Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study.

The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects < 18 years with community-acquired pneumonia (CAP), assessing possible sex differences. We used Spanish national hospital discharge data to select all patients < 18 years with CAP. We identified 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was significantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03-1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p < 0.0001). There were no sex differences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls. CONCLUSION: The incidence of hospital admissions for CAP was higher among boys than among girls and rose significantly from 2016 to 2019. There were no sex differences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No differences were found in IHM over time. WHAT IS KNOWN: • Community-acquired pneumonia is one of the most common reasons for hospitalizations among children. • There are few studies that allow to know the evolution of community-acquired pneumonia in children. WHAT IS NEW: • Incidence of hospital admissions for community-acquired pneumonia was higher in boys than girls and it rose significantly from 2016 to 2019. • Age 10 to 17 years, congenital heart disease, neurological diseases and use of mechanical ventilation were risk factors for in-hospital mortality in both sexes.

Long-term follow-up of patients with venous thromboembolism and COVID-19: Analysis of risk factors for death and major bleeding.

INTRODUCTION: COVID-19 predisposes patients to a higher risk of venous thromboembolism (VTE), although the extent of these implications is unclear and the risk of bleeding has been poorly evaluated. To date, no studies have reported long-term outcomes of patients with COVID-19 and VTE. METHOD: Prospective observational study to evaluate long-term (90 days or more) outcomes of patients diagnosed with VTE (PE, DVT of the extremities, or both) in the setting of COVID-19. The main outcome of the study was a compound of major bleeding and death. RESULTS: The study comprised 100 patients (mean age 65 ± 13.9 years). At the time of VTE diagnosis, 66% patients were hospitalized, 34.8% of them in the ICU. Mean follow-up was 97.9 ± 23.3 days. During the study period, 24% patients died and median time to death was 12 (IQR: 2.25-20.75) days, 11% patients had major bleeding and median time to event was 12 (IQR: 5-16) days. The cause of death was PE in 5% and bleeding in 2% of patients. There were no VTE recurrences. The main study outcome occurred in 29% patients. Risk of death or major bleeding was independently associated with ICU admission (HR 12.2; 95% CI 3.0-48.3), thrombocytopenia (HR 4.5; 95% CI 1.2-16.5), and cancer (HR 21.6; 95% CI 1.8-259). CONCLUSION: In patients with COVID-19 and VTE, mortality and major bleeding were high and almost a third of deaths were VTE-related. The majority of complications occurred in the first 30 days. ICU admission, thrombocytopenia, and cancer are risk factors for poor prognosis.

The significance of heart failure in hospitalised patients with pulmonary embolism. A gender-specific analysis.

BACKGROUND: Heart failure (HF) is a risk factor for the development of pulmonary embolism (PE). Few studies have examined sex differences in risk of PE among HF patients. AIMS: (a) To examine the incidence, characteristics and in-hospital outcomes among patients hospitalised with PE according to HF status; (b) to compare the in-hospital mortality (IHM) after PE between HF and non-HF patients and (c) to identify variables associated with IHM. All analyses were stratified by sex. METHODS: We included all adult patients hospitalised for PE from 1 January 2016 to 31 December 2018. Data were collected from the Spanish National Hospital Discharge Database. Poisson regression models were constructed to quantify the difference in the incidences between HF and non-HF populations. Propensity score matching (PSM) was used to obtain comparable subgroups by sex and HF status. RESULTS: We identified 46,835 PE hospitalisations, 11.4% with HF. Adjusted incidence of PE was higher in HF patients than in those without HF (Incidence Rate Ratio 1.11; 95% CI 1.08-1.13). Crude and PSM adjusted IHM were significantly higher in men and women hospitalised with PE suffering HF than in men and women without HF (P < .001). Women with HF who suffered a PE had lower IHM than men with this condition (P < .001) after adjusting. CONCLUSIONS: Adjusted incidence of PE was higher in HF patients than in those without HF. After PSM suffering, HF was associated to higher IHM in men and women. Women with PE and HF had lower IHM than men with these conditions.

Gender differences in incidence and in-hospital outcomes of community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in Spain.

