Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19.

Introduction: Patients with septic shock face an elevated risk of mortality compared to those with sepsis. Several biomarkers, including lactate dehydrogenase, albumin, and lactate/albumin (L/A), have been associated with increased mortality in COVID-19 patients. This study aims to assess the relationship between sepsis, septic shock, and mortality, as well as the need for mechanical ventilation in COVID-19 patients. Demographic, sepsis severity factors, and biomarkers are examined. Methods: A retrospective case series from June 2020 to March 2021 included 490 patients diagnosed with sepsis or septic shock secondary to SARS-CoV-2 pneumonia. Time-to-event analyses were conducted for mechanical ventilation and mortality. Statistical significance was set at p ≤ .0038. Serum lactate, albumin, lactate/albumin ratio, C-reactive protein, platelet levels, and three sepsis severity scales, (CCI, SOFA, APACHE IV) were assessed. Results: Sepsis was identified in 352 patients (71.8%), while 138 had septic shock. Patients with septic shock were more likely to require invasive ventilator support. Factors associated with a higher risk of intubation included higher APACHE IV scores, elevated serum albumin levels, and increased L/A ratio. L/A ratio and serum lactate levels demonstrated the best diagnostic accuracy for mechanical ventilation (AUC, 0.964 and 0.946, respectively), mortality (AUC, 0.926 and 0.887, respectively). Discussion: Increased C-reactive protein, combined with increased serum lactate and a high lactate/albumin ratio, may assist clinicians in identifying COVID-19 patients at risk of mechanical ventilation and mortality upon admission. Optimal cut-off values for lactate (1.45-1.65 mmol/L) and L/A ratio (0.413) can aid in prioritizing medical care for at risk COVID-19 patients.

Different serum sodium assay, different model for end stage liver disease - sodium scores in patients awaiting liver transplant: A cross-sectional study.

INTRODUCTION AND AIMS: Sodium can be measured with direct or indirect methods; abnormal plasma total protein concentration can impact on sodium measured by indirect ion-selective electrodes (ISE). Serum sodium is an important item to determine the Model for End Stage Liver Disease Sodium (MELD-Na) score, commonly used for liver graft allocation. Patients with cirrhosis usually have hypoproteinemia. The aim of this study was to determine if there was a significant difference between the MELD-Na scores calculated based on the results of two different serum sodium ISE: indirect and direct. METHODS: This was a retrospective study; we included 166 patients that underwent liver transplant assessment, and that had paired (i.e. same date and time) direct and indirect sodium determinations. We calculated the MELD-Na scores with both sodium determinations, and we compared them. RESULTS: There was a significant difference between MELD-Na scores; the mean difference was 0.4±1.3. If MELD-Na score had been determined by the sodium measured by the direct ISE, 69 patients (42%) would have stayed in the same place on the waiting list, 67 patients (40%) would have moved up, and 30 patients (18%) would have moved down. CONCLUSIONS: There was a statistically significant difference between the MELD-Na scores calculated based on the two different sodium concentrations, which would theoretically result in changes in the order of the waiting list. This finding should prompt studies to assess if MELD-Na calculated based on direct methods has a better performance to predict clinically relevant outcomes.

Hipoalbuminemia y riesgo de muerte en pacientes críticos en una unidad polivalente

Introducción: La hipoalbuminemia se puede desarrollar en las primeras horas posteriores a una enfermedad aguda y está muy relacionada con un estado inflamatorio activo, independientemente del estado nutricional del paciente. Se ha asociado con la mortalidad hospitalaria en pacientes con complicaciones postquirúrgicas, pacientes con sepsis y trauma. Objetivo: Evaluar la asociación entre los niveles de hipoalbuminemia y el riesgo de mortalidad del paciente crítico en una unidad polivalente. Métodos: Estudio observacional, descriptivo, prospectivo, de serie de casos, con 216 pacientes que ingresaron en la unidad. Se analizaron variables demográficas, clínicas, de laboratorio y se aplicó el índice pronóstico APACHE II. Se determinó la concentración de albúmina al ingreso y se clasificó la hipoalbuminemia en leve (30-35 g/L) y moderada/grave (≤ 30 g/L). Resultados: En el estudio fallecieron 28 pacientes, lo que representó un 13 % del total de pacientes ingresados. La albúmina presentó niveles bajos en 118 pacientes (54,6 %), y de estos, 66 (56 %) presentaron cifras inferiores a los 30 g/L; o sea, una hipoalbuminemia moderada o grave. Los pacientes con hipoalbuminemia moderada-grave tuvieron un riesgo de muerte superior (23,5 %) a aquellos con niveles clasificados como leve (15,3 %), diferencia estadísticamente significativa (p= 0,034); y en el grupo de pacientes con hipoalbuminemia moderada- grave falleció el 67 %, en relación con el 33 % de los pacientes con niveles clasificados como leve. Conclusiones: La hipoalbuminemia moderada-grave se asocia con el riesgo de mortalidad, independientemente del diagnóstico al ingreso.

