Usefulness of Preoperative Determination of Serum MR-ProAdrenomedullin Levels to Predict the Need for Postoperative Organ Support in Abdominal Oncological Surgery.

The need for postoperative organic support is associated with patient outcomes. Biomarkers may be useful for detecting patients at risk. MR-ProADM is a novel biomarker with an interesting profile that can be used in this context. The main objective of this study was to verify whether there was an association between the preoperative serum levels of MR-ProADM and the need for organic support after elective abdominal cancer surgery, and to determine the preoperative MR-ProADM value that predicts the need for postoperative organic support. This was a multicenter prospective observational study conducted by four tertiary hospitals in Spain between 2017 and 2018. Plasma samples were collected for the quantification of MR-ProADM from adults who underwent major abdominal surgery during 2017-2018. The primary outcome was the need for organic support in the first seven postoperative days and its association with the preoperative levels of MR-ProADM, and the secondary outcome was the preoperative levels of MR-ProADM in the study population. This study included 370 patients with a mean age of 67.4 ± 12.9 years. Seventeen percent (63 patients) required some postoperative organic support measures in the first week. The mean preoperative value of MR-ProADM in patients who required organic support was 1.16 ± 1.15 nmol/L. The AUC-ROC of the preoperative MR-ProADM values associated with the need for organic support was 0.67 (95% CI: 0.59-0.75). The preoperative MR-ProADM value, which showed the best compromise in sensitivity and specificity for predicting the need for organic support, was 0.70 nmol/L. The negative predictive value was 91%. A multivariate analysis confirmed that a preoperative level of MR-ProADM ≥ 0.70 nmol/L is an independent factor associated with risk of postoperative organic support (OR 2, 6). Elevated preoperative MR-ProADM levels are associated with the need for postoperative organic support. Therefore, MR-ProADM may be a useful biomarker for perioperative risk assessment.

Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward / Impacto de la implementación del Programa Código Sepsis en una planta de hospitalización médica: estudio de una cohorte de pacientes de Medicina Interna

Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is alack of evidence about patients attended in conventional units.Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units withsepsis were included and assigned to two cohorts according toSepsis Code (SC) activation (group A) or not (B). Baseline andevolution variables were collected.Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed somefunctional disability. More bundles were completed in group A:blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrumantibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation96.62% vs 80.95% (p < 0.001). Infection control at 72 hourswas quite higher in group A (81.42% vs 55.18%, odds ratio3.55 [2.48-5.09]). Antibiotic was optimized more frequently ingroup A (60.77% vs 47.03%, p 0.008). Mean in-hospital staywas 10.63 days (11.44 vs 8.53 days, p < 0.001). Complicationsduring hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs24.76%, p < 0.001). 28-day mortality was significantly lower ingroup A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]).Conclusions. Implementation of SC seems to be effectivein improving short-term outcomes in IM patients, althoughtherapy should be tailored in an individual basis (AU)

Introducción. La sepsis es la principal causa de muerte enlos hospitales y la implantación de códigos para su manejo hademostrado mejorar su evolución. Sin embargo, es escasa laevidencia relativa a los pacientes atendidos en unidades médicas convencionales.Métodos. Se realizó un estudio de cohortes retrospectivode 3 años. Se incluyeron pacientes con sepsis hospitalizados enunidades de Medicina Interna y se asignaron a dos cohortessegún la activación del Código Sepsis (CS) (grupo A) o no (B).Se recogieron variables basales y de evolución.Resultados. Se incluyeron 653 pacientes. En 296 casos seactivó el SC. La edad media fue de 81,43 años, la mediana delíndice de comorbilidad de Charlson (ICC) fue de 2 y el 63,25%presentaba alguna limitación funcional. Se realizaron más acciones diagnósticas y terapéuticas en el grupo A: hemocultivos95,2% vs 72,5% (p < 0,001), antibióticos de espectro extendido59,1% vs 41,4% (p < 0,001), reanimación con líquidos 96,62%vs 80,95% (p < 0,001). El control de la infección a las 72 horasfue superior en el grupo A (81,42% vs 55,18%, odds ratio 3,55[2,48-5,09]). La optimización de los antibióticos fue más frecuente en el grupo A (60,77% vs 47,03%, p 0,008). La estanciamedia en el hospital fue de 10,63 días (11,44 vs 8,53 días, p <0,001). Aparecieron complicaciones durante la hospitalizaciónen el 51,76% de los pacientes, especialmente en el grupo B(45,95% vs 56,58%, odds ratio 1,53 [1,12-2,09]). Los pacientesdel grupo A reingresaron más (40% vs 24,76%, p < 0,001). Lamortalidad a los 28 días fue significativamente menor en elgrupo A (20,95% frente a 42,86%, odds ratio 0,33 [0,23-0,47]). (AU)