AIMS: We aim to compare the incidence and in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) according to gender. METHODS: This was a retrospective observational epidemiological study using the Spanish National Hospital Discharge Database for the years 2016 and 2017. RESULTS: Of 277 785 hospital admissions, CAP was identified in 257 455 (41.04% females), VAP was identified in 3261 (30.42% females) and NV-HAP was identified in 17 069 (36.58% females). The incidence of all types of pneumonia was higher amongst males (CAP: incidence rate ratio [IRR] 1.05, 95% CI 1.03-1.06; VAP: IRR 1.36, 95% CI 1.26-1.46; and NV-HAP: IRR 1.16, 95% CI 1.14-1.18). The crude in-hospital mortality (IHM) rate for CAP was 11.44% in females and 11.80% in males (P = .005); for VAP IHM, the rate was approximately 35% in patients of both genders and for NV-HAP IHM, the rate was 23.97% for females and 26.40% for males (P < .001). After multivariable adjustment, in patients of both genders, older age and comorbidities were factors associated with IHM in the three types of pneumonia analysed. Female gender was a risk factor for IHM after VAP (OR 1.24; 95% CI 1.06-1.44), and no gender differences were found for CAP or NV-HAP. CONCLUSIONS: Our findings show a difference between females and males, with females presenting a lower incidence of all types of pneumonia. However, female gender was a risk factor for IHM after VAP.

Advances and Challenges in COVID-19 and Pneumonia.

In recent years, the pandemic caused by SARS-CoV-2 has posed a significant challenge to the entire medical community [...].

Adherence to Screening Tests for Gynaecological and Colorectal Cancer in Patients with Diabetes in Spain: A Population-Based Study (2014-2020).

Objectives: Both diabetes mellitus (DM) and gynaecological and colorectal cancers are highly prevalent diseases. Furthermore, the presence of DM constitutes a risk factor and poor prognostic indicator for these types of cancer. This study is based on the European Health Interview Surveys in Spain (EHISS) of 2014 and 2020. It aimed to determine the trends in adherence to screening tests for gynaecological cancers (breast and cervical) and colorectal cancer, compare adherence levels between populations with and without diabetes, and identify predictors of adherence in the population with diabetes. Methods: An epidemiological case-control study based on the EHISS data of 2014 and 2020 was conducted. The characteristics of participants who underwent screening tests were analysed based on the presence or absence of DM, and predictors of adherence to these preventive activities were identified. Results: A total of 1852 participants with reported DM and 1852 controls without DM, adjusted for age and sex, were included. A higher adherence to mammography was observed in women without diabetes compared to those with diabetes, although statistical significance was not reached (72.9% vs. 68.6%, p = 0.068). Similarly, higher Pap smear adherence was observed in the population without diabetes in the age group between 60 and 69 years compared to the population with diabetes (54.0% vs. 45.8%, p = 0.016). Pap smear adherence among women with diabetes was significantly higher in the EHISS of 2020 (52.0% in 2014 vs. 61.0% in 2020, p = 0.010), as was the case for faecal occult blood testing (13.8% in 2014 vs. 33.8% in 2020, p < 0.001), but it was not significant for mammography (70.4% in 2014 vs. 66.8% in 2020, p = 0.301). Overall, the predictors of adherence to screening tests were older age, history of cancer and higher education level. Conclusions: Adherence levels to cancer screening tests were lower in the population with diabetes compared to those without diabetes, although an improvement in Pap smear and faecal occult blood test adherence was observed in 2020 compared to 2014. Understanding predictors is important to improve adherence rates in the population with diabetes.

Influence of Diabetes Mellitus and Nutritional Parameters on Clinical and Functional Aspects and Quality of Life in Patients Hospitalized Due to Exacerbation of Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations. During severe exacerbations, nutritional and endocrinological comorbidities can play an important role in the clinical and functional aspects of these patients. The aim of this study was to analyse the influence of the presence of diabetes mellitus (DM) and nutritional parameters on the deterioration of symptoms and quality of life during a severe exacerbation in patients with COPD. An observational study was conducted on COPD patients admitted due to an exacerbation. The COPD Assessment Test (CAT) questionnaire was administered, and clinical and functional parameters were compared based on the presence of nutritional and endocrinological alterations. A total of 50 patients were included, of whom 30 (60%) were male. The mean age was 70.5 years (standard deviation (SD) 9.6). The median CAT score during exacerbation was 25 (interquartile range (IQR) 17.5-30), and the baseline score was 13.5 (IQR 7-19), which represented a statistically significant difference (p < 0.001). Patients with iron deficiencies had a lower total CAT score (p = 0.041), specifically for items related to daily activity (p = 0.009) and energy (p = 0.007). Diabetic patients exhibited a greater decline in pulmonary function during exacerbation (p = 0.016), while patients with high thyroid-stimulating hormone (TSH) levels had a shorter hospital stay (p = 0.016). For COPD patients admitted due to an exacerbation, the metabolic assessment is useful and relevant in the clinical set-up, as endocrinological comorbidities negatively affect clinical and functional aspects of these patients.

