Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19 / Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry

ANTECEDENTES: España ha sido uno de los países más afectados por la pandemia de COVID-19. OBJETIVO: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. MÉTODOS: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. RESULTADOS: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente. Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como la linfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%) y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años: 10,5%; 70-79 años: 26,9%; ≥80 años: 46%). CONCLUSIONES: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality

Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry. / Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19.

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.

[Clinical characteristics of patients hospitalized with COVID-19 in Spain: Results from the SEMI-COVID-19 Registry]. / Características clínicas de los pacientes hospitalizados con COVID-19 en España: resultados del Registro SEMI-COVID-19.

BACKGROUND: Spain has been one of the countries most affected by the COVID-19 pandemic. OBJECTIVE: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. METHODS: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. RESULTS: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥ 80 years: 46.0%). CONCLUSIONS: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality.

A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES).

BACKGROUND: In patients with unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulation is anchored on estimating the risk of disease recurrence. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk. METHODS: In a prospective cohort study, 398 patients with a first unprovoked VTE were followed up for a median of 21.3months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect. Preselected clinical and laboratory variables were analyzed based on the independent confirmation of the impact on the recurrence risk, simplicity of assessment, and reproducibility. Multivariable Cox regression analysis was used to develop a recurrence score that was subsequently internally validated by bootstrap analysis. RESULTS: A total of 65 patients (16.3%) had recurrent VTE. In all patients, VTE recurred spontaneously. Male sex (HR=2.89 [95% CI 1.21-6.90] P=0.016), age (HR=1.0310 per additional decade [95% CI 1.01-1.07] P=0.011), obesity (HR=3.92 [95% CI 1.75-8.75] P=0.0001), varicose veins (HR=4.14 [95% CI 1.81-9.43] P=0.0001), abnormal D-dimer during anticoagulation (HR=13.66 [95% CI 4.74-39.37] P=0.0001), high factor VIII coagulant activity (HR=1.01 [95% CI 1.00-1.02] P=0.028) and heterozygous of factor V Leiden and/or Prothrombin G20210A mutation (HR=13.86 [95% CI 5.87-32.75] P=0.0001) were related to a higher recurrence risk. Using these variables, we developed a nomogram [hereafter referred to as DAMOVES score (D-dimer, Age, Mutation, Obesity, Varicose veins, Eight, Sex)] for prediction of recurrence in an individual patient. CONCLUSIONS: The DAMOVES score can be used to predict recurrence risk in patients with a first unprovoked VTE and may be useful to decide whether anticoagulant therapy should be continued indefinitely or stopped after an initial treatment period of at least 3months.

Descripción de las altas hospitalarias en pacientes con lupus eritematoso sistémico / Description of hospital discharges in patients with systemic lupus erythematosus

Antecedentes. El lupus eritematoso sistémico (LES) es una enfermedad de naturaleza autoinmune que afecta fundamentalmente a mujeres jóvenes y cuya mortalidad está aumentada para estos grupos de edad. Objetivos. Mediante el registro de altas hospitalarias en España y el análisis del conjunto mínimo básico de datos (CMBD) facilitado por el Ministerio de Sanidad se han analizado las altas hospitalarias en cuyos diagnósticos se incluyera el de LES. Material y métodos. Estudio transversal descriptivo de todos los episodios codificados, según la CIE-9-MC, como LES de los pacientes hospitalizados durante 2005-2008 en todo el territorio español. Resultados. Se identificaron un total de 5.464 episodios, de los cuales 1.855 (33%) tenían lupus como diagnóstico principal y 3.609 (66%) como secundario. Los pacientes del grupo LES principal son más jóvenes (41,56±17,55 vs. 56,07±19,01 años; p<0,001), tienen un menor porcentaje de ingresos urgentes (62,5 vs. 84,8%; p<0,001) y una comorbilidad menor, medida por el índice de Charlson (Charlson>2; 18 vs. 35%; p<0,001), así como una menor mortalidad (1,1 vs. 5,4%; p<0,001). Conclusiones. Los pacientes con LES que ingresan en los servicios de Medicina Interna en España suponen el 0,3% del total. Se identifican 2 grupos de pacientes, aquellos más jóvenes, con menor comorbilidad en proceso de diagnóstico y tratamiento inicial de la enfermedad y una segunda población de pacientes de más edad, con mayor comorbilidad y cuyos motivos de ingreso están relacionados con las infecciones y las complicaciones cardiovasculares. La mortalidad en este grupo es superior(AU)