Introduction: Hypoalbuminemia can develop in the first hours after an acute illness, and is closely related to an active inflammatory state, regardless of the patient's nutritional status. It has been associated with hospital mortality in patients with post-surgical complications, patients with sepsis and trauma. Objective: To evaluate the association between hypoalbuminemia level and the risk of mortality in critically ill patients in a polyvalent unit. Methods: Observational, descriptive, prospective, case series study, with 216 patients admitted to the unit. Demographic, clinical, and laboratory variables were analyzed and the APACHE II prognostic score was applied. Albumin concentration is calculated on admission and hypoalbuminemia is classified as mild (30-35 g/L) and moderate/severe (≤ 30 g/L). Results: In the study, 28 patients died, which represented 13% of the total number of patients admitted. Albumin levels were low in 118 patients (54.6%), and of these 66 patients (56%) were classified as hypoalbuminemia moderate/severe, with albumin values below 30 g/L. Patients with moderate-severe hypoalbuminemia had a higher risk of death (23.5%) than those patients with levels classified as mild (15.3%), a statistically significant difference (p= 0.034); and in the group of patients with moderate-severe hypoalbuminemia, 67% died, in relation to 33% of patients with levels classified as mild. Conclusions: Moderate-severe hypoalbuminemia is associated with mortality risk, regardless of admission diagnosis.

Síndrome Edematoso Generalizado por citomegalovirus

El síndrome edematoso generalizado o anasarca está presente secundario a un desequilibrio de la homeostasis hídrica, electrolítica y osmolar del organismo, En el adulto el estado de anasarca es más frecuente secundario a insuficiencia cardiaca, en pediatría, el edema que se generaliza está asociado con más frecuencia a bajo aporte proteico, baja síntesis de proteínas o debido a perdida de proteínas de origen gastrointestinal o renal. La disminución de la presión oncótica plasmática genera fuga de líquidos a compartimientos intersticiales de forma generalizada y produce edema. Existen múltiples patologías y mecanismos para la producción del edema generalizado; el conocimiento de la fisiopatología de su desarrollo permite un análisis clínico, de laboratorio y de gabinete que orientan al diagnostico. La infección por citomegalovirus es una causa poco frecuente de edema generalizado, reconocer esta entidad y llegar a un adecuado diagnóstico diferencial es el objetivo de esta revisión.

The generalized edematous syndrome or anasarca is present secondary to an imbalance in the body's water, electrolyte and osmolar homeostasis. In adults, the state of anasarca is more frequent secondary to heart failure; in pediatrics, generalized edema is associated with more frequency due to low protein intake, low protein synthesis or due to protein loss of gastrointestinal or renal origin. The decrease in plasma oncotic pressure generates generalized fluid leakage into interstitial compartments and produces edema. There are multiple pathologies and mechanisms for the production of generalized edema; knowledge of the pathophysiology of its development allows a clinical, laboratory and office analysis that guides the diagnosis. Cytomegalovirus infection is a rare cause of generalized edema; recognizing this entity and reaching an appropriate differential diagnosis is the objective of this review.

Feline leishmaniosis: hematological and biochemical analysis / Leishmaniose felina: análises de hematologia e bioquímica

One hundred and sixty-six cats from two animal shelters were subjected to enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence antibody test (IFAT), conventional polymerase chain reaction (cPCR), quantitative PCR (qPCR) and parasitological tests (PA) for the diagnosis of Leishmania spp. Among them, 15% (25/166), 53.6% (89/166), 3.6% (06/166) and 1.8% (03/166) were positive by ELISA, IFAT, both PCRs and PA, respectively. The sequencing of ITS-1 PCR amplicons revealed a 100% match with Leishmania infantum. After the Leishmania spp. survey, 12 cats were selected and divided into two groups for clinical, hematological, and biochemical analysis: six L. infantum positive cats (G1) and six Leishmania spp. negative cats (G2). All the cats were negative for feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV). A statistical analysis indicated significantly low platelet counts and significant hyperproteinemia associated with hypoalbuminemia in positive cats (p<0.05). Our results suggest that in endemic areas, cats with clinical signs of feline leishmaniosis (such as skin lesions, weight loss and/or enlarged lymph nodes) and that exhibit hematological and biochemical changes, such as low platelet counts and hyperproteinemia with hypoalbuminemia, should be tested for Leishmania spp. infection.(AU)

