Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage.

BACKGROUND: The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit. METHODS: Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database. RESULTS: The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years. CONCLUSIONS: In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.

Estudio descriptivo del síndrome confusional agudo en Urgencias / Descriptive study of delirium in the emergency department

Objetivo: Conocer mejor las variables clínicas, funcionales y analíticas que se asocian al síndrome confusional agudo (SCA) en urgencias y la evolución de las mismas con el fin de obtener una mejora en el abordaje terapéutico del paciente anciano previniendo así la morbimortalidad en este tipo de pacientes. Diseño: Se trata de un estudio descriptivo prospectivo de SCA en urgencias. Emplazamiento: Hospital General Universitario de Ciudad Real. Participantes: Se incluyó, en el intervalo de las 24 h siguientes al ingreso en el Servicio de Geriatría, a todos los pacientes procedentes del Servicio de Urgencias con diagnóstico de SCA. Mediciones principales: Se realizó un análisis de las variables del conjunto de datos (variables sociodemográficas y clínicas), calculando tablas de frecuencias para variables de tipo cualitativo y estadísticos descriptivos para las variables cuantitativas. Posteriormente, se han empleado técnicas de inferencia estadística. Resultados: El antecedente médico más frecuente fueron la enfermedad neurológica y la HTA, seguida de las enfermedades reumatológicas. Los motivos de consulta principales fueron el deterioro del estado general, la disnea, la disminución del nivel de consciencia y la fiebre. Se debe destacar la incidencia de la polifarmacia, especialmente de fármacos como los diuréticos, benzodiacepinas o hipnóticos. En relación con la etiología principal, destaca el papel de las infecciones de tipo urinario y respiratorio. Conclusiones: Se destaca el papel fundamental de las enfermedades neurológicas (especialmente la demencia), la HTA, la polifarmacia (uso inadecuado de benzodiacepinas e hipnóticos) y las infecciones urinarias y respiratorias como factores tratables o prevenibles del delirium en el paciente de Atención Primaria en nuestro medio.(AU)

Objective: To better understand the clinical, functional and analytical variables associated with delirium in emergencies and their evolution in order to obtain an improvement in the therapeutic approach of the elderly patient, thus preventing morbidity and mortality in this type of patient. Design: This is a prospective descriptive study of acute confusional syndrome in the emergency department. Site: General University Hospital of Ciudad Real. Participants: All patients from the emergency department with a diagnosis of delirium were included in the 24-h interval following admission to the geriatric service. Main measurements: An analysis of the variables of the data set (sociodemographic and clinical variables) was performed, calculating frequency tables for qualitative variables and descriptive statistics for quantitative variables. Subsequently, statistical inference techniques have been used. Results: The most frequent medical antecedent were neurological pathology and hypertension, followed by rheumatologic diseases. The main reasons for consultation were deterioration in general condition, dyspnea, decreased level of consciousness, and fever. Highlight the incidence of polypharmacy, especially drugs such as diuretics, benzodiazepines or hypnotics. In relation to the main etiology, the role of urinary and respiratory infections is noteworthy. Conclusions: Highlight the fundamental role of neurological diseases (especially dementia), hypertension, polypharmacy (inappropriate use of benzodiazepines and hypnotics) and urinary and respiratory infections as treatable and/or preventable factors of delirium in Primary Care patients in our setting.(AU)

[Descriptive study of delirium in the emergency department]. / Estudio descriptivo del síndrome confusional agudo en Urgencias.