Background. Systemic lupus erythematosus (SLE) is an autoimmune disease that mainly affects young women and whose mortality is increasing for this age group. Objectives. We used the national registry of Hospital discharges in Spain based on the study of the Minimum Basic Data Set (MBDS) to analyze hospital discharges of patients whose diagnosis included that of LES. Material and methods. A cross-sectional, descriptive study was performed of all episodes coded as having LES using ICD-9-MC coding system of the patients hospitalized within the period 2005-2008. Results. A total of 5,464 episodes were identified, 1,855 (33%) as main diagnosis and 3,609 (66%) as secondary diagnosis. Patients having LES the main diagnosis were younger (41.56±17.55 vs 56.07±19.01 years; P<.001), had fewer elective admittances (62.5 vs 84.8%; P<.001), lower comorbidity as measured by the Charlson's index (Charlson>2; 18 vs 35%; P<.001) and lower mortality (1.1 vs 5.4%; P<.001). Conclusions. Patients admitted to internal medicine departments in Spain with a diagnosis of LES accounts for 0.3% of the total. Two different groups of patients are identified. The first group was younger, had lower comorbidity and were in the early phases of diagnosis and/or treatment. The second group was more numerous, older, with a higher comorbidity, with admittances frequently related to infections or cardiovascular complications and higher mortality rate(AU)

[Description of hospital discharges in patients with systemic lupus erythematosus]. / Descripción de las altas hospitalarias en pacientes con lupus eritematoso sistémico.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease that mainly affects young women and whose mortality is increasing for this age group. OBJECTIVES: We used the national registry of Hospital discharges in Spain based on the study of the Minimum Basic Data Set (MBDS) to analyze hospital discharges of patients whose diagnosis included that of LES. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed of all episodes coded as having LES using ICD-9-MC coding system of the patients hospitalized within the period 2005-2008. RESULTS: A total of 5,464 episodes were identified, 1,855 (33%) as main diagnosis and 3,609 (66%) as secondary diagnosis. Patients having LES the main diagnosis were younger (41.56 ± 17.55 vs 56.07 ± 19.01 years; P < .001), had fewer elective admittances (62.5 vs 84.8%; P<.001), lower comorbidity as measured by the Charlson's index (Charlson>2; 18 vs 35%; P<.001) and lower mortality (1.1 vs 5.4%; P < .001). CONCLUSIONS: Patients admitted to internal medicine departments in Spain with a diagnosis of LES accounts for 0.3% of the total. Two different groups of patients are identified. The first group was younger, had lower comorbidity and were in the early phases of diagnosis and/or treatment. The second group was more numerous, older, with a higher comorbidity, with admittances frequently related to infections or cardiovascular complications and higher mortality rate.

[Lymphocytic variant of the hypereosinophilic syndrome]. / Variante linfoide del síndrome hipereosinófilo.

OBJECTIVES: Hypereosinophilic syndromes (HSS) are a rare group of heterogeneous disorders characterized by prominent and persistent eosinophilia and organ dysfunction. Secondary causes of eosinophilia must be excluded. Recent advances in molecular biology and cytogenetics have permitted the characterization of different subsets of hypereosinophilic syndrome. We describe a patient with the lymphocytic variant. PATIENT: A 46-year old male Philippine patient presented skin lesions, fever, red eyes, enlarged lymph nodes and marked eosinophilia. RESULTS: Lymphocytic phenotyping by flow cytometry analysis was performed on peripheral blood and an aberrant population of T lymphocytes CD3-CD4+ producing interleukin 5 was found. TCR gene rearrangement using PCR amplification confirmed T cell clonality. CONCLUSIONS: The lymphocytic variant of the hypereosinophilic syndrome is a primitive lymphocytic disorder characterized by a non-malignant T cell population expansion producing eosinophilopoietic cytokines, with an indolent clinical course but that can transform into a peripheral T lymphoma. We report the first case of such a variant published in our country and review the characteristics of this variety.