Mental health in patients with asthma: A population-based case-control study.

BACKGROUND: This study's objectives were to compare the prevalence of mental disorders and consumption of psychiatric medications in asthmatic subjects with non-asthmatic controls and identify risk factors associated with psychiatric conditions. METHODS: This was an epidemiological case-control study based on the 2020 European Health Survey in Spain self-reported data. Each asthmatic subject was paired with a non-asthmatic control. Study variables included demographics, use of healthcare services, comorbidities, and risky behaviours were compared. RESULTS: There were 22,072 participants in the survey; 1151 cases and 1151 controls were selected. The prevalence of mental disorders (25.5% versus 13.4%; p < 0.001) and consumption of psychiatric medications (25.8% versus 15.6%; p < 0.001) were higher in cases than controls. In asthmatic subjects, female gender (OR 1.814; p = 0.001), age over 80 years (OR 2.558; p = 0.002), poor self-rated health (OR 2.047; p < 0.001), visits to a psychologist (OR 10.854; p < 0.001) and chronic pain (OR 1.938; p < 0.001) were independently associated with mental disorder diagnoses. Meanwhile, female sex (OR 1.710; p < 0.001), age over 80 years (OR 3.802; p < 0.001), poor self-rated health (OR 2.482; p < 0.001), visits to a psychologist (OR 2.694; p < 0.001) and chronic pain (OR 1.494; p = 0.012) were risk factors independently associated with psychiatric medication consumption. CONCLUSIONS: The prevalence of psychiatric conditions were higher in asthmatic subjects. Female gender, older age, worse self-rated health, visits to a psychologist and chronic pain were associated with psychiatric conditions in asthmatic subjects.

Differences in Survival of Patients With COPD According to the New GesEPOC 2021 Classification of Phenotypes.

Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory pathology with high prevalence, morbidity and mortality. The Spanish COPD guideline (GesEPOC) recommends individualizing treatment according to phenotypes. The phenotype classification was updated in 2021. This study aimed to determine the survival of patients by this new classification and compare the predictive capacity of mortality compared to the previous version. Methods: This observational study of COPD patients involved prospective follow-up for 6 years. Demographic and clinical data were collected at the beginning and evolutionary data at the end of the study. Patients were classified according to GesEPOC 2017 and GesEPOC 2021. Univariate survival analysis and multivariate analysis identified mortality risk factors. Results: Of the 273 patients, 243 (89.0%) were male. Ninety-three patients (34.1%) died during follow-up. Regarding phenotypes, 190 patients (69.6%) were non-exacerbators, 69 (25.3%) belonged to the non-eosinophilic exacerbator phenotype and 14 (5.1%) were of the eosinophilic exacerbator phenotype. Compared with non-exacerbator patients, those with the non-eosinophilic exacerbator phenotype had lower survival (p = 0.009). Risk factors independently associated with mortality were older age (p < 0.001), non-eosinophilic exacerbator phenotype (p = 0.017) and a high Charlson index score (p < 0.001). The new classification presented a worse ability to predict mortality than the previous version (area under the curve 0.632 vs 0.566, p = 0.018). Conclusion: Patients with the non-eosinophilic exacerbator phenotype had worse prognoses. This phenotype, advanced age and high comorbidity were mortality risk factors. The GesEPOC 2021 classification predicts mortality worse than the 2017 version. These data must be considered for more individualized management of COPD patients.

