Remdesivir plus dexamethasone is associated to improvement in the clinical outcome of COVID-19 hospitalized patients regardless of their vaccination status / Remdesivir más dexametasona se asocian a una reducción de los eventos clínicos en los pacientes hospitalizados por COVID-19, independientemente de su estado de vacunación

Introduction Remdesivir seems to reduce the risk of hospitalization and improve clinical outcome in hospitalized patients with COVID-19. Objectives To compare the clinical outcome of COVID-19 hospitalized patients treated with remdesivir plus dexamethasone versus dexamethasone alone, according to their vaccination status. Material and methods A retrospective observational study was carried out in 165 patients hospitalized for COVID-19 from October 2021 to January 2022. Multivariate logistic regression, Kaplan–Meier and the log-rank tests were used to evaluate the event (need for ventilation or death). Results Patients treated with remdesivir plus dexamethasone (n=87) compared with dexamethasone alone (n=78) showed similar age (60±16, 47–70 vs. 62±37, 51–74 years) and number of comorbidities: 1 (0–2) versus 1.5 (1–3). Among 73 fully vaccinated patients, 42 (47.1%) were in remdesivir plus dexamethasone and 31 (41%) in dexamethasone alone. Patients treated with remdesivir plus dexamethasone needed intensive care less frequently (17.2% vs. 31%; p=0.002), high-flow oxygen (25.3% vs. 50.0%; p=0.002) and non-invasive mechanical ventilation (16.1% vs. 47.4%; p<0.001). Furthermore, they had less complications during hospitalization (31.0% vs. 52.6%; p=0.008), need of antibiotics (32.2% vs. 59%; p=0.001) and radiologic worsening (21.8% vs. 44.9%; p=0.005). Treatment with remdesivir plus dexamethasone (aHR, 0.26; 95% CI: 0.14–0.48; p<0.001) and vaccination (aHR 0.39; 95% CI: 0.21–0.74) were independent factors associated with lower progression to mechanical ventilation or death. Conclusions Remdesivir in combination with dexamethasone and vaccination independently and synergistically protects hospitalized COVID-19 patients requiring oxygen therapy from progression to severe disease or dead (AU)

Introducción Remdesivir parece reducir el riesgo de hospitalización y mejorar el resultado clínico en pacientes hospitalizados con COVID-19. Objetivos Comparar el desenlace clínico de pacientes hospitalizados con COVID-19 tratados con remdesivir más dexametasona vs. dexametasona sola, según su estado de vacunación. Material y métodos Se realizó un estudio observacional retrospectivo en 165 pacientes hospitalizados por COVID-19 desde octubre de 2021 hasta enero de 2022. Se consideró como evento la necesidad de ventilación o muerte. esultados Los pacientes tratados con remdesivir más dexametasona (n=87) en comparación con dexametasona sola (n=78) mostraron una edad similar (60±16, 47-70 vs. 62±37, 51-74 años) y número de comorbilidades: 1 (0-2) vs. 1,5 (1-3). Entre 73 pacientes completamente vacunados, 42 (47,1%) estaban en remdesivir más dexametasona y 31 (41%) en dexametasona sola. Los pacientes tratados con remdesivir más dexametasona necesitaron cuidados intensivos con menos frecuencia (17,2 vs. 31%; p=0,002), oxígeno de alto flujo (25,3 vs. 50%; p=0,002) y ventilación mecánica no invasiva (16,1 vs. 47,4%, p<0,001). Además, tuvieron menos complicaciones durante la hospitalización (31 vs. 52,6%; p=0,008), necesidad de antibióticos (32,2 vs. 59%; p=0,001) y empeoramiento radiológico (21,8 vs. 44,9%; p=0,005). El tratamiento con remdesivir más dexametasona (aHR, 0,26; IC 95% 0,14-0,48; p<0,001) y la vacunación (aHR 0,39; IC 95% 0,21-0,74>) fueron factores independientes asociados con una menor progresión a ventilación mecánica o muerte. Conclusiones Remdesivir en combinación con dexametasona protegieron de forma independiente y sinérgica a los pacientes hospitalizados con COVID-19 que requieren oxigenoterapia de la progresión a la enfermedad grave o la muerte (AU)

Role of vaccination and anti-SARS-CoV-2 antibodies in the clinical outcome of hospitalized COVID-19 patients.

