[Living in nursing homes. Prognostic factor of mortality in respiratory infections?] / Vivir en residencias de ancianos ¿Factor pronóstico de mortalidad en infecciones respiratorias?

Respiratory infection is one of the most frequent diagnoses associated with high mortality. Living in a nursing home could be a predictive risk factor for mortality. The objective was to study the characteristics of patients with respiratory infection according to whether they came from their home or nursing homes, and to analyze whether their origin is a risk factor for mortality. It was a prospective cohort study, that included 208 patients with respiratory infection admitted to the Internal Medicine Service, that participated in the study. Clinical, analytical, epidemiological, prognostic and therapeutic variables were collected and a multivariate analysis was performed. Patients had an average age of 83 years and 64.9% came from their home. 44.7% had heart failure as a clinical history. Most of patients met criteria of pluripatology, polypharmacy and were moderately dependent according to Barthel's index. Mortality at admission was 16 patients (7.7%), and during the six-month follow-up of 37 patients (17.8%). Those coming from nursing homes had a higher mortality rate, 37%, than those who lived in their own home, 19.3% (p = 0.005). In the multivariate analysis, the prognostic factors for mortality were a higher level of urea at admission (OR = 2.33, IC 95% = 1.06-5.11) and the non-prescription of oxygen at discharge (OR = 2.96, IC 95% = 1.29-6.82). In conclusion, a higher percentage of mortality is observed in patients coming from nursing homes, however further research is needed to clarify whether living in a residence for elderly can be considered an independent risk factor for mortality.

La infección respiratoria es uno de los diagnósticos más frecuentes en el ámbito sanitario asociado a una elevada mortalidad. Residir en una residencia de ancianos podría ser un factor de riesgo predictivo de mortalidad. El objetivo fue estudiar las características de los pacientes con infección respiratoria según procedieran de su domicilio o de residencias de ancianos, y analizar si la procedencia es un factor de riesgo de mortalidad. Se trata de un estudio de cohortes prospectivo. Participaron 208 pacientes con infección respiratoria ingresados en un Servicio de Medicina Interna. Se recogieron variables clínicas, analíticas, epidemiológicas, pronosticas y terapéuticas realizándose un análisis multivariado. Los pacientes tuvieron una edad media 83 años y 135 (64.9%) procedían de su domicilio. El 44.7% presentaban insuficiencia cardiaca como antecedente clínico. La mayoría cumplían criterios de pluripatología, polifarmacia y tenían una dependencia moderada según índice de Barthel. La mortalidad durante el internamiento hospitalario fue de 16 pacientes (7.7%), y durante el seguimiento a seis meses de 37 (17.8%). Los procedentes de residencias de ancianos presentaron una mayor mortalidad, un 37%, que los que vivían en su propio domicilio, un 19,3% (p = 0.005). En el análisis multivariado los factores pronósticos de mortalidad fueron un mayor nivel de urea al ingreso (OR = 2.33, IC 95% = 1.06-5.11) y la no prescripción de oxígeno al alta (OR = 2.96, IC 95% = 1.29-6.82). En conclusión, se observó un mayor porcentaje de mortalidad en los pacientes procedentes de residencias de ancianos, sin embargo, es necesario realizar más investigaciones para clarificar si el residir en un centro geriátrico puede ser considerado un factor de riesgo independiente de mortalidad.

Vivir en residencias de ancianos ¿Factor pronóstico de mortalidad en infecciones respiratorias? / Living in nursing homes. Prognostic factor of mortality in respiratory infections?