Introducción: La enfermedad obstructiva crónica (EPOC) es una patología respiratoria con elevada prevalencia y alta morbimortalidad. La guía española de la EPOC (GesEPOC) recomienda individualizar el tratamiento según fenotipos. En su última actualización en 2021, se ha actualizado la clasificación de fenotipos. Se realiza este estudio para conocer la supervivencia de los pacientes sobre esta nueva clasificación y para comparar la capacidad predictiva de mortalidad con respecto a la versión previa. Métodos: Estudio observacional de pacientes con EPOC con un seguimiento prospectivo durante 6 años. Se recogieron datos demográficos y clínicos al inicio y datos evolutivos al final del estudio. Se clasificó a los pacientes según GesEPOC 2017 y GesEPOC 2021. Se realizó un análisis univariante de supervivencia y un análisis multivariante para identificar factores de riesgo de mortalidad. Resultados: Del los 273 pacientes, 243 (89,0%) eran varones. Fallecieron 93 sujetos (34,1%) durante el seguimiento. En cuanto a los fenotipos, 190 pacientes (69,6%) eran no agudizadores, 69 (25,3%) pertenecían al fenotipo agudizador no eosinofílico, y 14 (5,1%) eran del fenotipo agudizador eosinofílico. Comparando con los enfermos no agudizadores, los del fenotipo agudizador no eosinofílico tuvieron una menor supervivencia (p = 0,009). Los factores de riesgo independientemente asociados a la mortalidad fueron la edad avanzada (p < 0,001), el fenotipo agudizador no eosinofílico (p = 0,017) y una puntuación elevada en el índice de Charlson (p < 0,001). La nueva clasificación presentó una peor capacidad para predecir mortalidad en comparación con la versión previa (área bajo curva 0,632 vs 0,566, p = 0,018). Conclusión: Los pacientes del fenotipo agudizador no eosinofílico tenían peor pronóstico. Este fenotipo, junto con la edad avanzada y la elevada comorbilidad, fueron factores de riesgo de mortalidad. La clasificación GesEPOC 2021 predice peor la mortalidad con respecto a la versión de 2017. Es importante tener estos datos en cuenta para ofrecer un manejo más individualizado a los pacientes con EPOC.

Sex Differences in the Effects of COPD on Incidence and Outcomes of Patients Hospitalized with ST and Non-ST Elevation Myocardial Infarction: A Population-Based Matched-Pair Analysis in Spain (2016-2018).

We aimed to compare the incidence, clinical characteristics, and outcomes of patients admitted with myocardial infarction (MI), whether ST elevation MI (STEMI) or non-ST elevation MI (NSTEMI), according to the presence of chronic obstructive pulmonary disease (COPD), and to identify variables associated with in-hospital mortality (IHM). We selected all patients with MI (aged ≥40 years) included in the Spanish National Hospital Discharge Database (2016-2018). We matched each patient suffering COPD with a non-COPD patient with identical age, sex, type of MI, and year of hospitalization. We identified 109,759 men and 44,589 women with MI. The MI incidence was higher in COPD patients (incident rate ratio (IRR) 1.32; 95% confidence interval (CI) 1.29-1.35). Men with COPD had higher incidence of STEMI and NSTEMI than women with COPD. After matching, COPD men had a higher IHM than non-COPD men, but no differences were found among women. The probability of dying was higher among COPD men with STEMI in comparison with NSTEMI (odds ratio (OR) 2.33; 95% CI 1.96-2.77), with this risk being higher among COPD women (OR 2.63; 95% CI 1.75-3.95). Suffering COPD increased the IHM after an MI in men (OR 1.14; 95% CI 1.03-1.27), but no differences were found in women. COPD women had a higher IHM than men (OR 1.19; 95% CI 1.01-1.39). We conclude that MI incidence was higher in COPD patients. IHM was higher in COPD men than in those without COPD, but no differences were found among women. Among COPD patients, STEMI was more lethal than NSTEMI. Suffering COPD increased the IHM after MI among men. Women with COPD had a significantly higher probability of dying in the hospital than COPD men.

Gender Differences in the Prevalence of Mental Health, Psychological Distress and Psychotropic Medication Consumption in Spain: A Nationwide Population-Based Study.

