Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation.

To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary hospital in Manchester (UK) between January 2012 and December 2016. Data collected included epidemiological data, microbiological cultures, radiographic findings and outcomes. Cases were classified as proven IPA, putative IPA or Aspergillus colonisation according to a validated clinical algorithm. One hundred thirty-four patients were supported with vv-ECMO, median age of 45.5 years (range 16.4-73.4). Ten (7%) patients had putative IPA and nine (7%) had Aspergillus colonisation. Half of the patients with putative IPA lacked classical host risk factors for IPA. The median number of days on ECMO prior to Aspergillus isolation was 5 days. Immunosuppression and influenza A infection were significantly associated with developing IPA in a logistic regression model. Cox regression model demonstrates a three times greater hazard of death associated with IPA. Overall 6-month mortality rate was 38%. Patients with putative IPA and colonised patients had a 6-month mortality rate of 80 and 11%, respectively. Immunosuppression and influenza A infection are independent risk factors for IPA. IPA, but not Aspergillus colonisation, is associated with high long-term mortality in patients supported with vv-ECMO.

Hipopotasemia, dato clínico clave en el diagnóstico de un hiperaldosteronismo primario / Hypokalemia, a key clinical data for diagnosing primary hyperaldosteronism

Describimos el caso de un varón de 37 años con antecedentes de hipertensión arterial de varios años de evolución, en tratamiento farmacológico, que ingresa por un cuadro de astenia generalizada con disminución de fuerza en ambos miembros inferiores. En la analítica realizada en Urgencias de detecta una hipopotasemia severa, por lo que se inicia el estudio de posible hipertensión arterial secundaria. Con la sospecha inicial de hiperaldosteronismo primario se realiza analítica completa, incluyendo actividad de renina plasmática basal, que está claramente suprimida, así como aldosterona plasmática basal, que resulta normal. Así mismo, se realiza una TC abdominal que muestra la existencia de un adenoma suprarrenal. Por este motivo se decide realizar una sobrecarga oral de sodio con determinación posterior de actividad de renina plasmática, que sigue estando suprimida, aldosterona plasmática, que sigue siendo normal, y aldosterona en orina de 24 h, que aparece claramente elevada y confirma así el diagnóstico de sospecha. Tras la cirugía el paciente se mantiene normotenso, sin necesidad de tratamiento farmacológico y con niveles de potasio sérico normales

We report a case of a 37 year-old man with a long history of hypertension under treatment, who was admitted at our institution with intense fatigue and weakness of lower limbs. The laboratory results at Emergency Department showed severe hypokalemia. A study of secondary hypertension was carried out. With the initial suspicion of primary hyperaldosteronism, complete blood test was done including plasma renine activity, which was completely suppressed, and plasma aldosterone concentration, which resulted normal. Likewise, an abdomen CT was performed and revealed a left adrenal mass consistent of suprarrenal adenoma. Therefore, a salt loading suppression test was done with subsequent measure of plasmatic renine activity, which was still suppressed, plasma aldosterone concentration, that persisted normal, and a 24-h urinary aldosterone excretion rate, which was clearly high, supporting the suspected diagnosis. After the adrenalectomy, the patient remained asymptomatic with normal blood pressure without treatment and with normal serum potassium levels

[Hypokalemia, a key clinical data for diagnosing primary hyperaldosteronism]. / Hipopotasemia, dato clínico clave en el diagnóstico de un hiperaldosteronismo primario.

We report a case of a 37 year-old man with a long history of hypertension under treatment, who was admitted at our institution with intense fatigue and weakness of lower limbs. The laboratory results at Emergency Department showed severe hypokalemia. A study of secondary hypertension was carried out. With the initial suspicion of primary hyperaldosteronism, complete blood test was done including plasma renine activity, which was completely suppressed, and plasma aldosterone concentration, which resulted normal. Likewise, an abdomen CT was performed and revealed a left adrenal mass consistent of suprarrenal adenoma. Therefore, a salt loading suppression test was done with subsequent measure of plasmatic renine activity, which was still suppressed, plasma aldosterone concentration, that persisted normal, and a 24-h urinary aldosterone excretion rate, which was clearly high, supporting the suspected diagnosis. After the adrenalectomy, the patient remained asymptomatic with normal blood pressure without treatment and with normal serum potassium levels.