Evaluation of the Khorana Predictive Thrombotic Risk and Thromboprophylaxis Score in Cancer Patients in a Third Level Hospital.

Introduction: Current clinical guidelines do not recommend the routine use of thromboprophylaxis in cancer primary unselected patients. Identifying cancer patients who could be beneficiaries of thrombotic prophylaxis is a real challenge. We aimed to analyse the application of Khorana score in cancer patients. We also tried to evaluate the prescription of primary thromboprophylaxis in cancer patients at risk of venous thromboembolic disease (VTED). Methods: A retrospective observational study of survival of hospitalised patients diagnosed with pulmonary embolism (PE) at the Hospital Central de la Defensa from January 2009 to March 2018. They were stratified into tumour PE (TPE) and non-tumour PE (nTPE). A case-control study was also carried out by TPE patients and non PE cancer patients (nPEC). Results: 108 patients were diagnosed with TPE, 260 nTPE and 324 nPEC. Gynaecological tumours were the most frequent (23.1%), followed by lung, digestive and urological cancer (20.4% each) in the TPE group. Death risk was 1.9 times higher in cancer patients (95% CI: 1.23-2.8) (p < 0.001). Khorana score was ≥3 points in 9.7% of TPE and 3.1% of nPEC compared to 26.2% of TPE and 9.9% of nPEC with Khorana score ≥2 points (p < 0.001). 7.4% of TPE patients received thromboprophylaxis. Khorana score in TPE patients without thromboprophylaxis was ≥3 points in the 9% and ≥2 points in the 24%. Conclusions: There is an underutilisation of thromboprophylaxis in our cancer patients and mainly in those with high risk of VTED, as well as poor adherence to the Khorana score. More studies are needed to validate these findings and to optimise predictive strategies in the management of these patients.

Introducción: El objetivo del estudio es analizar la aplicación de la escala predictiva de Khorana en el paciente oncológico. Asimismo el estudio trata de evaluar la prescripción de tromboprofilaxis primaria en los pacientes con cáncer en riesgo de enfermedad tromboembólica venosa (ETV). Métodos: Estudio observacional retrospectivo de supervivencia en pacientes hospitalizados en el Hospital Central de la Defensa diagnosticados de embolia pulmonar (EP) desde el 01 de enero de 2009 al 15 de marzo de 2018, estratificándose en EP tumoral (EPT) y EP no tumoral (EPnT). Se ha realizado también un estudio de casos y controles, con pacientes con EPT y con cáncer sin EP (CsEP). Resultados: Se encontró que 108 pacientes presentaron EPT, 260 EPnT y 324 CsEP. En la EPT el tumor ginecológico fue el más frecuente (23,1%), seguido de pulmón, digestivo y urológico (20,4% cada uno). Los pacientes con cáncer presentaron 1,9 veces más riesgo de muerte (IC 95%: 1,23-2,8) (p < 0,001). Mediante la escala de Khorana el 9,7% de EPT y el 3,1% de CsEP presentaron ≥3 puntos, frente a 26,2% de EPT y 9,9% de CsEP con ≥2 puntos (p < 0,001). Un 7,4% de EPT recibió tromboprofilaxis. De los que no la recibieron el 9% tenía ≥3 puntos y el 24% ≥2 puntos. Conclusiones: Existe una infrautilización de la tromboprofilaxis en nuestros pacientes oncológicos y fundamentalmente en los de alto riesgo de ETV, así como una escasa adherencia a la escala de Khorana. Son necesarios más estudios para validar estos hallazgos y conseguir optimizar las estrategias predictivas en el manejo de estos pacientes.

[COPD and endocrine and metabolic alterations]. / EPOC y alteraciones endocrinometabólicas.

The clinical course and therapeutic management of chronic obstructive pulmonary disease (COPD) may be affected by the presence of comorbid diseases, which also usually worsen prognosis. Among the endocrinological and metabolic alterations that can be associated with COPD are diabetes mellitus, osteoporosis, metabolic syndrome and malnutrition. There are several possible etiopathogenic mechanisms that intervene in the association between COPD and distinct endocrine and metabolic disorders, such as smoking and systemic inflammation, influenced by distinct cytokines among other factors. The high-dose glucocorticosteroids used in the treatment of severe COPD and exacerbations are a major risk factor for the development of some metabolic alterations such as diabetes and osteoporosis. Study of patients with COPD should identify the possible coexisting endocrinological and metabolic alterations in order to apply preventive measures and treatment. In general, patients benefit from being included in a respiratory rehabilitation program with physical exercise and a balanced diet, in addition to appropriate drug treatment in each case. Certain measures such as avoiding smoking and sedentariness are also essential in the correct treatment of COPD.

Control of persistent asthma in Spain: associated factors.

INTRODUCTION: The main objective of asthma treatment is tailored control for each patient. However, despite the excellent therapeutic arsenal currently available, many patients remain unable to achieve adequate control of this disease. OBJECTIVE: The main objective this study was to evaluate the degree of control and the determinants of asthma in patients with persistent asthma in Spain in usual clinical practice. MATERIALS AND METHODS: This was a cross-sectional epidemiological study. The patients enrolled were 18 years of age or over, with a 6-month history of diagnosed persistent asthma, who were followed up by primary care physicians in Spain between the months of June and December 2006. Demographic and socioeconomic data were collected, as were anthropometric data and different clinical variables. The control of asthma was evaluated using the Asthma Control Questionnaire (ACQ). RESULTS: The study included 6,824 patients, of whom 306 were excluded; therefore the final number of patients analyzed was 6,518 (95.5%). According to severity, 41.4% of patients had mild persistent asthma, 51.2% had moderate persistent asthma, and the remainder severe persistent asthma. The mean score in the ACQ was 1.4 +/- 1.0, distributed as follows: in 28.4% of cases, the score was below 0.75; in 31.6%, it was between 0.75 and 1.5; and in 39.7% it was above 1.5. Multiple regression analysis showed that the factor that most affected the degree of control of the disease was classification by severity. Other associated factors were sex, race, body mass index, smoking, level of education, habitual activity, years since diagnosis of asthma, number of exacerbations and admissions to hospital during the last year, and basic treatment of the disease. CONCLUSIONS: The number of patients with poorly controlled persistent asthma in Spain is high (71.6%). There are demographic, socioeconomic, anthropometric, and clinical variables that affect the level of control of this disease.