Background: Although vaccination has considerably reduced the risk of hospitalization and death from COVID19, the impact of vaccination and anti-SARS-CoV-2 antibody status on the outcome of patients who required hospitalization has been poorly investigated. Material and methods: A prospective observational study in 232 patients hospitalized for COVID19 was carried out from October 2021 to January 2022 to evaluate the role on patient outcome of their vaccination and anti-SARS-CoV-2 antibody status and titer, comorbidities, analytical determinations, clinical presentation at admission, treatments and requirements for respiratory support. Cox regression and survival analyzes were performed. The SPSS and "R" programs were used. Results: Patients with complete vaccination schedule had higher S-protein antibody titers (log10 3.73 [2.83-4.6] UI/ml vs 1.6 [2.99-2.61] UI/ml; p < 0.001), lower probability of radiographic worsening (21.6% vs. 35.4%; p = 0.005), less likely required high doses of dexamethasone (28.4% vs. 45.4%; p = 0.012), high-flow oxygen (20.6% vs. 35.4%; p = 0.02), ventilation (13.7% vs, 33.8%; p = 0.001) and intensive care admissions (10.8% vs. 32.6%; p < 0.001). Remdesivir (HR = 0.38; p < 0.001) and complete vaccination schedule (HR = 0.34; p = 0.008) were protective factors. No differences in antibody status were detected between groups (HR = 0.58; p = 0.219). Conclusions: SARS-CoV-2 vaccination was associated with higher S-protein antibody titers and lower probability of radiological progression, immunomodulators requirement and respiratory support or death. However, vaccination but not antibody titters protected from adverse events pointing a role of immune-protective mechanisms in addition to humoral response.

Antecedentes: Aunque la vacunación ha reducido considerablemente el riesgo de hospitalización y muerte por COVID-19, se ha investigado poco el impacto de la vacunación y el estado de los anticuerpos anti-SARS-CoV-2 en la evolución de los pacientes que requieren hospitalización. Material y métodos: Se realizó un estudio observacional prospectivo en 232 pacientes hospitalizados por COVID-19 desde octubre del 2021 hasta enero del 2022 para evaluar el impacto en la evolución clínica del estado vacunal, el título de anticuerpos anti-SARS-CoV-2, la presencia de comorbilidades, analítica, la clínica al ingreso, tratamientos y soporte respiratorio. Se realizaron análisis de supervivencia y regresión de Cox. Se utilizaron los programas SPSS y «R¼. Resultados: Los pacientes con esquema de vacunación completo presentaron títulos de anticuerpos contra la proteína S más elevados (log10 3,73 [2,83-4,6] UI/mL vs. 1,6 [2,99-2,61] UI/mL; p < 0,001), menor probabilidad de empeoramiento radiográfico (21,6 vs. 35,4%; p = 0,005), requirieron con menor probabilidad dosis elevadas de dexametasona (28,4 vs. 45,4%; p = 0,012), oxígeno de alto flujo (20,6 vs. 35,4%; p = 0,02), ventilación (13,7 vs. 33,8%; p = 0,001) e ingresos en cuidados intensivos (10,8 vs. 32,6%; p < 0,001). El remdesivir (HR = 0,38; p < 0,001) y el esquema completo de vacunación (HR = 0,34; p = 0,008) fueron factores protectores de mala evolución. No se detectaron diferencias en el estado de los anticuerpos entre los grupos (HR = 0,58; p = 0,219). Conclusiones: La vacunación contra el SARS-CoV-2 se asoció con mayores títulos de anticuerpos contra la proteína S y menor probabilidad de progresión radiológica, requerimiento de inmunomoduladores y soporte respiratorio o muerte. Sin embargo, la vacunación, pero no los títulos de anticuerpos, protegió de los eventos adversos, lo que indica un papel de los mecanismos de protección inmunológica además de la respuesta humoral.

Role of vaccination and anti-SARS-CoV-2 antibodies in the clinical outcome of hospitalized COVID-19 patients / Papel de la vacunación y los anticuerpos anti-SARS-CoV-2 en el desenlace clínico de pacientes hospitalizados por COVID-19

Background Although vaccination has considerably reduced the risk of hospitalization and death from COVID19, the impact of vaccination and anti-SARS-CoV-2 antibody status on the outcome of patients who required hospitalization has been poorly investigated. Material and methods A prospective observational study in 232 patients hospitalized for COVID19 was carried out from October 2021 to January 2022 to evaluate the role on patient outcome of their vaccination and anti-SARS-CoV-2 antibody status and titer, comorbidities, analytical determinations, clinical presentation at admission, treatments and requirements for respiratory support. Cox regression and survival analyzes were performed. The SPSS and “R” programs were used. Results Patients with complete vaccination schedule had higher S-protein antibody titers (log10 3.73 [2.83–4.6]UI/ml vs 1.6 [2.99–2.61]UI/ml; p<0.001), lower probability of radiographic worsening (21.6% vs. 35.4%; p=0.005), less likely required high doses of dexamethasone (28.4% vs. 45.4%; p=0.012), high-flow oxygen (20.6% vs. 35.4%; p=0.02), ventilation (13.7% vs, 33.8%; p=0.001) and intensive care admissions (10.8% vs. 32.6%; p<0.001). Remdesivir (HR=0.38; p<0.001) and complete vaccination schedule (HR=0.34; p=0.008) were protective factors. No differences in antibody status were detected between groups (HR=0.58; p=0.219). Conclusions SARS-CoV-2 vaccination was associated with higher S-protein antibody titers and lower probability of radiological progression, immunomodulators requirement and respiratory support or death. However, vaccination but not antibody titters protected from adverse events pointing a role of immune-protective mechanisms in addition to humoral response (AU)