OBJECTIVE: To better understand the clinical, functional and analytical variables associated with delirium in emergencies and their evolution in order to obtain an improvement in the therapeutic approach of the elderly patient, thus preventing morbidity and mortality in this type of patient. DESIGN: This is a prospective descriptive study of acute confusional syndrome in the emergency department. SITE: General University Hospital of Ciudad Real. PARTICIPANTS: All patients from the emergency department with a diagnosis of delirium were included in the 24-h interval following admission to the geriatric service. MAIN MEASUREMENTS: An analysis of the variables of the data set (sociodemographic and clinical variables) was performed, calculating frequency tables for qualitative variables and descriptive statistics for quantitative variables. Subsequently, statistical inference techniques have been used. RESULTS: The most frequent medical antecedent were neurological pathology and hypertension, followed by rheumatologic diseases. The main reasons for consultation were deterioration in general condition, dyspnea, decreased level of consciousness, and fever. Highlight the incidence of polypharmacy, especially drugs such as diuretics, benzodiazepines or hypnotics. In relation to the main etiology, the role of urinary and respiratory infections is noteworthy. CONCLUSIONS: Highlight the fundamental role of neurological diseases (especially dementia), hypertension, polypharmacy (inappropriate use of benzodiazepines and hypnotics) and urinary and respiratory infections as treatable and/or preventable factors of delirium in Primary Care patients in our setting.

Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study.

INTRODUCTION: Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS: A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS: 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS: In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.

Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain.

OBJECTIVE: Validation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU). METHODS: A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated. RESULTS: A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years. APACHE-II: 21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79). CONCLUSIONS: ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

Risk factors for intracranial lesions and mortality in older patients with mild traumatic brain injuries.

PRIMARY OBJECTIVE: To identify risk factors for intracerebral lesion (ICL) in older adults with mild traumatic brain injury (MTBI) and evaluate the influence of comorbidities on outcomes. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: Information was gathered on clinical history/examination, cranial computed tomography, admission Glasgow Coma Scale (GCS) score, analytical and coagulation findings, and mortality at 1 week post-discharge. Bivariate and multivariate logistic regression analyses were performed, calculating odds ratios for ICL with 95% confidence interval. P < 0.05 was considered significant. MAIN OUTCOMES AND RESULTS: Data were analyzed on 504 patients with mean±SD age of 79.37 ± 8.06 years. Multivariate analysis showed that traffic accident, GCS score of 14/15, transient consciousness loss, nausea, and receipt of antiplatelets were predictors of ICL, while SRRI and/or benzodiazepine intake was a protective factor. A score was assigned to patients by rounding OR values, and a score ≥1 indicated moderate/high risk of ICL. CONCLUSIONS: MTBI management should be distinct in over-60 year-olds, who may not present typical symptoms, with frequent comorbidities. Knowledge of risk factors for post-MTBI ICL, associated with higher mortality, is important to support clinical decision-making. Further research is warranted to verify our novel finding that benzodiazepines and/or SSRI inhibitors may act as neuroprotectors.

Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension / Estudio de supervivencia en hemorragia intracerebral espontánea con extensión intraventricular evacuada quirúrgicamente

OBJECTIVE: To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012. Data collected: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge. RESULTS: A total of 263 patients were included. Mean age: 59.74 ± 14.14 years. GCS: 8 ± 4 points, APACHE II: 20.7 ± 7.68 points. ICH Score: 2.32 + 1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p = 0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n = 78) versus those conservatively managed (58.9%, n = 185); specifically in those with IVH surgically treated (34.2%, n = 38) versus non-operated IVH (67.2%, n = 125), p < 0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33-3.22) in patients without IVH versus 0.19 (95% CI; 0.07-0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07-0.75), p = 0.01. CONCLUSIONS: Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhag

OBJETIVO: Estudio de supervivencia y evaluación del tratamiento quirúrgico en una cohorte de pacientes con hematoma intracerebral espontáneo supratentorial. MATERIAL Y MÉTODOS: Incluidos todos los pacientes con hematoma cerebral espontáneo supratentorial ingresados en las unidades de cuidados intensivos de 3 hospitales españoles con servicios de neurocirugía (2009-2012). Se recogieron la edad, APACHE-II, escala de coma de Glasgow y alteraciones pupilares al ingreso, intracerebral haemorrhage (ICH) score, localización/volumen del hematoma, presencia de hemorragia intraventricular (IVH), evacuación quirúrgica±drenaje ventricular externo, supervivencia a los 30 días y hospitalaria. RESULTADOS: Doscientos sesenta y tres pacientes, con edad media 59,74 ± 14,14 años, escala de coma de Glasgow: 8 ± 4 puntos e ICH score: 2,32 ± 1,04 puntos. El 30% presentaba alteraciones pupilares. Mortalidad a los 30 días: 51,3% (predicha por ICH score 45,3%) y hospitalaria 53,2%. Hubo diferencia estadísticamente significativa (p = 0,004) entre la mortalidad-hospitalaria de los pacientes intervenidos quirúrgicamente (39,7%; n = 78) frente a los tratados de modo conservador (58,9%; n = 185), y específicamente para los pacientes intervenidos con IVH (34,2%; n = 38) frente a los no operados con IVH (67,2%; n = 125), (p < 0,001). No hubo diferencias en la mortalidad de los pacientes sin IVH. En el análisis de regresión logística múltiple la OR para la cirugía fue 1,04 (IC 95%: 0,33-3,22) en pacientes sin IVH, frente a 0,19 (IC 95%: 0,07-0,53) en pacientes con IVH. El análisis con índice de propensión para pacientes con IVH demostró mejoría en la supervivencia del grupo operado (OR: 0,23; IC 95%: 0,07-0,75), p = 0,01. CONCLUSIÓN: La mortalidad hospitalaria fue menor en los pacientes intervenidos quirúrgicamente en comparación con los tratados de modo conservador, específicamente para el subgrupo de pacientes con IVH

Survival analysis of surgically evacuated supratentorial spontaneous intracerebral hemorrhage with intraventricular extension.

OBJECTIVE: To conduct a survival study and evaluation of surgical treatment in a cohort of patients with diagnosis of supratentorial spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: The study included all consecutive patients with supratentorial ICH admitted to the Intensive Care Units of three Spanish hospitals with Neurosurgery Department between 2009 and 2012. DATA COLLECTED: age, APACHE-II, Glasgow Coma Score (GCS), and pupillary anomalies on admission, intracerebral hemorrhage (ICH) score, location/volume of hematoma, intraventricular hemorrhage (IVH), surgical evacuation alone or with additional external ventricular drain, and 30-days survival and at hospital discharge RESULTS: A total of 263 patients were included. Mean age: 59.74±14.14 years. GCS: 8±4 points, APACHE II: 20.7±7.68 points. ICH Score: 2.32+1.04 points. Pupillary anomalies were observed in 30%. The 30-day mortality: 51.3% (45.3% predicted by ICH-score), and 53.2% at hospital discharge. A significant difference (p=0.004) was observed in hospital mortality rates between surgically treated patients (39.7%, n=78) versus those conservatively managed (58.9%, n=185); specifically in those with IVH surgically treated (34.2%, n=38) versus non-operated IVH (67.2%, n=125), p<0.001. No significant difference was found between mortality rates in patients without IVH. Multiple logistic regression analysis showed an OR for surgery of 1.04 (95% CI; 0.33-3.22) in patients without IVH versus 0.19 (95% CI; 0.07-0.53) in patients with IVH (decreased mortality with surgical treatment). The propensity score analysis for IVH patients showed improved survival of operated group (OR 0.23, 95% CI; 0.07-0.75), p=0.01. CONCLUSIONS: Hospital mortality was lower in patients who underwent surgery compared to patients conservatively managed, specifically for the subgroup of patients with intraventricular hemorrhage.

Modelo predictivo de ansiedad y depresión en pacientes españoles con enfermedad pulmonar obstructiva crónica estable / Predictive Model for Anxiety and Depression in Spanish Patients with Stable Chronic Obstructive Pulmonary Disease