BACKGROUND: To assess gender differences in the prevalence of self-reported mental disorders, psychological distress and psychotropic drug consumption, and to identify sociodemographic and health-related variables associated with these conditions in the male and female population (aged ≥ 18 years). METHODS: A cross-sectional study was carried on 22,141 subjects aged 18 and over, using data from the Spanish National Health Interview Survey 2017. RESULTS: We found an overall prevalence of mental disorders, psychological distress and psychotropic drug consumption of 13.8%, 18.3% and 13.9%, respectively. After multivariable adjustment, women showed significantly increased probabilities of 1.74-fold for mental disorders, 1.26-fold for psychological distress and 1.26-fold for psychotropic drug consumption compared to men. Variables such as gender, age, nationality, marital status, educational level, self-rated health, the presence of different chronic disorders, alcohol consumption and smoking habit were independently associated with mental disorders, psychological distress and psychotropic drug consumption. Several variables showed a differential effect on mental health status and psychotropic drug consumption according to gender. CONCLUSIONS: Women suffer from mental disorders, experience psychological distress and consume psychotropic drugs significantly more than men in Spain. Possible explanations for these results may be related to differences in emotional processing, willingness to report diseases and even intrinsic biological traits. Screening for mental health status and psychotropic drug consumption should be considered, particularly in Spanish women, younger adults and individuals who are not married, are obese, have poor self-rated health, suffer from chronic diseases or have a smoking habit.

Sex Differences in the Incidence and Outcomes of COPD Patients Hospitalized with Ischemic Stroke in Spain: A Population-Based Observational Study.

Purpose: To compare the incidence, clinical characteristics and outcomes of patients admitted with ischemic stroke (IS) according to the presence of COPD and sex in Spain (2016-2018). Patients and Methods: We selected all admissions with IS (≥35 years) included in the Spanish National Hospital Discharge Database. We matched each patient suffering COPD with a non-COPD patient with identical age, sex, IS type and year of hospitalization. Results: IS was coded in 92,524 men and 79,731 women (8.67% with COPD). The incidence of IS was higher in COPD men than in non-COPD men (IRR 1.04; 95% CI 1.03-1.06), although the differences were not significant among women. COPD men had twice higher incidence of IS than COPD women (IRR 2.00; 95% CI 1.93-2.07). After matching, COPD men had a higher in-hospital mortality (IHM) than non-COPD men (11.48% vs 9.80%; p<0.001), and the same happened among women (14.09% vs 11.96%; p=0.002). COPD men received thrombolytic therapy less frequently than non-COPD men. For men and women, the risk of dying in the hospital increased with age, some comorbidities and mechanical ventilation use. After multivariable adjustment, COPD increased the risk of IHM in men (OR 1.16; 95% CI 1.06-1.28) and women (OR 1.12; 95% CI 1.01-1.27). Finally, among COPD patients, being women increased the risk of dying during the hospitalization with IS by 15% (OR 1.15; 95% CI 1.03-1.28). Conclusion: Incidence of IS was higher in COPD patients, although the difference was only significant for men. COPD was associated with an increased risk of IHM. Among COPD patients, women had higher IHM.

Prevalence and Determinants of Mental Health among COPD Patients in a Population-Based Sample in Spain.

(1) Background: To assess the prevalence of mental disorders (depression and anxiety), psychological distress, and psychiatric medications consumption among persons suffering from COPD; to compare this prevalence with non-COPD controls and to identify which variables are associated with worse mental health. (2) Methods: This is an epidemiological case-control study. The data were obtained from the Spanish National Health Survey 2017. Subjects were classified as COPD if they reported suffering from COPD and the diagnosis of this condition had been confirmed by a physician. For each case, we selected a non-COPD control matched by sex, age, and province of residence. Conditional logistic regression was used for multivariable analysis. (3) Results: The prevalence of mental disorders (33.9% vs. 17.1%; p < 0.001), psychological distress (35.4% vs. 18.2%; p < 0.001), and psychiatric medications consumption (34.1% vs. 21.9%; p < 0.001) was higher among COPD cases compared with non-COPD controls. After controlling for possible confounding variables, such as comorbid conditions and lifestyles, using multivariable regression, the probability of reporting mental disorders (OR 1.41; 95% CI 1.10-1.82).), psychological distress (OR 1.48; 95% CI 1.12-1.91), and psychiatric medications consumption (OR 1.38 95% CI 1.11-1.71) remained associated with COPD. Among COPD cases, being a woman, poor self-perceived health, more use of health services, and active smoking increased the probability of suffering from mental disorders, psychological distress, and psychiatric medication use. Stroke and chronic pain were the comorbidities more strongly associated with these mental health variables. (4) Conclusions: COPD patients have worse mental health and higher psychological distress and consume more psychiatric medications than non-COPD matched controls. Variables associated with poorer mental health included being a woman, poor self-perceived health, use of health services, and active smoking.

Mental Health among Spanish Adults with Diabetes: Findings from a Population-Based Case-Controlled Study.

