The impact of frailty on intra-hospital survival in older patients with COVID-19 infection: the importance of early identification. SEMI-COVID National Registry.

BACKGROUND: Emerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. METHODS: This observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. RESULTS: A total of 1,878 participants (52% men and 48% women) were included, with 1,351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate-severe degree of frailty is the primary factor independently associated with shorter survival [HR 2.344 (1.437-3.823; p<0.001) for CFS 5-6 and 3.694 (2.155-6.330; p<0.001) for CFS 7-9]. CONCLUSION: Frailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

[A reversible posterior leukoencephalopathy syndrome]. / Síndrome de leucoencefalopatía posterior reversible.

INTRODUCTION AND METHOD: The reversible posterior leukoencephalopathy (RPLS) was initially described by Hinchey et al in patients hospitalized due to different acute process that cause hypertension and renal disease that were being treated with immunosuppressive agents. Clinically it produces an acute or subacute encephalopathy that usually agrees with a fast increase of blood pressure. Neuroimaging technique demonstrated abnormalities involving the white matter, especially bilateral edema in the posterior portions of the cerebral hemispheres, although it can also affect to any other cerebral area, trunk or cerebellum. The production mechanism is not well know. In case of hypertensive encephalopathy and eclampsia of pregnancy it is believed to be caused by vascular and endothelial autoregulation alterations, and when it's related to immunosuppressors the edema seems to have a cytotoxical origin. The particularity that defines the RPLS is that, in most cases, neurological symptoms and white matter lesions disappear after anti hypertensive treatment or when immunosuppressive agents is ceased. CONCLUSION: The RPLS is an uncommon neurological complication, however each time more news cases appear in the medical literature. The excellent evolution and treatment response that these patients show and the full clinical and radiological recuperation suggest the need of its early identification to avoid unnecessary diagnostic studies or wrong treatments.

Síndrome de leucoencefalopatía posterior reversible / A reversible posterior leukoencephalopathy syndrome

Introducción y desarrollo. El síndrome de leucoencefalopatía posterior reversible (SLPR) fue descrito por Hinchey et al, en 1996, en enfermos hospitalizados por distintos procesos causantes de hipertensión arterial e insuficiencia renal o que estaban en tratamiento con inmunosupresores. Clínicamente produce una encefalopatía aguda o subaguda, que suele coincidir con un rápido aumento de la presión arterial. Las pruebas de neuroimagen cerebral muestran una alteración bilateral extensa en la sustancia blanca por edema cerebral en las porciones posteriores de los hemisferios cerebrales, aunque pueden afectar a cualquier área cerebral, tronco cerebral o cerebelo. El mecanismo de producción del SLPR se conoce poco; en los casos de encefalopatía hipertensiva y eclampsia parece que se debe a alteraciones en la autorregulación vascular y del endotelio, y en los casos relacionados con inmunosupresores el edema parece ser de origen citotóxico. La particularidad que define al SLPR es que, en casi todos los casos, se resuelven los síntomas neurológicos y desaparecen las lesiones en la sustancia blanca después del tratamiento con antihipertensivos o al suspender la terapia inmunosupresora. Conclusión. El SLPR constituye una complicación neurológica poco frecuente, aunque cada vez son más numerosos los casos comunicados en la literatura médica. La excelente evolución y respuesta al tratamiento que presentan estos pacientes y la íntegra recuperación del estado clínico y de las alteraciones radiológicas sugiere la importancia de su identificación precoz, para evitar pruebas diagnósticas innecesarias o tratamientos inadecuados (AU)

Introduction and method. The reversible posterior leukoencephalopathy (RPLS) was initially described by Hinchey et al in patients hospitalized due to different acute process that cause hypertension and renal disease that were being treated with immunosuppressive agents. Clinically it produces an acute or subacute encephalopathy that usually agrees with a fast increase of blood pressure. Neuroimaging technique demonstrated abnormalities involving the white matter, especially bilateral edema in the posterior portions of the cerebral hemispheres, although it can also affect to any other cerebral area, trunk or cerebellum. The production mechanism is not well know. In case of hypertensive encephalopathy and eclampsia of pregnancy it is believed to be caused by vascular and endothelial autoregulation alterations, and when it's related to immunosuppressors the edema seems to have a cytotoxical origin. The particularity that defines the RPLS is that, in most cases, neurological symptoms and white matter lesions disappear after anti-hypertensive treatment or when immunosuppressive agents is ceased. Conclusion. The RPLS is an uncommon neurological complication, however each time more news cases appear in the medical literature. The excellent evolution and treatment response that these patients show and the full clinical and radiological recuperation suggest the need of its early identification to avoid unnecessary diagnostic studies or wrong treatments (AU)