Adecuación de la prescripción de hierro intravenoso en pacientes hospitalizados / Appropriateness of Intravenous Iron Prescription in Hospitalized Patients

Introducción: La ferropenia y la anemia ferropénica son condiciones clínicas frecuentes en la práctica clínica diaria, requiriendo terapia de reemplazo con hierro. El objetivo de este estudio fue evaluar la adecuación del tratamiento con hierro intravenoso de los pacientes ingresados e identificar las principales causas de prescripción inadecuada. Método: Estudio retrospectivo observacional. Se incluyeron pacientes adultos a los que se les prescribió hierro intravenoso durante el periodo de estudio. Se consideró el tratamiento como adecuado si el paciente presentaba ferropenia, bien por déficit absoluto (ferritina<100 ng/mL) o funcional de hierro (índice de saturación de transferrina sérica < 20 % y ferritina < 300 ng/ml). La variable principal del estudio fue el porcentaje de pacientes con prescripción adecuada de hierro intravenoso. Resultados: El estudio incluyó 250 pacientes. El uso del hierro fue adecuado en el 41,6 % (104) de los 250 pacientes analizados. La causa principal de inadecuación en un 46,4 % de pacientes, fue la falta de datos analíticos que corroboraran la ferropenia. Conclusiones: Nuestro centro presenta un déficit de adecuación de la prescripción de hierro intravenoso pese a la existencia de un protocolo de utilización del mismo. El principal punto de mejora sería la realización de un perfil analítico que permita el diagnóstico adecuado del déficit de hierro previo a la prescripción de hierro intravenoso. En algunas patologías, la inexistencia de guías clínicas con puntos de corte específicos para los marcadores analíticos indicativos de déficit de hierro en la bibliografía disponible puede contribuir a esta situación. (AU)

Introduction: Iron deficiency anemia and iron deficiency are usual clinical conditions in daily clinical practice, requiring iron replacement therapy. The study objective was to evaluate the appropriateness of intravenous iron treatment in hospitalized patients and to identify the main causes of inappropriate prescription. Method: This is a retrospective observational study. Adult patients who received intravenous iron therapy at their hospital during the study period were included. Appropriate treatment was considered when patient presented iron deficiency, either due to absolute (ferritin <100 ng/mL) or functional iron deficiency (transferrin saturation index < 20 % and ferritin < 300 ng/mL). The main variable of the study was patient percentage with adequate prescription or parenteral iron. Results: The study included 250 patients. The use of iron was adequate in 41.6 % (104) of the 250 patients analyzed. The main cause of inadequacy in 46.4 % of patients was the lack of analytical data which corroborated iron defi-ciency. Conclusions: Our center has a deficiency in the appropriateness of the prescription of parenteral iron despite the existence of a protocol for its use. The main point of improvement would be the creation of an analytical profile that allows the adequate diagnosis of iron deficiency prior to the prescription of intravenous iron. In some pathologies, the lack of clinical guidelines with specific cut-off points for analytical markers indicative of iron deficiency in the available literature may contribute to this situation. (AU)

Use of Tocilizumab in hospitalized patients during the first wave of the COVID-19 pandemic

Introduction: The aim of this study was to characterize the use of tocilizumab in a hospital. Method: Retrospective cohort study including adult SARS-CoV-2 infected inpatients with moderately severe infection (PaO2/FiO2 < 300). ORs for mortality and treatment success were calculated. Results: The tocilizumab group (n=18), presented 5 days of symptoms vs 7 days in the untreated group (n=71). Minimum PaO2/FiO2 was 147.5 (95%CI: 116.7 to 194.0) vs 255.6 (95%CI: 320.7 to 452.4) (p=0.01).No significant differences were found between the two groups concerning survival (OR=1.22; 95%CI: 0.38 to 3.92), nor treatment success (OR=0.46; 95%CI: 0.16 to 1.33). After adjusting for age, sex and total corticosteroid dose, OR for success was 0.18 (95%CI: 0.03 to 0.96), while mortality was not significant. Conclusions: The use of tocilizumab in moderately severe hospitalized patients could decrease the hyperinflammatory state preventing disease progression (AU)

Introducción: El objetivo del estudio fue estudiar la utilización de tocilizumab en un centro hospitalarioMétodo:Estudio de cohortes retrospectivo que incluyó pacientes ingresados adultos infectados por SARS-CoV-2, con una infección de gravedad moderada (PaO2/FiO2 < 300). Se calcularon las OR de mortalidad y éxito del tratamiento. Resultados: El grupo tocilizumab (n=18), tuvo 5 vs 7 días con síntomas en el grupo no tratado (n=71). El PaO2/FiO2 mínimo fue de 147,5 (IC95%: 116,7 a 194,0) versus 255,6 (IC95%: 320,7 a 452,4) (p=0,01).No se encontraron diferencias significativas entre ambos grupos en supervivencia (OR=1,22; IC95%: 0,38 a 3,92); ni en el éxito del tratamiento (OR=0,46; IC95%: 0,16 a 1,33). Tras ajustar por edad, sexo y dosis total de corticoide, OR de éxitos fue 0,18 (IC95%: 0,03 a 0,96), mientras que mortalidad no fue significativa. Conclusiones: El uso de tocilizumab en pacientes hospitalizados moderadamente graves podría disminuir su estado hiperinflamatorio (AU)