Cento e sessenta e seis gatos de dois abrigos foram submetidos ao diagnóstico de Leishmania spp. por ensaio imunoenzimático (ELISA), imunofluorescência indireta (RIFI), reação em cadeia pela polimerase convencional (cPCR) e quantitativa (qPCR) e métodos parasitológicos (PA). Destes, 15% (25/166), 53,6% (89/166), 3,6% (06/166) e 1,8% (03/166) foram positivos por ELISA, RIFI, as duas PCRs e PA, respectivamente. O sequenciamento dos produtos amplificados da PCR ITS-1 foi 100% idêntico à Leishmania infantum. Após o inquérito, 12 gatos foram selecionados para compor dois grupos para análises de hematologia e bioquímica: 6 gatos positivos para L. infantum (G1) e 6 gatos Leishmania spp. negativos (G2). Todos os gatos foram negativos para o vírus da imunodeficiência felina (FIV) e o da leucemia felina (FeLV). Foi observada uma diminuição na contagem de plaquetas e uma hiperproteinemia e hipoalbuminemia significativas em gatos positivos (p<0,05). Esses resultados sugerem que, em áreas endêmicas, os gatos com sinais clínicos de leishmaniose felina (tais como lesões dermatológicas, perda de peso e/ou linfonodos aumentados), associados a alterações hematológicas e bioquímicas, como contagem reduzida de plaquetas e hiperproteinemia com hipoalbuminemia, devem ser testados para leishmaniose felina.(AU)

The impact of stratified hypoalbuminemia and dialysis on morbidity/mortality after posterior spinal fusion surgery: An ACS-NSQIP study.

Background: Preoperative optimization in patients undergoing posterior spinal fusion is essential to limit the number and severity of postoperative complications. Here, we, additionally, evaluated the impact of hypoalbuminemia on morbidity and mortality after posterior spinal fusion surgery. Methods: This retrospective analysis was performed using data from a prospective multicentric database (ACSNSQIP:2015-2020) regarding patients undergoing posterior spinal fusions. Factors studied included; baseline demographics and 30-day postoperative complications (i.e., reoperations, readmissions, and mortality rates). Results: There were 6805 patients who met the inclusion criteria. They averaged 62 years of age and had an average BMI of 30.2. Within the 30-day postoperative period, 634 (9.3%) sustained complications; 467 (6.9%) were readmitted, 263 (3.9%) required reoperations, and 37 (0.5%) expired. Although multiple preoperative risk factors were analyzed, hypoalbuminemia, severe hypoalbuminemia, and dialysis were the strongest independent risk factors associated with complications (i.e., reoperations, readmissions, and mortality). Conclusion: Hypoalbuminemia, severe hypoalbuminemia, and dialysis were significant predictors for morbidity and mortality after posterior spinal fusion surgery.

Preoperative hypoalbuminemia and dialysis increase morbidity/mortality after spine surgery for primary pyogenic spinal infections (ACS-NSQIP Study).

Background: We analyzed the role of hypoalbuminemia, dialysis, and other risk factors that increase morbidity/ mortality following surgery for primary pyogenic spinal infections (PSIs). The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) that included 627 patients was utilized as our database. Methods: Primary spinal surgery for spondylodiscitis was evaluated in a ACS-NSQIP database involving 627 patients between 2010 and 2019. Outcome assessment included evaluation of 30-day postoperative morbidity, and mortality rates. Results: Within 30 postoperative days, complications occurred in 14.6% (92/627) of patients; 59 (9.4%) required readmission, and 39 (6.2%) required additional surgery. The most common complications were: wound infections, pneumonia, septic shock, and death (1.8%). Hypoalbuminemia (i.e., significantly associated with unplanned readmission and reoperation), and dialysis were the two major risk factors contributing to increased perioperative morbidity and mortality. Conclusion: Among 627 ACS-NSQIP patients undergoing primary surgery for PSIs, hypoalbuminemia and dialysis were associated with higher risks of major perioperative morbidity (i.e., within 30 postoperative days - mostly readmissions and reoperations) and mortality.

A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study

ABSTRACT BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

Age and Spinal Disease Correlate to Albumin and Vitamin D Status.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: Thus, this study aimed to assess the epidemiological profile of a patient sample that underwent spinal surgery regarding their nutritional and vitamin D status. METHODS: Serum albumin and vitamin D (25-hydroxyvitamin D) levels were measured in patients with different spinal surgical approaches and various pathologies at a single institution. 112 patients were retrospectively identified for inclusion and stratified by age into 4 age groups and by pathology. The nutritional status of the patients was classified in vitamin D inadequacy (< 30ng/mL), vitamin D deficiency (<20ng/mL), and hypoalbuminemia (<3.5g/dL). Data was analyzed comparing vitamin D, and albumin means considering gender, age group, and pathologies. RESULTS: Twenty-eight (25.2%) patients had hypoalbuminemia. There was no difference between gender (p = 0.988); there was a significant decrease in albumin concentration increasing the age (p < 0.001). The prevalence of hypoalbuminemia was significantly higher in patients with trauma, tumor and infection than in those patients with degenerative and deformity diseases (p = 0.003). The prevalence of vitamin D inadequacy was 33.7%, and that of deficiency was 62.2%, while severe deficiency (< 10 ng/mL) in 16.3%. The vitamin D concentration was significantly different among the pathologies (P = 0.047), the lower concentration occurring in patients with tumor. CONCLUSION: Older patients, as well as patients with tumor and infectious pathologies, seem to have a higher prevalence of hypoalbuminemia, inferring malnutrition. There was a low epidemic level of vitamin D concentration, almost all patients presenting some degree of hypovitaminosis D, independent of age, gender and nutritional status.

