), la familia (42%) y los propios pacientes (11%). En 7 casos hubo constancia en la historia clínica (11%). Diecisiete pacientes (27%) con LET fallecieron durante la internación, mientras que 44 (71%) fueron dados de alta. En conclusión, la limitación de esfuerzos terapéuticos en nuestros pacientes constituyó un hecho frecuente. No se logró identificar un proceso uniforme o sistematizado para la toma de la decisión de LET. Resulta innegable la necesidad de normativas que guíen al equipo de salud en la toma de decisiones, tranquilicen a familiares y acompañen a los pacientes en sus reales necesidades.

The purpose of this study is to describe the limiting life-sustaining treatment process of patients admitted to a general ward. A prospective descriptive study was designed. The setting was the general ward of universitary hospital. Study participants were patients assisted by the internal medicine department during a 60- consecutive days period who had limitations of life sustaining treatments. During the study period, 402 patients were hospitalized, 62 (15%) of them had limitations of life support care. The median patient age of the last group was 86 years (78-90), 66% were women and the length of stay was 12 days (8-18). A low quality of life was the most frequent cause of limitation (69%). Information about the limitations was provided to 43 families (69%) and 8 patients (13%). The primary care physician participated in the decision in 50% of the cases, while the attending physician, the resident in charge, patient's family and patients themselves participated in 50%, 40%, 42% and 11% of the cases respectively. The decision of limiting life-sustaining treatments was recorded in seven patient's charts (11%). Seventeen (27%) patients with limitations died during the hospital stay while 44 (71%) were discharged. In conclusion, we found a frequent life sustaining treatment limitation in our patients. These decisions did not follow a uniform or systemized process. The need of guidelines to sort the medical and ethical challenges imposed to the medical team is undeniable.

[Limitation of life-sustaining treatment. A prospective study in a clinical ward]. / Limitaciones de esfuerzos terapéuticos. Resultados de un registro prospectivo en una sala de clínica médica.

The purpose of this study is to describe the limiting life-sustaining treatment process of patients admitted to a general ward. A prospective descriptive study was designed. The setting was the general ward of universitary hospital. Study participants were patients assisted by the internal medicine department during a 60-consecutive days period who had limitations of life sustaining treatments. During the study period, 402 patients were hospitalized, 62 (15%) of them had limitations of life support care. The median patient age of the last group was 86 years (78-90), 66% were women and the length of stay was 12 days (8-18). A low quality of life was the most frequent cause of limitation (69%). Information about the limitations was provided to 43 families (69%) and 8 patients (13%). The primary care physician participated in the decision in 50% of the cases, while the attending physician, the resident in charge, patient's family and patients themselves participated in 50%, 40%, 42% and 11% of the cases respectively. The decision of limiting life-sustaining treatments was recorded in seven patient's charts (11%). Seventeen (27%) patients with limitations died during the hospital stay while 44 (71%) were discharged. In conclusion, we found a frequent life sustaining treatment limitation in our patients. These decisions did not follow a uniform or systemized process. The need of guidelines to sort the medical and ethical challenges imposed to the medical team is undeniable.

[Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode]. / Factores de mal pronóstico en pacientes internados con neutropenia al inicio del episodio febril.

Patients with neutropenia and fever conform a heterogeneous population with a variable risk of serious complications and mortality. The goal of this study was to identify prognostic risk factors present at the beginning of the episode, for adverse events and serious complications in patients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia and fever (neutrophils < 1000/mm3 and T > 38.3 00) in 167 patients admitted to our general hospital between 1997 and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors and 4% were not associated with chemotherapy. Sixty seven adverse events were registered (46% renal insufficiency, 27% refractory hypotension, 15% respiratory insufficiency and 12% major bleeding). Significant differences were found in presence of current co-morbidities, body temperature > 39 00, heart rate > 120 beats per minute, respiratory rate > 24 per minute, systolic blood pressure < 90 mm Hg, presence of 3 or more altered laboratory values, presence of a clinical site of infection and positive blood cultures. The logistic regression multivariate analysis showed that the following characteristics were independently associated with adverse events: systolic blood pressure < 90 mm Hg (OR = 7, p < 0.01), current co-morbidities (OR = 8.5, p = 0.02), respiratory rate > 24 per minute (OR = 2.8, p = 0.01), and the presence of a clinical site of infection (OR = 2.1, p = 0.03). The presence of systolic hypotension, high respiratory rate, current co-morbidities and a clinical site of infection at the time of admission were identified predictors of subsequent serious complications in patients admitted with fever and neutropenia in a general ward.