Antecedentes Aunque la vacunación ha reducido considerablemente el riesgo de hospitalización y muerte por COVID-19, se ha investigado poco el impacto de la vacunación y el estado de los anticuerpos anti-SARS-CoV-2 en la evolución de los pacientes que requieren hospitalización. Material y métodos Se realizó un estudio observacional prospectivo en 232 pacientes hospitalizados por COVID-19 desde octubre del 2021 hasta enero del 2022 para evaluar el impacto en la evolución clínica del estado vacunal, el título de anticuerpos anti-SARS-CoV-2, la presencia de comorbilidades, analítica, la clínica al ingreso, tratamientos y soporte respiratorio. Se realizaron análisis de supervivencia y regresión de Cox. Se utilizaron los programas SPSS y «R». Resultados Los pacientes con esquema de vacunación completo presentaron títulos de anticuerpos contra la proteína S más elevados (log10 3,73 [2,83-4,6] UI/mL vs. 1,6 [2,99-2,61] UI/mL; p < 0,001), menor probabilidad de empeoramiento radiográfico (21,6 vs. 35,4%; p = 0,005), requirieron con menor probabilidad dosis elevadas de dexametasona (28,4 vs. 45,4%; p = 0,012), oxígeno de alto flujo (20,6 vs. 35,4%; p = 0,02), ventilación (13,7 vs. 33,8%; p = 0,001) e ingresos en cuidados intensivos (10,8 vs. 32,6%; p < 0,001). El remdesivir (HR = 0,38; p < 0,001) y el esquema completo de vacunación (HR = 0,34; p = 0,008) fueron factores protectores de mala evolución. No se detectaron diferencias en el estado de los anticuerpos entre los grupos (HR = 0,58; p = 0,219). Conclusiones La vacunación contra el SARS-CoV-2 se asoció con mayores títulos de anticuerpos contra la proteína S y menor probabilidad de progresión radiológica, requerimiento de inmunomoduladores y soporte respiratorio o muerte. Sin embargo, la vacunación, pero no los títulos de anticuerpos, protegió de los eventos adversos, lo que indica un papel de los mecanismos de protección inmunológica además de la respuesta humoral (AU)

Remdesivir plus dexamethasone is associated to improvement in the clinical outcome of COVID-19 hospitalized patients regardless of their vaccination status.

INTRODUCTION: Remdesivir seems to reduce the risk of hospitalization and improve clinical outcome in hospitalized patients with COVID-19. OBJECTIVES: To compare the clinical outcome of COVID-19 hospitalized patients treated with remdesivir plus dexamethasone versus dexamethasone alone, according to their vaccination status. MATERIAL AND METHODS: A retrospective observational study was carried out in 165 patients hospitalized for COVID-19 from October 2021 to January 2022. Multivariate logistic regression, Kaplan-Meier and the log-rank tests were used to evaluate the event (need for ventilation or death). RESULTS: Patients treated with remdesivir plus dexamethasone (n=87) compared with dexamethasone alone (n=78) showed similar age (60±16, 47-70 vs. 62±37, 51-74 years) and number of comorbidities: 1 (0-2) versus 1.5 (1-3). Among 73 fully vaccinated patients, 42 (47.1%) were in remdesivir plus dexamethasone and 31 (41%) in dexamethasone alone. Patients treated with remdesivir plus dexamethasone needed intensive care less frequently (17.2% vs. 31%; p=0.002), high-flow oxygen (25.3% vs. 50.0%; p=0.002) and non-invasive mechanical ventilation (16.1% vs. 47.4%; p<0.001). Furthermore, they had less complications during hospitalization (31.0% vs. 52.6%; p=0.008), need of antibiotics (32.2% vs. 59%; p=0.001) and radiologic worsening (21.8% vs. 44.9%; p=0.005). Treatment with remdesivir plus dexamethasone (aHR, 0.26; 95% CI: 0.14-0.48; p<0.001) and vaccination (aHR 0.39; 95% CI: 0.21-0.74) were independent factors associated with lower progression to mechanical ventilation or death. CONCLUSIONS: Remdesivir in combination with dexamethasone and vaccination independently and synergistically protects hospitalized COVID-19 patients requiring oxygen therapy from progression to severe disease or dead.

Role of vaccination and anti-SARS-CoV-2 antibodies in the clinical outcome of hospitalized COVID-19 patients.

