Correction: Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018-2019 epidemic season.

[This corrects the article DOI: 10.1371/journal.pone.0260397.].

Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18 years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12 h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48 h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018-2019 epidemic season.

INTRODUCTION: Influenza vaccination rates in risk groups remain suboptimal. Evidence supporting a significant association between influenza vaccination and severe illness is limited. METHODS: We retrospectively analyzed the epidemiological characteristics of out- and inpatients with laboratory-confirmed influenza infection attended during the 2018-19 epidemic season. Influenza vaccination coverage by indication was analyzed. Logistic regression was used to compare the odds of vaccination between severe and non-severe influenza-positive patients. Severe cases were defined as presenting pneumonia, admission to critical care units and/or death. RESULTS: The overall vaccination coverage among influenza-positive patients was 30.4%. In subjects with ≥ 1 indication for vaccination, the vaccination coverage was 42.4%. By indication, coverage rates were: 52.5% in patients aged ≥ 59 years, 42.2% in obese patients, 29.2% in immunosuppressed subjects and 6.5% in pregnant women. In patients with underlying chronic diseases, a higher coverage was found in patients with cognitive impairment (77%), muscular dystrophy (63.6%) and renal disease (60.4%). The multivariate logistic regression model showed severe influenza-related illness was associated with a lack of influenza vaccination before seeking care during the 2018-2019 season [0.59 (95%CI 0.36-0.97); p = 0.038], older age [1.01 (95%CI 1.00-1.02); p = 0.009] and current or former smoking status [1.63 (95%CI 0.84-3.18) and 2.03 (95%CI 1.16-3.57); p = 0.031], adjusted by underlying disease. CONCLUSION: Adjusting by age, smoking status and underlying disease, a moderate association between the influenza vaccine and severe laboratory-confirmed influenza-related illness was found in an epidemic season in which there was matching between the vaccine and circulating strains. Protection against complications, especially in older subjects and in those with underlying disease is postulated as one of the strengths of annual influenza vaccination. However, influenza vaccination is a pending issue in these groups, especially in pregnant women and obese people. To avoid suboptimal vaccination coverages, health professionals should recommend the seasonal influenza vaccination according to the annual instructions of the health authorities.

Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study.

BACKGROUND: Recent reports of patients with coronavirus disease 2019 (COVID-19) developing pneumothorax correspond mainly to case reports describing mechanically ventilated patients. The real incidence, clinical characteristics, and outcome of spontaneous pneumothorax (SP) as a form of COVID-19 presentation remain to be defined. RESEARCH QUESTION: Do the incidence, risk factors, clinical characteristics, and outcomes of SP in patients with COVID-19 attending EDs differ compared with COVID-19 patients without SP and non-COVID-19 patients with SP? STUDY DESIGN AND METHODS: This case-control study retrospectively reviewed all patients with COVID-19 diagnosed with SP (case group) in 61 Spanish EDs (20% of Spanish EDs) and compared them with two control groups: COVID-19 patients without SP and non-COVID-19 patients with SP. The relative frequencies of SP were estimated in COVID-19 and non-COVID-19 patients in the ED, and annual standardized incidences were estimated for both populations. Comparisons between case subjects and control subjects included 52 clinical, analytical, and radiologic characteristics and four outcomes. RESULTS: We identified 40 occurrences of SP in 71,904 patients with COVID-19 attending EDs (0.56‰; 95% CI, 0.40‰-0.76‰). This relative frequency was higher than that among non-COVID-19 patients (387 of 1,358,134, 0.28‰; 95% CI, 0.26‰-0.32‰; OR, 1.93; 95% CI, 1.41-2.71). The standardized incidence of SP was also higher in patients with COVID-19 (34.2 vs 8.2/100,000/year; OR, 4.19; 95% CI, 3.64-4.81). Compared with COVID-19 patients without SP, COVID-19 patients developing SP more frequently had dyspnea and chest pain, low pulse oximetry readings, tachypnea, and increased leukocyte count. Compared with non-COVID-19 patients with SP, case subjects differed in 19 clinical variables, the most prominent being a higher frequency of dysgeusia/anosmia, headache, diarrhea, fever, and lymphopenia (all with OR > 10). All the outcomes measured, including in-hospital death, were worse in case subjects than in both control groups. INTERPRETATION: SP as a form of COVID-19 presentation at the ED is unusual (< 1‰ cases) but is more frequent than in the non-COVID-19 population and could be associated with worse outcomes than SP in non-COVID-19 patients and COVID-19 patients without SP.