Síndrome nefrótico congénito debutando con enfermedad de cambios mínimos / Congenital nephrotic syndrome debuting with disease of minimal changes

Resumen El síndrome nefrótico es la glomerulopatía primaria más frecuente en pediatría; es una patología que se caracteriza por la presencia de proteinuria, hipoalbuminemia, edema e hipercolesterolemia. Se habla de un neonato con antecedentes de prematuridad y hospitalización al nacer, posterior a múltiples infecciones recurrentes con evolución tórpida durante estancia hospitalaria y edema generalizado, de quien se sospecha tener síndrome nefrótico congénito, apoyándose en resultados paraclínicos positivos y una biopsia renal que reporte enfermedad de cambios mínimos. El síndrome nefrótico congénito es una entidad poco frecuente; sin embargo, presenta alta morbimortalidad, así como diversas formas de presentación clínica e histológica, y su manejo suele ser difícil dada la baja respuesta a corticoides. La presencia del síndrome nefrótico congénito es inusual, no obstante, presenta alta mortalidad y deja muchas secuelas, siendo la enfermedad renal crónica la más temida. Así que resulta importante sospechar en recién nacidos con infecciones recurrentes asociadas a presencia de edema generalizado para iniciar un manejo precoz que pueda ayudar a evitar consecuencias y mejorar la calidad de vida del paciente y su familia.

Abstract Nephrotic syndrome is the most common primary glomerulopathy in pediatrics; it is a pathology characterized by the presence of proteinuria, hypoalbuminemia, edema, and hypercholesterolemia. There is talk of a neonate with a history of prematurity and hospitalization at birth, after multiple infections recurrent with torpid evolution during hospital stay and edema generalized, suspected of having congenital nephrotic syndrome, relying on positive paraclinical results and a renal biopsy that reports minimal change disease. Congenital nephrotic syndrome is a rare entity; However, presents high morbidity and mortality, as well as various forms of clinical and histological, and its management is usually difficult given the low response to corticosteroids. The presence of congenital nephrotic syndrome is unusual; however, it presents high mortality and leaves many sequelae, with chronic kidney disease being the most feared. So, it is important to suspect in newborns with infections recurrent associated with the presence of generalized edema to initiate management early that can help prevent consequences and improve the quality of life of the patient and his family. .

Relación entre complicaciones postoperatorias e hipoalbuminemia en pacientes con cáncer de cabeza y cuello

RESUMEN Introducción: El cáncer de cabeza y cuello es un problema de salud a nivel global. La cirugía oncológica desempeña importantes funciones en la terapéutica del cáncer y las complicaciones son en mayor o menor medida inherentes a ella. Los niveles de albúmina pretratamiento han demostrado tener valor pronóstico en pacientes oncológicos, pero se desconoce la relación entre la hipoalbuminemia y las complicaciones posquirúrgicas en pacientes con cáncer de cabeza y cuello. Objetivo: Evaluar la relación entre complicaciones posoperatorias e hipoalbuminemia en pacientes con cáncer de cabeza y cuello. Métodos: Se realizó un estudio transversal, con una muestra de 133 casos, se utilizaron las variables: edad, sexo, hipoalbuminemia, complicaciones y tipo de complicaciones. Se utilizó el test exacto de Fisher y su significación exacta, con un nivel de confianza del 95 %. Para el análisis pronóstico de la relación entre las complicaciones y la hipoalbuminemia se calculó el riesgo absoluto con el odds ratio. Resultados: El 54,8 % correspondió al grupo con más de 60 años, el 75,9 % al sexo masculino, el 20,3 % de los casos tenía hipoalbuminemia y solo presentaron complicaciones el 19,5 %. El riesgo absoluto de complicaciones en los pacientes con hipoalbuminemia fue 1312,5. Conclusiones: La hipoalbuminemia es un factor de mal pronóstico para la aparición de complicaciones postoperatorias en pacientes con cáncer de cabeza y cuello.

