Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain.

The risk factors for complications in patients with influenza A (H1N1)v virus infection have not been fully elucidated. We performed an observational analysis of a prospective cohort of hospitalized adults with confirmed pandemic influenza A (H1N1)v virus infection at 13 hospitals in Spain, between June 12 and November 10, 2009, to identify factors associated with severe disease. Severe disease was defined as the composite outcome of intensive-care unit (ICU) admission or in-hospital mortality. During the study period, 585 adult patients (median age 40 years) required hospitalization because of pandemic (H1N1) 2009. At least one comorbid condition was present in 318 (54.4%) patients. Pneumonia was diagnosed in 234 (43.2%) patients and bacterial co-infection in 45 (7.6%). Severe disease occurred in 75 (12.8%) patients, of whom 71 required ICU admission and 13 (2.2%) died. Independent factors for severe disease were age <50 years (OR, 2.39; 95% CI, 1.05-5.47), chronic comorbid conditions (OR, 2.93; 95% CI, 1.41-6.09), morbid obesity (OR, 6.7; 95% CI, 2.25-20.19), concomitant and secondary bacterial co-infection (OR, 2.78; 95% CI, 1.11-7) and early oseltamivir therapy (OR, 0.32; 95% CI 0.16-0.63). In conclusion, although adults hospitalized for pandemic (H1N1) 2009 suffer from significant morbidity, mortality is lower than that reported in the earliest studies. Younger age, chronic comorbid conditions, morbid obesity and bacterial co-infection are independent risk factors for severe disease, whereas early oseltamivir therapy is a protective factor.

Inmigración y diabetes mellitus: características de la descompensación diabética aguda / Immigration and diabetes mellitus: characteristics of the acute diabetic decompensation

Objetivo: Estudiar las diferencias de las características clínicas, bioquímicas yepidemiológicas entre inmigrantes no europeos (I-NE) y españoles ingresadospor descompensación hiperglucémica aguda en un servicio de endocrinologíay nutrición. Material y métodos: Analizar prospectivamente 98 pacientesingresados consecutivamente durante 30 meses con el diagnóstico de descompensaciónhiperglucémica aguda. Los pacientes fueron divididos en dosgrupos según el origen étnico, comparando las características epidemiológicas,clínicas y terapéuticas. Resultados: Los I-NE representaron el 42,9% deltotal, presentando diabetes tipo 2 (DM2) en más de la mitad de los casos, asícomo una mayor incidencia de debut diabético. Los españoles presentaronhiperglucemias y acidosis más severas. Los anticuerpos anticélulas insulares(ICA) fueron más frecuentes entre los I-NE con debut de diabetes tipo 1(DM1). Previo al ingreso, los I-NE usaban insulina no prandial y no seguíantratamiento para los factores de riesgo cardiovascular. Conclusiones: LosI-NE representan un alto porcentaje de ingresos hospitalarios por descompensacióndiabética, con mejor perfil metabólico, siendo la DM2 el diagnósticomás frecuente. El perfil inmunológico en la DM1 podría variar según la etnia.Las diferencias socioculturales que ello implica podrían condicionar la terapiainsulínica y de prevención de comorbilidades(AU)

Background: We aimed to study whether significant differences exist betweennon European immigrants (NE-I) and native Spaniards (N-S) in clinical,biochemical and epidemiological characteristics when admitted for acute hyperglycaemiccrisis at the Endocrinology and Nutrition Department. Methods:A prospective analysis of 98 adults consecutively admitted for acute hyperglycaemiccrisis during 30 months was performed. Patients were divided intogroups according ethnicity. Epidemiological, clinical and therapeutic data werecompared between both groups. Results: Immigrants represented 42.9% ofcases. More than half of the cases NE-I were diagnosed with type 2 diabetes(T2DM). Rate of new onset diabetes was higher among NE-I. N-S had moresevere hyperglycaemia and acidosis. Positive ICA were more frequent in NE-Iwith type 1 diabetes (T1DM). Before admission, no prandial insulin was beingused for NE-I either T1DM or T2DM. Conclusions: NE-I represent a high percentageof admission due to hyperglycaemic crisis, with a better metabolicprofile. Among this group, T2DM is more frequent than T1DM. The immunologicalprofile (ICA) of patients with T1DM could differ according ethnicity andthe medical management of diabetes, and prevention of comorbidities couldbe influenced by socio-cultural differences(AU)