BACKGROUND: The purpose of this study was to assess and compare the prevalence of self-reported mental disorders, psychological distress, and psychotropic drug consumption among people with diabetes mellitus (DM) and matched non-DM controls. METHODS: A case-controlled study using data from the Spanish National Health Interview Survey was conducted in 2017. We identified 2116 DM adults (aged ≥35 years). Non-DM controls were matched 1:1 by age, sex, and province of residence. RESULTS: Prevalence of mental disorders (25.0% vs. 19.2%; p < 0.001), psychological distress (29% vs. 19.5%; p < 0.001), and consumption of psychiatric medications (29.7% vs. 23.5%; p < 0.001) among DM cases were higher than those among matched non-DM controls. The DM patient variables associated with experiencing a mental disorder, psychological distress, and consumption of psychiatric medications were: being a woman, worse self-rated health, and a visit to a psychologist within the last year. Older age (≥80 years) was associated with a lower probability of reporting mental disorders and psychological distress among DM cases. Not practicing physical exercise was significantly associated with experiencing psychological distress. CONCLUSIONS: Adults with DM included in our investigation have a significantly higher prevalence of mental disorders, psychological distress, and consumption of psychiatric medications than non-DM controls. It is necessary to implement screening strategies and psychological interventions to improve the mental health of DM patients in Spain, focusing especially on women and those aged 35 to 59 years.

[All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic]. / Todos los caminos llevan a Roma: resultados de las terapias respiratorias no invasivas aplicadas en un centro terciario sin Unidad de Cuidados Intermedios durante la pandemia de COVID-19.

Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Variation in Assignment of the COPD Patients into a GOLD Group According to Symptoms Severity.

Introduction: The Global Organization of Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The modified Medical Research Council's dyspnea scale (mMRC) and the COPD assessment test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of GOLD classification using mMRC and CAT. Patients and Methods: This is an observational study of a cohort of 169 patients with COPD, who were classified following the GOLD 2017 recommendations, using both mMRC and CAT. A concordance analysis was applied, and a ROC curve was generated to identify the CAT score that best concorded with the mMRC scale. Results: The concordance for the GOLD groups classified by CAT and mMRC was moderate (kappa 0.492). For mMRC score of 1 and 2, a CAT score of ≥9 and ≥16 showed the maximum value of the Youden index, respectively. By reclassifying the patients with the new cut-off points obtained, the best concordance was obtained between the cut-off point for CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1. Conclusion: Because of the deficient concordance between CAT and mMRC, we propose the use of new cut-off points in future updates of the GOLD strategy.

Ventilatory Support Use in Hospitalized Patients With Community-Acquired Pneumonia. Fifteen-year Trends in Spain (2001-2015).

AIM: We examined fifteen years trends (2001-2015) in the use of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both (NIV+IMV) among patients hospitalized for community acquired pneumonia (CAP). We also analyzed trends overtime and the influence of patient factors in the in-hospital mortality (IHM) after receiving NIV, IMV or NIV+IMV. METHODS: Observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database. RESULTS: Over a total of 1,486,240 hospitalized patients with CAP, we identified 56,158 who had received ventilator support in Spain over the study period. Of them, 54.82% received NIV, 37.04% IMV and 8.14% both procedures. The use of NIV and NIV+IMV increased significantly (p<0.001) over time (from 0.91 to 12.84 per 100.000 inhabitant and from 0.23 to 1.19 per 100.000 inhabitants, respectively), while the IMV utilization decreased (from 3.55 to 2.79 per 100,000 inhabitants; p<0.001). Patients receiving NIV were the oldest and had the highest mean value in the Charlson comorbidity index (CCI) score and readmission rate. Patients who received only IMV had the highest IHM. Factors associated with IHM for all groups analyzed included age, comorbidities and readmission. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV+IMV. CONCLUSIONS: We found an increase in NIV use and a decline in IMV utilization in patients hospitalized for CAP over the study period. Patients receiving NIV were the oldest and had the highest CCI score and readmission rate. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV+IMV.

COPD is Associated with Higher Prevalence of Back Pain: Results of a Population-Based Case-Control Study, 2017.

