RESUMEN
Acute gastroenteritis (AGE) is a common disease within the population. Most cases are self-limited. However, intensive treatment is sometimes necessary to ensure patient integrity. This disease is characterized by vomiting and/or diarrhea with blood or mucus, discomfort, fever, and nonspecific abdominal pain. Commonly involved pathogens in the developed world include: viruses, bacteria, and parasites. In this paper we report a rare cause of AGE.
Asunto(s)
Gastroenteritis/diagnóstico , Trasplante de Riñón , Complicaciones Posoperatorias/diagnóstico , Infecciones por Salmonella/diagnóstico , Salmonella typhimurium/genética , beta-Lactamasas/genética , Enfermedad Aguda , Anciano , Gastroenteritis/etiología , Marcadores Genéticos , Humanos , Masculino , Complicaciones Posoperatorias/microbiología , Infecciones por Salmonella/etiología , Salmonella typhimurium/enzimología , Salmonella typhimurium/aislamiento & purificación , EspañaRESUMEN
INTRODUCTION AND PURPOSE: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. METHODS: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. RESULTS: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p=0.003; 52 (34.4%) vs 35 (23.2%), p=0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. CONCLUSIONS: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
Asunto(s)
Fibrilación Atrial , COVID-19 , Trombosis , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , COVID-19/complicaciones , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2RESUMEN
Introduction and purpose: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. Methods: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. Results: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. Conclusions: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
Antecedentes y objetivos: La fibrilación auricular (FA) es frecuente en pacientes ingresados por COVID-19 grave. Sin embargo, los datos sobre el manejo de la anticoagulación crónica en estos pacientes son escasos. Analizamos la anticoagulación y la incidencia de episodios cardiovasculares mayores en pacientes con FA ingresados por la COVID-19. Métodos: Retrospectivamente, se identificaron todos los pacientes con FA ingresados por la COVID-19 entre marzo y mayo de 2020, en 9 hospitales españoles. Se seleccionó un grupo control de pacientes ingresados consecutivamente por la COVID-19 sin FA. Se compararon las características basales, incidencia de hemorragias mayores, episodios trombóticos y mortalidad. Para reducir potenciales factores de confusión se realizó un emparejamiento por puntuación de propensión, así como un análisis multivariante para predecir hemorragia mayor y mortalidad. Resultados: Se incluyeron 305 pacientes con FA ingresados por la COVID-19. Tras el emparejamiento por puntuación de propensión, 151 pacientes con FA fueron emparejados con 151 controles. Durante el ingreso, la heparina de bajo peso molecular fue el principal anticoagulante y la incidencia de hemorragia mayor y mortalidad fue mayor en el grupo de FA (16[10,6%] vs. 3[2%], p = 0,003; 52[34,4%] vs. 35[23,2%], p = 0,03, respectivamente). El análisis multivariante demostró la presencia de FA como predictor independiente de sangrados y mortalidad intrahospitalaria en los pacientes con la COVID-19. En el grupo de FA, un segundo análisis multivariante identificó valores elevados de dímero-D como predictor independiente de hemorragia mayor intrahospitalaria. Conclusiones: Los pacientes con FA ingresados por la COVID-19 representan una población de alto riesgo de sangrado y mortalidad durante el ingreso. Parece recomendable individualizar la anticoagulación durante el ingreso, considerando el riesgo específico de sangrado y trombosis.
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Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones Urinarias/tratamiento farmacológico , Streptococcus gallolyticus/efectos de los fármacos , Infecciones Estreptocócicas/tratamiento farmacológico , Bacteriuria/microbiología , Estudios Retrospectivos , Streptococcus gallolyticus/patogenicidadRESUMEN
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Asunto(s)
Humanos , Femenino , Salmonella typhimurium/aislamiento & purificación , Trasplante de Riñón/métodos , Gastroenteritis/complicaciones , Gastroenteritis/diagnóstico , beta-Lactamasas/administración & dosificación , beta-Lactamasas/análisis , Dolor Abdominal/etiología , Insuficiencia Renal/complicaciones , Insuficiencia Renal/diagnóstico , Ciprofloxacina/uso terapéuticoAsunto(s)
Anuria/etiología , Biopsia con Aguja/efectos adversos , Hematoma/etiología , Trasplante de Riñón , Riñón/patología , Complicaciones Posoperatorias/etiología , Arteria Renal/lesiones , Drenaje , Embolización Terapéutica , Hematoma/cirugía , Hematoma/terapia , Humanos , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Arteria Renal/cirugía , Diálisis Renal , Trasplantes/patologíaRESUMEN
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