INCIDENCE OF PREGNANCY RELATED PULMONARY EMBOLISM IN SPAIN 2016-2021: an observational population-based retrospective study.

OBJECTIVE: This study aimed to estimate the overall and annual age-standardized incidence of pregnancy-related pulmonary embolism (PE) in Spain from 2016 to 2021, explore the distribution of PE events during pregnancy and the postpartum period, identify potential risk factors, and estimate mortality rates during hospital admission. METHODS: In a retrospective, observational, population-based study, data from the Spanish National Hospital Discharge Database were analyzed to identify women with hospital episodes of pregnancy-related-PE. The primary outcome was the overall and annual age-standardized incidence of pregnancy-related-PE, with secondary aims including the distribution of events during pregnancy and postpartum and the calculation of age-standardized mortality rates during admission. RESULTS: Among 2,178,805 births from 2016-2021, 522 women were diagnosed with pregnancy-related PE, yielding an overall age-standardized incidence of 2.83 cases per 10,000 births. A non-significant increasing trend was observed from 2.43 to 4.18 cases per 10,000 births (p = 0.06). Comorbidities were low, with a notable association between PE and SARS-CoV-2 infection during the last two years. The mortality rate among women with pregnancy-related PE was 2.8%, with a higher incidence of PE reported during the postpartum period. CONCLUSION: The incidence of pregnancy-related-PE in Spain exhibits a non-significant increasing trend, with a significant risk of mortality. The association with SARS-CoV-2 infection underscores the importance of vigilant monitoring and management of pregnant women, particularly during pandemics. This study contributes specific data on the incidence and characteristics of pregnancy-related-PE in Spain, emphasizing the need to consider PE in the differential diagnosis and management strategies for pregnant and postpartum women.

Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism.

Introduction: D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. Patients and methods: Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. Results: Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165 ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. Conclusion: It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.

Introducción: El dímero-D está elevado en la COVID-19 y se correlacionan con los niveles de otros marcadores inflamatorios como ferritina, fibrinógeno y proteína C reactiva. Cabe la posibilidad de corregir el dímero-D en función de dichos marcadores inflamatorios, identificando así los pacientes con mayor riesgo de enfermedad tromboembólica venosa (ETV). Nuestros objetivos son estimar un valor corregido de dímero-D como función lineal de ferritina, proteína C reactiva y fibrinógeno, y establecer un punto de corte de alta probabilidad de ETV. Pacientes y métodos: Estudio de casos y controles emparejados por sexo y edad de todos los pacientes diagnosticados con COVID-19 y ETV entre marzo y mayo de 2020 en un hospital terciario de Madrid, España. Mediante regresión lineal, se estima el mejor modelo predictivo y se obtiene el valor residual de dímero-D. Este se analizará con curvas ROC para determinar su capacidad discriminativa. Resultados: Se incluyeron 38 casos y 76 controles. Había un 63,2% de varones y la edad media fue de 68,2 años. El valor de dímero-D fue predicho por un modelo que incluyó fibrinógeno, ferritina y proteína C reactiva. Usando los valores residuales, el punto de corte óptimo estimado de 2.165 ng/ml, con una sensibilidad del 57,9% y una especificidad del 98,7%. Conclusiones: Es posible estimar un valor corregido de dímero-D en función de ferritina, fibrinógeno y proteína C reactiva. Usando el valor observado y estimado podemos obtener un valor residual que funciona bien como método de cribado para detectar pacientes que podrían beneficiarse de más estudios diagnósticos de la ETV.

Heart failure and in-hospital mortality in elderly patients after elective noncardiac surgery in Spain.