Efecto de la vacunación en la prevención de gripe grave en adultos atendidos en un hospital de tercer nivel durante la temporada 2017-2018 / Effect of vaccination on the prevention of influenza-related severe illness in adults attended in a third level hospital during the 2017-2018 epidemic season

OBJETIVOS: El objetivo de este trabajo fue evaluar el efecto de la vacunación antigripal en la prevención de casos graves asociados a gripe en pacientes adultos atendidos en un hospital de tercer nivel durante la temporada epidémica 2017-2018. METODOLOGÍA: Se realizó un análisis descriptivo con toda la población de sujetos con gripe confirmada por laboratorio en la temporada 2017-2018. Se definió caso grave como el ingreso en unidades de críticos o muerte. El efecto de la vacuna en la población adulta se determinó mediante análisis de regresión logística multivariante. RESULTADOS: Entre las semanas epidemiológicas 44/2017 y 19/2018, el laboratorio del hospital detectó 706 muestras positivas de virus influenza. De los 551 pacientes confirmados de 18 años o más, cuarenta y tres fueron ingresados en alguna de las unidades de críticos del hospital y 26 fallecieron durante el ingreso. El modelo multivariante explicativo mostró la vacunación de la gripe durante la temporada de estudio como factor protector del desarrollo de gravedad [OR: 0,27 (0,11-0,65), p = 0,004], ajustada por edad [1,03 (1,01-1,06), p = 0,04], sexo, tipo de virus (H1N1-pdm09, H3N2 o B) y el estar clasificado como Paciente Crónico Complejo o Enfermedad Avanzada Crónica. CONCLUSIONES: La vacuna de la gripe se muestra como factor protector frente al desarrollo de complicaciones en una temporada en la que la vacuna no contiene el virus que más ha circulado entre la población. Se debe recomendar la vacuna antigripal con periodicidad anual a los grupos de riesgo establecidos por las autoridades sanitarias

OBJECTIVES: The objective of this research was to evaluate the effect of influenza vaccination on the prevention of influenza-related severe cases in adults treated in a third-level hospital during the 2017-2018 epidemic season. METHODOLOGY: A descriptive analysis was performed on the entire population of subjects with a laboratory-confirmed influenza test during the 2017-2018 season. A severe case was defined as a patient treated in one of the Intensive Care Units (ICUs) and/or death. The effect of the vaccine on the adult population was determined by multivariate logistic regression analysis. RESULTS: Between epidemiological weeks 44/2017 and 19/2018, the hospital's laboratory detected 706 positive samples for influenza virus. Of the 551 confirmed patients aged 18 years or older, forty-three were admitted to one of the ICUs, and 26 died during admission. The explanatory multivariate model has shown that flu vaccination prior to or during the epidemic season was a protective factor for the development of severity [OR:0.27 (0.11-0.65, p = 0.004)], adjusted by age [OR: 1.03 (1.01-1.06), p=.04], sex, type of virus (H1N1-pdm09, H3N2 or B virus), Chronic Complex Patient index or Advanced Chronic Disease index. Conclussions: Influenza vaccination is a protective factor against the development of severity associated with influenza infection in a season when vaccination did not contain the virus with higher epidemic circulation among the population. Flu vaccination should be recommended annually following the guidelines established by the health authorities

Effect of vaccination on the prevention of influenza-related severe illness in adults attended in a third level hospital during the 2017-2018 epidemic season. / Efecto de la vacunación en la prevención de gripe grave en adultos atendidos en un hospital de tercer nivel durante la temporada 2017-2018.

OBJECTIVES: The objective of this research was to evaluate the effect of influenza vaccination on the prevention of influenza-related severe cases in adults treated in a third-level hospital during the 2017-2018 epidemic season. METHODOLOGY: A descriptive analysis was performed on the entire population of subjects with a laboratory-confirmed influenza test during the 2017-2018 season. A severe case was defined as a patient treated in one of the Intensive Care Units (ICUs) and/or death. The effect of the vaccine on the adult population was determined by multivariate logistic regression analysis. RESULTS: Between epidemiological weeks 44/2017 and 19/2018, the hospital's laboratory detected 706 positive samples for influenza virus. Of the 551 confirmed patients aged 18 years or older, forty-three were admitted to one of the ICUs, and 26 died during admission. The explanatory multivariate model has shown that flu vaccination prior to or during the epidemic season was a protective factor for the development of severity [OR:0.27 (0.11-0.65, p=0.004)], adjusted by age [OR: 1.03 (1.01-1.06), p=.04], sex, type of virus (H1N1-pdm09, H3N2 or B virus), Chronic Complex Patient index or Advanced Chronic Disease index. CONCLUSSIONS: Influenza vaccination is a protective factor against the development of severity associated with influenza infection in a season when vaccination did not contain the virus with higher epidemic circulation among the population. Flu vaccination should be recommended annually following the guidelines established by the health authorities.

