Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism.

Introduction: D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. Patients and methods: Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. Results: Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165 ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. Conclusion: It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.

Introducción: El dímero-D está elevado en la COVID-19 y se correlacionan con los niveles de otros marcadores inflamatorios como ferritina, fibrinógeno y proteína C reactiva. Cabe la posibilidad de corregir el dímero-D en función de dichos marcadores inflamatorios, identificando así los pacientes con mayor riesgo de enfermedad tromboembólica venosa (ETV). Nuestros objetivos son estimar un valor corregido de dímero-D como función lineal de ferritina, proteína C reactiva y fibrinógeno, y establecer un punto de corte de alta probabilidad de ETV. Pacientes y métodos: Estudio de casos y controles emparejados por sexo y edad de todos los pacientes diagnosticados con COVID-19 y ETV entre marzo y mayo de 2020 en un hospital terciario de Madrid, España. Mediante regresión lineal, se estima el mejor modelo predictivo y se obtiene el valor residual de dímero-D. Este se analizará con curvas ROC para determinar su capacidad discriminativa. Resultados: Se incluyeron 38 casos y 76 controles. Había un 63,2% de varones y la edad media fue de 68,2 años. El valor de dímero-D fue predicho por un modelo que incluyó fibrinógeno, ferritina y proteína C reactiva. Usando los valores residuales, el punto de corte óptimo estimado de 2.165 ng/ml, con una sensibilidad del 57,9% y una especificidad del 98,7%. Conclusiones: Es posible estimar un valor corregido de dímero-D en función de ferritina, fibrinógeno y proteína C reactiva. Usando el valor observado y estimado podemos obtener un valor residual que funciona bien como método de cribado para detectar pacientes que podrían beneficiarse de más estudios diagnósticos de la ETV.

Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism / Valor del dímero-D corregido por marcadores inflamatorios en pacientes con infección por SARS-CoV-2 en el diagnóstico de enfermedad tromboembólica venosa

Introduction:D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE.Patients and methods:Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance.Results:Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165ng/mL, with a sensitivity of 57.9% and specificity of 98.7%.Conclusion:It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.(AU)

Introducción:El dímero-D está elevado en la COVID-19 y se correlacionan con los niveles de otros marcadores inflamatorios como ferritina, fibrinógeno y proteína C reactiva. Cabe la posibilidad de corregir el dímero-D en función de dichos marcadores inflamatorios, identificando así los pacientes con mayor riesgo de enfermedad tromboembólica venosa (ETV). Nuestros objetivos son estimar un valor corregido de dímero-D como función lineal de ferritina, proteína C reactiva y fibrinógeno, y establecer un punto de corte de alta probabilidad de ETV.Pacientes y métodos:Estudio de casos y controles emparejados por sexo y edad de todos los pacientes diagnosticados con COVID-19 y ETV entre marzo y mayo de 2020 en un hospital terciario de Madrid, España. Mediante regresión lineal, se estima el mejor modelo predictivo y se obtiene el valor residual de dímero-D. Este se analizará con curvas ROC para determinar su capacidad discriminativa.Resultados:Se incluyeron 38 casos y 76 controles. Había un 63,2% de varones y la edad media fue de 68,2 años. El valor de dímero-D fue predicho por un modelo que incluyó fibrinógeno, ferritina y proteína C reactiva. Usando los valores residuales, el punto de corte óptimo estimado de 2.165ng/ml, con una sensibilidad del 57,9% y una especificidad del 98,7%.Conclusiones:Es posible estimar un valor corregido de dímero-D en función de ferritina, fibrinógeno y proteína C reactiva. Usando el valor observado y estimado podemos obtener un valor residual que funciona bien como método de cribado para detectar pacientes que podrían beneficiarse de más estudios diagnósticos de la ETV. (AU)

Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism.

INTRODUCTION: D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. PATIENTS AND METHODS: Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. RESULTS: Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. CONCLUSION: It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.

Ventilación mecánica no invasiva en pacientes de edad avanzada: ¿hacia una nueva estrategia de organización hospitalaria? / Non-Invasive Mechanical Ventilation in Elderly Patients: Moving Towards a New Strategy for Hospital Organization?

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Tabaquismo en la enfermedad pulmonar obstructiva crónica / Smoking in COPD

El tabaquismo es una enfermedad crónica adictiva recidivante, causante de múltiples patologías y principal causa conocida de morbilidad y mortalidad evitables, y constituye un importante problema para la salud pública. En los países desarrollados es la principal causa aislada de morbilidad y mortalidad prematuras prevenibles. La combustión del tabaco libera más de 4.000 sustancias tóxicas para la salud y más de 50 con efectos cancerígenos comprobados; es un factor de riesgo para 6 de las 8 causas principales de muerte en el mundo. El tratamiento del tabaquismo es eficaz y coste-efectivo. Cualquier intervención terapéutica que los profesionales realicemos sobre el tabaquismo de nuestros pacientes será eficaz. Si dicha intervención se adecua a las características individuales de cada fumador, su eficacia y eficiencia serán mucho mayores. Todos los tratamientos son seguros, presentándose efectos secundarios generalmente leves y que raramente obligan a la suspensión de la medicación. Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tienen una mayor dependencia a la nicotina y aparentemente una mayor dificultad para dejar de fumar. En los pacientes con EPOC debe considerarse una prioridad, al ser la única medida capaz de frenar el avance de la enfermedad (AU)

Smoking is a recurrent, chronic addictive disease that causes multiple diseases and is the main known cause of avoidable morbidity and mortality, constituting a major public health problem. In developed countries, smoking is the main single cause of premature preventable morbidity and mortality. Tobacco combustion releases more than 4,000 toxic substances and more than 50 substances with demonstrated carcinogenic effects; smoking is a risk factor for six of the eight main causes of death worldwide. The treatment of smoking is both effective and cost-effective. Any therapeutic intervention performed by health professions for smoking will have beneficial results. If such interventions are adapted to the individual characteristics of each patient, their efficacy and efficiency will be much greater. All treatments are safe, with generally mild adverse effects that rarely lead to treatment withdrawal. Patients with COPD show higher nicotine dependence and seem to have greater difficulty in quitting smoking. Nevertheless, smoking cessation should be a priority in these patients, as it constitutes the only measure able to halt progression of the disease (AU)

[Smoking in COPD]. / Tabaquismo en la enfermedad pulmonar obstructiva crónica.

Smoking is a recurrent, chronic addictive disease that causes multiple diseases and is the main known cause of avoidable morbidity and mortality, constituting a major public health problem. In developed countries, smoking is the main single cause of premature preventable morbidity and mortality. Tobacco combustion releases more than 4,000 toxic substances and more than 50 substances with demonstrated carcinogenic effects; smoking is a risk factor for six of the eight main causes of death worldwide. The treatment of smoking is both effective and cost-effective. Any therapeutic intervention performed by health professions for smoking will have beneficial results. If such interventions are adapted to the individual characteristics of each patient, their efficacy and efficiency will be much greater. All treatments are safe, with generally mild adverse effects that rarely lead to treatment withdrawal. Patients with COPD show higher nicotine dependence and seem to have greater difficulty in quitting smoking. Nevertheless, smoking cessation should be a priority in these patients, as it constitutes the only measure able to halt progression of the disease.