Resumen La infección respiratoria es uno de los diagnósticos más frecuentes en el ámbito sanitario asociado a una elevada mortalidad. Residir en una residencia de ancianos podría ser un factor de riesgo predictivo de mortalidad. El objetivo fue estudiar las características de los pacientes con infección respiratoria según procedieran de su domicilio o de residencias de ancianos, y analizar si la procedencia es un factor de riesgo de mortalidad. Se trata de un estudio de cohortes prospectivo. Participaron 208 pacientes con infección respiratoria ingresados en un Servicio de Medicina Interna. Se recogieron variables clínicas, analíticas, epidemio lógicas, pronosticas y terapéuticas realizándose un análisis multivariado. Los pacientes tuvieron una edad media 83 años y 135 (64.9%) procedían de su domicilio. El 44.7% presentaban insuficiencia cardiaca como antecedente clínico. La mayoría cumplían criterios de pluripatología, polifarmacia y tenían una dependencia moderada según índice de Barthel. La mortalidad durante el internamiento hospitalario fue de 16 pacientes (7.7%), y durante el seguimiento a seis meses de 37 (17.8%). Los procedentes de residencias de ancianos presentaron una mayor mortalidad, un 37%, que los que vivían en su propio domicilio, un 19,3% (p = 0.005). En el análisis multivariado los factores pronósticos de mortalidad fueron un mayor nivel de urea al ingreso (OR = 2.33, IC 95% = 1.06-5.11) y la no prescripción de oxígeno al alta (OR = 2.96, IC 95% = 1.29-6.82). En conclusión, se observó un mayor porcentaje de mortalidad en los pacientes procedentes de residencias de ancianos, sin embargo, es necesario realizar más investigaciones para clarificar si el residir en un centro geriátrico puede ser considerado un factor de riesgo independiente de mortalidad.

Abstract Respiratory infection is one of the most frequent diagnoses associated with high mortality. Living in a nursing home could be a predictive risk factor for mortality. The objective was to study the characteristics of patients with respi ratory infection according to whether they came from their home or nursing homes, and to analyze whether their origin is a risk factor for mortality. It was a prospective cohort study, that included 208 patients with respiratory infection admitted to the Internal Medicine Service, that participated in the study. Clinical, analytical, epidemiologi cal, prognostic and therapeutic variables were collected and a multivariate analysis was performed. Patients had an average age of 83 years and 64.9% came from their home. 44.7% had heart failure as a clinical history. Most of patients met criteria of pluripatology, polypharmacy and were moderately dependent according to Barthel's index. Mortality at admission was 16 patients (7.7%), and during the six-month follow-up of 37 patients (17.8%). Those coming from nursing homes had a higher mortality rate, 37%, than those who lived in their own home, 19.3% (p = 0.005). In the multivariate analysis, the prognostic factors for mortality were a higher level of urea at admission (OR = 2.33, IC 95% = 1.06-5.11) and the non-prescription of oxygen at discharge (OR = 2.96, IC 95% = 1.29-6.82). In conclusion, a higher percentage of mortality is observed in patients coming from nursing homes, however further research is needed to clarify whether living in a residence for elderly can be considered an independent risk factor for mortality.

Mortalidad hospitalaria de las infecciones respiratorias comunitarias y asociadas a cuidados socio-sanitarios: una revisión sistemática / Hospital mortality of community respiratory infections and associated with long-term care facilities: a systematic review

Resumen Introducción: Las infecciones respiratorias son causa de preocupación socio-sanitaria por su elevada mortalidad y el coste económico que conllevan. El número de pacientes procedentes de centros socio-sanitarios con infecciones respiratorias que requieren ingreso hospitalario está aumentando en las últimas décadas. Las particularidades de estos pacientes pueden influir en la evolución de estas infecciones. Objetivo: Analizar si existen diferencias entre las infecciones respiratorias de origen comunitario y las asociadas a cuidados sanitarios respecto a la mortalidad. Material y Métodos: Se realizó una revisión sistemática en tres bases de datos: Medline, Web of Science y Scopus. Se incluyeron estudios empíricos, publicados entre 2000 y 2016. Resultados: La procedencia de los enfermos, la edad y la malnutrición fueron los factores que se asociaron con peor pronóstico, junto con la presencia de co-morbilidad cardiaca o neurológica. La mortalidad fue más elevada en los pacientes procedentes de centros socio-sanitarios respecto a aquellos que procedían de su domicilio. Conclusión: Los profesionales de la salud deberían tener en cuenta la procedencia de los enfermos para dar un cuidado personalizado acorde a las particularidades de estos enfermos.

Background: Respiratory infections are a cause of socio-health concern due to their high mortality and the economic cost. The number of patients from social care centers with respiratory infections requiring hospital admission is increasing in recent decades. The particularities of these patients could influence the evolution of these infections. Aim: To analyze if there are differences respect to mortality between respiratory infections of community origin and those associated with social care centers. Methods: A systematic review was carried out in three databases: Medline, Web of Science and Scopus. Empirical studies, published between 2000 and 2016, were included. Results: The origin of the patients, age and malnutrition were the factors associated with worse prognosis, together with the presence of cardiac or neurological comorbidity. Mortality was higher in patients from social care centers compared to those who came from their home. Conclusion: Health professionals should take into account the origin of the patients in order to give a more personalized care according to the particularities of these patients.