BACKGROUND: Patients with heart failure (HF) undergoing noncardiac surgical procedures is rising worldwide. This study was aiming at analyzing the impact of heart failure (HF) on the outcomes (mortality, complications, readmissions, and length of stay) of elderly patients undergoing elective major noncardiac surgical procedures in Spain. METHODS: A retrospective observational study of patients undergoing noncardiac surgery was conducted. The Minimum Basic Data Set (MBDS) was used to collect information about the demographic characteristics of patients discharged from hospitals of the Spanish National Health System (SNHS), variables related to patients' medical conditions and surgeries conducted during the episode. RESULTS: A total of 996,986 selected procedures in the discharge record were identified in the period 2007-2015. HF was recorded as a secondary diagnosis in 22,367 discharges (2.24%). The mean age of patients was 76.6±7.27 years, with a difference in patients without and with HF: 76.5 (95% CI: 76.47-76.50) vs 82.8 (95% CI: 82.71-82.90). The number of selected surgical procedures increased by 13.2% (117,487 in 2015 vs. 103,744 in 2007), and the proportion of presence HF as a comorbidity increased by 24.4% (2.4% in 2015 v 1.9% in 2007). The proportion of women was higher in the HF group: 53.2% (95% CI: 53.18-53.22) vs 64.3% (95% CI: 64.20-64.44), with a longer average length of stay: 7.9 (95% CI: 7.9-7.9) vs 14.9 (95% CI 14.7-15.0) days, and women had a higher proportion of comorbidities. HF was found to be an independent risk factor in-hospital mortality in the multilevel risk adjustment model (OR=2.3; 95% CI: 2.2-2.4). CONCLUSIONS: Patients with HF undergoing any of the selected surgical procedures are older; there was women predominance and there is also an important burden of comorbidities than patients without HF undergoing these surgical procedures. HF in the selected procedures, increasing in-hospital mortality, mean length of stay, and the occurrence of adverse events in the Spanish population. The percentage of patients with HF who underwent the selected surgical procedures increased in the study period.

Usefulness of lung ultrasound in the early identification of severe COVID-19: results from a prospective study.

AIM: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS); however, its role in predicting the prognosis has yet to be explored. The aim of the study was to assess the relationship between lung ultrasound findings with the degree of respiratory failure measured by the PaO2/FiO2 ratio (PaFi) andthe prognosis of these patients: need for non-invasive mechanical ventilation (NIMV), admission to the Intensive Care Unit (ICU) and mortality. MATERIAL AND METHOD: Prospective, longitudinal and observational study performed in patients with confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 107 patients were enrolled: 93.4% with bilateral involvement and 73.83% presented at least one consolidation. A good inverse correlation (Rho Spearman coefficient -0.897) between the ultrasound score and PaFi was obtained. The AUC for identification of patients with more severe respiratory failure, a moderate and severe ARDS, was 0.97 (CI 95%: 0.95-1) and a cut-off score of 34.5 showed a sensitivity of 0.94 and a specificity of 0.91. The Kappa index showed a high concordance (0.83) of the classification by ultrasound lunginvolvement and ARDS. CONCLUSIONS: The combination of the ultrasound score and the presence of respiratory failure can easily identify patients with a higher risk to present complications.

Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism.

INTRODUCTION: D-dimer levels are elevated in COVID 19 and they correlate to the levels of other inflammatory markers such us ferritin, fibrinogen and C-reactive protein. It may be possible to correct D-dimer value in function of inflammatory markers, thus identifying patients at higher risk of venous thromboembolism (VTE). Our objectives are estimating a corrected value of plasma D-dimer as a linear function of ferritin, C-reactive protein and fibrinogen and stablishing a cut-off point of high probability of VTE. PATIENTS AND METHODS: Age and sex matched case-control study of all patients diagnosed with COVID 19 and VTE between March and May 2020 in a tertiary hospital in Madrid (Spain). Using linear regression, the best predictive model will be estimated and residual D-dimer values will be obtained and analyzed using ROC curves to determine its discriminative performance. RESULTS: Thirty-eight cases and seventy-six controls were included. There was 63.2% of men and mean age was 68.2. D-dimer was best predicted by a linear model including fibrinogen, ferritin and C-reactive protein. Using residual values, the optimal cutoff point was 2165ng/mL, with a sensitivity of 57.9% and specificity of 98.7%. CONCLUSION: It is possible to estimate a D-dimer corrected value in function of ferritin, C-reactive protein and fibrinogen. Using the observed and estimated value we can obtain a residual value that performs well as a screening method to detect patients who would benefit for further VTE diagnostic testing.