ABSTRACT Introduction: Head and neck cancer is a global health problem. Cancer surgery plays important roles in cancer therapy and complications are, to a greater or lesser extent, inherent to it. Pretreatment albumin levels have been shown to have prognostic value in cancer patients; but the relationship between hypoalbuminemia and postoperative complications in patients with head and neck cancer is unknown. Objective: To evaluate the relationship between postoperative complications and hypoalbuminemia in patients with head and neck cancer. Method: A cross-sectional study was carried out, with a sample of 133 cases, the variables were used: age, sex, hypoalbuminemia, complications and type of complications. Fisher's exact test and its exact significance were used, with a confidence level of 95 %. For the prognostic analysis of the relationship between complications and hypoalbuminemia, the absolute risk was calculated with the odds ratio. Results: 54,8 % corresponded to the group over 60 years old, 75,9 % to the male sex, 20,3 % of the cases had hypoalbuminemia and only 19,5 % presented complications. The absolute risk of complications in patients with hypoalbuminemia was 1312,5. Conclusions: Hypoalbuminemia is a poor prognostic factor for the appearance of postoperative complications in patients with head and neck cancer.

Hypoalbuminemia: a risk factor in patients with STEC-associated hemolytic uremic syndrome.

BACKGROUND: We aimed to determine the prevalence of hypoalbuminemia in STEC-HUS patients with hemorrhagic colitis (HC) and whether serum albumin level (SAL), leukocyte count, hematocrit and serum sodium level (SSL) are prognostic markers of HC, central nervous system disease (CNSd) and/or dialysis requirement and evaluate if hypoalbuminemia is associated with fecal protein losses. METHODS: We prospectively evaluated STEC-HUS patients treated at our institution from 9/2011 to 2/2019, analyzing the presence of HC, CNSd and dialysis requirement and SAL, SSL, leukocytes, hematocrit and α1-antitrypsin clearance. RESULTS: We evaluated 98 patients, with mean age of 33.3 months. SAL ≤ 29.5 g/l, > 24,600 leukocytes/mm3 and hematocrit > 30% behave as independent prognostic markers for HC. SAL ≤ 28 g/l, > 25,200 leukocytes/mm3 and hematocrit > 30% behave as prognostic markers for CNSd. SAL ≤ 31.6 g/l, > 13,800 leukocytes/mm3, hematocrit > 18.9% and hyponatremia (≤ 132 mEq/l) behave as prognostic markers for dialysis requirement. However, in multivariate logistic regression models, only hypoalbuminemia behaved as a risk factor for HC, CNSd and dialysis. α1-antitrypsin clearance was performed in 69 patients and was high in 9/69 (13%), only 4 with HC. No significant association was observed between α1-antitrypsin clearance and albuminemia (χ2 = 0.1076, p = 0.7429) as well as α1-antitrypsin clearance and HC (χ2 = 1.7892, p = 0.1810). CONCLUSIONS: Almost all patients with HC had hypoalbuminemia, which behaves as a risk factor for HC, CNSd and dialysis requirement. No significant association was observed between elevated α1-antitrypsin clearance and hypoalbuminemia nor between elevated α1-antitrypsin clearance and HC. These findings could be related to the small number of evaluated patients.

Hipoalbuminemia Como Predictor De Mortalidad De Sepsis Por COVID-19. Hospital II Chocope, 2020. / Hypoalbuminemia as a predicator of mortality of sepsis from COVID-19. Hospital II Chocope, 2020.

Se realizó una investigación de tipo correlacional evaluando a 145 pacientes con sepsis por covid-19. Objetivos: Determinar si la hipoalbuminemia es predictor de mortalidad e identificar el valor sérico de albumina más frecuentemente relacionado con la letalidad. Métodos: Se incluyeron a pacientes mayores o igual de 18 años atendidos en el Hospital II Chocope durante mayo a agosto del 2020. Se excluyeron a pacientes con patologías oncológicas, e historias clínicas incompletas. La técnica empleada es la de análisis documental, mediante la revisión de historias clínicas. Resultados: Hubo asociación estadísticamente significativa entre la hipoalbuminemia y mortalidad (p = 0.00), los pacientes con hipoalbuminemia tuvieron 3 veces más riesgo de fallecer. (OR=3.97 IC al 95%). Así mismo, la sensibilidad y especificidad más alta de la prueba fue cuando el punto de corte de la hipoalbuminemia estuvo en 1.38 g/dl. Finalmente, la hipertensión arterial es la enfermedad asociada más frecuente. Conclusiones: la hipoalbuminemia es predictor de mortalidad y a menor valor de albumina mayor mortalidad.

A correlational type investigation was carried out evaluating 145 patients with covid-19 sepsis. Objectives: To determine whether hypoalbuminemia is a predictor of mortality and to identify the serum albumin value most frequently related to lethality. Method: Patients older than or equal to 18 years seen at Hospital II Chocope during May to August 2020 were included. Patients with oncological pathologies and incomplete medical records were excluded. The documentary analysis technique was used, by reviewing medical records. Results: There was a statistically significant association between hypoalbuminemia and mortality (p = 0.00), patients with hypoalbuminemia had 3 times the risk of dying. (OR = 3.97 95% CI). Likewise, the highest sensitivity and specificity of the test was when the cut-off point for hypoalbuminemia was 1.38 g / dl. Finally, the most frequent comorbidity was arterial hypertension. Conclusions: hypoalbuminemia is a predictor of mortality and the lower the albumin value, the higher the mortality.