Impact of emergency department management of atrial fibrillation with amiodarone on length of stay. A propensity score analysis based on the URGFAICS registry.

OBJECTIVE: Amiodarone is a widely used drug in the emergency department (ED) for control of atrial fibrillation, but it has a delayed onset of action and slow metabolism, leading to longer length of ED stay. The aim of this study was to compare the length of ED stay of atrial fibrillation patients who were treated with or without amiodarone. METHODS: We undertook a multicenter, observational, cohort study of the URGFAICS registry of older adults with atrial fibrillation who presented to five Spanish EDs and compared patients who had received amiodarone with those who had not. Afterward, we performed a propensity score matched analysis of atrial fibrillation to determine the ED length of stay related to amiodarone. RESULTS: Of the 1199 patients included in the registry, 225 patients (18.8%) were treated with amiodarone while 974 (81.2%) were not. We performed a univariate study depending on amiodarone administration followed by propensity score calculation according to the 14 statistically different features found previously and six significant variables, obtaining 150 patients (75 for each group) suitable for the analysis. The length of ED stay was analyzed using box plot, with a P <0.001 in the crude analysis and P = 0.012 after propensity score matching and using survival curves for the analysis of prolonged ED stay, with a log rank <0.001 in the crude analysis and log rank 0.021 after the propensity score-matched analysis. CONCLUSION: Amiodarone is associated with longer length of ED stay until discharge independently of the baseline characteristics of the patients.

Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days. / Registro de fibrilación auricular en servicios de urgencias del Institut Català de la Salut (URGFAICS): análisis en función del tipo de fibrilación auricular y de la reconsulta a urgencias relacionada a los 30 días.

OBJECTIVES: To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. MATERIAL AND METHODS: Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. RESULTS: We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. CONCLUSION: We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge.

OBJETIVO: Estudiar las características de los pacientes que consultan por un episodio de fibrilación auricular (FA) en los servicios de urgencias hospitalarios (SUH), en función de si la FA es de novo o conocida previamente, y la reconsulta relacionada con la FA a los 30 días (R30d). METODO: Estudio observacional de cohorte prospectivo y multicéntrico que incluyó a todos los pacientes 18 años que consultaron por síntomas relacionados con una FA o el hallazgo de una FA en 5 SUH catalanes. Se recogieron variables demográficas, del episodio agudo, de manejo en urgencias y la R30d. RESULTADOS: De los 1.199 pacientes, 1.052 tuvieron seguimiento a 30 días. La edad media fue de 73 (DE 13) años y 646 (53,9%) eran mujeres. Seiscientos cincuenta y dos pacientes (54,4%) tenían una FA conocida, los cuales tenían mayor edad, presencia de comorbilidades y uso de antiarrítmicos y anticoagulantes orales. Hubo escasas diferencias en el manejo farmacológico en urgencias. La R30d fue de un 7,9%, y fue más frecuente cuando se usó digoxina en urgencias y bloqueadores de los canales del calcio al alta. CONCLUSIONES: Existen diferencias basales entre los pacientes con FA de novo y conocida, pero estas son escasas en el manejo en urgencias. En pacientes atendidos por fibrilación auricular en urgencias, la R30d se relacionó con el uso de digoxina en urgencias y de bloqueadores de los canales del calcio al alta.

Registro de fibrilación auricular en servicios de urgencias del Institut Català de la Salut (URGFAICS): análisis en función del tipo de fibrilación auricular y de la reconsulta a urgencias relacionada a los 30 días / Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days

