Anemia en pacientes ingresados por una exacerbación de EPOC. Influencia sobre el pronóstico de la enfermedad / No disponible

Objetivo: Estudiar la prevalencia de anemia en pacientes con EPOC ingresados por exacerbación de su enfermedad, características de estos enfermos, factores asociados a la existencia de anemia e influencia de ésta en la supervivencia. Pacientes y métodos: Estudio de cohortes observacional, prospectivo, realizado en pacientes con EPOC ingresados por exacerbación. Se analizaron datos demográficos, características clínicas, estudio funcional respiratorio, impedanciometría bioeléctrica y analítica sanguínea. Tras el alta se realizó seguimiento para calcular supervivencia y factores determinantes de mortalidad. Resultados: Se evaluaron 106 pacientes (93 varones), con edad media 71 ± 9 años, IMC medio 25,7 ± 5,6 kg/m2 y FEV1 medio 39 ± 13%. El 88,9% eran fumadores o exfumadores. La prevalencia de anemia fue 37,7%. Las comorbilidades más frecuentes fueron: dislipemia (73,6%), hipertensión arterial (59,4%) y cardiopatía (59,4%). El índice de Charlson medio fue de 5,9 ± 1,4 y el índice META medio, medido por bioimpedancia, de 22,3 ± 7,8. El análisis de regresión logística mostró quelos factores determinantes de anemia fueron: edad, niveles de hierro y creatinina e índice META. La supervivencia media de los pacientes que tenían anemia fue 31 ± 4,4 meses frente a 48,1 ± 2,9 en los que no tenían anemia (p < 0,001). Los factores determinantes de mortalidad fueron IMC y niveles de creatinina. Conclusiones: Un elevado porcentaje de pacientes con EPOC ingresados por una exacerbación tienen anemia. Los factores asociados a la existencia de anemia en estos pacientes son edad, niveles de hierro y creatinina e índice META. La presencia de anemia tiene un impacto significativo en la supervivencia (AU)

Objective: To study the prevalence of anemia in patients admitted for COPD exacerbations, the characteristics of these patients, the associated factors with the presence of anemia, and the influence of anemia on survival. Patients and methods: A cohort prospective observational study of patients admitted for COPD exacerbation. Demographic data, clinical characteristics, lung function tests, blood tests and bioelectrical impedance were analyzed. After discharge, monitoring was performed to estimate survival and determinants of mortality. Results: We evaluated 106 patients (93 males), mean age 71 ± 9 years, mean BMI 25.7 ± 5.6 kg/m2 and mean FEV1 39 ± 13%. 88.9% were smokers or former smokers. The prevalence of anemia was 37.7%. The most frequent comorbidities were dyslipidemia (73.6%), hypertension (59.4%) and heart disease (59.4%). The mean Charlson index was 5.9 ± 1.4 and the average META index, measured by bioimpedance, 22.3 ± 7.8. The logistic regression analysis showed that associated factors with anemia were age, creatinine levels, iron and META index. The median survival of patients with anemia was 31 ± 4.4 months versus 48.1 ± 2.9 in those without anemia (p <0.001). The determinants of mortality were BMI and creatinine levels. onclusions: A high percentage of COPD patients admitted with an exacerbation have anemia. Factors associated with the presence of anemia in these patients are age, iron and creatinine levels and META index. The presence of anemia has a significant impact on survival (AU)

Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias / Unsuspected pulmonary thromboembolism in the Emergency Department

Antecedentes y objetivos. El tromboembolismo pulmonar (TEP) es una enfermedad que en ocasiones, se diagnostica con un elevado retraso, lo que puede provocar una mayor morbimortalidad. Hemos definido el perfil clínico de los pacientes con TEP no sospechado en el Servicio de Urgencias, y los factores que influyen en el retraso para establecer el diagnóstico de TEP. Pacientes y métodos. Se analizaron retrospectivamente 148 pacientes ingresados con diagnóstico de TEP confirmado mediante TAC (n=133) o gammagrafía de ventilación/perfusión de alta probabilidad (n=15). Fueron divididos en dos grupos: los que no tenían sospecha diagnóstica de la enfermedad en el Servicio de Urgencias (TEP no sospechado) y aquellos en los que sí se sospechó este proceso (TEP sospechado). Se estudiaron las características clínicas, los factores de riesgo, los signos y los síntomas a su llegada a Urgencias; las pruebas complementarias realizadas, los días de ingreso hospitalario y la mortalidad. Resultados. De los 148 enfermos con TEP, el diagnóstico no se sospechó en el Servicio de Urgencias en 63 pacientes (42,6%). La disnea y el dolor torácico fueron las manifestaciones clínicas más comunes y se identificaron con mayor frecuencia entre los enfermos con TEP sospechado, que entre los pacientes con TEP no sospechado, con diferencias significativas (OR=0,4 [0,2-0,9] para la disnea y OR=0,3 [0,2-0,7], para el dolor torácico). Sin embargo, la presencia asociada de trombopenia (OR=3,4 [1,1-10,2], p<0,05), un electrocardiograma (ECG) normal (OR=3,4 [1,1-10,2], p<0,05), y la localización del TEP en pulmón derecho (OR=4,7 [2-11,3], p<0,001), fueron factores asociados a la no sospecha de la enfermedad. Los días de ingreso y de duración de los síntomas, así como la mortalidad, no fueron estadísticamente diferentes entre ambos grupos. Conclusiones. La proporción de enfermos con TEP confirmado pero no sospechado en el Servicio de Urgencias fue elevada (cerca del 40%). La presencia de disnea y dolor torácico se asociaron a la sospecha de TEP. Por el contrario, la presencia de trombopenia, un ECG normal, y la localización del TEP en el pulmón derecho se asociaron a la no sospecha de TEP en urgencias(AU)

Background and objectives. Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. Patients and methods. A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. Results. The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. Conclusions. According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department(AU)

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.

Neumonía lipoidea por aspiración accidental de queroseno en un «comedor de fuego» / Lipoid pneumonia by accidental aspiration of kerosene in a «fire eater»

La neumonía lipoidea es una entidad clínica causada por la aspiración o inhalación de sustancias grasas de origen animal. En este artículo se presenta el caso de un paciente de 24 años que realizaba actuaciones esporádicas como «tragafuegos», utilizando el queroseno como elemento fundamental, y que presentó una neumonía lipoidea aguda con resolución completa. Asimismo, se realiza una revisión del tema hasta la fecha actual (AU)

Lipoid pneumonia is a clinical entity caused by aspiration of animal fat substances or their inhalation. This article presents the case of a 24-year old male patient who performed sporadic performances as a «fire eater», using kerosene as a fundamental element, and who had acute lipoid pneumonia with complete resolution. Furthermore, a review is made of the subject up to the present date (AU)

Neumotórax de repetición / Recurrent pneumothorax

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