Predictors of the presence of radiological abnormalities 6 months after severe COVID-19 pneumonia.

BACKGROUND: SARS-CoV-2 pneumonia can cause significant long-term radiological changes, even resembling pulmonary fibrosis. However, the risk factors for these long-term effects are unknown. This study aims to assess radiological abnormalities and their possible risk factors six months after hospital discharge due to COVID-19 pneumonia. MATERIAL AND METHODS: This cross-sectional study in a tertiary hospital included adults admitted for COVID-19 pneumonia from March 2020 to February 2021, who underwent high-resolution computed tomography (HRCT) scans of the chest six months after hospital discharge. The primary outcome was radiological abnormalities on HRCT, while the main explanatory variables were drawn from the patient's medical history along with the disease course, analytical indicators, and the treatment received during admission. RESULTS: The 189 included patients had a mean age of 61.5 years; 70.9% were male, and hypertension was the main comorbidity (45%). About two-thirds (67.2%) presented acute respiratory distress syndrome (ARDS). Most (97.9%) received systemic corticosteroid therapy, and 81% presented pathological findings on HRCT, most commonly ground glass (63.5%), followed by bronchial dilatation (36%) and subpleural bands (25.4%). The multivariable analysis showed that age was the main risk factor, associated with most radiological changes. Other factors were the duration of corticosteroid therapy for ground glass (adjusted odds ratio [aOR] 1.020) as well as a longer stay in the intensive care unit (ICU) (aOR 1.290) and high levels of IL-6 for bronchial dilation (aOR 1.002). CONCLUSION: Radiological involvement of the lungs six months after COVID-19 pneumonia is frequent, especially ground glass. Elderly patients with prolonged ICU admission and a significant inflammatory response measured by IL-6 are more likely to present worse radiological evolution and are candidates for radiological follow-up after COVID-19 pneumonia.

One-year quality of life among post-hospitalization COVID-19 patients.

Introduction: The long-term effects of SARS-CoV-2 are unclear, as are the factors influencing the evolution. Objective: to assess health-related quality of life 1 year after a hospital admission due to COVID-19 and to identify factors that may influence it. Materials and methods: Retrospective observational study in a tertiary hospital from March 2021 to February 2022. Inclusion criteria: ≥18 years old and admitted for SARS-CoV-2 infection. Exclusion criteria: death, not located, refusal to participate, cognitive impairment, and language barrier. Variables: demographic data, medical history, clinical and analytical outcomes during hospital admission, treatment received, and vaccination against SARS-CoV-2 following admission. Participants were interviewed by phone 1 year after admission, using the SF-36 quality of life questionnaire. Results: There were 486 included patients. The domains yielding the lowest scores were general health (median 65%, interquartile range [IQR] 45-80), vitality (median 65%, IQR 45-80), and mental health (median 73.5%, IQR 60-100). Multivariable analysis showed that female sex and fibromyalgia/fatigue had a negative influence on all domains. Obesity was associated with worse outcomes in physical functioning, physical role, bodily pain, and vitality. Other factors associated with worse scores were an older age in physical functioning and high age-adjusted Charslon comorbidity in physical functioning and general health. Age was associated with better results in emotional role and High C-reactive protein at admission on vitality. Conclusion: One year after admission for COVID-19, quality of life remains affected, especially the domains of general health, vitality, and mental health. Factors associated with worse outcomes are female sex, fibromyalgia/chronic fatigue, and obesity.

[Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases]. / Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. INCLUSION CRITERIA: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.

Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas / Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases

INTRODUCCIÓN: La sepsis es una entidad grave siendo su sospecha y tratamiento precoces claves para el pronóstico. OBJETIVO: Analizar la utilidad pronóstica de la escala qSOFA en pacientes que ingresan por infección en un servicio de Medicina Interna. PACIENTES Y MÉTODOS: Estudio descriptivo, tranversal, de los pacientes ingresados con infección en el Hospital General de Castellón (España) de noviembre de 2017 a febrero de 2018. Criterio de inclusión: pacientes admitidos por la sospecha de un proceso infeccioso. Variable principal dependiente: mortalidad. Variable principal independiente: qSOFA. Variables secundarias: tiempo hasta primera valoración médica y hasta inicio de antibioterapia empírica en Urgencias (minutos), características demográficas del paciente, analíticas y evolutivas. RESULTADOS: Se analizó un total de 311 pacientes, 145 varones, edad media 78 años (DE 16,23). Setenta y cinco (24%) presentaron qSOFA ≥ 2. Se observó una mayor mortalidad en aquellos pacientes con qSOFA ≥ 2 (36 vs 11%, p = 0,00). CONCLUSIÓN: En pacientes admitidos con enfermedades infecciosas, un valor de qSOFA > = 2 se asoció a mayor mortalidad. Se requieren futuros estudios para comprobar su potencial utilidad diagnóstica.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. Inclusion criteria: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.

Predicting Clinical Outcome with Phenotypic Clusters in COVID-19 Pneumonia: An Analysis of 12,066 Hospitalized Patients from the Spanish Registry SEMI-COVID-19.

(1) Background: Different clinical presentations in COVID-19 are described to date, from mild to severe cases. This study aims to identify different clinical phenotypes in COVID-19 pneumonia using cluster analysis and to assess the prognostic impact among identified clusters in such patients. (2) Methods: Cluster analysis including 11 phenotypic variables was performed in a large cohort of 12,066 COVID-19 patients, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish Society of Internal Medicine (SEMI)-COVID-19 Registry. (3) Results: Of the total of 12,066 patients included in the study, most were males (7052, 58.5%) and Caucasian (10,635, 89.5%), with a mean age at diagnosis of 67 years (standard deviation (SD) 16). The main pre-admission comorbidities were arterial hypertension (6030, 50%), hyperlipidemia (4741, 39.4%) and diabetes mellitus (2309, 19.2%). The average number of days from COVID-19 symptom onset to hospital admission was 6.7 (SD 7). The triad of fever, cough, and dyspnea was present almost uniformly in all 4 clinical phenotypes identified by clustering. Cluster C1 (8737 patients, 72.4%) was the largest, and comprised patients with the triad alone. Cluster C2 (1196 patients, 9.9%) also presented with ageusia and anosmia; cluster C3 (880 patients, 7.3%) also had arthromyalgia, headache, and sore throat; and cluster C4 (1253 patients, 10.4%) also manifested with diarrhea, vomiting, and abdominal pain. Compared to each other, cluster C1 presented the highest in-hospital mortality (24.1% vs. 4.3% vs. 14.7% vs. 18.6%; p < 0.001). The multivariate study identified age, gender (male), body mass index (BMI), arterial hypertension, chronic obstructive pulmonary disease (COPD), ischemic cardiopathy, chronic heart failure, chronic hepatopathy, Charlson's index, heart rate and respiratory rate upon admission >20 bpm, lower PaO2/FiO2 at admission, higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH), and the phenotypic cluster as independent factors for in-hospital death. (4) Conclusions: The present study identified 4 phenotypic clusters in patients with COVID-19 pneumonia, which predicted the in-hospital prognosis of clinical outcomes.