Deterioration is sometimes unexpected in SARS-CoV2 infection. The aim of our study is to establish laboratory predictors of mortality in COVID-19 disease which can help to identify high risk patients. All patients admitted to hospital due to Covid-19 disease were included. Laboratory biomarkers that contributed with significant predictive value for predicting mortality to the clinical model were included. Cut-off points were established, and finally a risk score was built. 893 patients were included. Median age was 68.2 ± 15.2 years. 87(9.7%) were admitted to Intensive Care Unit (ICU) and 72(8.1%) needed mechanical ventilation support. 171(19.1%) patients died. A Covid-19 Lab score ranging from 0 to 30 points was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included haemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, creatinine, C-reactive protein, interleukin-6, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. Three groups were established. Low mortality risk group under 12 points, 12 to 18 were included as moderate risk, and high risk group were those with 19 or more points. Low risk group as reference, moderate and high patients showed mortality OR 4.75(CI95% 2.60-8.68) and 23.86(CI 95% 13.61-41.84), respectively. C-statistic was 0-85(0.82-0.88) and Hosmer-Lemeshow p-value 0.63. Covid-19 Lab score can very easily predict mortality in patients at any moment during admission secondary to SARS-CoV2 infection. It is a simple and dynamic score, and it can be very easily replicated. It could help physicians to identify high risk patients to foresee clinical deterioration.
COVID-19/diagnosis , Aged , Biomarkers/analysis , COVID-19/mortality , COVID-19/pathology , COVID-19/therapy , Female , Hospitalization , Humans , Male , Multivariate Analysis , Retrospective Studies , Risk Assessment , SARS-CoV-2/physiology , Spain/epidemiology , Treatment Outcome
BACKGROUND: Limited data are available regarding change in the nutritional status after transcatheter aortic valve replacement (TAVR). This study evaluated the prognostic impact of the change in the geriatric nutritional risk index following TAVR. METHODS: TAVR patients were analyzed in a prospective and observational study. To analyze the change in nutritional status, geriatric nutritional risk index of the patients was calculated on the day of TAVR and at 3-month follow-up. The impact of the change in nutritional risk index after TAVR on all-cause mortality, heart failure hospitalization (HF-h), and the composite of all-cause death and HF hospitalization was analyzed using the Cox Proportional Hazards model. RESULTS: Four hundred thirty-three patients were included. After TAVR, 68.4% (n=182) patients with baseline nutritional risk improved compared with 31.6% (n=84) who remained at nutritional risk. The change from no-nutritional risk to nutritional risk after TAVR occurred in 15.0% (n=25), while 85.0% (n=142) remained without risk of malnutrition. During follow-up, 157 (36.3%) patients died and 172 patients (39.7%) were hospitalized due to HF. Patients who continued to be at nutritional risk had a higher risk of mortality (hazard ratio [HR], 2.10 [95% CI, 1.30-3.39], P=0.002), HF-h (HR, 1.97 [95% CI, 1.26-3.06], P=0.000), and the composite of death and HF-h (HR, 2.0 [95% CI, 1.37-2.91], P<0.001). The change to non-nutritional risk after TAVR significantly impacted mortality (HR, 0.48 [95% CI, 0.30-0.78], P=0.003), HF-h (HR, 0.50 [95% CI, 0.34-0.74], P=0.001), and the composite outcome (HR, 0.44 [95% CI, 0.32-0.62], P<0.001). CONCLUSIONS: Remaining at nutritional risk after TAVR confers a poor prognosis and is associated with an increased risk of mortality and HF-h, while the change from risk of malnutrition to non-nutritional risk after TAVR was associated with a halving of the risk of mortality and HF-h. Further studies are needed to identify whether patients at nutritional risk would benefit from nutritional intervention during processes of care of TAVR programs.
Aortic Valve Stenosis , Heart Failure , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Heart Failure/therapy , Humans , Prognosis , Prospective Studies , Risk Factors , Severity of Illness Index , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
Introducción y objetivos La Organización Mundial de la Salud calificó la enfermedad por coronavirus (COVID-19) como una pandemia global. No está claro si el tratamiento previo con inhibidores de la enzima de conversión de la angiotensina (IECA) y antagonistas de los receptores de angiotensina (ARA-II) tiene un impacto en el pronóstico de los pacientes infectados con COVID-19. El objetivo fue evaluar la implicación clínica del tratamiento previo con IECA/ARA-II en el pronóstico de la COVID-19. Métodos Estudio observacional, retrospectivo, unicéntrico, de cohortes basado en todos los habitantes del área de salud. El análisis de los resultados principales (mortalidad, insuficiencia cardiaca, hospitalización, ingreso en la unidad de cuidados intensivos (UCI) y eventos cardiovasculares agudos mayores [un compuesto de mortalidad e insuficiencia cardiaca]), se ajustó mediante modelos de regresión logística multivariada y modelos de coincidencia de puntaje de propensión. Resultados De una población total, 447.979 habitantes, 965 pacientes (0,22%), fueron diagnosticados de infección por COVID-19, 210 (21,8%) estaban bajo tratamiento con IECA o ARA-II en el momento del diagnóstico. El tratamiento con IECA/ARA-II (combinado e individualmente) no tuvo efecto sobre la mortalidad (OR=0,62; IC95%, 0,17-2,26; p=0,486), insuficiencia cardiaca (OR=1,37; IC95%, 0,39-4,77; p=0,622), tasa de hospitalización (OR=0,85; IC95%, 0,45-1,64; p=0,638), ingreso en UCI (OR=0,87; IC95%, 0,30-2,50; p=0,798) y cardiopatía aguda grave eventos (OR=1,06; IC95%, 0,39-2,83; p=0,915). En el análisis del subgrupos de pacientes que requirieron hospitalización, el efecto se mantuvo neutral. Conclusiones El tratamiento previo con IECA/ARA-II en pacientes con COVID-19 no tuvo efecto sobre la mortalidad, la aparición de insuficiencia cardíaca, ni en la necesidad de hospitalización ni ingreso en UCI. La supresión de IECA/ARA-II en pacientes con COVID-19 ... . (AU)
Introduction and objectives Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. Methods Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. Results Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. Conclusions Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies. (AU)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , /diagnosis , /mortality , Heart Failure/epidemiology , Hospitalization/statistics & numerical data , Prognosis , Retrospective Studies , Spain/epidemiology
INTRODUCTION AND OBJECTIVES: Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. METHODS: Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. RESULTS: Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P = .486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P = .622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P = .638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P = .798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P = .915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. CONCLUSIONS: Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.