Introducción: La asociación entre la enfermedad pulmonar obstructiva crónica (EPOC) y la ansiedad o la depresión no se conoce adecuadamente, y puede haber diferencias entre distintos países. Investigamos un modelo predictivo para esta asociación en una población española. Pacientes y método: Estudio prospectivo descriptivo transversal incluyendo 204 pacientes con EPOC estable. Se diagnostica la presencia de ansiedad o depresión mediante valoración psiquiátrica, aplicando los criterios diagnósticos de la 10.ª revisión del International Statistical Classification of Diseases and Related Health Problems (ICD-10). Se analizan variables sociodemográficas, clínicas y de función pulmonar. Resultados: Un 36% de pacientes con EPOC estable tienen comorbilidad psiquiátrica, pero en el 76% de los casos se desconocía dicho diagnóstico. Presentan un trastorno de ansiedad pura el 19%, depresión aislada el 9,8% y un trastorno mixto de ansiedad y depresión el 7,3% de los pacientes. En el análisis multivariante las variables predictoras son: edad más joven, mayor nivel de estudios, falta de apoyo domiciliario, mayor índice de BODE y mayor número de agudizaciones. La curva ROC del modelo muestra un AUC de 0,765 (p<0,001). Conclusiones: En la EPOC, una mayoría de pacientes con comorbilidad psiquiátrica no son identificados. Los trastornos de ansiedad son más frecuentes que la depresión, en base a un diagnóstico mediante entrevista estructurada. Los pacientes más jóvenes y con mayor nivel de estudios tienen más riesgo de de padecer ansiedad o depresión. Otros factores predictivos son: un mayor índice BODE, más agudizaciones y la falta de apoyo domiciliario

Introduction: The association between chronic obstructive pulmonary disease (COPD) and anxiety and depression is not yet completely characterized, and differences between countries may exist. We used a predictive model to assess this association in a Spanish population. Patients and method: Prospective transversal descriptive study of 204 patients with stable COPD. Concomitant anxiety or depression were diagnosed by psychiatric assessment, using the diagnostic criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Sociodemographic, clinical and lung function parameters were analyzed. Results: In total, 36% of stable COPD patients had psychiatric comorbidities, but 76% were unaware of their diagnosis. Nineteen percent had a pure anxiety disorder, 9.8% had isolated depression, and 7.3% had a mixed anxiety-depression disorder. Predictive variables in the multivariate analysis were younger age, higher educational level, lack of home support, higher BODE index, and greater number of exacerbations. The ROC curve of the model had an AUC of 0.765 (P<0.001). Conclusions: In COPD, concomitant psychiatric disorders are significantly associated with sociodemographic factors. Anxiety disorders are more common than depression. Patients with more severe COPD, according to BODE, younger patients and those with a higher educational level have a greater risk of being diagnosed with anxiety or depression in a structured psychiatric interview. In our population, most patients with psychiatric comorbidities remain unidentified

Drug-related mortality among inpatients: a retrospective observational study.

PURPOSE: Hospital mortality related to adverse drug reactions (ADRs) is a relevant clinical problem with major health and economic consequences. We conducted a study to assess hospital mortality related to ADRs, the drugs most frequently involved, and the possible risk factors associated with fatal ADRs. METHODS: A retrospective observational study was conducted, reviewing the clinical records of 1388 consecutive adult patients (18-101 years) who died during a 22-month period in a tertiary hospital in Southern Europe (Granada, Spain). The main outcome was the prevalence of hospital death suspected to be related to administered drugs. RESULTS: Out of the 1388 adult deaths studied, 256 (18.4 %) were suspected of being related to drugs. Drugs were suspected of causing death in 146 inpatients (10.5 %) and contributing to death in 110 (7.9 %). Drugs related to death were administered during the hospital stay in 161 cases (11.5 %) and before hospital admission in 95 (6.84 %). The most frequent fatal ADRs were cardiac arrhythmia, gastrointestinal bleeding, and respiratory failure. The drugs most frequently involved in fatal ADRs were antithrombotics (anticoagulants or antiplatelets) (23 %), psychotropic drugs (21.2 %), and digoxin (11.3 %). Independent risk factors for ADR-related death were the presence of ≥4 diseases (OR = 1.43) and the receipt of ≥10 drugs (OR = 3.24), but no significant association with gender or age was found. CONCLUSIONS: A high percentage of hospital deaths were suspected of being associated with ADRs, especially in patients with comorbidity and/or polypharmacy. Antithrombotics, psychotropics, and digoxin were the drugs most frequently associated with in-hospital drug-related deaths.