Clinical and laboratory factors associated with nosocomial pneumonia in adult patients in the internal medicine department of a national hospital in Peru: A case-control study. / Factores clínicos y de laboratorio asociados a neumonía nosocomial en pacientes adultos en el servicio de medicina interna de un hospital nacional de Perú: estudio de casos y controles.

OBJECTIVE: To determine how clinical and laboratory factors were associated with nosocomial pneumonia in adult patients hospitalized in an internal medicine department. METHODS: We conducted a retrospective unmatched case-control study. We recorded clinical and epidemiological data from patients discharged from an internal medicine department of a Peruvian reference hospital, the Hospital Nacional Arzobispo Loayza, between 2016 and 2018. Bivariate and multivariate analyses (using logistic regression models) were performed to obtain crude and adjusted odds ratios with 95% confidence intervals. A P value < 0.05 was considered significant. We calculated the population attributable fraction of the significant variables. RESULTS: We analyzed 138 cases and 200 controls, with a mean age of 72.6 ± 17.8 years (21 to 104) for cases and 71.7 ± 15.3 years (19 to 98) for controls. The multivariate analysis indicated that severe anemia (adjusted odds ratio 9.0, confidence interval 95% 1.9 to 43.1, P = 0.01), severe hypoalbuminemia (adjusted odds ratio 4.0, confidence interval 95% 1.2 to 13.8, P = 0.03), altered state of consciousness (adjusted odds ratio 3.6, confidence interval 95% 1.6 to 8.2, P = 0.00), and prior use of antibiotics (adjusted odds ratio 6.3, confidence interval 95% 2.7 to 14.5, P = 0.00) were significantly associated with nosocomial pneumonia. The population attributable fraction found were 41.8% for altered state of consciousness, 33.2% for severe anemia, and 36.3% for severe hypoalbuminemia. CONCLUSION: Clinical and laboratory risk factors associated with nosocomial pneumonia development in adult patients hospitalized in an internal medicine department were severe anemia, severe hypoalbuminemia, altered consciousness, and previous use of antibiotics.

INTRODUCCIÓN: La neumonía nosocomial es la infección intrahospitalaria más frecuente y es responsable de alta morbimortalidad en todo el mundo, por lo que su estudio es muy importante. OBJETIVO: Determinar cómo los factores clínicos y de laboratorio se asociaron a neumonía nosocomial en pacientes adultos hospitalizados en un servicio de medicina interna. MÉTODOS: Se realizó un estudio retrospectivo de casos y controles no pareado. Se recolectaron los datos clínicos epidemiológicos de pacientes egresados del departamento de medicina interna durante el periodo 2016 a 2018 de un centro de referencia en Perú: el Hospital Nacional Arzobispo Loayza. Se realizó análisis bivariado y multivariado, usando el método de regresión logística, para obtener Odds ratio crudos y ajustados, con un intervalo de confianza de 95%. El valor p < 0,05 fue considerado significativo. Se calculó la fracción atribuible poblacional de las variables significativas. RESULTADOS: Se analizaron 138 casos y 200 controles, la media de edad fue de 72,6 ± 17,8 años (21 a 104) para los casos y 71,7 ± 15,3 años (19 a 98) para los controles. En el análisis multivariado la anemia severa (Odds ratio ajustado: 9,0; intervalo de confianza 95%: 1,9 a 43,1; p = 0,01), hipoalbuminemia severa (Odds ratio ajustado: 4,0; intervalo de confianza 95%: 1,2 a 13,8; p = 0,03), trastorno de conciencia (Odds ratio ajustado: 3,6; intervalo de confianza 95%: 1,6 a 8,2; p = 0,00) y el uso previo de antibióticos (Odds ratio ajustado: 6,3; intervalo de confianza 95%: 2,7 a 14,5; p = 0,00) se asociaron independientemente con la neumonía nosocomial. La fracción atribuible poblacional encontrada fue 41,8% para trastorno de conciencia, 33,2% para anemia severa y 36,3% para hipoalbuminemia severa. CONCLUSIONES: Los factores de riesgos clínicos y de laboratorio asociados al desarrollo de neumonía nosocomial en pacientes adultos hospitalizados fueron la anemia severa, la hipoalbuminemia severa, el trastorno de conciencia y el uso previo de antibióticos.

Sjögren syndrome associated with protein-losing enteropathy: case-based review.