Importance of Lung Ultrasound Follow-Up in Patients Who Had Recovered from Coronavirus Disease 2019: Results from a Prospective Study.

There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasounds, however, their role in predicting the prognosis has yet to be explored. Our objective was to assess the usefulness of lung ultrasound in the short-term follow-up (1 and 3 months) of patients with SARS-CoV-2 pneumonia, and to describe the progression of the most relevant lung ultrasound findings. We conducted a prospective, longitudinal and observational study performed in patients with confirmed COVID-19 who underwent a lung ultrasound examination during hospitalization and repeated it 1 and 3 months after hospital discharge. A total of 96 patients were enrolled. In the initial ultrasound, bilateral involvement was present in 100% of the patients with mild, moderate or severe ARDS. The most affected lung area was the posteroinferior (93.8%) followed by the lateral (88.7%). Subpleural consolidations were present in 68% of the patients and consolidations larger than 1 cm in 24%. One month after the initial study, only 20.8% had complete resolution on lung ultrasound. This percentage rose to 68.7% at 3 months. Residual lesions were observed in a significant percentage of patients who recovered from moderate or severe ARDS (32.4% and 61.5%, respectively). In conclusion, lung injury associated with COVID-19 might take time to resolve. The findings in this report support the use of lung ultrasound in the short-term follow-up of patients recovered from COVID-19, as a radiation-sparing, easy to use, novel care path worth exploring.

Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis.

BACKGROUND: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). METHODS: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007-2015 were included. Demographic and administrative variables related to patients' diseases as well as procedures were collected. RESULTS: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models' discrimination was high in both cases, with AUROC values = 0.963 (0.960-0.965) in the APRG-DRG model and AUROC = 0.965 (0.962-0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. CONCLUSIONS: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients).

Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment.

BACKGROUND: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. METHODS: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007-2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient's diseases and procedures performed during the episode were evaluated. RESULTS: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). CONCLUSIONS: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged.

Implementation of an Algorithm of Cohort Classification to Prevent the Spread of COVID-19 in Nursing Homes.

Older adults living in nursing homes are the most vulnerable group of the COVID-19 pandemic. There are many difficulties in isolating residents and limiting the spread in this setting. We have developed a simple algorithm with a traffic light format for resident classification and sectorization within nursing homes, based on basic diagnostic tests, surveillance of symptoms onset, and close contact monitoring. We have implemented the algorithm in several centers with good data on adherence. Suggestions for implementation and evaluation are discussed.

Preoperative intragastric balloon in morbid obesity is unable to decrease early postoperative morbidity of bariatric surgery (sleeve gastrectomy and gastric bypass): a clinical assay.

INTRODUCTION: There are few studies that investigate the usefulness of the preoperative intragastric balloon (IGB). This study will evaluate if pre-surgical weight loss with IGB reduces morbidity and mortality after surgery. METHOD: Prospective randomised study of patients with morbid obesity treated with gastric bypass or vertical gastrectomy, with two arms: the balloon arm (B-arm), where an IGB was inserted within the 6 months before surgery, and the control arm (C-arm). RESULTS: The study included 66 patients: 65.6% women, 69.6% with bypass. Age: 43 years (SD 10.2) B-arm and 42.6 years (SD 9.2) in the C-arm. We found 34.4% therapeutic failures in IGB. The mean body weight loss, %EWL and BMI reduction before surgery was 16.2 kg (SD 9.84) B-arm versus 4.7 (SD 8.70) in the C-arm, 23.6% versus 4.7% (p < 0.001) and 6.04 versus 1 (p < 0.001), respectively. The hospital stay was 7 days (p25-75: 5-8) B-arm and 7 days (p25-75: 5-9) in the C-arm (p = 0.937). Post-surgical morbidity with IGB was 25% versus 29.5% in the C-arm, p = 0.689. The number needed to treat (NNT) to prevent of post-surgical morbidity was 23 patients. The B-arm presented 54.5% moderate-severe post-surgical adverse events (12.5%) versus 82.6% in the C-arm (23.5%), p = 0.111. The cost of placing a balloon was more than 4000 Euros each. CONCLUSIONS: The preoperative balloon does not achieve a reduction in the post-surgical morbidity, nor does it reduce the hospital stay or rate of re-operations. The balloon achieves a higher weight loss result when compared to a diet programme, its added cost must also be given due consideration. TRAIL REGISTRY: This study has been registered on ClinicalTrials.gov with the Identifier: NCT01998243 (November 28, 2013).