Predictive Model for Anxiety and Depression in Spanish Patients with Stable Chronic Obstructive Pulmonary Disease.

INTRODUCTION: The association between chronic obstructive pulmonary disease (COPD) and anxiety and depression is not yet completely characterized, and differences between countries may exist. We used a predictive model to assess this association in a Spanish population. PATIENTS AND METHOD: Prospective transversal descriptive study of 204 patients with stable COPD. Concomitant anxiety or depression were diagnosed by psychiatric assessment, using the diagnostic criteria of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Sociodemographic, clinical and lung function parameters were analyzed. RESULTS: In total, 36% of stable COPD patients had psychiatric comorbidities, but 76% were unaware of their diagnosis. Nineteen percent had a pure anxiety disorder, 9.8% had isolated depression, and 7.3% had a mixed anxiety-depression disorder. Predictive variables in the multivariate analysis were younger age, higher educational level, lack of home support, higher BODE index, and greater number of exacerbations. The ROC curve of the model had an AUC of 0.765 (P<0.001). CONCLUSIONS: In COPD, concomitant psychiatric disorders are significantly associated with sociodemographic factors. Anxiety disorders are more common than depression. Patients with more severe COPD, according to BODE, younger patients and those with a higher educational level have a greater risk of being diagnosed with anxiety or depression in a structured psychiatric interview. In our population, most patients with psychiatric comorbidities remain unidentified.

Cambio de nomenclatura de los marcadores tumorales / Terminology changes in serum tumor markers

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Estudio de la albúmina sérica y del índice de masa corporal como marcadores nutricionales en pacientes en hemodiálisis / Study of serum albumin and BMI as nutritional markers in hemodialysis patients

Introducción: La malnutrición proteíco calórica así como la inflamación sistémica y metabólica son trastornos frecuentes entre los pacientes con insuficiencia renal crónica sometidos a tratamiento renal sustitutivo (Hemodiálisis), lo que contribuye a su morbilidad y mortalidad. Objetivos: El objetivo de este trabajo fue evaluar el estado nutricional de los pacientes de una unidad de hemodiálisis mediante la valoración de parámetros bioquímicos nutricionales como la albúmina, y parámetros antropométricos de índice de masa corporal durante diez años de seguimiento. Métodos: En este trabajo se ha seguido a 90 pacientes de ambos sexos con insuficiencia renal crónica que fueron tratados con hemodiálisis periódicamente en nuestra unidad durante diez años. A todos los pacientes se le realizaron mediciones trimestrales de albúmina plasmática (Alb), y otras determinaciones bioquímicas, y se les efectuaron mediciones antropométricas de peso, altura e índice de masa corporal calculado mediante la fórmula peso/talla², agrupada en IMC < 23 kg/m2 y niveles de albumina <3,8 g/dl según el consenso del panel de expertos de la International Society for Renal Nutrition and Metabolism. Resultados: Durante los 10 años todos los pacientes manifestaron un importante descenso de los parámetros bioquímicos y de al albúmina, en cambio el IMC no presentó cambios significativos en relación a la desnutrición. Conclusiones: La desnutrición de los pacientes en diálisis es un hecho patente, el IMC no se corresponde con lo parámetros bioquímicos observados, por lo que el deterioro nutricional de estos pacientes se manifiesta principalmente mediante la albúmina sérica (AU)

Background: Protein calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (haemodialysis), which contributes to its morbidity and mortality. Aims: The aims of this work was to evaluate the nutritional status of patients in a hemodialysis treatment through the assessment of biochemical parameters nutritional as albumin, and anthropometric parameters of body mass index during ten years of follow up. Methods: In this work has been followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis regularly on our unit for ten years. All patients were conducted quarterly measurements of plasma albumin (Alb), and other biochemical determinations, and anthropometric measurements of height, weight and body mass index calculated by the formula weight/height², grouped n BMI < 23 kg/m2 and albumin levels <3.8 g/dl according to the consensus of the panel of experts of the International Society for renal Nutritionand metabolism. Results: During the 10 years all patients showed a significant decline in the biochemical parameters and the albumin, change in BMI does not presented significant changes in relation to malnutrition. Conclusions: Malnutrition in patients on dialysis is a fact patent, BMI does not correspond with the biochemical parameters were observed, for what nutritional impairment in these patients is mainly expressed by serumal bumin (AU)