The association between Sjögren's syndrome (SS) and protein-losing enteropathy (PLE) was scarcly reported. To analyze the clinical, therapeutic, and outcome characteristics of patients with SS and PLE and also to delineate the potential mechanisms and pathways connecting the gut to SS targeted organ's pathology. Systematic screening was conducted using PubMed/MEDLINE, LILACS, SciELO, Web of Science, and Cochrane, dating 1980 to 2020. SS and PLE were the key words. Eighteen patients with SS and PLE were summarized. The patient's ages ranged between 20 and 88 years, and only 4 were males. Primary SS was observed in most cases. Anti-Ro was detected in 100% of the cases while anti-La was reported in 64% of them. The clinical manifestations were protein loss, edema of the lower limbs, pleural effusion, ascites, facial edema, anasarca, diarrhea, and weight loss. Among these clinical manifestations, edema of the lower limbs was the most severe. Albumin concentration was 0.9-3.4 g/dL which increased to 2.8-4.3 g/dL after treatment. Small bowel biopsy was performed in all of the cases. Concerning the therapy, all the patients received systemic glucocorticoids. All of them improved. The period of onset of improvement ranged from 3 weeks to 36 months (an average of 3 months). The early diagnosis and appropriate therapy of PLE in patients with anti-Ro positive SS and who present edema, anasarca, or hypoalbuminemia is vital for a beneficial outcome. An excellent clinical improvement in all the cases was observed when treated early enough by cortico-therapy, thus preventing patient's deterioration, complications, and reducing morbidity and potential mortality.

Factores asociados a mortalidad de adultos mayores hospitalizados en un servicio de Medicina Interna / Factors associated with mortality in hospitalized elders in an internal medicine department

El presente estudio prospectivo de cohorte tuvo como objetivo determinar los factores asociados a la mortalidad de los adultos mayores admitidos en un servicio de Medicina Interna de un hospital público de Lima. Durante el 2019 se evaluaron consecutivamente 360 pacientes mayores de 60 años mediante la aplicación de las herramientas de la Valoración Geriátrica Integral y la revisión de sus historias clínicas. Del total, 45 (12,5%) fallecieron durante el internamiento. En el modelo multivariado, la presencia de delirio al ingreso se asoció con un mayor riesgo de mortalidad hospitalaria (RR = 3,64; IC95%: 1,51-8,76, p = 0,004). Hubo una mayor frecuencia de anemia (p = 0,043), hipoalbuminemia (p = 0,006), úlceras por presión (p = 0,003), comorbilidad alta (p < 0,001), dependencia funcional (p < 0,001) y malnutrición (p = 0,002) entre los pacientes fallecidos respecto a los no fallecidos. Se requieren estudios adicionales en nuestro país para evaluar el valor pronóstico del delirio, otros síndromes geriátricos sobre la mortalidad y otros desenlaces adversos.

The aim of this prospective cohort study was to determine the factors associated with mortality in elders admitted to an Internal Medicine Department of a public hospital in Lima. During 2019, 360 patients over 60 years of age were consecutively evaluated by applying the Comprehensive Geriatric Assessment tools and reviewing their medical records. During hospitalization, 45 (12.5%) died. There was a higher frequency of anemia (p = 0.043), hypoalbuminemia (p = 0.006), pressure ulcers (p = 0.003), high comorbidity (p < 0.001), functional dependence (p < 0.001) and malnutrition (p = 0.002) among deceased patients compared to non-deceased. In the multivariate model, the presence of delirium on admission was associated with a higher risk of hospital mortality (RR = 3.64; 95% CI: 1.51 - 8.76, p = 0.004). Additional studies are required in our country to assess the prognostic value of delirium and other geriatric syndromes on mortality and other adverse outcomes.

The role of serum inflammatory markers, albumin, and hemoglobin in predicting the diagnosis in patients admitted to the emergency department with a pre-diagnosis of COVID-19

SUMMARY OBJECTIVE: Serum inflammatory markers and albumin levels provide an assumption for the severity of COVID-19 infection. Our objective was to investigate the determinant role of serum inflammatory markers, albumin, and hemoglobin (Hb) in predicting the diagnosis in patients with a pre-diagnosis of COVID-19. METHODS: Demographic findings, complete blood count and serum biochemical values of the patients analyzed. RESULTS: Of the patients included in the study, 48 were COVID (+) and 253 were COVID (-). Statistically significant difference was found in terms of hemoglobin, mean platelet volume, and monocyte/eosinophil ratio. CONCLUSIONS: The levels of serum albumin, hemoglobin, monocyte/eosinophil ratio, and mean platelet volume can be predictive factors for diagnosis in patients with COVID-19.

HYPOALBUMINEMIA IN MICROSURGICAL FLAPS OF THE MUSCULOSKELETAL APPARATUS.