INTRODUCTION AND OBJECTIVES: Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. METHODS: Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. RESULTS: Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. CONCLUSIONS: Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 Drug Treatment , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/mortality , Child , Child, Preschool , Female , Heart Failure/epidemiology , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prognosis , Registries , Retrospective Studies , Spain , Young Adult
OBJECTIVE: The aim of this work is to assess the relationship between significant paravalvular leak (SPL) after transcatheter aortic valve implantation (TAVI) on anaemia and their impact on prognosis. METHODS: Observational analytic study developed at two university hospitals, including all consecutive patients who underwent TAVI during a 10-year period (2009 to 2018). A logistic regression model was created to determine independent predictors of anaemia at 3 months. Time to event outcomes were analysed with Cox regression. Median follow-up was 21.3±21.9 months. RESULTS: 788 patients were included. 5.3% had SPL. SPL was an independent predictor of anaemia 3 months after TAVI (OR: 8.31, 95% CI: 2.06 to 33.50). SPL and anaemia at 3 months were independently associated with long-term mortality (HR: 1.82, 95% CI: 1.16 to 2.85; HR: 2.07, 95% CI: 1.39 to 3.08). CONCLUSION: SPL is an independent predictor of anaemia at 3 months after TAVI, a condition that doubles long-term mortality. Our findings could explain in part the worse prognosis of SPL after TAVI. Further pathophysiological studies are necessary to explain this association.
No disponible
Humans , Coronavirus Infections/complications , Cardiomyopathies/complications , Severe Acute Respiratory Syndrome/complications , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Pandemics/statistics & numerical data , Severity of Illness Index , Risk Factors , Inpatients/statistics & numerical data , Troponin/analysis
INTRODUCCIÓN Y OBJETIVOS: La Organización Mundial de la Salud calificó la enfermedad por coronavirus (COVID-19) como una pandemia global. No está claro si el tratamiento previo con inhibidores de la enzima de conversión de la angiotensina (IECA) y antagonistas de los receptores de angiotensina (ARA-II) tiene un impacto en el pronóstico de los pacientes infectados con COVID-19. El objetivo fue evaluar la implicación clínica del tratamiento previo con IECA/ARA-II en el pronóstico de la COVID-19. MÉTODOS: Estudio observacional, retrospectivo, unicéntrico, de cohortes basado en todos los habitantes del área de salud. El análisis de los resultados principales (mortalidad, insuficiencia cardiaca, hospitalización, ingreso en la unidad de cuidados intensivos (UCI) y eventos cardiovasculares agudos mayores [un compuesto de mortalidad e insuficiencia cardiaca]), se ajustó mediante modelos de regresión logística multivariada y modelos de coincidencia de puntaje de propensión. RESULTADOS: De una población total, 447.979 habitantes, 965 pacientes (0,22%), fueron diagnosticados de infección por COVID-19, 210 (21,8%) estaban bajo tratamiento con IECA o ARA-II en el momento del diagnóstico. El tratamiento con IECA/ARA-II (combinado e individualmente) no tuvo efecto sobre la mortalidad (OR=0,62; IC95%, 0,17-2,26; p = 0,486), insuficiencia cardiaca (OR=1,37; IC95%, 0,39-4,77; p = 0,622), tasa de hospitalización (OR=0,85; IC95%, 0,45-1,64; p = 0,638), ingreso en UCI (OR=0,87; IC95%, 0,30-2,50; p = 0,798) y cardiopatía aguda grave eventos (OR=1,06; IC95%, 0,39-2,83; p = 0,915). En el análisis del subgrupos de pacientes que requirieron hospitalización, el efecto se mantuvo neutral. CONCLUSIONES: El tratamiento previo con IECA/ARA-II en pacientes con COVID-19 no tuvo efecto sobre la mortalidad, la aparición de insuficiencia cardíaca, ni en la necesidad de hospitalización ni ingreso en UCI. La supresión de IECA/ARA-II en pacientes con COVID-19 no estaría justificada en ningún caso, de acuerdo a las recomendaciones actuales de las sociedades científicas y las agencias gubernamentales
INTRODUCTION AND OBJECTIVES: Coronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. METHODS: Single-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. RESULTS: Of the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. CONCLUSIONS: Previous treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies
Humans , Coronavirus Infections/drug therapy , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Diseases Registries/statistics & numerical data , Pandemics/statistics & numerical data , Premedication/methods , Retrospective Studies
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Obesity, Morbid/complications , Transcatheter Aortic Valve Replacement , Aged , Aged, 80 and over , Aortic Valve/physiopathology , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Female , Heart Valve Prosthesis , Hemodynamics , Humans , Male , Obesity, Morbid/mortality , Obesity, Morbid/physiopathology , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/mortality , Treatment Outcome