BACKGROUND: Although vaccination has considerably reduced the risk of hospitalization and death from COVID19, the impact of vaccination and anti-SARS-CoV-2 antibody status on the outcome of patients who required hospitalization has been poorly investigated. MATERIAL AND METHODS: A prospective observational study in 232 patients hospitalized for COVID19 was carried out from October 2021 to January 2022 to evaluate the role on patient outcome of their vaccination and anti-SARS-CoV-2 antibody status and titer, comorbidities, analytical determinations, clinical presentation at admission, treatments and requirements for respiratory support. Cox regression and survival analyzes were performed. The SPSS and "R" programs were used. RESULTS: Patients with complete vaccination schedule had higher S-protein antibody titers (log10 3.73 [2.83-4.6]UI/ml vs 1.6 [2.99-2.61]UI/ml; p<0.001), lower probability of radiographic worsening (21.6% vs. 35.4%; p=0.005), less likely required high doses of dexamethasone (28.4% vs. 45.4%; p=0.012), high-flow oxygen (20.6% vs. 35.4%; p=0.02), ventilation (13.7% vs, 33.8%; p=0.001) and intensive care admissions (10.8% vs. 32.6%; p<0.001). Remdesivir (HR=0.38; p<0.001) and complete vaccination schedule (HR=0.34; p=0.008) were protective factors. No differences in antibody status were detected between groups (HR=0.58; p=0.219). CONCLUSIONS: SARS-CoV-2 vaccination was associated with higher S-protein antibody titers and lower probability of radiological progression, immunomodulators requirement and respiratory support or death. However, vaccination but not antibody titters protected from adverse events pointing a role of immune-protective mechanisms in addition to humoral response.

Prognostic value of pro-adrenomedullin and NT-proBNP in patients referred from the emergency department with influenza syndrome. / Valor pronóstico de la proadrenomedulina y el NT-proBNP en los pacientes procedentes de urgencias con síndrome gripal.

OBJECTIVES: To assess the prognostic value of procalcitonin (PTC), C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and mid-regional pro-adrenomedullin (MR-proADM) in patients with influenza syndrome. MATERIAL AND METHODS: Prospective study in patients admitted from the emergency department with influenza syndrome. Biomarker concentrations were measured in the first 24 h after admission and a test for influenza. The results were analyzed for ability to predict a hospital stay longer than 7 days, intensive care unit admission, or in-hospital death. RESULTS: Ninety-eight patients were included; the prognosis of 44 (44.9%) was classified as poor. The areas under the receiving operator characteristic curve were 0.68 (95% CI, 0.56-0.80) for NT-proBNP, 0.73 (95% CI, 0.62-0.84) for MR-proADM, and nonsignificant for PCT and CRP. The following variables were independently associated with a poor prognosis: pneumonia (OR, 7.46 [95% CI, 2.08-26.73]; P=.002), heart failure (OR, 5.16 [95% CI, 1.35-19.74]; P=.016), and NT-proBNP > 580 pg/mL (OR, 4.68 [95% CI, 1.53-14.26]; P=.006). In the 53 patients with confirmed A(H1N1) influenza, only NT-proBNP was an independent predictor of prognosis (adjusted OR, 5.75 [95% CI, 1.46- 22.61]; P=.012). CONCLUSION: NT-proBNP and MR-proADM were the only biomarkers with prognostic value. Only NT-proBNP was a useful predictor in patients with confirmed influenza.

OBJETIVO: Analizar el valor pronóstico de la procalcitonina (PCT), la proteína C reactiva (PCR), el NT-proBNP y la región medial de la proadrenomedulina (MR-proADM) en pacientes hospitalizados con síndrome gripal. METODO: Estudio prospectivo realizado en pacientes hospitalizados desde urgencias por síndrome gripal. Se analizaron las concentraciones de biomarcadores en las primeras 24 h de ingreso y el test de gripe y se analizó su capacidad predictiva de mal pronóstico: estancia superior a 7 días, ingreso en unidad de cuidados intensivos o fallecimiento intrahospitalario. RESULTADOS: Se incluyeron 98 pacientes, 44 (44,9%) de ellos con mal pronóstico. Las áreas bajo la curva COR para mal pronóstico fueron de 0,68 (IC 95% 0,56-0,80) para NT-proBNP y de 0,73 (IC 95% 0,62-0,84) para la MRproADM, y no significativas para PCT y PCR. Las variables asociadas independientemente con mal pronóstico fueron: neumonía (OR 7,46 [IC 95% 2,08-26,73]; p = 0,002), insuficiencia cardiaca (OR 5,16 [IC 95% 1,35-19,74]; p = 0,016) y NT-proBNP > 580 pg/ml (OR 4,68 [IC 95% 1,53-14,26]; p = 0,006). En los 53 pacientes con gripe A(H1N1) confirmada, solo el NT-proBNP tuvo un valor pronóstico independiente (OR ajustado 5,75 [IC 95% 1,46-22,61]; p = 0,012). CONCLUSIONES: En pacientes con síndrome gripal, el NT-proBNP y la MR-proADM fueron los únicos biomarcadores con valor pronóstico, y solo el primero de ellos mantuvo esta asociación en pacientes con gripe confirmada.

