Valor pronóstico del cociente lactato/albúmina para la mortalidad en pacientes mayores de 65 años con infección urinaria complicada / Lactate/albumin ratio prognostic value for mortality in patients older than 65 years with complicated urinary tract infection

Antecedentes El cociente lactato/albúmina (LAR) es un biomarcador emergente de sepsis que se ha evaluado para determinar la mortalidad en pacientes con sepsis de distinto foco. Nuestro objetivo es evaluar el valor pronóstico de LAR en pacientes ingresados en el hospital por infecciones urinarias complicadas. Métodos Estudio observacional prospectivo de pacientes mayores de 65 años diagnosticados de ITU. Se calcularon y compararon el área bajo la curva ROC, la sensibilidad y la especificidad para predecir la mortalidad a 30 días para LAR, qSOFA y SOFA. Resultados Se analizaron 341 casos de ITU. La mortalidad a 30 días (20,2 frente a 6,7%, p<0,001) y la mayor estancia hospitalaria (5 [4-8] frente a 4 [3-7], p=0,018) se asociaron con LAR≥0,708. LAR no presenta diferencias estadísticamente significativas en comparación con qSOFA y SOFA para predecir la mortalidad a 30 días (AUROC 0,737 frente a 0,832 y 0,777, respectivamente, p=0,119 y 0,496). La sensibilidad de LAR fue similar a la de qSOFA y SOFA (60,8 frente a 84,4 y 82,2%, respectivamente, p=0,746 y 0,837). Sin embargo, su especificidad fue inferior a la del qSOFA (60,8 frente a 75%, p=0,003), pero similar a la del SOFA (60,8 frente a 57,8%, p=0,787). Conclusiones LAR no presenta diferencias significativas con otras puntuaciones bien establecidas en sepsis, como qSOFA y SOFA, para predecir la mortalidad a 30 días en pacientes con ITU complicada (AU)

Background Lactate to albumin ratio (LAR) is an emerging sepsis biomarker that has been tested for mortality in patients with sepsis of different focus. Our goal is to evaluate the prognostic value of LAR in patients admitted to the hospital due to complicated urinary tract infections. Methods Prospective observational study of patients older than 65 years diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for LAR, qSOFA and SOFA. Results Three hundred and forty-one UTI cases were analyzed. Thirty-day mortality (20.2 vs. 6.7%, p<0.001) and longer hospital stay (5 [4–8] vs. 4 [3–7], p=0.018) were associated with LAR≥0.708. LAR has no statistically significant differences compared to qSOFA and SOFA for predicting 30-day mortality (AUROC 0.737 vs. 0.832 and 0.777, respectively, p=0.119 and 0.496). The sensitivity of LAR was similar to the sensitivity of qSOFA and SOFA (60.8 vs. 84.4 and 82.2%, respectively, p=0.746 and 0.837). However, its specificity was lower than the specificity of qSOFA (60.8 vs. 75%, p=0.003), but similar to the specificity of SOFA (60.8 vs. 57.8%, p=0.787). Conclusions LAR has no significant differences with other well-stablished scores in sepsis, such as qSOFA and SOFA, to predict 30-day mortality in patients with complicated UTI (AU)

[Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: Time matters]. / Impacto de los días transcurridos desde el inicio de los síntomas hasta la hospitalización en la mortalidad hospitalaria por COVID-19: el tiempo importa.

Background: COVID-19 shows different clinical and pathophysiological stages over time. Theeffect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospital-ization and how other independent prognostic factors perform when taking this time elapsedinto account. Methods: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online datacapture registry. Univariate and multivariate COX-regression were performed in the generalcohort and the final multivariate model was subjected to a sensitivity analysis in an earlypresenting (EP; < 5 DEOS) and late presenting (LP; ≥5 DEOS) group. Results: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in theLP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortalityin the multivariate Cox regression model along with other 9 variables. Each DEOS incrementaccounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93---0.98). Regarding variationsin other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index onlyremained significant in the EP group while D-dimer only remained significant in the LP group. Conclusion: When caring for COVID-19 patients, DEOS to hospitalization should be consideredas their need for early hospitalization confers a higher risk of mortality. Different prognosticfactors vary over time and should be studied within a fixed timeframe of the disease.

Impact of days elapsed from the onset of symptoms to hospitalization in COVID-19 in-hospital mortality: time matters.

BACKGROUND: COVID-19 shows different clinical and pathophysiological stages over time. The effect of days elapsed from the onset of symptoms (DEOS) to hospitalization on COVID-19 prognostic factors remains uncertain. We analyzed the impact on mortality of DEOS to hospitalization and how other independent prognostic factors perform when taking this time elapsed into account. METHODS: This retrospective, nationwide cohort study, included patients with confirmed COVID-19 from February 20th and May 6th, 2020. The data was collected in a standardized online data capture registry. Univariate and multivariate COX-regression were performed in the general cohort and the final multivariate model was subjected to a sensitivity analysis in an early presenting (EP; <5 DEOS) and late presenting (LP; ≥5 DEOS) group. RESULTS: 7915 COVID-19 patients were included in the analysis, 2324 in the EP and 5591 in the LP group. DEOS to hospitalization was an independent prognostic factor of in-hospital mortality in the multivariate Cox regression model along with other 9 variables. Each DEOS increment accounted for a 4.3% mortality risk reduction (HR 0.957; 95% CI 0.93-0.98). Regarding variations in other mortality predictors in the sensitivity analysis, the Charlson Comorbidity Index only remained significant in the EP group while D-dimer only remained significant in the LP group. CONCLUSION: When caring for COVID-19 patients, DEOS to hospitalization should be considered as their need for early hospitalization confers a higher risk of mortality. Different prognostic factors vary over time and should be studied within a fixed timeframe of the disease.