RESUMEN
OBJECTIVES: Identifying early markers of poor prognosis of coronavirus disease 2019 (COVID-19) is mandatory. Our purpose is to analyze by chest radiography if rapid worsening of COVID-19 pneumonia in the initial days has predictive value for ventilatory support (VS) need. METHODS: Ambispective observational ethically approved study in COVID-19 pneumonia inpatients, validated in a second outpatient sample. Brixia score (BS) was applied to the first and second chest radiography required for suspected COVID-19 pneumonia to determine the predictive capacity of BS worsening for VS need. Intraclass correlation coefficient (ICC) was previously analyzed among three radiologists. Sensitivity, specificity, likelihood ratios, AUC, and odds ratio were calculated using ROC curves and binary logistic regression analysis. A value of p < .05 was considered statistically significant. RESULTS: A total of 120 inpatients (55 ± 14 years, 68 men) and 112 outpatients (56 ± 13 years, 61 men) were recruited. The average ICC of the BS was between 0.812 (95% confidence interval 0.745-0.878) and 0.906 (95% confidence interval 0.844-0.940). According to the multivariate analysis, a BS worsening per day > 1.3 points within 10 days of the onset of symptoms doubles the risk for requiring VS in inpatients and 5 times in outpatients (p < .001). The findings from the second chest radiography were always better predictors of VS requirement than those from the first one. CONCLUSION: The early radiological worsening of SARS-CoV-2 pneumonia after symptoms onset is a determining factor of the final prognosis. In elderly patients with some comorbidity and pneumonia, a 48-72-h follow-up radiograph is recommended. KEY POINTS: ⢠An early worsening on chest X-ray in patients with SARS-CoV-2 pneumonia is highly predictive of the need for ventilatory support. ⢠This radiological worsening rate can be easily assessed by comparing the first and the second chest X-ray. ⢠In elderly patients with some comorbidity and SARS-CoV-2 pneumonia, close early radiological follow-up is recommended.
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COVID-19 , SARS-CoV-2 , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Pronóstico , RadiografíaRESUMEN
SARS-CoV-2 infection increases the risk of thrombosis by different mechanisms not fully characterized. Although still debated, an increase in D-dimer has been proposed as a first-line hemostasis test associated with thromboembolic risk and unfavorable prognosis. We aim to systematically and comprehensively evaluate the association between thrombin generation parameters and the inflammatory and hypercoagulable state, as well as their prognostic value in COVID-19 patients. A total of 127 hospitalized patients with confirmed COVID-19, 24 hospitalized patients with SARS-CoV-2-negative pneumonia and 12 healthy subjects were included. Clinical characteristics, thrombin generation triggered by tissue factor with and without soluble thrombomodulin, and also by silica, as well as other biochemical parameters were assessed. Despite the frequent use of heparin, COVID-19 patients had similar thrombin generation to healthy controls. In COVID-19 patients, the thrombin generation lag-time positively correlated with markers of cell lysis (LDH), inflammation (CRP, IL-6) and coagulation (D-dimer), while the endogenous thrombin potential (ETP) inversely correlated with D-dimer and LDH, and positively correlated with fibrinogen levels. Patients with more prolonged lag-time and decreased ETP had higher peak ISTH-DIC scores, and had more severe disease (vascular events and death). The ROC curve and Kaplan Meier estimate indicated that the D-dimer/ETP ratio was associated with in-hospital mortality (HR 2.5; p = 0.006), and with the occurrence of major adverse events (composite end-point of vascular events and death) (HR 2.38; p = 0.004). The thrombin generation ETP and lag-time variables correlate with thromboinflammatory markers, and the D-dimer/ETP ratio can predict major adverse events in COVID-19.
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COVID-19/diagnóstico , Trombina/análisis , Adulto , Anciano , Pruebas de Coagulación Sanguínea , COVID-19/sangre , Coagulación Intravascular Diseminada/sangre , Coagulación Intravascular Diseminada/diagnóstico , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , SARS-CoV-2/aislamiento & purificación , Trombosis/sangre , Trombosis/diagnósticoAsunto(s)
COVID-19/sangre , Trombofilia/sangre , Trombosis/sangre , Adulto , Anciano , Antitrombina III/genética , Deficiencia de Antitrombina III/sangre , Deficiencia de Antitrombina III/complicaciones , Deficiencia de Antitrombina III/genética , COVID-19/complicaciones , COVID-19/fisiopatología , Estudios de Cohortes , Deficiencia del Factor V/sangre , Deficiencia del Factor V/complicaciones , Deficiencia del Factor V/genética , Femenino , Productos de Degradación de Fibrina-Fibrinógeno , Humanos , Hipoprotrombinemias/sangre , Hipoprotrombinemias/complicaciones , Hipoprotrombinemias/genética , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mortalidad , Proyectos Piloto , Proteína C/genética , Deficiencia de Proteína C/sangre , Deficiencia de Proteína C/complicaciones , Deficiencia de Proteína C/genética , Proteína S/genética , Deficiencia de Proteína S/sangre , Deficiencia de Proteína S/complicaciones , Deficiencia de Proteína S/genética , Síndrome de Dificultad Respiratoria/sangre , Síndrome de Dificultad Respiratoria/fisiopatología , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Trombofilia/complicaciones , Trombofilia/genética , Trombofilia/fisiopatología , Trombosis/fisiopatologíaRESUMEN
