Disease-Related Malnutrition and Sarcopenia Predict Worse Outcome in Medical Inpatients: A Cohort Study.

(1) Background: Both sarcopenia and disease-related malnutrition (DRM) are unfortunately underdiagnosed and undertreated in our Western hospitals, which could lead to worse clinical outcomes. Our objectives included to determine the impact of low muscle mass (MM) and strength, and also DRM and sarcopenia, on clinical outcomes (length of stay, death, readmissions at three months, and quality of life). (2) Methodology: Prospective cohort study in medical inpatients. On admission, MM and hand grip strength (HGS) were assessed. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose DRM and EWGSOP2 for sarcopenia. Assessment was repeated after one week and at discharge. Quality of life (EuroQoL-5D), length of stay (LoS), readmissions and mortality are reported. (3) Results: Two hundred medical inpatients, median 76.0 years-old and 68% with high comorbidity. 27.5% met GLIM criteria and 33% sarcopenia on admission, increasing to 38.1% and 52.3% on discharge. Both DRM and sarcopenia were associated with worse QoL. 6.5% died and 32% readmission in 3 months. The odds ratio (OR) of mortality for DRM was 4.36 and for sarcopenia 8.16. Readmissions were significantly associated with sarcopenia (OR = 2.25) but not with DRM. A higher HGS, but not MM, was related to better QoL, less readmissions (OR = 0.947) and lower mortality (OR = 0.848) after adjusting for age, sex, and comorbidity. (4) Conclusions: In medical inpatients, mostly polymorbid, both DRM but specially sarcopenia are associated with poorer quality of life, more readmissions, and higher mortality. Low HGS proved to be a stronger predictor of worse outcomes than MM.

Colección intraabdominal en paciente con infección por virus de la inmunodeficiencia humana / Abdominal collection in a patient with Human Inmunodeficieny Virus infection

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Fístula esófago-mediastínica por M. tuberculosis en paciente con infección por VIH / Tuberculous esophagomediastinal fistula in and HIV-infected patient

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Factores predictores de no adherencia al tratamiento antirretroviral de gran actividad / Factors predicting lack of adherence to highly active antiretroviral treatment

INTRODUCCIÓN. Conocer la adherencia a los tratamientos antirretrovirales y las variables asociadas es de gran utilidad en el seguimiento de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). PACIENTES, MATERIAL Y MÉTODOS. Se han incluido todos los pacientes que acudieron a consultas externas de los Hospitales de León y el Bierzo entre enero y junio de 2000.Se consideraron no adherentes aquellos que manifestaron no haber ingerido en los 4 días previos a la entrevista el 10 por ciento o más del total de dosis prescritas de al menos un fármaco, o aquellos que en los últimos 3 meses habían acumulado un retraso en la recogida de los fármacos superior a 9 días. Se llevó a cabo un análisis de regresión logística con las variables asociadas a nivel univariado con la adherencia. RESULTADOS. Los métodos utilizados para medir la adherencia presentaron un índice kappa de 12,6 por ciento. De los 206 pacientes entrevistados se consideraron no adherentes 108 (52,4 por ciento; intervalo de confianza [IC] al 95 por ciento 45,6-59,2). Tras el análisis multivariado presentaban una significativa menor adherencia quienes refirieron haber consumido cocaína en los últimos 6 meses (odds ratio [OR] ajustada 5,1), no estar totalmente seguros de poder tomar correctamente los tratamientos prescritos (OR ajustada 2,5), y quienes no tenían prescritos la combinación de análogos zidovudina (AZT) y lamivudina (OR ajustada 1,9). Más de una tercera parte de los pacientes sin ninguna variable asociada a la no adhesión fueron considerados no adherentes. CONCLUSIÓN. La medida de la adherencia y sus predictores presenta importantes dificultades metodológicas. Con los criterios utilizados más de la mitad de los pacientes se consideraron no adherentes. Las variables asociadas a una baja adhesión son susceptibles de ser modificadas mediante intervenciones socio-psicosanitarias (AU)

[Factors predicting lack of adherence to highly active antiretroviral treatment]. / Factores predictores de no adherencia al tratamiento antirretroviral de gran actividad.

INTRODUCTION: Knowledge of adherence to highly active antiretroviral treatment (HAART) and the variables associated with poor compliance is useful for the follow-up of HIV infected patients. PATIENTS, MATERIAL AND METHODS: Patients were consecutively recruited from the HIV outpatient clinics of the Hospitals of Leon and El Bierzo from January to June 2000. Patients were considered non-adherent to treatment if they failed to take 10% or more of their prescribed total dose of at least one drug during the 4 days before the interview, or if they had accumulated a delay of more than 9 days over the previous 3 months in picking up their prescribed drugs from the hospital pharmacy. Logistic regression analysis was performed with variables found to be associated with adherence in the univariate analysis. RESULTS: The methods used to determine adherence had a Kappa index of 12.6%. Among the 206 patients interviewed, 108 were considered non-adherent (52.4%; CI 95% 5 45.6-59.2). Multivariate analysis showed that the following factors were associated with poor treatment adherence: cocaine consumption in the previous six months (adjusted OR 5 5.1); patients unsure about the proper way to take prescribed treatment; (adjusted OR 5 2.5); and patients not prescribed the zidovudine-lamivudine combination (adjusted OR 5 1.9). Over one-third of patients with no variable associated with treatment adherence were considered non-compliant. CONCLUSION: Measurement of medication adherence and its predictive factors involved methodological difficulties. With the criteria used in the present study more than half the patients were considered non-compliant. The variables found to be related to poor adherence can be modified by social, psychological or health care interventions.