OBJECTIVE: We aimed to assess whether patients suffering from COPD have a higher prevalence of chronic back pain (neck and low back pain) than age-, sex-, and residence-matched non-COPD controls. We also aimed to identify which variables are associated with chronic neck pain (CNP) and chronic low back pain (CLBP) among COPD patients. METHODS: We carried out a retrospective case-control study using data obtained from the Spanish National Health Survey conducted in 2017. RESULTS: We analyzed data from 1034 COPD and 1034 matched non-COPD controls. The prevalence of CNP and CLBP was 38.20% and 45.16%, respectively, among COPD patients and 22.82% and 28.34% for non-COPD controls, respectively (p<0.001 for both). Multivariable analysis showed that COPD patients had a 1.62-fold (95% CI 1.50-1.74) higher risk of CNP and a 1.83-fold (95% CI 1.73-1.91) higher risk of CLBP than non-COPD controls. Experiencing one type of pain greatly increased the risk of having the other. Factors associated with the presence of both types of pain among COPD patients included female sex, "fair/poor/very poor" self-rated health, migraine or frequent headache and use of pain medication. Being aged from 70 to 79 years was a risk factor for CLBP, and suffering from a mental disorder was a risk factor for CNP. CONCLUSION: The prevalence of CNP and CLBP was significantly higher among COPD patients than among non-COPD controls after adjusting for age, sex and other relevant clinical variables. Our findings add new data to the knowledge of chronic pain in COPD patients.

Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain.

INTRODUCTION: To describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching. RESEARCH DESIGN AND METHODS: This was a retrospective observational epidemiological study using the 2016-2017 Spanish Hospital Discharge Records. RESULTS: Of 245 221 admissions, CAP was identified in 227 524 (27.67% with T2DM), VAP was identified in 2752 (18.31% with T2DM) and NV-HAP was identified in 14 945 (25.75% with T2DM). The incidence of pneumonia was higher among patients with T2DM (CAP: incidence rate ratio (IRR) 1.44, 95% CI 1.42 to 1.45; VAP: IRR 1.24, 95% CI 1.12 to 1.37 and NV-HAP: IRR 1.38, 95% CI 1.33 to 1.44). In-hospital mortality (IHM) for CAP was 12.74% in patients with T2DM and 14.16% in matched controls (p<0.001); in patients with VAP and NV-HAP, IHM was not significantly different between those with and without T2DM (43.65% vs 41.87%, p=0.567, and 29.02% vs 29.75%, p=0.484, respectively). Among patients with T2DM, older age and dialysis were factors associated with IHM for all types of pneumonia. In patients with VAP, the risk of IHM was higher in females (OR 1.95, 95% CI 1.28 to 2.96). CONCLUSION: The incidence rates of all types of pneumonia were higher in patients with T2DM. Higher mortality rates in patients with T2DM with any type of pneumonia were associated with older age, comorbidities and dialysis.

Hospital admissions for community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in COPD patients in Spain (2016-2017).

BACKGROUND: To examine the incidence, characteristics and outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) in patients with or without COPD; compare in-hospital outcomes; and identify factors associated with in-hospital mortality (IHM) for pneumonia. METHODS: We carried out a retrospective observational study using the hospital discharge records from 2016-17 of the Spanish National Health System. Propensity score matching was used for data analysis. RESULTS: We found 245,905 patients (≥40 years) with pneumonia; we identified CAP in 228,139 patients (19.85% with COPD), VAP in 2,771 patients (8.55% with COPD) and NV-HAP in 14,995 patients (14.17% with COPD). The incidence for the three types of pneumonia was higher in COPD patients (CAP: incidence rate ratio (IRR) 2.23, 95% CI 2.21-2.26; VAP: IRR 1.25, 95% CI 1.08-1.42; and NV-HAP: IRR 1.55, 95% CI 1.48-1.63). The IHM for CAP was 10.35% in COPD patients and 12.91% in the controls (p<0.001). In patients with VAP and NV-HAP, IHM was not significantly different between those with and without COPD (43.88% vs. 41.77%;p=0.643 and 29.21% vs. 30.57%;p=0.331, respectively). Factors associated with IHM for all types of pneumonia analyzed in COPD patients were older age and receiving dialysis. CONCLUSIONS: The incidence of hospitalizations for all types of pneumonia was significantly higher in COPD patients than in the non-COPD population. In contrast, IHM was significantly lower among COPD patients with CAP than among matched non-COPD patients. Higher mortality rates in COPD patients with any pneumonia type were associated with increasing age and receiving dialysis.