Valor pronóstico de la proadrenomedulina y el NT-proBNP en los pacientes procedentes de urgencias con síndrome gripal / Prognostic value of pro-adrenomedullin and NT-proBNP in patients referred from the emergency department with influenza syndrome

Objetivos: Analizar el valor pronóstico de la procalcitonina (PCT), la proteína C reactiva (PCR), el NT-proBNP y la región medial de la proadrenomedulina (MR-proADM) en pacientes hospitalizados con síndrome gripal. Método: Estudio prospectivo realizado en pacientes hospitalizados desde urgencias por síndrome gripal. Se analizaron las concentraciones de biomarcadores en las primeras 24 h de ingreso y el test de gripe y se analizó su capacidad predictiva de mal pronóstico: estancia superior a 7 días, ingreso en unidad de cuidados intensivos o fallecimiento intrahospitalario. Resultados: Se incluyeron 98 pacientes, 44 (44,9%) de ellos con mal pronóstico. Las áreas bajo la curva COR para mal pronóstico fueron de 0,68 (IC 95% 0,56-0,80) para NT-proBNP y de 0,73 (IC 95% 0,62-0,84) para la MRproADM, y no significativas para PCT y PCR. Las variables asociadas independientemente con mal pronóstico fueron: neumonía (OR 7,46 [IC 95% 2,08-26,73]; p = 0,002), insuficiencia cardiaca (OR 5,16 [IC 95% 1,35-19,74]; p = 0,016) y NT-proBNP > 580 pg/ml (OR 4,68 [IC 95% 1,53-14,26]; p = 0,006). En los 53 pacientes con gripe A(H1N1) confirmada, solo el NT-proBNP tuvo un valor pronóstico independiente (OR ajustado 5,75 [IC 95% 1,46-22,61]; p = 0,012). Conclusiones: En pacientes con síndrome gripal, el NT-proBNP y la MR-proADM fueron los únicos biomarcadores con valor pronóstico, y solo el primero de ellos mantuvo esta asociación en pacientes con gripe confirmada

Objectives: To assess the prognostic value of procalcitonin (PTC), C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and mid-regional pro-adrenomedullin (MR-proADM) in patients with influenza syndrome. Methods: Prospective study in patients admitted from the emergency department with influenza syndrome. Biomarker concentrations were measured in the first 24 h after admission and a test for influenza. The results were analyzed for ability to predict a hospital stay longer than 7 days, intensive care unit admission, or in-hospital death. Results: Ninety-eight patients were included; the prognosis of 44 (44.9%) was classified as poor. The areas under the receiving operator characteristic curve were 0.68 (95% CI, 0.56-0.80) for NT-proBNP, 0.73 (95% CI, 0.62-0.84) for MR-proADM, and nonsignificant for PCT and CRP. The following variables were independently associated with a poor prognosis: pneumonia (OR, 7.46 [95% CI, 2.08-26.73]; P=.002), heart failure (OR, 5.16 [95% CI, 1.35-19.74]; P=.016), and NT-proBNP > 580 pg/mL (OR, 4.68 [95% CI, 1.53-14.26]; P=.006). In the 53 patients with confirmed A(H1N1) influenza, only NT-proBNP was an independent predictor of prognosis (adjusted OR, 5.75 [95% CI, 1.4622.61]; P=.012). Conclusions: NT-proBNP and MR-proADM were the only biomarkers with prognostic value. Only NT-proBNP was a useful predictor in patients with confirmed influenza

Respuesta: El fragmento N-terminal del propéptido natriurético cerebral como predictor de mortalidad en pacientes con neumonía adquirida en la comunidad / Reply: The N-terminal pro brain natriuretic peptide as a predictor of mortality in patients with community acquired pneumonia

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Usefulness of midregional pro-adrenomedullin as a marker of organ damage and predictor of mortality in patients with sepsis.