External validation of the PALIAR index for patients with advanced, nononcologic chronic diseases.

OBJECTIVE: To externally validate the PALIAR index for patients with advanced, nononcologic chronic diseases. METHODS: We performed a prospective, multicenter cohort study that included patients with advanced, nononcologic chronic diseases hospitalized in internal medicine departments and treated consecutively by the researchers between July 1st and December 31st, 2014. Data were collected from each patient on age, sex, advanced disease, Charlson index, comorbidities, Barthel index, terminal illness symptoms, need for caregiver, hospitalization in the past 3 and 12 months and number of drugs. We calculated the PALIAR index and conducted a 6-month follow-up. To analyze the association between the variables and mortality, we constructed several multivariate logistic regression models. RESULTS: The study included 295 patients with a mean age of 82.7 (8.6) years, 148 (50.2%) of whom were women. Mortality at 6 months was associated with the albumin level (OR 0.52, 95% CI 0.30-0.85, p = 0.011), and the terminal illness (OR 2.75, 95% CI 1.55-4.89, p = 0.001). The PALIAR index showed good discrimination for predicting mortality (statistical C, 0.728, 95% CI 0.670-0.787). A reduced version of the PALIAR index showed similar mortality discriminatory power. CONCLUSIONS: The PALIAR index is a reliable tool for predicting mortality in patients with advanced, nononcologic chronic diseases.

[Hospital mortality of community respiratory infections and associated with long-term care facilities: a systematic review]. / Mortalidad hospitalaria de las infecciones respiratorias comunitarias y asociadas a cuidados socio-sanitarios: una revisión sistemática.

BACKGROUND: Respiratory infections are a cause of socio-health concern due to their high mortality and the economic cost. The number of patients from social care centers with respiratory infections requiring hospital admission is increasing in recent decades. The particularities of these patients could influence the evolution of these infections. AIM: To analyze if there are differences respect to mortality between respiratory infections of community origin and those associated with social care centers. METHODS: A systematic review was carried out in three databases: Medline, Web of Science and Scopus. Empirical studies, published between 2000 and 2016, were included. RESULTS: The origin of the patients, age and malnutrition were the factors associated with worse prognosis, together with the presence of cardiac or neurological comorbidity. Mortality was higher in patients from social care centers compared to those who came from their home. CONCLUSION: Health professionals should take into account the origin of the patients in order to give a more personalized care according to the particularities of these patients.

Osteítis infecciosa del pubis. A propósito de un caso / Infectious osteitis pubis. A propos of a case

Se presenta un caso de osteitis del pubis por Staphylococcus aureus, en un varón de 30 años y tratado exitosamente con linezolid y levofloxacina.

We describe a case o infectious osteitis pubis in one male patient of 30 years. The patient had favorable clinical course after treament with linezolid and levofloxacin.

External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

Influence of gender on prognosis of acute coronary syndromes.

INTRODUCTION: Ischemic heart disease presents different features in men and women. We analyzed the relation between gender and prognosis in patients who had suffered a high-risk acute coronary syndrome (ACS). METHODS: This was a prospective analytical cohort study performed at Lozano Blesa University Hospital, Zaragoza, Spain, of 559 patients diagnosed with high-risk ACS with and without ST-segment elevation according to the American College of Cardiology/American Heart Association guidelines. The sample was divided into two groups by gender and differences in epidemiologic, laboratory, electrocardiographic and echocardiographic variables and treatment were recorded. A Cox's proportional hazard model was applied and 6-month mortality was analyzed as the main variable. RESULTS: The median age was 65.2±12.7 years, and 21.8% were women. Baseline characteristics in women were more unfavorable, with higher GRACE scores, older age, higher prevalence of hypertension, diabetes and heart failure, lower ejection fraction and more renal dysfunction at admission. Women suffered more adverse cardiovascular events (27.9% vs. 15.8%, p=0.002). Sixty-four patients died, 18.9% of the women vs. 9.4% of the men (p=0.004). After multivariate analysis, female gender did not present an independent relation with mortality. Hemoglobin level, renal function, ejection fraction and Killip class >1 presented significant differences. CONCLUSIONS: Acute syndrome coronary in women has a worse prognosis than in men. Their adverse course is due to their baseline characteristics and not to their gender.