Impact of Tricuspid Regurgitation Severity and Repair on Aortic Valve Replacement.

BACKGROUND: Aortic stenosis is one of the most prevalent valve diseases but is rarely accompanied by tricuspid regurgitation. Our objective was to analyze the impact of tricuspid regurgitation severity and its surgical treatment on prognosis of patients undergoing aortic valve replacement. METHODS: This was a retrospective cohort study including all patients presenting with aortic stenosis with some degree of tricuspid regurgitation between 2001 and 2018. Patients were grouped according to the degree of tricuspid regurgitation. RESULTS: From a sample of 8080 patients with aortic stenosis, 143 (1.8%) presented with more than trace tricuspid regurgitation. Among patients with mild, moderate, or severe tricuspid regurgitation, we observed no differences in 30-day (15.1% vs 14.8% vs 8.7%; P = .727), 12-month (51.2% vs 56% vs 55%; P = .892), or 5-year (64% vs 73.3% vs 66.7%; P = .798) survival. Aortic valve replacement plus tricuspid annuloplasty, when compared with aortic valve replacement only was associated with longer intensive care unit stay (9 vs 3 days; P = .043) but not higher 30-day (0% vs 15.5%; P = .112), 12-month (38.5% vs 54.3%; P = .278), or 5-year mortality (57.1% vs 67.1%; P = .594). Only history of liver disease and postoperative major morbidity were independent predictors of survival 30 days, 12 months and 5 years after surgery. CONCLUSIONS: Severity of tricuspid regurgitation in patients with aortic stenosis was not associated with increased mortality. Tricuspid annuloplasty did not improve survival in this subset of patients but was associated with increased postoperative morbidity.

Potenciales biomarcadores predictores de mortalidad en pacientes COVID-19 en el Servicio de Urgencias / Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department

OBJETIVO: Identificar qué biomarcadores realizados en la primera analítica de urgencias ayudan a estratificar según riesgo de mortalidad a pacientes COVID 19. MÉTODO: Estudio observacional descriptivo y transversal realizado con datos recogidos de los pacientes con sospecha de COVID-19 en el Servicio de Urgencias del 24 de febrero al 16 de marzo del 2020. Se realizó el estudio univariante y multivariante para encontrar los marcadores independientes de mortalidad y calcular el riesgo mediante la construcción de una escala de gravedad. RESULTADOS: Se incluyeron 163 pacientes de los que fallecieron 33 y 29 de ellos resultaron positivos para la prueba PCR COVID-19. Obtuvimos como posibles factores para conformar el score de riesgo de mortalidad edad>75 años ((OR ajustada=12,347, IC95%: 4,138-36,845 p = 0.001), leucocitos totales> 11.000 cel/mm3 (OR ajustada=2,649, IC95%: 0,879-7,981 p = 0,083), glucosa> 126 mg/dL (OR ajustada=3,716, IC95%: 1,247-11,074 p = 0,018) y creatinina>1,1 mg/dL (OR ajustada= 2,566, IC95%: 0,889-7,403, p = 0,081). Este score se denominó COVEB (COVID, Edad, perfil Básico analítico) con un AUC 0,874 (IC95%: 0,816-0,933, p < 0.001; punto de corte= 1 (sensibilidad= 89,66% (IC95%: 72,6%-97,8%), especificidad= 75,59% (IC95%: 67,2%-82,8%). Un score < 1 posee un valor predictivo negativo = 100% (IC95%: 93,51%-100%) y un valor predictivo positivo = 18,59% (IC95%: 12,82%-25,59%). CONCLUSIONES: Las escalas clínicas de gravedad, los biomarcadores de función renal, los parámetros del recuento leucocitario, el ratio neutrófilos totales/linfocitos y procalcitonina son factores de riesgo tempranos de mortalidad. Destacan las variables edad, glucosa, creatinina y leucocitos totales como mejores predictores de mortalidad. Un score COVEB< 1 indica con un 100% de probabilidad, que el paciente con sospecha de COVID-19 no va a fallecer en los próximos 30 días

OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHOD: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days

Developing a faster way to identify biocontamination in the air of controlled environment rooms with HEPA filters: airborne particle counting.

Our aim was to assess whether airborne particle counting is an immediate indicator of biocontamination in controlled environment rooms with HEPA filters in a hospital. A prospective study was carried out in a tertiary care hospital between 2016 and 2018. The study was divided in two periods and the measurements were performed in different controlled environment rooms with HEPA filters. The Environmental Biosafety Criterion (EBC) was defined as the absence of fungal and bacterial contamination. In the training period, the area under the ROC curve (aROC) of airborne particle counting and EBC was calculated for each particle size as well as the cut-off points that optimize the combination of sensitivity and specificity in the association between them. aROC is created by plotting sensitivity against 1-specificity. In the testing period, the cut-off points previously selected were validated. 328 measurements were carried out in the training period and 301 in the testing period. In the training period, an association was found between airborne particle counting and EBC. An aROC = 0.760, 95% Confidence Interval (95% CI) 0.695-0.825 was observed for 0.3 µm particles; an aROC = 0.797 (95% CI 0.734-0.860) for 0.5 µm particles; and an aROC = 0.751 (95% CI 0.673-0.829) for 5 µm particles. The cut-off points that optimized the combination of sensitivity and specificity were 9.0 × 103 for 0.3 µm particles, 3.6 × 103 particles for 0.5 µm, and 3.2 × 102 particles for 5 µm. In the testing period, the previous cut-off points were validated. We conclude that airborne particle counting is a useful, immediate, and preliminary measure to identify the presence of biocontamination in controlled environment rooms with HEPA filters.

A New Surgical Site Infection Risk Score: Infection Risk Index in Cardiac Surgery.

Various scoring systems attempt to predict the risk of surgical site infection (SSI) after cardiac surgery, but their discrimination is limited. Our aim was to analyze all SSI risk factors in both coronary artery bypass graft (CABG) and valve replacement patients in order to create a new SSI risk score for such individuals. A priori prospective collected data on patients that underwent cardiac surgery (n = 2020) were analyzed following recommendations from the Reporting of studies Conducted using Observational Routinely collected health Data (RECORD) group. Study participants were divided into two periods: the training sample for defining the new tool (2010­2014, n = 1298), and the test sample for its validation (2015­2017, n = 722). In logistic regression, two preoperative variables were significantly associated with SSI (odds ratio (OR) and 95% confidence interval (CI)): diabetes, 3.3/2­5.7; and obesity, 4.5/2.2­9.3. The new score was constructed using a summation system for punctuation using integer numbers, that is, by assigning one point to the presence of either diabetes or obesity. The tool performed better in terms of assessing SSI risk in the test sample (area under the Receiver-Operating Characteristic curve (aROC) and 95% CI, 0.67/055­0.76) compared to the National Nosocomial Infections Surveillance (NNIS) risk index (0.61/0.50­0.71) and the Australian Clinical Risk Index (ACRI) (0.61/0.50­0.72). A new two-variable score to preoperative SSI risk stratification of cardiac surgery patients, named Infection Risk Index in Cardiac surgery (IRIC), which outperforms other classical scores, is now available to surgeons. Personalization of treatment for cardiac surgery patients is needed.

Surgery for acute infective endocarditis: epidemiological data from a Spanish nationwide hospital-based registry.