BACKGROUND: Midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP) and sepsis. In this paper, we examined the ability of MR-proADM to predict organ damage and long-term mortality in sepsis patients, compared to that of procalcitonin, C-reactive protein and lactate. METHODS: This was a prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to internal service department. The association between biomarkers and 90-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. The accuracy of biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS: A total of 148 patients with severe sepsis, according to the criteria of the campaign to survive sepsis, were enrolled. Eighty-five (57.4%) had sepsis according to the new criteria of Sepsis-3. MR-proADM showed the best AUROC to predict sepsis as defined by the Sepsis-3 criteria (AUROC of 0.771, 95% CI 0.692-0.850, p <0.001) and was the only marker independently associated with Sepsis-3 criteria (OR = 4.78, 95% CI 2.25-10.14; p < 0.001) in multivariate analysis. MR-proADM was the biomarker with the best AUROC to predict mortality in 90 days (AUROC of 0.731, CI 95% 0.612-0.850, p <0.001) and was the only marker that kept its independence [hazard ratio (HR) of 1.4, 95% CI 1.2-1.64, p <0.001] in multivariate analysis. The cut-off point of MR-proADM of 1.8 nmol/L (HR of 4.65, 95% CI 6.79-10.1, p < 0.001) was the one that had greater discriminative capacity to predict 90 days mortality. All patients with MR-proADM concentrations ≤0.60 nmol/L survived up to 90 days. In patients with SOFA ≤ 6, the addition of MR-proADM to SOFA score increased the ability of SOFA to identify non-survivors, AUROC of 0.65 (CI 95% 0.537-0.764) and AUROC of 0.700 (CI 95% 0.594-0.800), respectively (p < 0.05 for both). CONCLUSIONS: MR-proADM is a good biomarker in the early identification of high risk septic patients and may contribute to improve the predictive capacity of SOFA scale, especially when scores are low.

El fragmento N-terminal del propéptido natriurético cerebral es el mejor predictor de mortalidad intrahospitalaria en pacientes con sepsis y bajo riesgo de lesión orgánica / The N-terminal pro brain natriuretic peptide is the best predictor of mortality during hospitalization in patients with low risk of sepsis-related organ failure

Introducción: El objetivo de este estudio fue investigar el valor del fragmento N-terminal del propéptido natriurético cerebral (NT-proBNP), proteína C reactiva (PCR) y procalcitonina (PCT) para predecir la mortalidad en pacientes sépticos durante la hospitalización con un riesgo de mortalidad<10% evaluado por el Sepsis-related Organ Failure Assessment (SOFA). Material y métodos: Estudio observacional prospectivo realizado en pacientes hospitalizados con sepsis y riesgo SOFA<10%. Los biomarcadores se obtuvieron en las primeras 72h después del ingreso en el hospital. Todos fueron monitorizados durante la hospitalización o hasta la muerte. Se utilizaron las curvas ROC para determinar el área bajo la curva (ABC) e identificar las mejores concentraciones de corte para predecir la mortalidad. Resultados: Se analizaron un total de 174 pacientes. Diecisiete (9,8%) pacientes murieron durante la hospitalización. El ABC de NT-proBNP fue 0,793 (IC 95% 0,686-0,9; p<0,0005) en comparación con el ABC de la PCR (0,728; IC 95% 0,617-0,839; p=0,004) y el ABC del PCT (0,684; IC 95% 0,557-0,811; p=0,019). Los factores asociados a la mortalidad hospitalaria fueron: tener un NT-proBNP>1.330pg/ml (OR=23,23; IC 95% 2,92-182,25; p=0,003) y tener factores predisponentes para presentar sepsis (OR=3,05; IC 95% 1,3-9,3; p=0,044). Conclusiones: En pacientes con bajo riesgo de mortalidad según la puntuación SOFA, los niveles de NT-proBNP obtenidos en las primeras 72h después del ingreso son un poderoso predictor de mortalidad. Su implementación en la práctica clínica podría mejorar la capacidad predictiva de la puntuación de gravedad clínica en estos pacientes (AU)

Introduction: The purpose of this study was to investigate the value of N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and procalcitonin (PCT) in predicting mortality in septic patients during hospitalization with mortality risk<10% evaluated by Sepsis-related Organ Failure Assessment (SOFA). Material and methods: Prospective, observational study performed in sepsis patients with SOFA risk<10%. We obtained levels of biomarkers in the first 72h after admission in hospital. All patients were monitored during hospitalization or until death. We used ROC curves to determine area under curve (AUC) and identify the best cutoff concentrations to predict mortality. Results: A total of 174 patients were analyzed. Seventeen (9.8%) patients died during hospitalization. The AUC of NT-proBNP was 0.793 (95% CI 0.686-0.9; P<.0005) compared to AUC of CRP (0.728; 95% CI 0.617-0.839; P=.004) and AUC of PCT (0.684; 95% CI 0.557-0.811; P=.019). Factors independently associated with in-hospital mortality were NT-proBNP>1,330pg/ml (OR=23.23; 95% CI 2.92-182.25; P=.003) and to have predisposing factors (OR=3.05; 95% CI 1.3-9.3; P=.044). Conclusions: In patients with low mortality risk according to SOFA score, NT-proBNP obtained in the first 72h after admission prove to be a powerful predictor of mortality. Their implementations in clinical practice would improve the predictive ability of clinical severity scores (AU)

[Nomogram to predict a poor outcome in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA)]. / Nomograma para predecir mal pronóstico en pacientes procedentes de urgencias con sepsis y bajo riesgo de daño orgánico evaluado mediante SOFA.

