Neurological Comorbidity Is a Predictor of Death in Covid-19 Disease: A Cohort Study on 576 Patients.

Introduction: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission. Methods: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities. Results: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382-3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970-3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR. Conclusions: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.

Características, notación y sintaxis para el diseño de indicadores claves de proceso (KPI) en sistemas de adecuación de la demanda de laboratorio: el ejemplo de las recomendaciones de no hacer de AEBM-ML / Characteristics, function and syntax for the design of key performance indicators (KPI) in laboratory adjustment of the demand systems: The example of the “not to do” recommendations of the AEBM-ML

La Medicina del Laboratorio constituye un área de conocimiento multidisciplinar en continuo cambio, siendo responsabilidad de las sociedades científicas el compendiar y difundir los últimos avances científicos, así como proporcionar herramientas para su interpretación. El establecimiento de protocolos, guías y recomendaciones constituye una actividad esencial, pero estas acciones deben ir acompañadas de la definición de indicadores claves de procesos. Los indicadores claves de procesos permiten evaluar y hacer un seguimiento del correcto cumplimiento de los objetivos propuestos, así como actuar a modo de herramienta de mejora a través de la intercomparación entre laboratorios (benchmarking). La reciente publicación realizada por la Asociación Española de Biopatología Médica-Medicina del Laboratorio Decisiones inteligentes desde el laboratorio: de elegir sabiamente a no hacer constituye, en este sentido, un buen ejemplo. Elaborada en el seno del proyecto «Compromiso por la Calidad de las Sociedades Científicas en España» promovido por el Ministerio de Sanidad, Servicios Sociales e Igualdad, propone un total de 19 recomendaciones avaladas por un panel constituido por 26 expertos. Cada una de estas recomendaciones se acompaña de un conjunto de indicadores de proceso para evaluar el cumplimento y eficiencia de su implementación. Considerando como punto de partida la metodología y sistema de notación empleados en la citada monografía para el diseño de indicadores claves de procesos, constituye una guía de diseño útil para la evaluación de cualquier proceso de adecuación y uso efectivo del laboratorio (AU)

Laboratory Medicine is an area of multidisciplinary knowledge in continuous change. The scientific societies have the responsibility for summarising and disseminating the latest scientific advances, as well as providing tools for their interpretation. The establishment of protocols, guidelines and recommendations is an essential activity of these societies, but these actions must be accompanied by the definition of key performance indicators. The key performance indicators enable the objectives to be correctly fulfilled. Moreover, these indicators are an improvement tool based on the intercomparison between laboratories (benchmarking). Thus, the recent publication by the Spanish Medical Biopathology Society-Laboratory Medicine (Asociación Española de Biopatología Médica-Medicina del Laboratorio) entitled "Intelligent decisions since laboratory: from choose wisely till not to do" (Decisiones inteligentes desde el laboratorio: de elegir sabiamente a no hacer) is a good example. This publication, prepared within the framework of the "Commitment to Quality by the Spanish Scientific Societies" project, proposed by the Ministry of Health, makes 19 recommendations proposed by an expert panel of 26 laboratory professionals. Each recommendation includes several indicators to evaluate the compliance and effectiveness of their implementation. Taking the methodology and function used in the Spanish Medical Biopathology Association-Laboratory Medicine document for the design of key performance indicators as a basis, it becomes a useful guide for designing the evaluation of any adjustment process and its effective use in the laboratory (AU)

Current use of equations for estimating glomerular filtration rate in Spanish laboratories.

INTRODUCTION: In 2006 the Spanish Society of Clinical Biochemistry and Molecular Pathology (SEQC) and the Spanish Society of Nephrology (S.E.N.) developed a consensus document in order to facilitate the diagnosis and monitoring of chronic kidney disease with the incorporation of equations for estimating glomerular filtration rate (eGFR) into laboratory reports. The current national prevalence of eGFR reporting and the degree of adherence to these recommendations among clinical laboratories is unknown. METHODS: We administered a national survey in 2010-11 to Spanish clinical laboratories. The survey was through e-mail or telephone to laboratories that participated in the SEQC’s Programme for External Quality Assurance, included in the National Hospitals Catalogue 2010, including both primary care and private laboratories. RESULTS: A total of 281 laboratories answered to the survey. Of these, 88.2% reported on the eGFR, with 61.9% reporting on the MDRD equation and 31.6% using the MDRD-IDMS equation. A total of 42.5% of laboratories always reported serum creatinine values, and other variables only when specifically requested. Regarding the way results were presented, 46.2% of laboratories reported the exact numerical value only when the filtration rate was below 60mL/min/1.73m2, while 50.6% reported all values regardless. In 56.3% of the cases reporting eGFR, an interpretive commentary of it was enclosed. CONCLUSIONS: Although a high percentage of Spanish laboratories have added eGFR in their reports, this metric is not universally used. Moreover, some aspects, such as the equation used and the correct expression of eGFR results, should be improved.

Extreme concentrations of high density lipoprotein cholesterol affect the calculation of low density lipoprotein cholesterol in the Friedewald formula and other proposed formulas.

OBJECTIVES: To investigate the effect of extreme levels of high density lipoprotein cholesterol (HDL-C) in the calculation of low density lipoprotein cholesterol (LDL-C) using Friedewald's formula (FF) and other formulas proposed recently. DESIGN AND METHODS: Lipoprotein profile was performed in 2603 samples with HDL-C ≤ 20 mg/dL and 1953 samples with HDL-C ≥ 100 mg/dL. RESULTS: Wilcoxon's and Student's t-tests showed significant differences (p<0.001) between calculated LDL-C by different formulas and direct determination in the two groups of HDL-C values. Passing-Bablok regression and Bland-Altman plot showed disagreement for the four formulas studied, except for Vujovic formula in the HLD-C ≥ 100 mg/dL group. CONCLUSIONS: Our results suggested that none of the formulas under analysis should be used for estimating LDL-C in samples with extreme HDL-C concentrations due to absence of statistical correlation with LDL-C direct measurement.

Plasma fibronectin as a marker of sepsis.

OBJECTIVES: To evaluate the value of plasma fibronectin (pFN) as a diagnostic marker of sepsis. SUBJECTS AND METHODS: Plasma FN was determined in patients showing sepsis-related symptoms who had blood cultures performed. These patients were assigned to one of two groups according to their clinical situation: (1) Clinical Septic Group: patients with sepsis according to American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria; (2) Fever Peak Group: patients who did not fulfil sufficient ACCP/SCCM criteria for sepsis. Two additional control groups were also established: (3) Non-infectious Diseases Control Group and (4) Healthy Control Group. RESULTS: Plasma FN levels, microbiological and clinical data were compared among the different patient groups. For each group, the number of patients, median and mean pFN levels and the 95% confidence interval of the mean were: (1) n = 43, 102 mg/l, 122 mg/l (100-144); (2) n = 70, 185 mg/l, 207 mg/l (184-231); (3) n = 22, 175 mg/l, 181 mg/l (151-211); and (4) n = 22, 256 mg/l, 261 mg/l (229-292). Bonferroni's test of multiple comparisons was able to detect a significant difference between pFN concentrations corresponding to the septic group, compared to the remaining groups (pANOVA < 0.001 ). CONCLUSION: Plasma FN appears to act as a marker of sepsis in that patients showed diminished pFN levels. Along with other clinical and laboratory variables, the use of this marker would allow a rapid diagnosis of sepsis and limit the number of blood cultures to be processed and the number of antibiotic prescriptions, particularly when symptoms are insidious and diagnosis is doubtful. We propose further and more complex studies using a higher number of patients.