OBJECTIVES: Infective endocarditis (IE) is a serious and eventually lethal disease with rising incidence in the past couple of decades. The aim of this study was to evaluate the contemporary epidemiological trends of surgical endocarditis patients, to analyse the clinical outcomes and to study their profile, associated prognostic factors and costs. METHODS: This is a retrospective study of all patients admitted for IE in Spanish hospitals and discharged between 1 January 1997 and 31 December 2014. Data were extracted from the minimum basic data set of the National Surveillance System for Hospital Data in Spain provided by the Spanish Ministry of Health. Hospitalizations, comorbidities, outcomes and costs were analysed. RESULTS: In total, 34 399 patients with IE were included; 15.7% of patients received surgical treatment and 84.3% received medical treatment only. Surgical patients were mostly men (71.9%) and had a lower mean age (59.2 ± 16.08 years) than the medical treatment group (P < 0.0001). Mortality among surgical patients showed a decreasing trend between 1997 (32.0%) and 2014 (22.7%) and increased with age (47.6% in ≥85 years of age). Length of hospital stay and the percentage of patients with organ dysfunction were also higher in this group. The cost of the surgical treatment group was higher and increased since 1997 (15 259.22 euros), remaining stable from 2010 (40 700 euros) (P < 0.0001). CONCLUSIONS: Surgical treatment in IE has trended upwards in Spain during the last 2 decades. Patients are getting older and more frequently experience organ dysfunction. Mortality ratio steadily declined without changes in the length of hospital stay.

Vigilancia epidemiológica y factores de riesgo de infección de sitio quirúrgico en cirugía cardiaca: estudio de cohortes prospectivo / Epidemiological surveillance of surgical site infection and its risk factors in cardiac surgery: a prospective cohort study

Introducción y objetivos: La infección de sitio quirúrgico es poco frecuente en cirugía cardiaca. El objetivo es estudiar su incidencia, compararla con datos nacionales e internacionales y evaluar sus factores de riesgo. Métodos: Estudio de cohortes prospectivo que incluyó a pacientes intervenidos de cirugía cardiaca valvular y revascularización coronaria durante 6 años consecutivos. Se estudió la incidencia de infección de sitio quirúrgico. Se evaluó la asociación entre los factores de riesgo y la infección con la odds ratio (OR). Las tasas de infección se han comparado con las de España y Estados Unidos usando la razón estandarizada de infección. Resultados: Se incluyó a 1.557 pacientes. La incidencia de infecciones acumulada total fue del 4% (intervalo de confianza del 95% [IC95%], 3,6-5,6%), el 3,6% (IC95%, 2,5-4,7%) en cirugía valvular y el 4,3% (IC95%, 2,3-6,3%) en revascularización coronaria. La diabetes mellitus (OR = 2,8; p < 0,05) y la obesidad (OR = 6,6; p < 0,05) resultaron factores de riesgo de infección de sitio quirúrgico de la cirugía valvular. La diabetes mellitus (OR = 2,9; p < 0,05) y la reintervención por hemorragia (OR = 8,8; p < 0,05) son factores de riesgo de infección de sitio quirúrgico en revascularización coronaria. Conclusiones: La diabetes mellitus y la obesidad favorecen la infección de sitio quirúrgico en cirugía valvular. La diabetes mellitus y la reintervención por hemorragia favorecen la infección de sitio quirúrgico en revascularización coronaria. Los sistemas de vigilancia y control de infección permiten evaluar y comparar las tasas de infección en cirugía cardiaca (AU)

Introduction and objectives: Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. Methods: This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. Results: A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR = 2.8; P < .05) and obesity (OR = 6.6; P < .05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR = 2.9; P < .05) and reoperation for bleeding (OR = 8.8; P < .05). Conclusions: Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery (AU)

Epidemiological Surveillance of Surgical Site Infection and its Risk Factors in Cardiac Surgery: A Prospective Cohort Study.

INTRODUCTION AND OBJECTIVES: Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. METHODS: This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. RESULTS: A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR=2.8; P<.05) and obesity (OR=6.6; P<.05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR=2.9; P<.05) and reoperation for bleeding (OR=8.8; P<.05). CONCLUSIONS: Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery.