OBJECTIVES: To develop a nomograph to predict a poor outcome (death during hospitalization or a hospital stay longer than 15 days) in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA). MATERIAL AND METHODS: Prospective, observational study carried out in a single universitary hospital. All patients admitted from the emergency department with sepsis and SOFA scores of 6 or lower were enrolled. We used bivariate logistic regression analysis to develop a predictive nomogram. RESULTS: A total of 174 patients were included. Seventeen patients (9.8%) died during hospitalization and the average hospital stay was greater than 15 days in 29 (16.7%) patient. The outcome was poor in a total of 42 patients (24.1%);. Independent variables that were significantly associated with a poor outcome were SOFA score (odds ratio [OR], 1.3; 95% CI, 1.06-1.71; P<.05), C-reactive protein (CRP) concentration (OR, 1.04; 95% CI, 1.0-1.09; P<.05), N-terminal fragment of brain natriuretic peptide (NT-proBNP) concentration over 1330 ng/mL (OR, 2.64; 95% CI, 1.17-6.22; P<.05), and septic shock (OR, 8.3; 95% CI, 1.16-166.5; P<.05). For a SOFA score of 2 or more the crude OR was 4.44 (95%, CI, 1.91-10.34) and the OR adjusted for other variables was 3.08 (95% CI, 1.24-7.69). CONCLUSION: A high percentage of patients predicted to be at low risk of organ failure had poor outcomes, associated with SOFA score, the presence of septic shock, CRP concentration, and elevated NT-proBNP concentration. The SOFA score by itself is an inadequate prognostic tool in patients at low risk of organ damage. Other clinical and analytical variables are required to complement the SOFA score.

OBJETIVO: Elaborar un nomograma que permita predecir el mal pronóstico (mortalidad durante el ingreso o estancia media > 15 días) en pacientes procedentes de urgencias con sepsis y baja probabilidad de daño orgánico evaluado por SOFA (Sepsis-related Organ Failure Assessment). METODO: Estudio observacional prospectivo realizado en un único hospital. Se incluyeron de forma consecutiva pacientes del servicio de urgencias con sepsis y SOFA igual o inferior a 6 puntos. Se realizó un análisis de regresión logística binaria y se elaboró un nomograma predictivo. RESULTADOS: Se incluyeron 174 pacientes. Diecisiete (9,8%) pacientes fallecieron durante la hospitalización y 29 (16,7%) tuvieron una estancia media prolongada. En total, 42 (24,1%) pacientes tuvieron mal pronóstico. Las variables independientes de mal pronóstico fueron: la puntuación SOFA (OR 1,3; IC 95% 1,06-1,71; p < 0,05), las concentraciones de proteína C reactiva (PCR) (OR 1,04; IC 95% 1-1,09; p < 0,05), NT-proBNP > 1.330 ng/ml (OR 2,64; IC 95% 1,17-6,22; p < 0,05) y la presencia de shock séptico (OR 8,3; IC 95% 1,16-166,5; p < 0,05). Si tenemos en cuenta el índice SOFA >= 2, la OR cruda fue 4,44 (IC 95% 1,91-10,34) y ajustada por el resto de variables fue de 3,08 (IC 95%, 1,24-7,69). CONCLUSIONES: Una elevada proporción de pacientes con baja probabilidad de tener daño orgánico tuvieron mal pronóstico en relación con la puntuación en la escala SOFA, la presencia de shock séptico, concentraciones de PCR y NTproBNP. La utilización de la escala pronóstica SOFA en pacientes con bajo riesgo es insuficiente para predecir el pronóstico en estos pacientes y se hace necesario complementarla con otras variables clínicas y analíticas.

Factores asociados con estancia media prolongada en pacientes ingresados por tuberculosis / Factors Associated with a Long Mean Hospital Stay in Patients Hospitalized with Tuberculosis

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The N-terminal pro brain natriuretic peptide is the best predictor of mortality during hospitalization in patients with low risk of sepsis-related organ failure. / El fragmento N-terminal del propéptido natriurético cerebral es el mejor predictor de mortalidad intrahospitalaria en pacientes con sepsis y bajo riesgo de lesión orgánica.

