COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation.

INTRODUCTION: This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. METHODS: Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. RESULTS: A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01-1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39-3.63)] and [OR = 3.04 (95% CI: 1.88-4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06-1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91-0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12-0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45-2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15-5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02-1.11)]. CONCLUSION: These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

Derrames pleurales eosinofílicos: incidencia, etiología y significado pronóstico / Eosinophilic Pleural Effusion: Incidence, Etiology and Prognostic Significance

Introducción: Los derrames pleurales eosinofílicos (DPE) se asociaban a un menor riesgo de malignidad con una potencial relación causal con la presencia de aire y/o sangre en el espacio pleural. Sin embargo, ambas teorías han quedado en entredicho tras las últimas publicaciones. Objetivos: Conocer la incidencia y etiología de los DPE y comprobar si en toracocentesis sucesivas aumentan los eosinófilos en el líquido pleural (LP). Material y métodos: Analizamos 730 muestras de LP correspondientes a 605 pacientes ingresados entre enero-2004 y diciembre-2010. Resultados: Identificamos 55 muestras con un DPE correspondientes a 50 pacientes (8,3%). Las etiologías más frecuentes de DPE fueron: desconocida (36%) y neoplasia (30%). No hubo diferencias significativas en la incidencia de neoplasias entre los derrames pleurales no eosinofílicos (DPNE) (25,9%) y los DPE (30%) (p=0,533). A 100 pacientes (16,5%) se les repitió la toracocentesis. De los 9 con un DPE en la primera, 6 lo mantenían en la segunda. De los 91 con un DPNE en la primera toracocentesis, 8 (8,8%) tuvieron un DPE en las sucesivas. El porcentaje de eosinófilos no aumentó en las toracocentesis sucesivas (p=0,427). En los DPE se encontró correlación significativa entre los números de hematíes y de eosinófilos en LP (r=0,563; p=0,000). Conclusiones: Un DPE no puede considerarse un indicador de benignidad por lo que debe ser estudiado como cualquier derrame pleural. La repetición de toracocentesis no parece que aumente el número de eosinófilos y, por último, la presencia de sangre en el LP podría justificar la existencia de un DPE(AU)

Introduction: Eosinophilic pleural effusion (EPE) has been associated with less risk for malignancy with a potential causal relationship with the presence of air and/or blood in the pleural space. However, these theories have fallen by the wayside in the light of recent publications. Objectives: To determine the incidence and etiology of EPE and to observe whether the eosinophils in the pleural liquid (PL) increase in successive thoracocenteses. Patients and Methods: We analyzed 730 PL samples from 605 patients hospitalized between January 2004 and December 2010. Results: We identified 55 samples with EPE from 50 patients (8.3%). The most frequent etiologies of EPE were: unknown (36%) and neoplasm (30%). There were no significant differences in the incidence of neoplasms between the non-eosinophilic pleural effusions (non-EPE) (25.9%) and the EPE (30%) (p=0.533). One hundred patients (16.5%) underwent a second thoracocentesis. Out of the 9 who had EPE in the first, 6 maintained EPE in the second. Out of the 91 with non-EPE in the first thoracocentesis, 8 (8.8%) had EPE in the repeat thoracocentesis. The percentage of eosinophils did not increase in the successive thoracocenteses (p=0.427). In the EPE, a significant correlation was found between the number of hematites and eosinophils in the PL (r=0.563; p=0.000) .Conclusions: An EPE cannot be considered an indicator of benignancy, therefore it should be studied as any other pleural effusion. The number of eosinophils does not seem to increase with the of repetition of thoracocentesis and, lastly, the presence of blood in the PL could explain the existence of EPE(AU)

Eosinophilic pleural effusion: incidence, etiology and prognostic significance.

INTRODUCTION: Eosinophilic pleural effusion (EPE) has been associated with less risk for malignancy with a potential causal relationship with the presence of air and/or blood in the pleural space. However, these theories have fallen by the wayside in the light of recent publications. OBJECTIVES: To determine the incidence and etiology of EPE and to observe whether the eosinophils in the pleural liquid (PL) increase in successive thoracocenteses. PATIENTS AND METHODS: We analyzed 730 PL samples from 605 patients hospitalized between January 2004 and December 2010. RESULTS: We identified 55 samples with EPE from 50 patients (8.3%). The most frequent etiologies of EPE were: unknown (36%) and neoplasm (30%). There were no significant differences in the incidence of neoplasms between the non-eosinophilic pleural effusions (non-EPE) (25.9%) and the EPE (30%) (p=0.533). One hundred patients (16.5%) underwent a second thoracocentesis. Out of the 9 who had EPE in the first, 6 maintained EPE in the second. Out of the 91 with non-EPE in the first thoracocentesis, 8 (8.8%) had EPE in the repeat thoracocentesis. The percentage of eosinophils did not increase in the successive thoracocenteses (p=0.427). In the EPE, a significant correlation was found between the number of hematites and eosinophils in the PL (r=0.563; p=0.000). CONCLUSIONS: An EPE cannot be considered an indicator of benignancy, therefore it should be studied as any other pleural effusion. The number of eosinophils does not seem to increase with the of repetition of thoracocentesis and, lastly, the presence of blood in the PL could explain the existence of EPE.

