[Leuko-glycemic index in patients with ST elevation myocardial infarction]. / Índice leucoglucémico en pacientes con infarto miocárdico con elevación del ST.

Background: The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI). Material and methods: In this single-center and crosssectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant. Results: We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients. Conclusion: A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.

Introducción: la mortalidad asociada a infarto del miocardio (IM) no solo se debe a complicaciones cardiovasculares, sino tambien a complicaciones intrahospitalarias no cardiovasculares (CIHNC). El índice leuco-glucémico (ILG) se ha utilizado como un marcador pronóstico para el desarrollo de complicaciones cardiovasculares en el IM. Centramos este estudio en identificar el punto de corte de ILG para el desarrollo de CIHNC en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST). Material y métodos: en este diseño de un solo centro y transversal, incluimos pacientes con IAMCEST. El análisis bioquímico incluyó glucosa y leucocitos; se calculó ILG. Se realizaron análisis univariados y bivariados, curva ROC y análisis multivariado para el desarrollo de IAMCEST. Resultados: incluimos 1294 pacientes, 79.8% hombres y 20.2% mujeres. Las principales comorbilidades fueron: hipertensión arterial sistémica, diabetes mellitus y dislipidemia. Seiscientos cuarenta y cuatro pacientes (49.8%) presentaron CIHNC. El ILG > 1200 con área bajo la curva (AUC) 0.817 predice el desarrollo de CIHNC en pacientes con IAMCEST. Las variables que aumentaron el desarrollo de CIHNC fueron: ILG > 1200, creatinina > 0.91 mg/dL, diabetes mellitus y edad > 65 años. La neumonía intrahospitalaria y las complicaciones cardiovasculares aumentaron el riesgo de muerte entre los pacientes con IAMCEST. Conclusión: un LGI > 1200 aumentó más de nueve veces el riesgo de desarrollo de CIHNC en pacientes con IAMCEST.

Risk Factors and Outcomes for COVID-19 in Autoimmune Inflammatory Diseases during the SARS-CoV-2 Pandemic: A Comparative Study.

BACKGROUND: Patients with autoimmune disease (AID) and coronavirus disease 2019 (COVID-19) could have higher mortality due to the co-morbidity and the use of immunosuppressive therapy. OBJECTIVES: To analyze the risk factors and outcomes of patients with AID and COVID-19 versus a control group. METHODS: A prospective cohort study included patients with and without AID and COVID-19. Patients were paired by age and sex. Clinical, biochemical, immunological treatments, and outcomes (days of hospital stay, invasive mechanical ventilation [IMV], oxygen at discharge, and death) were collected. RESULTS: We included 226 COVID-19 patients: 113 with AID (51.15 ± 14.3 years) and 113 controls (53.45 ± 13.3 years). The most frequent AIDs were Rheumatoid arthritis (26.5%), systemic lupus erythematosus (21%), and systemic sclerosis (14%). AID patients had lower lactate dehydrogenas, C-reactive protein, fibrinogen, IMV (P = 0.027), and oxygen levels at discharge (P ≤ 0.0001) and lower death rates (P ≤ 0.0001). Oxygen saturation (SaO2) ≤ 88% at hospitalization provided risk for IMV (RR [relative risk] 3.83, 95% confidence interval [95%CI] 1.1-13.6, P = 0.038). Higher creatinine and LDH levels were associated with death in the AID group. SaO2 ≤ 88% and CO-RADS ≥ 4 were risk factors for in-hospital mortality (RR 4.90, 95%CI 1.8-13.0, P = 0.001 and RR 7.60, 95%CI 1.4-39.7, P = 0.016, respectively). Anticoagulant therapy was protective (RR 0.36, 95%CI 0.1-0.9, P = 0.041). CONCLUSIONS: Patients with AID had better outcomes with COVID-19 than controls. Anticoagulation was associated with a lower death in patients with AID.