Factores de mal pronostico en pacientes internados con neutropenia al inicio del episodio febril / Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode

Los pacientes con neutropenia y fiebre constituyen una población heterogénea con riesgo variable para el desarrollo de complicaciones serias y mortalidad. El objetivo de este trabajo es identificarfactores que, presentes al ingreso, estuvieran asociados a mayor riesgo de complicaciones graves en pacientesque se internan por neutropenia y fiebre. Se trata de un estudio de seguimiento de una cohorte de 238 episodios de neutropenia y fiebre (neutrófilos <1000/mm3 y T>38.3 °C) en 167 pacientes internados en sala general en nuestra institución desde 1997 a 2004. Ochenta y dos por ciento de los pacientes tenían enfermedad hematológica, 14% tumores sólidos y 4% no asociados a quimioterapia. Se registraron 67 eventos adversos (46% de insuficiencia renal, 27% de hipotensión refractaria, 15% de insuficiencia respiratoria y 12% con sangrado mayor). Se hallaron diferencias significativas en presencia de comorbilidades previas, temperatura mayor a 39 °C, frecuencia cardíaca mayor a 120 latidos por minuto, frecuencia respiratoria mayor a 24 por minuto, tensión arterial sistólica menor a 90 mm Hg, presencia de 3 o más valores de laboratorio alterados al ingreso, presencia de foco clínico y hemocultivos positivos. En el análisis multivariado de regresión logística mantuvieron asociación independiente con mayor riesgo de eventos graves: hipotensión arterial sistólica (OR=7, p<0.01), comorbilidades (OR=8.5, p=0.02), taquipnea (OR=2.8, p=0.01), y presencia de foco clínico (OR=2.1, p=0.03)

Patients with neutropenia and fever conform a heterogeneouspopulation with a variable risk of serious complications and mortality. The goal of this study was to identifyprognostic risk factors present at the beginning of the episode, for adverse events and serious complications inpatients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia andfever (neutrophils <1000/mm3 and T>38.3 °C) in 167 patients admitted to our general hospital between 1997and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors and4% were not associated with chemotherapy. Sixty seven adverse events were registered (46% renal insufficiency, 27% refractory hypotension, 15% respiratory insufficiency and 12% major bleeding). Significant differences werefound in presence of current co-morbidities, body temperature >39 °C, heart rate >120 beats per minute, respiratory rate >24 per minute, systolic blood pressure <90 mm Hg, presence of 3 or more altered laboratory values, presenceof a clinical site of infection and positive blood cultures. The logistic regression multivariate analysis showedthat the following characteristics were independently associated with adverse events: systolic blood pressure<90 mm Hg (OR=7, p<0.01), current co-morbidities (OR=8.5, p=0.02), respiratory rate >24 per minute (OR=2.8, p=0.01), and the presence of a clinical site of infection (OR=2.1, p=0.03). The presence of systolic hypotension, high respiratory rate, current co-morbidities and a clinical site of infection at the time of admission were identified predictors of subsequent serious complications in patients admitted with fever and neutropenia in a general ward

Factores de mal pronostico en pacientes internados con neutropenia al inicio del episodio febril / Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode

Los pacientes con neutropenia y fiebre constituyen una población heterogénea con riesgo variable para el desarrollo de complicaciones serias y mortalidad. El objetivo de este trabajo es identificarfactores que, presentes al ingreso, estuvieran asociados a mayor riesgo de complicaciones graves en pacientesque se internan por neutropenia y fiebre. Se trata de un estudio de seguimiento de una cohorte de 238 episodios de neutropenia y fiebre (neutrófilos <1000/mm3 y T>38.3 ºC) en 167 pacientes internados en sala general en nuestra institución desde 1997 a 2004. Ochenta y dos por ciento de los pacientes tenían enfermedad hematológica, 14% tumores sólidos y 4% no asociados a quimioterapia. Se registraron 67 eventos adversos (46% de insuficiencia renal, 27% de hipotensión refractaria, 15% de insuficiencia respiratoria y 12% con sangrado mayor). Se hallaron diferencias significativas en presencia de comorbilidades previas, temperatura mayor a 39 ºC, frecuencia cardíaca mayor a 120 latidos por minuto, frecuencia respiratoria mayor a 24 por minuto, tensión arterial sistólica menor a 90 mm Hg, presencia de 3 o más valores de laboratorio alterados al ingreso, presencia de foco clínico y hemocultivos positivos. En el análisis multivariado de regresión logística mantuvieron asociación independiente con mayor riesgo de eventos graves: hipotensión arterial sistólica (OR=7, p<0.01), comorbilidades (OR=8.5, p=0.02), taquipnea (OR=2.8, p=0.01), y presencia de foco clínico (OR=2.1, p=0.03) (AU)