OBJECTIVE: To evaluate if the levels of serum total protein and serum albumin are risk factors for surgical complications of free flap limb reconstruction. METHODS: Consecutive inclusion of all patients undergoing microsurgical flaps for limb reconstruction of complex injuries. We recorded epidemiological and laboratory data, including total proteins and fractions, for descriptive and analytical statistics. RESULTS: Our study analyzed one microsurgical flap from 35 patients that underwent complex injuries of the limbs. In total, 23 patients were men, and mean age of all patients was 35 years. After statistical analysis, no influence of pre or postoperative hypoalbuminemia was observed on the incidence of complications. Patients with hypoalbuminemia had a higher length of stay than those with normal albumin levels (p = 0.008). CONCLUSION: We observed that 71% of patients had hypoalbuminemia in early postoperative period and we suggest a nutritional support for patients requiring complex traumatic limb reconstruction. Hypoalbuminemia in patients subjected to microsurgical flaps for the treatment of complex traumatic limb injuries did not influence the complications that required surgical reintervention; However, it was associated with prolonged hospital stay. Level of Evidence II, Retrospective study.

OBJETIVO: Avaliar a influência dos níveis totais de proteína sérica e albumina como fator de risco para complicações de retalhos microcirúrgicos para reconstrução de membros. MÉTODOS: Inclusão consecutiva de todos os pacientes submetidos a retalhos microcirúrgicos para reconstrução de membros de lesões complexas. Foram registrados dados epidemiológicos e laboratoriais, incluindo proteínas e frações totais, para fins estatísticos descritivos e analíticos. RESULTADOS: 35 retalhos microcirúrgicos foram estudados em 35 pacientes com lesões complexas dos membros. A idade média dos pacientes foi de 35 anos, e 23 pacientes eram do sexo masculino. Após análise estatística, não foi observada influência da hipoalbuminemia pré ou pós-operatória na incidência de complicações. Pacientes com hipoalbuminemia permaneceram mais tempo hospitalizados do que aqueles com níveis normais de albumina (p = 0,008). CONCLUSÃO: Observamos 71% dos pacientes com hipoalbuminemia no início do período pós-operatório e sugerimos fornecer suporte nutricional para pacientes que necessitam de reconstrução traumática complexa dos membros. A presença de hipoalbuminemia em pacientes submetidos a retalhos microcirúrgicos para o tratamento de lesões traumáticas complexas nos membros não influenciou a presença de complicações que exigiam reintervenção cirúrgica, mas foi associada ao tempo de hospitalização prolongado. Nível de Evidência II, Estudo retrospectivo .

Hypoalbuminemia in microsurgical flaps of the musculoskeletal apparatus / A hipoalbuminemia em retalhos microcirúrgicos do aparelho musculoesquelético

ABSTRACT Objective: To evaluate if the levels of serum total protein and serum albumin are risk factors for surgical complications of free flap limb reconstruction. Methods: Consecutive inclusion of all patients undergoing microsurgical flaps for limb reconstruction of complex injuries. We recorded epidemiological and laboratory data, including total proteins and fractions, for descriptive and analytical statistics. Results: Our study analyzed one microsurgical flap from 35 patients that underwent complex injuries of the limbs. In total, 23 patients were men, and mean age of all patients was 35 years. After statistical analysis, no influence of pre or postoperative hypoalbuminemia was observed on the incidence of complications. Patients with hypoalbuminemia had a higher length of stay than those with normal albumin levels (p = 0.008). Conclusion: We observed that 71% of patients had hypoalbuminemia in early postoperative period and we suggest a nutritional support for patients requiring complex traumatic limb reconstruction. Hypoalbuminemia in patients subjected to microsurgical flaps for the treatment of complex traumatic limb injuries did not influence the complications that required surgical reintervention; However, it was associated with prolonged hospital stay. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Avaliar a influência dos níveis totais de proteína sérica e albumina como fator de risco para complicações de retalhos microcirúrgicos para reconstrução de membros. Métodos: Inclusão consecutiva de todos os pacientes submetidos a retalhos microcirúrgicos para reconstrução de membros de lesões complexas. Foram registrados dados epidemiológicos e laboratoriais, incluindo proteínas e frações totais, para fins estatísticos descritivos e analíticos. Resultados: 35 retalhos microcirúrgicos foram estudados em 35 pacientes com lesões complexas dos membros. A idade média dos pacientes foi de 35 anos, e 23 pacientes eram do sexo masculino. Após análise estatística, não foi observada influência da hipoalbuminemia pré ou pós-operatória na incidência de complicações. Pacientes com hipoalbuminemia permaneceram mais tempo hospitalizados do que aqueles com níveis normais de albumina (p = 0,008). Conclusão: Observamos 71% dos pacientes com hipoalbuminemia no início do período pós-operatório e sugerimos fornecer suporte nutricional para pacientes que necessitam de reconstrução traumática complexa dos membros. A presença de hipoalbuminemia em pacientes submetidos a retalhos microcirúrgicos para o tratamento de lesões traumáticas complexas nos membros não influenciou a presença de complicações que exigiam reintervenção cirúrgica, mas foi associada ao tempo de hospitalização prolongado. Nível de Evidência II, Estudo retrospectivo .