Cistatina C en el derrame pleural / Cystatin C in Pleural Effusion

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Hiperlactatemia en pacientes hospitalizados por asma: Frecuencia e implicaciones clínicas / Hyperlactatemia in hospitalized patients with asthma. Frequency and clinical implications

Se ha descrito un incremento del lactato sanguíneo en algunos pacientes tratados por agudización del asma. Sin embargo, se desconoce su frecuencia y el significado clínico en la práctica clínica habitual. El objetivo del estudio ha sido evaluar las características asociadas a la presencia de hiperlactatemia en la gasometría arterial de pacientes que requirieron ingreso en la sala de neumonología por agudización del asma. Se realizó un estudio retrospectivo de las altas hospitalarias de un servicio de neumonología durante 3 años (2015 a 2017) analizando los valores del ácido láctico en la gasometría arterial y su posible relación con datos de antecedentes clínicos, de laboratorio, tratamiento, espirometría, estancia hospitalaria o uso de unidades de cuidados críticos. Se incluyeron 112 pacientes con 182 ingresos. Presentaron en alguna ocasión hiperlactatemia (> 2.2 mmol/l) 32 pacientes (29%). En 42 de los 182 ingresos (23%) se observó aumento de lactato, en quienes tenían mayor estancia hospitalaria (mediana 6 vs. 5 días, p = 0.013). En 8 de los 10 ingresos en unidades de cuidados críticos se observó hiperlactatemia, en general tras recibir el tratamiento broncodilatador. En las gasometrías con hiperlactatemia existía una correlación significativa entre lactato y bicarbonato (r = -0.417, p=0.003) y el exceso de base (r = -0.484, p < 0.001). La hiperlactatemia es relativamente frecuente en las gasometrías realizadas a los pacientes hospitalizados por asma (23% de los ingresos). Los ingresos con hiperlactatemia se asociaron a una internación más prolongada.

Increased levels of lactic acid have been described in patients treated for asthma exacerbation. However, the frequency and clinical significance of hyperlactatemia in real-world practice is unknown. The objective of the study was to evaluate the characteristics associated with hyperlactatemia in blood gas analysis of patients with asthma exacerbation hospitalized in a pulmonary department. This is a retrospective 3-year study (2015 to 2017) of patients discharged from the pulmonary department. The level of lactic acid in the blood gas test and the possible relationship with clinical, laboratory, therapy, spirometric values, hospitalization length and use of critical care resources were analyzed. A total of 112 patients with 182 admissions were included in the study. Thirty-two (29%) patients had hyperlactatemia in at least one blood gas analysis. Elevated lactic acid was observed in 42 of 182 admissions (23%), which had larger length hospital stay (median, 6 vs. 5 days, p = 0.013). Hyperlactatemia was present in 8 of 10 admissions in the critical care units, mainly after receiving bronchodilator therapy. There was a significant correlation between lactate level and bicarbonate level (r = -0.417, p = 0.003) and between lactate level and base excess (r = -0.484, p < 0.001) in cases with hiperlactatemia. Hyperlactatemia is a relatively frequent finding in blood gas analysis of patients hospitalized because of asthma (23% of admissions). These admissions with hiperlactatemia are associated with larger hospital length of stay.

[Hyperlactatemia in hospitalized patients with asthma. Frequency and clinical implications]. / Hiperlactatemia en pacientes hospitalizados por asma. Frecuencia e implicaciones clínicas.

Increased levels of lactic acid have been described in patients treated for asthma exacerbation. However, the frequency and clinical significance of hyperlactatemia in real-world practice is unknown. The objective of the study was to evaluate the characteristics associated with hyperlactatemia in blood gas analysis of patients with asthma exacerbation hospitalized in a pulmonary department. This is a retrospective 3-year study (2015 to 2017) of patients discharged from the pulmonary department. The level of lactic acid in the blood gas test and the possible relationship with clinical, laboratory, therapy, spirometric values, hospitalization length and use of critical care resources were analyzed. A total of 112 patients with 182 admissions were included in the study. Thirty-two (29%) patients had hyperlactatemia in at least one blood gas analysis. Elevated lactic acid was observed in 42 of 182 admissions (23%), which had larger length hospital stay (median, 6 vs. 5 days, p = 0.013). Hyperlactatemia was present in 8 of 10 admissions in the critical care units, mainly after receiving bronchodilator therapy. There was a significant correlation between lactate level and bicarbonate level (r = -0.417, p = 0.003) and between lactate level and base excess (r = -0.484, p < 0.001) in cases with hiperlactatemia. Hyperlactatemia is a relatively frequent finding in blood gas analysis of patients hospitalized because of asthma (23% of admissions). These admissions with hiperlactatemia are associated with larger hospital length of stay.

Análisis del líquido pleural: parámetros bioquímicos de uso infrecuente / Pleural fluid analysis: Biochemical parameters of infrequent use

El estudio bioquímico del líquido pleural es, con frecuencia, fundamental para el diagnóstico de la etiología del derrame. Existen parámetros básicos que aportan información relevante de forma inmediata (pH, glucosa, proteínas, lactato deshidrogenasa, adenosina desaminasa). Pero también existen otras magnitudes bioquímicas que pueden permitir el diagnóstico de determinadas causas de los derrames, como beta-2 transferrina, proteína-traza, creatinina, amilasa, bilirrubina, colesterol y triglicéridos o proteína C reactiva. Sin embargo, con frecuencia se solicitan al laboratorio numerosos parámetros de dudosa utilidad. La relación entre el médico asistencial y el laboratorio clínico es esencial para obtener la mayor rentabilidad diagnóstica del análisis bioquímico en líquido pleural. Una adecuada selección de los parámetros bioquímicos, a través del conocimiento y de la información compartida, conlleva una mejor aproximación diagnóstica en el estudio del derrame pleural

Biochemical studies of the pleural fluid are often a key step in the diagnostic workup. Several parameters (pH, glucose, protein, lactate dehydrogenase, adenosine deaminase) add immediate relevant information, or they can help in the diagnosis of specific causes of pleural effusion (beta-2 transferrin, beta-trace-protein, creatinine, amylase, bilirubin, cholesterol, triglycerides, and C-reactive protein). However, parameters of questionable value may also be requested. The relationship between the attending physician and the clinical laboratory is critical in order to obtain higher diagnostic efficiency. An accurate selection of the biochemical tests to perform achieves the best approach to the study of a pleural effusion

Tuberculosis endotraqueal en una paciente no bacilífera / Endotracheal Tuberculosis in a Patient with Smear-Negative Sputum

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Desigualdad de género en la autoría de artículos médicos: análisis de Medicina Clínica en 1999 y 2014 / Gender inequality in the authorship of medical articles: Analysis of Medicina Clinica, 1999 and 2014

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Exacerbación de la enfermedad pulmonar obstructiva crnica por Corynebacterium propinquum / Chronic Obstructive Pulmonary Disease Exacerbation by Corynebacterium Propinquum

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