Security profile of direct anticoagulants. Preferred use in atrial fibrillation. / Perfil de seguridad de los anticoagulantes directos. Uso preferente en fibrilación auricular.

A multidisciplinary panel of cardiologists, neurologists, internal medicine and specialists in hemostasis and thrombosis has elaborated this document showing recent scientific evidences supporting a better profile of direct oral anticoagulants (DOACs) versus vitaminK antagonists (VKA), as well as the indications of specific antidotes and hemostatic agents to reverse the anticoagulant effects of DOACs. The analysis reinforces the best profile of DOACs and its special benefit in patients with basal high hemorrhagic risk.

[Proposed development of a geriatric oncology unit. Times of change: Our reality]. / Propuesta de desarrollo de una unidad de oncogeriatría. Tiempos de cambio: nuestra realidad.

Age is one of the main risk factors for the development of cancer. It is expected that the progressive aging of the population will have an unprecedented impact on the incidence of various tumours. In fact, the management of elderly cancer patients is already a major public health problem in developed countries. However, elderly patients have systematically been excluded from cancer drug studies or protocol development. This has left health professionals in uncharted territory, without proper tools to address the multiple difficulties that arise in the treatment of these patients. A comprehensive geriatric assessment may serve as an ideal tool for the correct detection of hidden problems, facilitating treatment decisions in these complex patients, and integrating the care of patients with comorbidities.

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

OBJECTIVE: To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. DESIGN: Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. SETTING: Spanish National Health Service. PARTICIPANTS: One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). MAIN OUTCOME MEASURES: IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. RESULTS: Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. CONCLUSIONS: We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

Hyponatremia in hospitalised patients with heart failure in internal medicine: Analysis of the Spanish national minimum basic data set (MBDS) (2005-2011).

OBJECTIVE: Hyponatremia is the most common electrolyte disorder seen in clinical practice. Numerous studies have reported increased inhospital mortality associated to this condition, which is also an independent predictor of comorbidity in patients admitted with heart failure (HF). The objective of this study is to assess the incidence, average length of stay, associated comorbidities, readmissions and mortality caused by hyponatremia in admissions for acute heart failure from the Spanish national minimum basic data set (MBDS). MATERIALS AND METHODS: Data from the Spanish national minimum basic data set (MBDS) of discharged patients who were initially diagnosed with heart failure (HF) from all internal medicine (IM) departments of Spanish National Health System (SNS) hospitals between 2005 and 2011 were analysed (ICD-9: 428; DRGs 127 and 544). A descriptive data analysis was conducted comparing the diagnosis codes and administrative variables of heart failure patients with and without hyponatremia. The chi-square test was used for qualitative variables and the Student's t test for quantitative variables. A bivariate analysis was used to detect statistical differences in the mortality of both groups, as well as mean age, Charlson index, average length of stay and readmissions. A multivariate logistic regression analysis was performed, taking intrahospital mortality and hospital readmissions as dependent variables, and age, gender, comorbidity according to the Charlson index and hyponatremia as independent variables. RESULTS: A total of 504,860 patients with acute heart failure were identified, of whom 11,095 (2.2%) presented with HNa. A gradual year-on-year increase of hyponatremia codification (both primary and secondary diagnosis) was observed at discharge throughout the study period (from 1.6% in 2005 to 2.8% in 2011; p<0.0001). Overall mortality due to any cause in patients with hyponatremia was 17% (1937 patients) versus 11% in non-hyponatremic patients (53,820 patients). The probability of readmission for patients with hyponatremia was 22% versus 17% in the non-hyponatremic group. Hyponatremia was associated to a higher rate of mortality during hospitalisation for acute heart failure with an odds ratio (OR) of 1.58, 95% CI, 1.50-1.66 (p<0.05). Hyponatremia maintained statistical significance in the regression model after adjusting for gender, OR 0.919 (95% CI 0.902-0.936); age, OR 1.061 (95% CI 1.060-1.062); and Charlson index, OR 1.388 (95% CI 1.361-1.461). CONCLUSIONS: Hyponatremia is associated to an increased rate of mortality and readmission in patients admitted for acute heart failure in SNS hospitals. Our study identified a statistically significant association between hyponatremia and increased intrahospital mortality independent of age, gender and the Charlson comorbidity index. During the defined follow-up period the discharge reports showed an increased codification of hyponatremia.