Características de pacientes con enfermedades inflamatorias inmunomediadas hospitalizados por infección por SARS-CoV-2 / Characteristics of Patients With Immune-Mediated Inflammatory Diseases Hospitalized for SARS-CoV-2 Infection

Fundamentos: Las enfermedades inflamatorias inmunomediadas (IMID) predisponen a un aumento del riesgo infeccioso al modificar la respuesta inmune del huésped, que resulta crucial para la resolución de la infección por SARS-CoV-2. Las últimas publicaciones indican que los pacientes con IMID y sus tratamientos de base no empeoran el pronóstico de la infección por SARS-CoV-2. Objetivos: Describir las características clínicas y la evolución de pacientes con IMID que requirieron ingreso hospitalario por infección por SARS-CoV-2. En segundo lugar, comparar las características clínicas y la evolución entre pacientes que requirieron ingreso hospitalario por infección por SARS-CoV-2 con IMID y aquellos que no la presentaban. Métodos: Estudio observacional de cohortes retrospectivo, que incluyó pacientes ingresados por sospecha de SARS-CoV-2, tratados según el criterio médico y los protocolos basados en la evidencia científica. La recogida de datos clínicos se realizó por descarga directa o mediante revisión manual de la historia clínica electrónica. El análisis estadístico determinó las diferencias de características y evolución clínica de la infección en pacientes con IMID. Resultados: De los 612 pacientes revisados, 23 padecían IMID y 9 de ellos fueron diagnosticados de infección por SARS-CoV-2. No se observó correlación entre infección por SARS-CoV-2 e IMID. Los pacientes con IMID presentaban mayor prevalencia de enfermedad cardiovascular y obesidad, aunque no significativamente. Asimismo, los pacientes con IMID no presentaron una evolución clínica durante el ingreso hospitalario diferente respecto al resto de pacientes. Conclusión: Las IMID y los tratamientos de las mismas no determinan el pronóstico del ingreso hospitalario de la infección por SARS-CoV-2.(AU)

Background: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. Objectives: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. Methods: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. Results: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. Conclusion: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.(AU)

Characteristics of patients with immune-mediated inflammatory diseases hospitalized for SARS-CoV-2 infection.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Descriptive study of a cohort of COVID-19 hospitalized patients in Spain.

BACKGROUND: Several descriptive cohort studies of patients affected by COVID-19 have been published. OBJECTIVE: To describe the characteristics of patients with SARS-CoV-2 infection who were admitted to Hospital Universitario la Plana, Castellón, Spain. METHODS: Retrospective, observational cohort study that included 18-year-old or older patients who were consecutively admitted with SARS-CoV2 confirmed infection. Demographic characteristics, comorbidities, clinical symptoms, laboratory results and radiological tests are described. RESULTS: The study included 255 patients with a mean age of 70 years; 54.9 % were males. Most common comorbidities were high blood pressure (58 %), dyslipidemia (42.4 %), diabetes (25.5 %) and obesity (24.3 %). Median number of days from the onset of clinical symptoms prior to hospital admission was seven. Most common manifestations prior to admission were fever (74.5 %), dry cough (61.2 %), malaise (51.8 %) and dyspnea (51.0 %); 19 patients (7.4 %) were admitted to the intensive care unit, where mortality was 50 %; overall mortality was 16.9 %. CONCLUSIONS: Our cohort reflects similar characteristics to those of other European series. Mortality was lower than that in similar studies.

ANTECEDENTES: Se han publicado varios estudios descriptivos de cohortes de pacientes afectados por COVID-19. OBJETIVO: Describir las características de pacientes con infección por SARS-CoV-2 que ingresaron al Hospital Universitario de La Plana, Castellón, España. MÉTODOS: Estudio observacional de cohortes retrospectivo, que incluyó pacientes de 18 años o mayores que ingresaron en forma consecutiva con infección confirmada por SARS-CoV2; se describen características demográficas, comorbilidades, síntomas clínicos, resultados de laboratorio y pruebas radiológicas. RESULTADOS: El estudio incluyó 255 pacientes con edad promedio de 70 años; 54.9 % fue del sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (58 %), dislipemia (42.4 %), diabetes (25.5 %) y obesidad (24.3 %). La mediana de días del inicio de síntomas clínicos antes del ingreso fue de siete. Las manifestaciones más frecuentes previas al ingreso fueron fiebre (74.5 %), tos seca (61.2 %), malestar general (51.8 %) y disnea (51.0 %); 19 pacientes (7.4 %) ingresaron a la unidad de cuidados intensivos, donde la mortalidad fue de 50 %; la mortalidad total fue de 16.9 %. CONCLUSIONES: Nuestra cohorte refleja características similares a las de otras series europeas. La mortalidad fue inferior a la de estudios similares.