Índice leucoglucémico en pacientes con infarto miocárdico con elevación del ST / Leuko-glycemic index in patients with ST elevation myocardial infarction

Introducción: la mortalidad asociada a infarto del miocardio (IM) no solo se debe a complicaciones cardiovasculares, sino también a complicaciones intrahospitalarias no cardiovasculares (CIHNC). El índice leuco-glucémico (ILG) se ha utilizado como un marcador pronóstico para el desarrollo de complicaciones cardiovasculares en el IM. Centramos este estudio en identificar el punto de corte de ILG para el desarrollo de CIHNC en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST). Material y métodos: en este diseño de un solo centro y transversal, incluimos pacientes con IAMCEST. El análisis bioquímico incluyó glucosa y leucocitos; se calculó ILG. Se realizaron análisis univariados y bivariados, curva ROC y análisis multivariado para el desarrollo de IAMCEST. Resultados: incluimos 1294 pacientes, 79.8% hombres y 20.2% mujeres. Las principales comorbilidades fueron: hipertensión arterial sistémica, diabetes mellitus y dislipidemia. Seiscientos cuarenta y cuatro pacientes (49.8%) presentaron CIHNC. El ILG > 1200 con área bajo la curva (AUC) 0.817 predice el desarrollo de CIHNC en pacientes con IAMCEST. Las variables que aumentaron el desarrollo de CIHNC fueron: ILG > 1200, creatinina > 0.91 mg/dL, diabetes mellitus y edad > 65 años. La neumonía intrahospitalaria y las complicaciones cardiovasculares aumentaron el riesgo de muerte entre los pacientes con IAMCEST. Conclusión: un LGI > 1200 aumentó más de nueve veces el riesgo de desarrollo de CIHNC en pacientes con IAMCEST.

Background: The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods: In this single-center and cross-sectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant. Results: We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients. Conclusion: A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.

[Pulmonary alveolar proteinosis. Report of a case]. / Proteinosis alveolar pulmonar. Reporte de un caso.

BACKGROUND: The pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoprotein material in the alveoli. It is classified as primary, secondary and congenital. The primary form, of autoimmune origin, is characterized by antibodies against granulocyte-macrophage colony stimulating factor (GM-CSF). The aim of this article is to present a case of PAP with adequate response to treatment with bronchoalveolar lavage (BAL) and GM-CSF. CLINICAL CASE: A 28-year-old female patient who started with mild to moderate effort dyspnea, distal cyanosis and lower respiratory tract infection. We found restrictive pattern respiratory function tests, chest X-ray with bilateral nodular reticulum pattern and high-resolution tomography with ground glass image and bronchiectasis, besides video bronchoscopy with inflammatory process. The open biopsy revealed data of alveolar proteinaceous material and mononuclear infiltrate. Treatment was given with BAL and GM-CSF which was suspended by dermal reaction. The patient had a satisfactory evolution and is currently asymptomatic. CONCLUSION: The present case had clinical, imaging and histological manifestations for the diagnosis of autoimmune PAP with a satisfactory response to treatment. Although PAP is a low prevalence entity, the diagnosis and therapeutic options must be taken into account, including BAL and GM-CSF, since this factor is required for surfactant factor homeostasis.

INTRODUCCIÓN: la proteinosis alveolar pulmonar (PAP) se caracteriza por la acumulación de material lipoproteináceo en los alveolos, y se clasifica en primaria, secundaria y congénita. La primaria, de origen autoinmune, se caracteriza por anticuerpos contra el factor estimulante de colonia de granulocitos y macrófagos (GM-CSF). El objetivo del presente trabajo es presentar un caso de PAP con buena respuesta al tratamiento con lavado broncoalveolar (LBA) y GM-CSF. CASO CLÍNICO: Caso clínico: distal e infección de vías respiratorias bajas. Se efectuaron pruebas de función respiratoria con patrón restrictivo, radiografía de tórax con patrón retículo nodular bilateral y tomografía de alta resolución con imagen de vidrio despulido y bronquiectasias, así como video broncoscopía con proceso inflamatorio. La biopsia a cielo abierto evidenció datos de material proteináceo alveolar e infiltrado mononuclear. Se dio tratamiento con LBA y GM-CSF, el cual fue suspendido por reacción dérmica. Tuvo evolución satisfactoria y actualmente se encuentra asintomática. CONCLUSIÓN: el presente caso tuvo manifestaciones clínicas, de imagen e histológicas para el diagnóstico de PAP autoinmune con respuesta satisfactoria. Para el tratamiento de la PAP, aunque es una entidad de baja prevalencia, se debe tener en cuenta el diagnóstico y las opciones terapéuticas, entre ellas, el LBA y el GM-CSF, puesto que este factor se requiere para la homeostasis del factor surfactante.