Objetivos: Estudiar las características de los pacientes que consultan por un episodio de fibrilación auricular (FA) en los servicios de urgencias hospitalarios (SUH), en función de si la FA es de novo o conocida previamente, y la reconsulta relacionada con la FA a los 30 días (R30d). Método: Estudio observacional de cohorte prospectivo y multicéntrico que incluyó a todos los pacientes ≥ 18 años que consultaron por síntomas relacionados con una FA o el hallazgo de una FA en 5 SUH catalanes. Se recogieron variables demográficas, del episodio agudo, de manejo en urgencias y la R30d. Resultados: De los 1.199 pacientes, 1.052 tuvieron seguimiento a 30 días. La edad media fue de 73 (DE 13) años y 646 (53,9%) eran mujeres. Seiscientos cincuenta y dos pacientes (54,4%) tenían una FA conocida, los cuales tenían mayor edad, presencia de comorbilidades y uso de antiarrítmicos y anticoagulantes orales. Hubo escasas diferencias en el manejo farmacológico en urgencias. La R30d fue de un 7,9%, y fue más frecuente cuando se usó digoxina en urgencias y bloqueadores de los canales del calcio al alta. Conclusiones: Existen diferencias basales entre los pacientes con FA de novo y conocida, pero estas son escasas en el manejo en urgencias. En pacientes atendidos por fibrilación auricular en urgencias, la R30d se relacionó con el uso de digoxina en urgencias y de bloqueadores de los canales del calcio al alta

Objectives: To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. Methods: Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. Results: We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. Conclusions: We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge

Hemocultivos en los servicios de urgencias, ¿hacia un nuevo enfoque? / Blood cultures in the emergency department: do we need a new approach?

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Ponga las arbovirosis en su esquema diagnóstico / Add arbovirosis in your diagnostic approach

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La saturación en los servicios de urgencias hospitalarios / On hospital emergency department crowding

En los últimos años hemos asistido al despliegue de diferentes medidas de desarrollo de los SUH, pero a pesar de ello los episodios de saturación siguen sucediéndose y el debate en cuanto a sus causas y posibles soluciones sigue abierto. Se trata de un problema universal y en el momento actual las circunstancias socioeconómicas comportan un replanteamiento del sistema sanitario, en el que los SUH tendrán un papel crucial. Recientemente se han consensuado los criterios concretos que definen una situación de saturación en los SUH. Las causas de la saturación son diversas e implican aspectos tanto externos a los SUH como intrínsecos a la propia unidad. Pero los más determinantes son propios de la dinámica hospitalaria, fundamentalmente la dificultad en adjudicación de cama para ingreso y en su disponibilidad real. Esta saturación se asocia a un descenso de la mayoría de indicadores de calidad. Así mismo, se incrementan el número de pacientes que esperan ser atendidos, el tiempo de espera para el inicio de la asistencia y el tiempo de actuación médico-enfermería. Además conlleva un alto riesgo de peores resultados clínicos. Esta situación conduce a la insatisfacción de pacientes, familiares y personal sanitario y a deterioro de aspectos como la dignidad, la comodidad o la confidencialidad. Las propuestas de mejora pasan por asegurar unos mínimos recursos estructurales y de personal, y agilizar algunas exploraciones complementarias, así como implementar áreas de observación y unidades de corta estancia. La respuesta de los centros a los SUH debería incluir alternativas a la hospitalización convencional con dispositivos de diagnóstico rápido, hospitales de día y hospitalización domiciliaria, así como acciones de res- puesta bien definidas a las necesidades de ingreso hospitalario, con agilización de la disponibilidad real de camas. El sistema sanitario por su parte debería mejorar el control de los pacientes crónicos para reducir las necesidades de ingreso, y adecuar la oferta a las necesidades reales de atención sociosanitaria (AU)

Recent years have seen a range of measures deployed to curb crowding in hospital emergency departments, but as episodes of overcrowding continue to occur the discussion of causes and possible solutions remains open. The problem is universal, and efforts to revamp health care systems as a result of current socioeconomic circumstances have put emergency services in the spotlight. Consensus was recently achieved on criteria that define emergency department overcrowding. The causes are diverse and include both external factors and internal ones, in the form of attributes specific to a department. The factors that have the most impact, however, involve hospital organization, mainly the availability of beds and the difficulty of assigning them to emergency patients requiring admission. Crowding is associated with decreases in most health care quality indicators, as departments see increases in the number of patients waiting, the time until initial processing, and the time until a physician or nurse intervenes. Crowding is also associated with risk for more unsatisfactory clinical outcomes. This situation leads to dissatisfaction all around—of patients, families, and staff—as aspects such as dignity, comfort, and privacy deteriorate. Proposals to remedy the problem include assuring that the staff and structural resources of a facility meet minimum standards and are all working properly, facilitating access to complementary tests, and providing observation areas and short-stay units. The response of hospitals to the situation in emergency departments should include alternatives to conventional admission, through means for rapid diagnosis, day hospitals, and home hospitalization as well as by offering a clear response in cases where admission is needed, granting easier access to beds that are in fact available. For its part, the health system overall, should improve the care of patients with chronic diseases, so that fewer admissions are required. It is also essential to search for ways to bring the supply of necessary social and health care services more in step with demand (AU)

[On hospital emergency department crowding]. / La saturación en los servicios de urgencias hospitalarios.