[Clostridium difficile infections in Spanish Internal Medicine departments during the period 2005-2010: the burden of the disease]. / Infección por Clostridium difficile en el período 2005-2010 en los Servicios de Medicina Interna españoles: el peso de la enfermedad.

INTRODUCTION: Clostridium Difficile infection (CDI) is increasing in Spain. A review is presented of this infection in order to evaluate the burden of the disease in this country. MATERIAL: An analytical retrospective and descriptive study was conducted by analyzing the Minimum Basic Data Set of patients admitted to Internal Medicine Departments and with and without CDI between the years 2005-2010. Clinical and demographical variables were compared. RESULTS: Mean age was 75.5 years (SD 15.4), 54.9% were women and mean stay was 22.2 days (SD 24.8). The Cost [(€ 5,001 (SD 4,985) vs [€ 3,934 (SD 2,738)] and diagnostic complexity [2.04 (SD 2.62) vs [1.67 (SD 1.47)] were also different. Mortality for all causes was 12.5% vs 9.8%. Death risk showed a 30% increase (odds ratio 1.30, 95% confidence interval;1.21-1.39) and readmission rate was 30.4% vs 13.5%. Distribution of cases showed season variations (more cases in winter), and annual incidence increased during the study period. Comorbidities associated to increased risk of acquiring CDI were: anemia, human immunodeficiency virus, dementia, malnutrition, chronic renal failure, and living in a nursing home. CONCLUSION: The results showed a clear negative impact of CDI on hospital admissions. A trend towards progression in its incidence without changes in mortality or readmission rates was observed, in common with the rest of Europe and the Western World.

Absence of interaction of diabetes mellitus with chronic kidney disease on mortality in acute heart failure.

OBJECTIVES: To evaluate how chronic kidney disease (CKD) and diabetes mellitus (DM) influence in-hospital mortality in patients urgently admitted for acute heart failure (HF). METHODS: We used data from the Spanish "Minimum Basic Data Set" for 2006-2007 to evaluate clinical differences and crude mortality rates for patients having versus non-having CKD or DM. We tested pre-specified predictive factors of in-hospital mortality in a multivariate logistic regression model, which included age, sex, CKD, DM, acute respiratory failure, a modified Charlson Comorbidity Index-excluding CKD/DM- and a CKD × DM-interaction variable. p Values < 0.05 were considered significant. MAIN FINDINGS: A total of 275,176 episodes of acute HF were analyzed (47.9% male, mean age 76.2 ± 12.8 years). CKD patients (N = 25,174, 9.1%) were older (78.4 ± 10.1 vs. 76.0 ± 13.1 years; p < 0.001) and more frequently had coexisting medical conditions. DM patients (N = 88,994, 32.3%) more often had vascular risk factors and CKD (11.4% vs. 8.1%; p < 0.001). Overall in-hospital mortality rate for admitted HF patients was 10.4%. Mortality was lower for DM versus non-DM patients (9.2% vs. 11.0%; p < 0.001), but higher for CKD versus non-CKD patients (14.1% vs. 10.0%; p < 0.001). No interaction effect was found between CKD and DM on survival for a HF episode (odds ratio; OR = 1.01, 95% CI: 0.91-1.10; p for interaction = 0.73). DM remained protective (OR = 0.85, 95% CI: 0.82-0.87; p < 0.001), while CKD was associated with increased mortality (OR = 1.46, 95% CI: 1.39-1.53; p < 0.001). CONCLUSIONS: In patients urgently admitted for HF, the association of CKD with higher in-hospital mortality was homogeneous irrespectively of the absence or presence of DM.