Characteristics of Patients With Immune-Mediated Inflammatory Diseases Hospitalized for SARS-CoV-2 Infection. / Características de pacientes con enfermedades inflamatorias inmunomediadas hospitalizados por infección por SARS-CoV-2.

BACKGROUND: Immune-mediated inflammatory diseases (IMID) predispose to a higher infection risk by modifying the host's immune response, which acts as a key factor in SARS-CoV-2 infection resolution. Recent publications show that IMID patients and its treatments do not worsen the outcome of SARS-CoV-2 infection. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with IMID who required hospital admission due to SARS-CoV-2 infection. Secondly, to compare clinical characteristics and outcomes between patients who required hospital admission due to SARS-CoV-2 infection with IMID and those who were not affected. METHODS: We performed an observational retrospective cohort study, including admitted patients with suspected SARS-CoV-2 infection, treated according to medical criteria and local protocols based on the best available scientific evidence. Clinical data were collected from their electronical clinical history. Statistical analysis determined the differences in the characteristics and clinical outcome of the infection in IMID patients. RESULTS: Of a total number of 612 revised patients, 23 had an IMID and 9 of them were positive for the SARS-CoV-2 infection. We did not observe a correlation between these two disorders. There was a higher frequency of obesity and cardiovascular disease among IMID patients, but without statistical significance. The clinical outcomes were no different between hospitalized IMID and non IMID patients. CONCLUSION: IMID and its treatments do not determine the outcome of patients admitted with SARS-CoV-2 infection.

Estudio descriptivo de una cohorte de pacientes con COVID-19 hospitalizados en España / Descriptive study of a cohort of COVID-19 hospitalized patients in Spain

Resumen Antecedentes: Se han publicado varios estudios descriptivos de cohortes de pacientes afectados por COVID-19. Objetivo: Describir las características de pacientes con infección por SARS-CoV-2 que ingresaron al Hospital Universitario de La Plana, Castellón, España. Métodos: Estudio observacional de cohortes retrospectivo, que incluyó pacientes de 18 años o mayores que ingresaron en forma consecutiva con infección confirmada por SARS-CoV2; se describen características demográficas, comorbilidades, síntomas clínicos, resultados de laboratorio y pruebas radiológicas. Resultados: El estudio incluyó 255 pacientes con edad promedio de 70 años; 54.9 % fue del sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (58 %), dislipemia (42.4 %), diabetes (25.5 %) y obesidad (24.3 %). La mediana de días del inicio de síntomas clínicos antes del ingreso fue de siete. Las manifestaciones más frecuentes previas al ingreso fueron fiebre (74.5 %), tos seca (61.2 %), malestar general (51.8 %) y disnea (51.0 %); 19 pacientes (7.4 %) ingresaron a la unidad de cuidados intensivos, donde la mortalidad fue de 50 %; la mortalidad total fue de 16.9 %. Conclusiones: Nuestra cohorte refleja características similares a las de otras series europeas. La mortalidad fue inferior a la de estudios similares.

Abstract Background: Several descriptive cohort studies of patients affected by COVID-19 have been published. Objective: To describe the characteristics of patients with SARS-CoV-2 infection who were admitted to Hospital Universitario la Plana, Castellón, Spain. Methods: Retrospective, observational cohort study that included 18-year-old or older patients who were consecutively admitted with SARS-CoV2 confirmed infection. Demographic characteristics, comorbidities, clinical symptoms, laboratory results and radiological tests are described. Results: The study included 255 patients, with a mean age of 70 years; 54.9 % were males. Most common comorbidities were high blood pressure (58 %), dyslipidemia (42.4 %), diabetes (25.5 %) and obesity (24.3 %). Median number of days from the onset of clinical symptoms prior to hospital admission was seven. Most common manifestations prior to admission were fever (74.5 %), dry cough (61.2 %), malaise (51.8 %) and dyspnea (51.0 %); 19 patients (7.4 %) were admitted to the intensive care unit, where mortality was 50 %; overall mortality was 16.9 %. Conclusions: Our cohort reflects similar characteristics to those of other European series. Mortality was lower than that in similar studies.

[Incidence of drug-induced thrombocytopenia in hospitalized patients]. / Incidencia de trombocitopenia inducida por fármacos en pacientes hospitalizados.