EN: Recent years have seen a range of measures deployed to curb crowding in hospital emergency departments, but as episodes of overcrowding continue to occur the discussion of causes and possible solutions remains open. The problem is universal, and efforts to revamp health care systems as a result of current socioeconomic circumstances have put emergency services in the spotlight. Consensus was recently achieved on criteria that define emergency department overcrowding. The causes are diverse and include both external factors and internal ones, in the form of attributes specific to a department. The factors that have the most impact, however, involve hospital organization, mainly the availability of beds and the difficulty of assigning them to emergency patients requiring admission. Crowding is associated with decreases in most health care quality indicators, as departments see increases in the number of patients waiting, the time until initial processing, and the time until a physician or nurse intervenes. Crowding is also associated with risk for more unsatisfactory clinical outcomes. This situation leads to dissatisfaction all around-of patients, families, and staff-as aspects such as dignity, comfort, and privacy deteriorate. Proposals to remedy the problem include assuring that the staff and structural resources of a facility meet minimum standards and are all working properly, facilitating access to complementary tests, and providing observation areas and short-stay units. The response of hospitals to the situation in emergency departments should include alternatives to conventional admission, through means for rapid diagnosis, day hospitals, and home hospitalization as well as by offering a clear response in cases where admission is needed, granting easier access to beds that are in fact available. For its part, the health system overall, should improve the care of patients with chronic diseases, so that fewer admissions are required. It is also essential to search for ways to bring the supply of necessary social and health care services more in step with demand.

ES: En los últimos años hemos asistido al despliegue de diferentes medidas de desarrollo de los SUH, pero a pesar de ello los episodios de saturación siguen sucediéndose y el debate en cuanto a sus causas y posibles soluciones sigue abierto. Se trata de un problema universal y en el momento actual las circunstancias socioeconómicas comportan un replanteamiento del sistema sanitario, en el que los SUH tendrán un papel crucial. Recientemente se han consensuado los criterios concretos que definen una situación de saturación en los SUH. Las causas de la saturación son diversas e implican aspectos tanto externos a los SUH como intrínsecos a la propia unidad. Pero los más determinantes son propios de la dinámica hospitalaria, fundamentalmente la dificultad en adjudicación de cama para ingreso y en su disponibilidad real. Esta saturación se asocia a un descenso de la mayoría de indicadores de calidad. Así mismo, se incrementan el número de pacientes que esperan ser atendidos, el tiempo de espera para el inicio de la asistencia y el tiempo de actuación médico-enfermería. Además conlleva un alto riesgo de peores resultados clínicos. Esta situación conduce a la insatisfacción de pacientes, familiares y personal sanitario y a deterioro de aspectos como la dignidad, la comodidad o la confidencialidad. Las propuestas de mejora pasan por asegurar unos mínimos recursos estructurales y de personal, y agilizar algunas exploraciones complementarias, así como implementar áreas de observación y unidades de corta estancia. La respuesta de los centros a los SUH debería incluir alternativas a la hospitalización convencional con dispositivos de diagnóstico rápido, hospitales de día y hospitalización domiciliaria, así como acciones de respuesta bien definidas a las necesidades de ingreso hospitalario, con agilización de la disponibilidad real de camas. El sistema sanitario por su parte debería mejorar el control de los pacientes crónicos para reducir las necesidades de ingreso, y adecuar la oferta a las necesidades reales de atención sociosanitaria.

Neumonía comunitaria y procalcitonina, ¿una oportunidad para mejorar? / Community-acquired pneumonia and procalcitonin, an opportunity to improve?