Valor diagnóstico de los niveles del N-terminal pro-póptido natriurótico cerebral en los derrames pleurales de origen cardiaco / Diagnostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Pleural Effusions of Cardiac Origin

Introducción: El diagnóstico del derrame pleural (DP) cardiogénico plantea dificultades con frecuencia.El objetivo de nuestro estudio fue evaluar la utilidad diagnóstica en el DP en pacientes con insuficienciacardíaca, de los niveles del fragmento N terminal del pro-póptido natriurítico cerebral (NT-proBNP),tanto en líquido pleural (LP) como en sangre (S), y compararlo con los criterios de Light, el colesterol en líquido pleural (COL LP) y en suero (COL S).Pacientes y método: Todos los biomarcadores fueron evaluados en 398 DP (26,9% trasudados). El ¨¢rea bajola curva (ABC) cuantificó la precisión diagnóstica global; y mediante curvas ROC se evaluó la precisión diagnóstica de los diversos parámetros. Resultados: El ABC ROC para el NT-proBNP pleural fue 0,894, sin diferencias significativas con el COL LP(0,914) ni con los criterios de Light (0,896). La sensibilidad, especificidad, razón de probabilidad positiva(RPP) y razón de probabilidad negativa (RPN) fueron 85,1% (94,1% para COL LP), 79,9% (90,2% para loscriterios de Light), 4,24 (7,27 para los criterios de Light) y 0,19 (0,07 para COL LP), respectivamente. La combinación del NT-proBNP en LP ¡Ý 276 pg/ml y COL LP ¡Ü 57 mg/dL consiguieron clasificar el mayorn¨²mero de DP correctamente (sensibilidad 97,8%, especificidad 85,4%). Conclusiones: El rendimiento diagnóstico del NT-proBNP en DP cardiogónicos no es superior al COL LP nia los criterios de Light, aunque pudiera ser diagnóstico en trasudados de otro origen (AU)

Introduction: The diagnosis of cardiogenic pleural effusion (PE) is often difficult to make. The objectiveof our study was to evaluate the diagnostic usefulness of N-terminal pro-brain natriuretic peptide (NTproBNP)levels in PE patients with heart failure, in pleural fluid (PF) and blood (B), and to compare thecholesterol in pleural fluid (CHOL PF) and in serum (CHOL S) with the Light criteria.Patients and methods: All the biomarkers were evaluated in 398 PF (26.9% transudates). The area underthe curve (AUC) quantified the overall diagnostic precision. The diagnostic precision of the different parameters was also assessed using the ROC curves.Results: The AUC of the ROC for pleural fluid NT-proBNP was 0.894, with no significant differences withCHOL LP (0.914) or with the Light criteria (0.896). The sensitivity, specificity, the positive probabilityratio (PPR) and negative probability ratio (NPR) were 85.1% (94.1% for CHOL LP), 79.9% (90.2% for the Lightcriteria), 4.24 (7.27 for the Light criteria) and 0.19 (0.07 for CHOL LP), respectively. The combination of NTproBNPin PF ¡Ý 276 pg/ml and CHOL LP ¡Ü 57 mg/dL managed to classify the highest number PE correctly(sensitivity 97.8%, specificity 85.4%). Conclusions. The diagnostic yield of NT-proBNP in cardiogenic PE isnot superior to the CHOL LP or the Light criteria, although it could be diagnostic in transudates of anotherorigin(AU)

Diagnostic value of N-terminal pro-brain natriuretic peptide in pleural effusions of cardiac origin.

INTRODUCTION: The diagnosis of cardiogenic pleural effusion (PE) is often difficult to make. The objective of our study was to evaluate the diagnostic usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in PE patients with heart failure, in pleural fluid (PF) and blood (B), and to compare the cholesterol in pleural fluid (CHOL PF) and in serum (CHOL S) with the Light criteria. PATIENTS AND METHODS: All the biomarkers were evaluated in 398 PF (26.9% transudates). The area under the curve (AUC) quantified the overall diagnostic precision. The diagnostic precision of the different parameters was also assessed using the ROC curves. RESULTS: The AUC of the ROC for pleural fluid NT-proBNP was 0.894, with no significant differences with CHOL PF (0.914) or with the Light criteria (0.896). The sensitivity, specificity, the positive probability ratio (PPR) and negative probability ratio (NPR) were 85.1% (94.1% for CHOL PF), 79.9% (90.2% for the Light criteria), 4.24 (7.27 for the Light criteria) and 0.19 (0.07 for CHOL PF), respectively. The combination of NT-proBNP in PF ≥ 276 pg/ml and CHOL PF ≤ 57 mg/dL managed to classify the highest number PE correctly (sensitivity 97.8%, specificity 85.4%). CONCLUSIONS: The diagnostic yield of NT-proBNP in cardiogenic PE is not superior to the CHOL LP or the Light criteria, although it could be diagnostic in transudates of another origin.