Capacidad diagnóstica de las ecuaciones Chronic Kidney Disease Epidemiology Collaboration y Modification of Diet in Renal Disease-4 en la estimación del filtrado glomerular en pacientes pluripatológicos / Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients

Fundamento y objetivo: La fórmula Modification of Diet in Renal Disease (MDRD) es la recomendada por la mayoría de las sociedades científicas para el cálculo del filtrado glomerular estimado (FGe). Recientemente el grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ha publicado una nueva ecuación con mayor exactitud y precisión. Hemos analizado su comportamiento en un grupo de pacientes pluripatológicos (PP) comparándola con la versión clásica MDRD-4. Pacientes y método: Estudio multicéntrico, observacional, descriptivo y transversal. Se calculó el FGe por MDRD-4 y CKD-EPI en 425 PP. A cada uno se le asignó un estadio según su FGe: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; y 5: < 15 ml/min/1,73m2. Se analizó la concordancia entre ambas y la reclasificación de pacientes por CKD-EPI. Resultados: La edad media (DE) fue de 81,7 (7,9) años. El 55,3% eran mujeres. La media del FGe fue de 58,6 (26,3) ml/min/1,73m2 según MDRD-4 y de 52,7 (23,0) ml/min/1,73m2 según CKD-EPI (p < 0,001; coeficientes de correlación Rho de Spearman y de concordancia de Lin: 0,993 y 0,948, respectivamente). Los gráficos de Bland-Altman reflejaban valores inferiores de FGe para la ecuación CKD-EPI. En el estadio 2, el 21,2% eran reasignados por CKD-EPI al estadio 3, siendo las mujeres mayores de 83 años el subgrupo más desfavorecido, con el 27,3% de reclasificación. Conclusiones: La CKD-EPI aplicada al cálculo del FGe en PP empeora los resultados de la estimación mediante MDRD-4. Origina, de forma general, valores de FGe inferiores e incrementa el grado de insuficiencia renal, en especial en mujeres más añosas (AU)

Background and objective: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version Patients and method: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m2. We analyzed the correlation between both and the patients reclassified by CKD-EPI. Results: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m2 by MDRD-4 and 52.7 (23.0) ml/min/1.73m2 by CKD-EPI (P < .001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. Conclusion: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women (AU)

[Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients]. / Capacidad diagnóstica de las ecuaciones Chronic Kidney Disease Epidemiology Collaboration y Modification of Diet in Renal Disease-4 en la estimación del filtrado glomerular en pacientes pluripatológicos.

BACKGROUND AND OBJECTIVE: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version PATIENTS AND METHOD: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1:>90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m(2). We analyzed the correlation between both and the patients reclassified by CKD-EPI. RESULTS: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m(2) by MDRD-4 and 52.7 (23.0) ml/min/1.73m(2) by CKD-EPI (P<.001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. CONCLUSION: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women.

Síndrome RS3PE como primera manifestación de un carcinoma de vejiga / No disponible

No disponible

Pronóstico del síndrome cardiorrenal en pacientes con síndrome coronario agudo / Prognosis of cardiorenal syndrome in patients with acute coronary syndrome

Fundamento y objetivo: El síndrome cardiorrenal (SCR) incluye numerosas patologías que afectan al corazón y al riñón. El objetivo del estudio es conocer las características y el pronóstico del SCR en pacientes con un síndrome coronario agudo (SCA). Pacientes y método: Estudio prospectivo de 87 pacientes con SCA con y sin elevación del segmento ST de alto riesgo e insuficiencia cardíaca. Analizamos la presencia de SCR y su relación con variables epidemiológicas, clínicas, analíticas y de exploración complementaria. Mediante regresión de Cox investigamos su relación con la mortalidad en los siguientes 6 meses al evento. Resultados: Los pacientes que presentaban SCR (43,7%) eran con mayor frecuencia mujeres, de mayor edad, con más enfermedad cardiovascular previa y un perfil de riesgo mayor. El pronóstico era significativamente peor en este grupo y el SCR se comportó como predictor independiente de mortalidad (hazard ratio 3,08; intervalo de confianza del 95% 1,13-8,40; p=0,029). Conclusiones: La presencia de SCR influye en el pronóstico de los pacientes que sufren un SCA de alto riesgo y aumenta la probabilidad de fallecer en los siguientes 6 meses al evento (AU)