Patients with neutropenia and fever conform a heterogeneouspopulation with a variable risk of serious complications and mortality. The goal of this study was to identifyprognostic risk factors present at the beginning of the episode, for adverse events and serious complications inpatients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia andfever (neutrophils <1000/mm3 and T>38.3 ºC) in 167 patients admitted to our general hospital between 1997and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors and4% were not associated with chemotherapy. Sixty seven adverse events were registered (46% renal insufficiency, 27% refractory hypotension, 15% respiratory insufficiency and 12% major bleeding). Significant differences werefound in presence of current co-morbidities, body temperature >39 ºC, heart rate >120 beats per minute, respiratory rate >24 per minute, systolic blood pressure <90 mm Hg, presence of 3 or more altered laboratory values, presenceof a clinical site of infection and positive blood cultures. The logistic regression multivariate analysis showedthat the following characteristics were independently associated with adverse events: systolic blood pressure<90 mm Hg (OR=7, p<0.01), current co-morbidities (OR=8.5, p=0.02), respiratory rate >24 per minute (OR=2.8, p=0.01), and the presence of a clinical site of infection (OR=2.1, p=0.03). The presence of systolic hypotension, high respiratory rate, current co-morbidities and a clinical site of infection at the time of admission were identified predictors of subsequent serious complications in patients admitted with fever and neutropenia in a general ward (AU)

Factores de mal pronostico en pacientes internados con neutropenia al inicio del episodio febril / Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode

Los pacientes con neutropenia y fiebre constituyen una población heterogénea con riesgo variable para el desarrollo de complicaciones serias y mortalidad. El objetivo de este trabajo es identificarfactores que, presentes al ingreso, estuvieran asociados a mayor riesgo de complicaciones graves en pacientesque se internan por neutropenia y fiebre. Se trata de un estudio de seguimiento de una cohorte de 238 episodios de neutropenia y fiebre (neutrófilos <1000/mm3 y T>38.3 ºC) en 167 pacientes internados en sala general en nuestra institución desde 1997 a 2004. Ochenta y dos por ciento de los pacientes tenían enfermedad hematológica, 14% tumores sólidos y 4% no asociados a quimioterapia. Se registraron 67 eventos adversos (46% de insuficiencia renal, 27% de hipotensión refractaria, 15% de insuficiencia respiratoria y 12% con sangrado mayor). Se hallaron diferencias significativas en presencia de comorbilidades previas, temperatura mayor a 39 ºC, frecuencia cardíaca mayor a 120 latidos por minuto, frecuencia respiratoria mayor a 24 por minuto, tensión arterial sistólica menor a 90 mm Hg, presencia de 3 o más valores de laboratorio alterados al ingreso, presencia de foco clínico y hemocultivos positivos. En el análisis multivariado de regresión logística mantuvieron asociación independiente con mayor riesgo de eventos graves: hipotensión arterial sistólica (OR=7, p<0.01), comorbilidades (OR=8.5, p=0.02), taquipnea (OR=2.8, p=0.01), y presencia de foco clínico (OR=2.1, p=0.03) (AU)

Patients with neutropenia and fever conform a heterogeneouspopulation with a variable risk of serious complications and mortality. The goal of this study was to identifyprognostic risk factors present at the beginning of the episode, for adverse events and serious complications inpatients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia andfever (neutrophils <1000/mm3 and T>38.3 ºC) in 167 patients admitted to our general hospital between 1997and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors and4% were not associated with chemotherapy. Sixty seven adverse events were registered (46% renal insufficiency, 27% refractory hypotension, 15% respiratory insufficiency and 12% major bleeding). Significant differences werefound in presence of current co-morbidities, body temperature >39 ºC, heart rate >120 beats per minute, respiratory rate >24 per minute, systolic blood pressure <90 mm Hg, presence of 3 or more altered laboratory values, presenceof a clinical site of infection and positive blood cultures. The logistic regression multivariate analysis showedthat the following characteristics were independently associated with adverse events: systolic blood pressure<90 mm Hg (OR=7, p<0.01), current co-morbidities (OR=8.5, p=0.02), respiratory rate >24 per minute (OR=2.8, p=0.01), and the presence of a clinical site of infection (OR=2.1, p=0.03). The presence of systolic hypotension, high respiratory rate, current co-morbidities and a clinical site of infection at the time of admission were identified predictors of subsequent serious complications in patients admitted with fever and neutropenia in a general ward (AU)