OBJECTIVE: To find out the incidence of drug-induced thrombocytopenia and which medications are implicated, and to establish pharmaceutical activity for its prevention and resolution. METHODS: A prospective study was conducted between June and December 2009 in hospitalized patients over 18 years of age with thrombocytopenia. The medications considered to be associated with thrombocytopenia were included in a database drawn up from the bibliography. In a suspected case, the doctor was recommended to discontinue, decrease the dosage or keep the drug under observation; and a follow-up of the patient's platelet count was made in order to classify the relationship between the drug and thrombocytopenia. RESULTS: 273 patients were included (61.5% men) with a mean age of 60 ± 15 years. Mean stay was 18 ± 17 days. TCP incidence was 2.26%. The services most involved were Haematology (56), Intensive Care Medicine (48) and Oncology (40). TCP was moderate in 69% of cases, mild in 26 % and severe in 5%. There were 8 cases of drug-induced thrombocytopenia (0.063% incidence), which were resolved in an average of 7.6 days. The medications related were enoxaparin (2), linezolid (2), tacrolimus (2), thymoglobulin (1) and heparin (1). The doctor was recommended to discontinue the drug (2), decrease the dosage (3) or keep it under observation (3), with 100% acceptance. CONCLUSIONS: Pharmaceutical validation must incorporate an assessment of the platelet count, as it may contribute both to early identification of thrombocytopenia, and to following up platelet counts in patients receiving therapy with thrombocytopenia related drugs.

Incidencia de trombocitopenia inducida por fármacos en pacientes hospitalizados / Incidence of drug-induced thrombocytopenia in hospitalized patients

Objetivo: Los objetivos del estudio fueron conocer la incidencia de trombocitopenia inducida por fármacos, los medicamentos implicados y establecer la actividad del farmacéutico para su prevención y resolución. Método: Se realizó un estudio prospectivo entre Junio y Diciembre de 2009 en mayores de 18 años ingresados con trombocitopenia. Se consideraron medicamentos asociados a trombocitopenia los incluidos en una base de datos elaborada a partir de bibliografía. En caso de sospecha, se recomendaba al médico suspender, disminuir dosis o monitorizar el fármaco y se realizaba el seguimiento del recuento plaquetario para clasificar la relación entre fármaco y trombocitopenia. Resultados: Se incluyeron 273 pacientes (61,5% hombres), edad media 60 ± 15 años. La estancia media fue de 18 ± 17 días. La incidencia de trombocitopenia fue de un 2,26%. Los servicios más implicados fueron Hematología (56), Medicina Intensiva (48) y Oncología (40). La trombocitopenia fue moderada en un 69% de los casos, en un 26 % leve y en un 5% grave. Hubo 8 casos de trombocitopenia inducida por fármacos (incidencia 0,063%), resueltos en una media de 7, 6 días. Los medicamentos relacionados fueron enoxaparina (2), linezolid (2), tacrolimus (2), timoglobulina (1) y heparina (1). Se recomendó al médico suspender el fármaco (2), disminuir la dosis (3) o monitorización (3), con una aceptación del 100%. Conclusiones: La validación farmacéutica debe incorporar la valoración del recuento plaquetario, porque puede contribuir tanto a la identificación precoz de una trombocitopenia, como al seguimiento del recuento plaquetario en pacientes en tratamiento con fármacos relacionados con trombocitopenia (AU)

Objective: To find out the incidence of drug-induced thrombocytopenia and which medications are implicated, and to establish pharmaceutical activity for its prevention and resolution. Methods: A prospective study was conducted between June and December 2009 in hospitalized patients over 18 years of age with thrombocytopenia. The medications considered to be associated with thrombocytopenia were included in a database drawn up from the bibliography. In a suspected case, the doctor was recommended to discontinue, decrease the dosage or keep the drug under observation; and a follow-up of the patient's platelet count was made in order to classify the relationship between the drug and thrombocytopenia. Results: 273 patients were included (61.5% men) with a mean age of60±15 years. Mean stay was 18± 17 days. TCP incidence was 2.26%. The services most involved were Haematology (56), Intensive Care Medicine (48) and Oncology (40). TCP was moderate in 69% of cases, mild in 26 % and severe in 5%. There were 8 cases of drug-induced thrombocytopenia (0.063% incidence), which were resolved in an average of 7.6 days. The medications related were enoxaparin (2), linezolid (2), tacrolimus (2), thymoglobulin (1) and heparin (1). The doctor was recommended to discontinue the drug (2), decrease the dosage (3) or keep it under observation (3), with 100% acceptance. Conclusions: Pharmaceutical vaiicianon musi incorporate an assessment of ihe platelet couni, as II may contribute bolh lo early Identification of thrombocytopenia, and to following up platelet counts in patients receiving therapy with thrombocytopenia related drugs (AU)