Variante linfoide del síndrome hipereosinófilo / Lymphocytic variant of the hypereosinophilic syndrome

Fundamento: El síndrome hipereosinófilo (SHE) es un grupo heterogéneo de procesos raros caracterizados por un aumento prominente y sostenido de eosinófilos en sangre y daño orgánico. Se deben excluir otras causas de hipereosinofilia. Avances recientes en biología molecular y citogenética han permitido caracterizar diferentes subtipos. Se describe un caso de la variedad linfoide. Paciente: Varón filipino de 46 años que consulta por lesiones cutáneas, fiebre, conjuntivitis, adenopatías y eosinofilia prominente. Resultados: El estudio de poblaciones linfocitarias en sangre periférica revela una población aberrante de linfocitos T (LT) CD3-CD4+ productora de interleucina 5 (IL-5). Se confirmó la clonalidad del TCR mediante PCR. Conclusiones: La variedad linfoide del SHE está caracterizada por una expansión clonal de LT no maligna que produce IL-5, de comportamiento indolente, pero que puede evolucionar a linfoma T periférico. Se describe el primer caso de variedad linfoide publicada en nuestro país y se revisan las características de esta variedad (AU)

Objectives: Hypereosinophilic syndromes (HSS) are a rare group of heterogeneous disorders characterized by prominent and persistent eosinophilia and organ dysfunction. Secondary causes of eosinophilia must be excluded. Recent advances in molecular biology and cytogenetics have permitted the characterization of different subsets of hypereosinophilic syndrome. We describe a patient with the lymphocytic variant. Patient: A 46-year old male Philippine patient presented skin lesions, fever, red eyes, enlarged lymph nodes and marked eosinophilia. Results: Lymphocytic phenotyping by flow cytometry analysis was performed on peripheral blood and an aberrant population of T lymphocytes CD3-CD4+ producing interleukin 5 was found. TCR gene rearrangement using PCR amplification confirmed T cell clonality. Conclusions: The lymphocytic variant of the hypereosinophilic syndrome is a primitive lymphocytic disorder characterized by a non-malignant T cell population expansion producing eosinophilopoietic cytokines, with an indolent clinical course but that can transform into a peripheral T lymphoma. We report the first case of such a variant published in our country and review the characteristics of this variety (AU)

Tumores neuroendocrinos de origen incierto: a propósito de 2 casos clínicos / Neuroendocrine tumors of uncertain origin: two clinical case reports

Presentamos dos casos clínicos que muestran tumores neuroendocrinos de origen incierto en nuestra consulta de Atención Primaria. Un primer caso clínico seguido por hipertransaminasemia y un segundo por una diabetes de reciente diagnóstico (AU)

We present two clinical cases that show neuroendocrine tumors of uncertain origin in our health center of primary care. The first clinical case was followed for hypertransaminasemia and second one by a diagnosis of recent-onset diabetes (AU)

Actuación en urgencias ante una crisis convulsiva en adultos / Emergency actuation in convulsive seizures in adults

Se describe la actuación a seguir en urgencias ante una crisis convulsiva, diferenciando entre la: A) Una primera crisis en la que es fundamental descartar posibles causas que pueden originarla. La atención debe ser preferente. Durante la crisis deben establecerse las medidas de soporte vital básico que hay que mantener durante el estado postcrítico en el que debe hacerse una vigilancia estrecha del nivel de consciencia. Mediante anamnesis, exploraqción física y pruebas complementarias se podrá evaluar adecuadamente el estado del paciente y descartar las causas de epilepsia secundaria. Se señalan las indicaciones de tomografía computadorizada craneal y de hospitalización. Se discute la necesidad de iniciar o no tratamiento anticonvulsivante en urgencias y los fármacos disponibles para ello, destacando ácido valproico, hidantoína y carbamacepina. B) Crisis convulsiva en paciente epiléptico conocido en el que la actuación inicial es semejante y para diferenciarse posteriormente. C) Estado epiléptico en el que la actuación va encaminada a abortar las crisis (diacepam o loracepan intravenosos), tratar las complicaciones y prevenir nuevas crisis (valproato sódico o difenilhidantoína) (AU)

We describe the measures to be undertaken in the Emergency setting in the case of a convulsive seizure in an adult patients, with the following differentiation: (A) A first seizure, in which it is fundamental to rule out possible causes. The patient should be attended to preferently. While the seizure lasts, adequate basic vital support measures should be instituted, which must be maintained in the post-critical period; during the latter, close surveillance of the conscience level should be maintained. The anamnesis, the physical examination and the complementary explorations and analyses will help to adequately assess the patient's status and to rule out causes of secondary epilepsy. The indications for cranial computerised tomography scan and for hospital admission are pointed out. The requirement or lack of it for instituting anticonvulsivant therapy in the Emergency setting is discussed, as well as the available drugs with particular stress on valproate, hydantoin and earbamazepin. B) A convulsive seizure in a known epileptic patient; the initial measures are similar, and the particular conditions may be differentiated later on. (C) Status epilepticus, where in the initial measures aim at aborting the seizure (intravenous diazepam or lorazepam), treating complications and preventing renewed seizures (sodium valproate or diphenyl-hydantoin) (AU)