Estudio del síndrome metabólico y de la obesidad en pacientes en hemodiálisis / Study of the metabolic síndrome and obesity in hemodialysis patients

Introducción: El síndrome metabólico (SM) está formado por un conjunto de alteraciones clínicas y bioquímicas es muy común entre los pacientes en hemodiálisis crónica y representa la principal causa de mortalidad en estos pacientes, 44% del total de pacientes sometidos a diálisis. Objetivos: El objetivo de este trabajo fue investigar la prevalencia del Síndrome Metabólico y factores de riesgo asociados a su desarrollo, así como la prevalencia de la obesidad en pacientes en HD. Métodos: En este trabajo se ha seguido a 90 pacientes de ambos sexos con IRC que fueron tratados con hemodiálisis periódicamente en nuestra unidad durante diez años. A todos los pacientes se le realizaron mediciones trimestrales de albúmina plasmática (Alb), y otras determinaciones bioquímicas, y se les efectuaron mediciones antropométricas de peso, altura e índice de masa corporal calculado mediante la fórmula peso/talla2, agrupada en valores IMC según la OMS, se recogieron datos acerca de hipertensión, glucosa. Resultados: La prevalencia de SM fue del 25º% y de la obesidad fue, 45% sobrepeso tipo I; 30,8% de pacientes con sobrepeso tipo II y 12 ,2% obesas. Como factores de riesgo estadísticamente significativos se obtuvieron el IMC, sobrepeso, triglicéridos, colesterol total y colesterol HDL así como la hipertensión y niveles elevados de glucosa. Conclusiones: El SM compromete la supervivencia del paciente hemodiálisis pudiendo apreciarse una alta prevalecía del mismo. Los factores de riesgo fundaménteles en el SM son la vigilancia del peso, IMC, triglicéridos y colesterol HDL, hipertensión y la diabetes (AU)

Introduction: The metabolic syndrome (MS) consists of a set of clinical and biochemical changes. It is very common among chronic hemodialysis patients, being the leading cause of death in these patients, 44% of all patients undergoing this therapy. Aims: The aim of this study was to investigate the prevalence of MS and risk factors associated with its development, as well as the prevalence of obesity in HD patients. Methods: This study has followed 90 patients of both sexes with chronic renal failure (CRF) who were treated with hemodialysis periodically in our unit for ten years. All patients were performed quarterly measurements of plasma albumin (A1b) and other biochemical analysis; besides, they underwent some anthropometric measurements like weight, height and body mass index (BMI). This was calculated using weight / size2 formula and grouped in BMI values according to WHO criteria. The data concerning hypertension and glucose were also considered. Results: The prevalence of MS was 25% and obesity was presented as follows: 45% with type I overweight; 30.8% with type II overweight and 12 patients (2%) were obese. Being statistically significant as risk factors, BMI, overweight, triglycerides, total cholesterol, HDL cholesterol as well as hypertension and elevated glucose levels were obtained. Conclusions: The metabolic syndrome compromises the patient survival causing a high prevalence in these patients. The principal risk factors in MS are monitoring weight, BMI, triglycerides, HDL cholesterol, hypertension and diabetes (AU)

Capacidad diagnóstica del antígeno carcinoembrionario / Diagnostic capability of carcinoembryonic antigen elevation