Background and objective: The cardiorenal syndrome (CRS) includes numerous pathologies affecting the heart and kidney. The objective of this study is to know the characteristics and prognosis of the CRS in patients with acute coronary syndrome (ACS). Patients and method: A prospective study of 87 patients with ACS with and without ST-segment elevation at high risk and heart failure. We analysed the presence of CRS and its relationship with epidemiological variables, clinical, analytical and complementary explorations. Through a Cox regression model we investigated its relationship with mortality in the subsequent 6 months of the event. Results: Patients with CRS (43.7%) were more frequently women, older, with more prior cardiovascular disease and a profile of higher risk. The prognosis was significantly worse in this group and the CRS was an independent predictor of mortality (hazard ratio 3.08; 95% confidence interval 1.13-8,40; P=.029). Conclusions: The presence of CRS has an influence in the prognosis of patients who suffer an ACS high-risk and increases the likelihood of dying during 6 months after the event (AU)

Subacute combined spinal cord degeneration and pancytopenia secondary to severe vitamin B12 deficiency.

CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.

[Prognosis of cardiorenal syndrome in patients with acute coronary syndrome]. / Pronóstico del síndrome cardiorrenal en pacientes con síndrome coronario agudo.

BACKGROUND AND OBJECTIVE: The cardiorenal syndrome (CRS) includes numerous pathologies affecting the heart and kidney. The objective of this study is to know the characteristics and prognosis of the CRS in patients with acute coronary syndrome (ACS). PATIENTS AND METHOD: A prospective study of 87 patients with ACS with and without ST-segment elevation at high risk and heart failure. We analysed the presence of CRS and its relationship with epidemiological variables, clinical, analytical and complementary explorations. Through a Cox regression model we investigated its relationship with mortality in the subsequent 6 months of the event. RESULTS: Patients with CRS (43.7%) were more frequently women, older, with more prior cardiovascular disease and a profile of higher risk. The prognosis was significantly worse in this group and the CRS was an independent predictor of mortality (hazard ratio 3.08; 95% confidence interval 1.13-8,40; P=.029). CONCLUSIONS: The presence of CRS has an influence in the prognosis of patients who suffer an ACS high-risk and increases the likelihood of dying during 6 months after the event.

La paradoja del tabaquismo: fumar o no fumar / Smoking paradox: smoking or not smoking

No disponible

Subacute combined spinal cord degeneration and pancytopenia secondary to severe vitamin B12 deficiency / Degenarión combinada subaguda medular y pancitopenia secundaria a déficit severo de vitamina B12

CONTEXT: Decreased vitamin B12 concentration does not usually result in clinical or hematological abnormalities. Subacute combined spinal cord degeneration and pancytopenia are two serious and rarely displayed consequences that appear in severe deficits. CASE REPORT: We present the case of a patient with subacute combined spinal cord degeneration and pancytopenia secondary to severe and sustained vitamin B12 deficiency. Such cases are rare nowadays and have potentially fatal consequences. CONCLUSIONS: Vitamin B12 deficiency should be taken into consideration in the differential diagnosis in cases of blood disorders or severe neurological symptoms. Early diagnosis and treatment can avoid irreversible consequences.

CONTEXTO: El descenso de la concentración de vitamina B12 no suele derivar en alteraciones clínicas o hematológicas. La degeneración combinada subaguda medular y la pancitopenia son dos consecuencias graves y poco frecuentes que aparecen en los déficit severos. CASO CLÍNICO: Presentamos el caso de un paciente con una degeneración combinada subaguda medular y pancitopenia secundarios a un déficit severo y mantenido de vitamina B12. Un caso poco común en nuestros días y con consecuencias potencialmente fatales. CONCLUSIONES: Debemos considerar el déficit de vitamina B12 dentro del diagnóstico diferencial en caso de alteraciones hematológicas o síntomas neurológicos graves. Su diagnóstico y tratamento precoz pueden evitar secuelas irreversibles.