Hypoalbuminemia and other prognostic factors of mortality at different time points after ischemic stroke.

OBJECTIVE: The aim of this study was to investigate whether hypoalbuminemia and other risk factors for mortality after stroke have the same or different short (1 month), medium (3 months), long (1 year) or very long term (5 years) prognostic value. SUBJECTS/METHODS: clinical and analytical data from 254 patients admitted to our Hospital with an ischemic stroke and followed up prospectively for 2 years were collected with a prospective standard protocol. Additional data up to 5 years were obtained from Clinical and Laboratory Registries of the Hospital, a mailed questionnaire, a phone call and the Council Registry of Mortality. Risk factors for mortality at different time points were calculated with logistic regression and Cox proportional hazard analyses. RESULTS: The following factors were significantly associated with mortality at one month: cardioembolic mechanism, hypoalbuminemia, glycemia, age, low diastolic arterial pressure and Canadian Scale, at three months: previous stroke and Barthel index at discharge, at one year: previous dementia and Barthel index at three months and at five years: age, Canadian Scale score at discharge and low cholesterol at admission. Cox regression analysis considering survival time showed hypoalbuminemia at admission (hazard ratio (HR) 2; p = 0.03), age (HR 1.06; p < 0.00), previous dementia (HR 2; p < 0.00), cardioembolic mechanism (HR 2; p < 0.00) and severity on the Canadian Neurological Stroke Scale (HR 1.2; p < 0.00) to be independently associated with mortality. CONCLUSION: Mortality after ischemic stroke seems to depend on different factors along time. Hypoalbuminemia at admission is an independent factor for short term (acute) and global mortality. Other risk factors for global mortality were previous dementia, cardioembolic mechanism and severity on the Canadian Neurological Stroke Scale at admittance.

Objetivo: El propósito del estudio era investigar si la hipoalbuminemia y otros factores de riesgo de mortalidad tras un ictus tenían el mismo valor pronóstico tras un ictus a corto (1 mes), medio (3 meses), largo (1 AÑO) o muy largo plazo (5 AÑOs). Métodos: Se estudiaron 254 pacientes ingresados en nuestro hospital con ictus isquémico y seguidos prospectivamente durante dos AÑOs con un procolo estándar de forma prospectiva. Se recogieron datos adicionales hasta 5 AÑOs de las Historias Clínicas, los datos del laboratorio, un cuestionario enviado por correo, una llamada telefónica y la revisión de los Registros de Mortalidad de los ayuntamientos. Los factores de riesgo de mortalidad en cada periodo se calcularon con regresión logistica y el modelo de riesgos proporcionales de Cox. Resultados: Se asociaron de forma significativa con la mortalidad al mes el mecanismo cardioembólico, la hipoalbuminemia, la glucemia al ingreso, la edad, la presión arterial diastólica más baja y la puntuación en la Escala Canadiense. A los tres meses, la existencia de ictus previos y el índice de Barthel al alta. Al AÑO la existencia previa de demencia y el índice de Barthel a los 3 meses y a los cinco AÑOs la edad, la puntuación en la escala Canadiense al alta y un colesterol menor al ingreso. El análisis de regresión de Cox considerando el tiempo de supervivencia, mostró una asociación independiente con la mortalidad de la hipoalbuminemia al ingreso ((HR) 2; p = 0,03), la edad (HR 1,06; p < 0,00), la demencia previa (HR 2; p < 0,00), el mecanismo cardioembólico (HR 2; p < 0,00) y la severidad según la escala Canadiense (HR 1.2; p < 0,00). Conclusión: La mortalidad tras un ictus isquémico parece depender de distintos factores según el tiempo transcurrido.