INTRODUCCIÓN: Existe escasa información sobre la precisión diagnóstica oncológica de la elevación del antígeno carcinoembrionario (CEA) más de tres veces por encima del valor normal. OBJETIVOS: Determinar la prevalencia de procesos oncológicos del rango establecido del CEA y el coste medio que supone el estudio. MÉTODOS: Estudio retrospectivo de todos los pacientes derivados a consultas externas de Aparato Digestivo o Medicina Interna para estudio de patología tumoral en relación con un CEA entre 3 y 10 ng/ml desde 2.001 a 2.007. RESULTADOS: Cien pacientes (60 hombres y 40 mujeres), 67,4 ± 14,2 años, y con nivel basal de 5,8 ± 1,7 ng/ml. Los síntomas/signos guía más relevantes fueron alteraciones analíticas (19, 19%). Se diagnosticaron 4 cánceres (uno gástrico, 2 de pulmón y uno de colon). En cuanto a la patología no oncológica, en 49 pacientes (49%) no se detectó ningún proceso relacionado, y en 47 (47%) se confirmaron otros diagnósticos asociados a aumento de dicho marcador. En el seguimiento (54,3 ± 24,6 meses) se detectó un cáncer laríngeo, una leucemia aguda mieloide y un cáncer de colon. El CEA basal de los pacientes con cáncer no tuvo diferencias con respecto a aquellos sin patología oncológica (6,6 ± 2,4 vs. 5,8 ± 1,7 ng/ml; p = 0,2). El gasto medio por paciente fue de 503,6 ± 257,6 euros. CONCLUSIONES: Existe una baja proporción (7%) de pacientes con proceso oncológico en relación con la elevación leve del CEA. Existe un gasto económico no desdeñable asociado directa e indirectamente al estudio de estos pacientes

INTRODUCTION: There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJECTIVES: To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. Methods A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS: We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 euros. CONCLUSIONS: Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost

[Diagnostic capability of carcinoembryonic antigen elevation]. / Capacidad diagnóstica del antígeno carcinoembrionario.

INTRODUCTION: There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal. OBJETIVES: To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination. METHODS: A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007. RESULTS: We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €. CONCLUSIONS: Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.

[Study of serum albumin and BMI as nutritional markers in hemodialysis patients]. / Estudio de la albúmina sérica y del índice de masa corporal como marcadores nutricionales en pacientes en hemodialysis.

BACKGROUND: Protein calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (haemodialysis), which contributes to its morbidity and mortality. AIMS: The aims of this work was to evaluate the nutritional status of patients in a hemodialysis treatment through the assessment of biochemical parameters nutritional as albumin, and anthropometric parameters of body mass index during ten years of follow up. METHODS: In this work has been followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis regularly on our unit for ten years. All patients were conducted quarterly measurements of plasma albumin (Alb), and other biochemical determinations, and anthropometric measurements of height, weight and body mass index calculated by the formula weight/height², grouped n BMI < 23 kg/m² and albumin levels <3.8 g/dl according to the consensus of the panel of experts of the International Society for renal Nutrition and metabolism. RESULTS: During the 10 years all patients showed a significant decline in the biochemical parameters and the albumin, change in BMI does not presented significant changes in relation to malnutrition. CONCLUSIONS: Malnutrition in patients on dialysis is a fact patent, BMI does not correspond with the biochemical parameters were observed, for what nutritional impairment in these patients is mainly expressed by serum albumin.

Introducción: La malnutrición proteíco calorica asi como la inflamación sistémica y metabólica son trastornos frecuentes entre los pacientes con insuficiencia renal crónica sometidos a tratamiento renal sustitutivo (Hemodiálisis), lo que contribuye a su morbilidad y mortalidad. Objetivos: El objetivo de este trabajo fue evaluar el estado nutricional de los pacientes de una unidad de hemodiálisis mediante la valoración de parámetros bioquímicos nutricionales como la albúmina, y parámetros antropométricos de índice de masa corporal durante diez años de seguimiento. Métodos: En este trabajo se ha seguido a 90 pacientes de ambos sexos con insuficiencia renal crónica que fueron tratados con hemodiálisis periódicamente en nuestra unidad durante diez años. A todos los pacientes se le realizaron mediciones trimestrales de albúmina plasmática (Alb), y otras determinaciones bioquimicas, y se les efectuaron mediciones antropométricas de peso, altura e índice de masa corporal calculado mediante la formula peso/talla², agrupada enIMC < 23 kg/m2 y niveles de albumina.