Introducción: El objetivo de este estudio fue investigar el valor del fragmento N-terminal del propéptido natriurético cerebral (NT-proBNP), proteína C reactiva (PCR) y procalcitonina (PCT) para predecir la mortalidad en pacientes sépticos durante la hospitalización con un riesgo de mortalidad<10% evaluado por el Sepsis-related Organ Failure Assessment (SOFA). Material y métodos: Estudio observacional prospectivo realizado en pacientes hospitalizados con sepsis y riesgo SOFA<10%. Los biomarcadores se obtuvieron en las primeras 72h después del ingreso en el hospital. Todos fueron monitorizados durante la hospitalización o hasta la muerte. Se utilizaron las curvas ROC para determinar el área bajo la curva (ABC) e identificar las mejores concentraciones de corte para predecir la mortalidad. Resultados: Se analizaron un total de 174 pacientes. Diecisiete (9,8%) pacientes murieron durante la hospitalización. El ABC de NT-proBNP fue 0,793 (IC 95% 0,686-0,9; p<0,0005) en comparación con el ABC de la PCR (0,728; IC 95% 0,617-0,839; p=0,004) y el ABC del PCT (0,684; IC 95% 0,557-0,811; p=0,019). Los factores asociados a la mortalidad hospitalaria fueron: tener un NT-proBNP>1.330pg/ml (OR=23,23; IC 95% 2,92-182,25; p=0,003) y tener factores predisponentes para presentar sepsis (OR=3,05; IC 95% 1,3-9,3; p=0,044). Conclusiones: En pacientes con bajo riesgo de mortalidad según la puntuación SOFA, los niveles de NT-proBNP obtenidos en las primeras 72h después del ingreso son un poderoso predictor de mortalidad. Su implementación en la práctica clínica podría mejorar la capacidad predictiva de la puntuación de gravedad clínica en estos pacientes (AU)
Introduction: The purpose of this study was to investigate the value of N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and procalcitonin (PCT) in predicting mortality in septic patients during hospitalization with mortality risk<10% evaluated by Sepsis-related Organ Failure Assessment (SOFA). Material and methods: Prospective, observational study performed in sepsis patients with SOFA risk<10%. We obtained levels of biomarkers in the first 72h after admission in hospital. All patients were monitored during hospitalization or until death. We used ROC curves to determine area under curve (AUC) and identify the best cutoff concentrations to predict mortality. Results: A total of 174 patients were analyzed. Seventeen (9.8%) patients died during hospitalization. The AUC of NT-proBNP was 0.793 (95% CI 0.686-0.9; P<.0005) compared to AUC of CRP (0.728; 95% CI 0.617-0.839; P=.004) and AUC of PCT (0.684; 95% CI 0.557-0.811; P=.019). Factors independently associated with in-hospital mortality were NT-proBNP>1,330pg/ml (OR=23.23; 95% CI 2.92-182.25; P=.003) and to have predisposing factors (OR=3.05; 95% CI 1.3-9.3; P=.044). Conclusions: In patients with low mortality risk according to SOFA score, NT-proBNP obtained in the first 72h after admission prove to be a powerful predictor of mortality. Their implementations in clinical practice would improve the predictive ability of clinical severity scores (AU)
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Humanos , Péptido Natriurético Encefálico/análisis , Sepsis/mortalidad , Choque Séptico/prevención & control , Insuficiencia Multiorgánica/prevención & control , Mortalidad Hospitalaria , Biomarcadores/análisis , Proteína C-Reactiva/análisis , Calcitonina/análisis , Factores de Riesgo , Estudios ProspectivosRESUMEN
INTRODUCTION: The purpose of this study was to investigate the value of N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and procalcitonin (PCT) in predicting mortality in septic patients during hospitalization with mortality risk<10% evaluated by Sepsis-related Organ Failure Assessment (SOFA). MATERIAL AND METHODS: Prospective, observational study performed in sepsis patients with SOFA risk<10%. We obtained levels of biomarkers in the first 72h after admission in hospital. All patients were monitored during hospitalization or until death. We used ROC curves to determine area under curve (AUC) and identify the best cutoff concentrations to predict mortality. RESULTS: A total of 174 patients were analyzed. Seventeen (9.8%) patients died during hospitalization. The AUC of NT-proBNP was 0.793 (95% CI 0.686-0.9; P<.0005) compared to AUC of CRP (0.728; 95% CI 0.617-0.839; P=.004) and AUC of PCT (0.684; 95% CI 0.557-0.811; P=.019). Factors independently associated with in-hospital mortality were NT-proBNP>1,330pg/ml (OR=23.23; 95% CI 2.92-182.25; P=.003) and to have predisposing factors (OR=3.05; 95% CI 1.3-9.3; P=.044) CONCLUSIONS: In patients with low mortality risk according to SOFA score, NT-proBNP obtained in the first 72h after admission prove to be a powerful predictor of mortality. Their implementations in clinical practice would improve the predictive ability of clinical severity scores.
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Mortalidad Hospitalaria , Insuficiencia Multiorgánica/diagnóstico , Péptido Natriurético Encefálico/sangre , Puntuaciones en la Disfunción de Órganos , Fragmentos de Péptidos/sangre , Sepsis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Calcitonina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Pronóstico , Estudios Prospectivos , Curva ROC , Factores de Riesgo , Sepsis/sangre , Sepsis/complicaciones , Sepsis/diagnósticoRESUMEN
Sarcoidosis is a worldwide spread disease with brad clinical spectrum, in which the pulmonary involvement is the main manifestation (more than 90% of cases); nevertheless, extrathoracic symptoms can predominate in the clinical picture and they may even be the first manifestation. One of them is the skeletal muscle involvement that normally is chronic and silent, with poor response to treatment with glucocorticoids. However, in some cases, it has an acute presentation. We present a case of a 61-year-old man with diagnosis of sarcoidosis whe were evaluated for proximal lower limb weakness within few days of evolution.