Evaluación de la infección de herida quirúrgica en 14 hospitales de la Comunidad de Madrid: estudio de incidencia / Assessment of the surgical site infection in 14 hospitals of the Madrid Region: an incidence study

Introducción y objetivos: Las infecciones relacionadas con la asistencia sanitaria son una causa importante de mortalidad y morbilidad entre los pacientes. Una de las más frecuentes es la infección de localización quirúrgica (ILQ). Los objetivos del estudio eran conocer las tasas de ILQ y valorar la aplicación de los protocolos de preparación prequirúrgica y profilaxis antibiótica preoperatoria establecidos en 14 hospitales públicos de la Comunidad de Madrid. Material y métodos: Estudio prospectivo observacional multicéntrico que incluye a todos los pacientes intervenidos quirúrgicamente en los servicios sometidos a vigilancia e ingresados durante más de 48 h, entre el 1 de enero y el 31 de diciembre de 2009. Fueron vigilados desde el ingreso hasta el alta. Resultados: La ILQ fue la infección nosocomial más frecuente (superficial = 1,7%, profunda = 2%; órgano espacio= 1,7%). Se muestran las tasas de ILQ por procedimiento quirúrgico e índice de riesgo National Nosocomial Infection Surveillance System, así como otros indicadores de calidad, como estancia hospitalaria,profilaxis antibiótica, mortalidad, reingresos por infección o complicación y tasa de reintervenciones quirúrgicas. Discusión: Los resultados obtenidos en este estudio multicéntrico no sólo pueden servir como referenciaa otros hospitales públicos, sino que también son comparables con otros sistemas de vigilancia internacionales. La vigilancia y el control de las infecciones asociadas a la asistencia sanitaria deben ser un aspecto clave en los programas de calidad asistencial y seguridad del paciente (AU)

Background and objectives: Health care-associated infections (HAIs) occur frequently in hospitals and have severe consequences, with surgical site infection (SSI) being one of the most commonly reported. The aim of this study was to determine SSI rates and to assess the application of presurgical preparation and antimicrobial prophylaxis protocols in 14 public hospitals of the region of Madrid. Material and methods: Multi-centre prospective surveillance study. All patients who underwent a surgical procedure from January 1 2009, to December 31, 2009 with a hospital stay of more than 48 hours, were monitored from the time of surgery until hospital discharge. Results: SSI was the most frequent HAI (superficial incisional SSI = 1.7%; deep incisional SSI = 2%; organ space SSI = 1.7%). SSI rates are provided by operative procedure and NNIS risk index category. Further quality indicators reported are surgical complications, length of stay, antimicrobial prophylaxis, mortality, readmission due to infection or other complications and revision surgery. Conclusions: The results obtained in this multicentre study can be used as a reference for other public hospitals, and allow comparisons with other international surveillance systems. Surveillance and control of HAIs must be a key aspect in patient safety and quality healthcare programs (AU)

[Assessment of the surgical site infection in 14 hospitals of the Madrid Region: an incidence study]. / Evaluación de la infección de herida quirúrgica en 14 hospitales de la Comunidad de Madrid: estudio de incidencia.

BACKGROUND AND OBJECTIVES: Health care-associated infections (HAIs) occur frequently in hospitals and have severe consequences, with surgical site infection (SSI) being one of the most commonly reported. The aim of this study was to determine SSI rates and to asses the application of presurgical preparation and antimicrobial prophylaxis protocols in 14 public hospitals of the region of Madrid. MATERIAL AND METHODS: Multi-centre prospective surveillance study. All patients who underwent a surgical procedure from January 1 2009, to December 31, 2009 with a hospital stay of more than 48 hours, were monitored from the time of surgery until hospital discharge. RESULTS: SSI was the most frequent HAI (superficial incisional SSI=1.7%; deep incisional SSI=2%; organ-space SSI=1.7%). SSI rates are provided by operative procedure and NNIS risk index category. Further quality indicators reported are surgical complications, length of stay, antimicrobial prophylaxis, mortality, readmission due to infection or other complications and revision surgery. CONCLUSIONS: The results obtained in this multicentre study can be used as a reference for other public hospitals, and allow comparisons with other international surveillance systems. Surveillance and control of HAIs must be a key aspect in patient safety and quality healthcare programs.