Bacterial infections in patients hospitalized with COVID-19.

Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.

Severe Lymphopenia as a Predictor of COVID-19 Mortality in Immunosuppressed Patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has a high mortality in certain group of patients. We analysed the impact of baseline immunosuppression in COVID-19 mortality and the role of severe lymphopenia in immunocompromised subjects. METHODS: We analysed all patients admitted with COVID-19 in a tertiary hospital in Madrid between March 1st and April 30th 2020. Epidemiological and clinical data, including severe lymphopenia (<500 lymphocytes/mm3) during admission, were analysed and compared based on their baseline immunosuppression condition. RESULTS: A total of 1594 patients with COVID-19 pneumonia were hospitalised during the study period. 166 (10.4%) were immunosuppressed. Immunocompromised patients were younger (64 vs. 67 years, p = 0.02) but presented higher rates of hypertension, diabetes, heart, neurological, lung, kidney and liver disease (p < 0.05). They showed more severe lymphopenia (53% vs 24.1%, p < 0.001), lower SapO2/FiO2 ratios (251 vs 276, p = 0.02) during admission and higher mortality rates (27.1% vs 13.5%, p < 0.001). After adjustment, immunosuppression remained as an independent factor related to mortality (Odds Ratio (OR): 2.24, p < 0.001). In the immunosuppressed group, age (OR = 1.06, p = 0.01), acute respiratory distress syndrome (ARDS) (OR = 12.27, p = 0.017) and severe lymphopenia (OR = 3.48, p = 0.04) were the factors related to high mortality rate. CONCLUSION: Immunosuppression is an independent mortality risk factor in COVID-19. Severe lymphopenia should be promptly identified in these patients.

Incidence of first cardiovascular event in Spanish patients with inflammatory rheumatic diseases: prospective data from the CARMA project.

OBJECTIVES: To determine the incidence and risk factors of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD). METHODS: Analysis of data after 2.5 years of follow-up from the prospective study CARMA project, that includes patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and matched individuals without CIRD from 67 hospitals in Spain. CVE cumulative incidence per 1000 patients was calculated after 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate hazard ratio (HR) and 95% confidence interval (95% CI) of the risk factors. RESULTS: 2595 (89.1%) patients completed the 2.5 years of follow-up visit. Cumulative incidence of CVE in patients with CIRD was 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in the subgroup with AS; 22.03 (95% CI: 11.01-33.04). Patients with AS (HR: 4.11; 95% CI: 1.07-15.79), those with older age (HR: 1.09; 95% CI: 1.05-1.13), systolic hypertension (HR: 1.02; 95% CI: 1.00-1.04) and long duration of the disease (HR: 1.07; 95% CI: 1.03-1.12) were at higher risk of first CVE during the 2.5 years of follow-up. In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00). CONCLUSIONS: Among CIRD patients prospectively followed-up at rheumatology outpatient clinics, those with AS show higher risk of first CVE. Besides cardiovascular risk factors, such as hypertension, being a man and older as well as having a long disease duration increase the risk of CVE in patients with CIRD.

Estudio transversal del efecto de la catastrofización y ansiedad ante el dolor sobre la capacidad funcional y el consumo de fármacos en pacientes con fibromialgia / Cross-sectional study about the effect of catastrophizing and anxiety to pain on functional capacity and consumption of drugs of fibromyalgia patients

(au)Introducción: La fibromialgia es una enfermedad crónica, caracterizada por dolor musculoesqueléticoasociado a otros síntomas. Se desconoce su etiología, el diagnóstico es clínico ylos tratamientos sintomáticos. El cómo afrontan los pacientes este dolor y su diagnósticoparece influir sobre su evolución y tratamiento.Objetivo: Evaluar el efecto de la catastrofización y ansiedad ante el dolor, sobre la capacidadfuncional y el consumo de fármacos de los pacientes con fibromialgia.Materiales y métodos: Estudio transversal de 50 pacientes con fibromialgia, citados en reumatologíadesde el 1 de enero hasta el 31 de marzo de 2014 y voluntarios de la Asociaciónde Enfermos de Fibromialgia de Asturias. Se registraron variables clínico-epidemiológicas,Cuestionario de Impacto de la Fibromialgia abreviado (CIF), Escala de Catastrofización Anteel Dolor (PCS-SP) y Escala de Síntomas de Ansiedad Ante el Dolor (PASS-20).Resultados: La correlación de Spearman entre PCS-SP y PASS-20 fue de 0,67 (p < 0,001), entreCIF y PASS-20 de 0,27 (p = 0,05) y entre CIF y PCS-SP de 0,03, sin significación estadística.La correlación con el consumo de fármacos fue: con PASS-20 0,41 (p = 0,003), con PCS-SP0,49 (p < 0,001) y con CIF 0,32 (p = 0,024). El coeficiente de correlación desde el inicio de lossíntomas fue: −0,21 (p = 0,14) con CIF, −0,16 (p = 0,26) con PCS y −0,25 (p = 0,08) con PASS-20.Conclusiones: Los niveles de ansiedad y catastrofización se encuentran fuertemente asociadosentre sí, sin embargo, ambos muestran una asociación débil con la capacidad funcional.Puntuaciones altas en las 3 escalas supusieron un aumento del consumo de fármacos. Conmayor tiempo de evolución de la fibromialgia parece disminuir el nivel de ansiedad, lacatastrofización y la repercusión funcional.