INTRODUCTION: The purpose of this study was to investigate the value of N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and procalcitonin (PCT) in predicting mortality in septic patients during hospitalization with mortality risk<10% evaluated by Sepsis-related Organ Failure Assessment (SOFA). MATERIAL AND METHODS: Prospective, observational study performed in sepsis patients with SOFA risk<10%. We obtained levels of biomarkers in the first 72h after admission in hospital. All patients were monitored during hospitalization or until death. We used ROC curves to determine area under curve (AUC) and identify the best cutoff concentrations to predict mortality. RESULTS: A total of 174 patients were analyzed. Seventeen (9.8%) patients died during hospitalization. The AUC of NT-proBNP was 0.793 (95% CI 0.686-0.9; P<.0005) compared to AUC of CRP (0.728; 95% CI 0.617-0.839; P=.004) and AUC of PCT (0.684; 95% CI 0.557-0.811; P=.019). Factors independently associated with in-hospital mortality were NT-proBNP>1,330pg/ml (OR=23.23; 95% CI 2.92-182.25; P=.003) and to have predisposing factors (OR=3.05; 95% CI 1.3-9.3; P=.044) CONCLUSIONS: In patients with low mortality risk according to SOFA score, NT-proBNP obtained in the first 72h after admission prove to be a powerful predictor of mortality. Their implementations in clinical practice would improve the predictive ability of clinical severity scores.

Nomograma para predecir mal pronóstico en pacientes procedentes de urgencias con sepsis y bajo riesgo de daño orgánico evaluado mediante SOFA / Nomogram to predict a poor outcome in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA)

Objetivo: Elaborar un nomograma que permita predecir el mal pronóstico (mortalidad durante el ingreso o estancia media > 15 días) en pacientes procedentes de urgencias con sepsis y baja probabilidad de daño orgánico evaluado por SOFA (Sepsis-related Organ Failure Assessment). Método: Estudio observacional prospectivo realizado en un único hospital. Se incluyeron de forma consecutiva pacientes del servicio de urgencias con sepsis y SOFA igual o inferior a 6 puntos. Se realizó un análisis de regresión logística binaria y se elaboró un nomograma predictivo. Resultados: Se incluyeron 174 pacientes. Diecisiete (9,8%) pacientes fallecieron durante la hospitalización y 29 (16,7%) tuvieron una estancia media prolongada. En total, 42 (24,1%) pacientes tuvieron mal pronóstico. Las variables independientes de mal pronóstico fueron: la puntuación SOFA (OR 1,3; IC 95% 1,06-1,71; p < 0,05), las concentraciones de proteína C reactiva (PCR) (OR 1,04; IC 95% 1-1,09; p < 0,05), NT-proBNP > 1.330 ng/ml (OR 2,64; IC 95% 1,17-6,22; p < 0,05) y la presencia de shock séptico (OR 8,3; IC 95% 1,16-166,5; p < 0,05). Si tenemos en cuenta el índice SOFA _ 2, la OR cruda fue 4,44 (IC 95% 1,91-10,34) y ajustada por el resto de variables fue de 3,08 (IC 95%, 1,24-7,69). Conclusiones: Una elevada proporción de pacientes con baja probabilidad de tener daño orgánico tuvieron mal pronóstico en relación con la puntuación en la escala SOFA, la presencia de shock séptico, concentraciones de PCR y NTproBNP. La utilización de la escala pronóstica SOFA en pacientes con bajo riesgo es insuficiente para predecir el pronóstico en estos pacientes y se hace necesario complementarla con otras variables clínicas y analíticas (AU)

Objective: To develop a nomograph to predict a poor outcome (death during hospitalization or a hospital stay longer than 15 days) in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA). Methods: Prospective, observational study carried out in a single universitary hospital. All patients admitted from the emergency department with sepsis and SOFA scores of 6 or lower were enrolled. We used bivariate logistic regression analysis to develop a predictive nomogram. Results: A total of 174 patients were included. Seventeen patients (9.8%) died during hospitalization and the average hospital stay was greater than 15 days in 29 (16.7%) patient. The outcome was poor in a total of 42 patients (24.1%);. Independent variables that were significantly associated with a poor outcome were SOFA score (odds ratio [OR], 1.3; 95% CI, 1.06-1.71; P<.05), C-reactive protein (CRP) concentration (OR, 1.04; 95% CI, 1.0-1.09; P<.05), N-terminal fragment of brain natriuretic peptide (NT-proBNP) concentration over 1330 ng/mL (OR, 2.64; 95% CI, 1.17-6.22; P<.05), and septic shock (OR, 8.3; 95% CI, 1.16-166.5; P<.05). For a SOFA score of 2 or more the crude OR was 4.44 (95%, CI, 1.91-10.34) and the OR adjusted for other variables was 3.08 (95% CI, 1.24-7.69). Conclusions: A high percentage of patients predicted to be at low risk of organ failure had poor outcomes, associated with SOFA score, the presence of septic shock, CRP concentration, and elevated NT-proBNP concentration. The SOFA score by itself is an inadequate prognostic tool in patients at low risk of organ damage. Other clinical and analytical variables are required to complement the SOFA score (AU)