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Correlation of inflammatory and cardiovascular biomarkers with pneumonia severity scores

PURPOSE: To assess the correlation of procalcitonin (PCT), C-reactive protein (CRP), neopterin, mid-regional pro-atrial natriuretic peptide (MR-proANP), and mid-regional pro-adrenomedullin (MR-proADM) with severity risk scores: severe CAP (SCAP) and SMART-COP in patients with community-acquired pneumonia (CAP), as well as short term prognosis and to determine the correlation with mortality risk scores. METHODS: Eighty-five patients with a final diagnosis of pneumonia were consecutively included during a two month period. Epidemiological, clinical, microbiological, and radiological data were recorded. Patients were stratified according to the PSI, CURB-65, SCAP and SMART-COP. Complications were defined as respiratory failure/shock, need of ICU, and death. Plasma samples were collected at admission. RESULTS: MR-proANP and MR-proADM showed significantly higher levels in high risk SCAP group in comparison to low risk. When considering SMART-COP none of the biomarkers showed statistical differences. MR-proADM levels were high in patients with high risk of needing intensive respiratory or vasopressor support according to SMRT-CO. Neopterin and MR-proADM were significantly higher in patients that developed complications. PCT and MR-proADM showed significantly higher levels in cases of a definite bacterial diagnosis in comparison to probable bacterial, and unknown origin. MR-proANP and MR-proADM levels increased statistically according to PSI and CURB-65. CONCLUSIONS: Biomarker levels are higher in pneumonia patients with a poorer prognosis according to SCAP and SMART-COP indexes, and to the development of complications

OBJETIVO: Establecer la correlación entre los niveles de procalcitonina (PCT), proteína C reactiva, neopterina, pro-péptido natriurético auricular (MR-proANP) y pro-adrenomedulina (MR-proADM) y los índices de severidad: severe CAP (SCAP) y SMART-COP en pacientes con neumonía adquirida en la comunidad (NAC), así como el pronóstico a corto plazo, y confirmar su correlación con los índices de severidad PSI y CURB-65. MÉTODOS: Ochenta y cinco pacientes con diagnóstico final de NAC fueron incluidos de forma consecutiva durante 2 meses. Se recogieron los datos epidemiológicos, clínicos, microbiológicos y radiológicos. Los pacientes se clasificaron en función del PSI, CURB-65, SCAP y SMART-COP. Las complicaciones se definieron como insuficiencia respiratoria/shock, ingreso en la UCI o muerte. Las muestras de plasma se recogieron en el momento del ingreso hospitalario. RESULTADOS: Los niveles de MR-proANP y MR-proADM fueron significativamente superiores en aquellos pacientes clasificados como alto riesgo según SCAP en comparación con los de bajo riesgo. Al considerar SMART-COP ninguno de los biomarcadores mostró significación estadística. Los niveles de MR-proADM fueron superiores en los pacientes con alto riesgo de necesitar soporte intensivo/vasopresor según SMRT-CO. Los valores de neopterina y MR-proADM fueron significativamente superiores en pacientes que desarrollaron alguna complicación. En los casos con diagnóstico bacteriano de seguridad, se observaron niveles significativamente más elevados de PCT y MR-proADM, respecto de los casos de probable origen bacteriano o origen desconocido. Los niveles de MR-proANP y MR-proADM se incrementaron en función del PSI y de CURB-65. CONCLUSIONES: Los niveles de biomarcadores son superiores en pacientes con peor pronóstico, según los índices de severidad evaluados, así como con el desarrollo de complicaciones

Correlation of inflammatory and cardiovascular biomarkers with pneumonia severity scores.

PURPOSE: To assess the correlation of procalcitonin (PCT), C-reactive protein (CRP), neopterin, mid-regional pro-atrial natriuretic peptide (MR-proANP), and mid-regional pro-adrenomedullin (MR-proADM) with severity risk scores: severe CAP (SCAP) and SMART-COP in patients with community-acquired pneumonia (CAP), as well as short term prognosis and to determine the correlation with mortality risk scores. METHODS: Eighty-five patients with a final diagnosis of pneumonia were consecutively included during a two month period. Epidemiological, clinical, microbiological, and radiological data were recorded. Patients were stratified according to the PSI, CURB-65, SCAP and SMART-COP. Complications were defined as respiratory failure/shock, need of ICU, and death. Plasma samples were collected at admission. RESULTS: MR-proANP and MR-proADM showed significantly higher levels in high risk SCAP group in comparison to low risk. When considering SMART-COP none of the biomarkers showed statistical differences. MR-proADM levels were high in patients with high risk of needing intensive respiratory or vasopressor support according to SMRT-CO. Neopterin and MR-proADM were significantly higher in patients that developed complications. PCT and MR-proADM showed significantly higher levels in cases of a definite bacterial diagnosis in comparison to probable bacterial, and unknown origin. MR-proANP and MR-proADM levels increased statistically according to PSI and CURB-65. CONCLUSIONS: Biomarker levels are higher in pneumonia patients with a poorer prognosis according to SCAP and SMART-COP indexes, and to the development of complications.