Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona.

BACKGROUND: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d'Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. METHODS: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. RESULTS: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. CONCLUSIONS: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study.

BACKGROUND: Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. OBJECTIVE: The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. METHODS: This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. RESULTS: An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. CONCLUSIONS: The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory-based mHealth strategy.

Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

BACKGROUND: Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. AIMS: To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. METHODS: Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. RESULTS: Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. CONCLUSION: QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere.

Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study.

BACKGROUND: Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona. METHODS: One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales. RESULTS: Response rate was 98 %. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89 % of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3 % reported not finding the Unit easily and 7 % said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94 % choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation. DISCUSSION: It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality. CONCLUSIONS: While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.

A quick diagnosis unit as an alternative to conventional hospitalization in a tertiary public hospital: a descriptive study.

INTRODUCTION:  Reports indicate that a significant number of patients admitted to internal medicine units could be studied on an outpatient basis. OBJECTIVES:  This article assesses a quick diagnosis unit (QDU) as an alternative to acute hospitalization for the diagnostic study of patients with potentially serious diseases and suspected malignancy.  PATIENTS AND METHODS:  Between March 2008 and June 2012, 1226 patients were attended by the QDU. Patients were referred from the emergency department, primary health care centers, and outpatient clinics according to well­defined criteria. Clinical information was prospectively registered in a database.  RESULTS:  There were 634 men (51.7%), with a mean age of 60.5 ±17.5 years. The mean time to the first visit was 3.5 ±5.3 days. Most patients (65.7%) required only 2 visits. The mean interval to diagnosis was 12.2 ±14.7 days. A total of 324 patients (26.4%) had cancer. The diagnosis was  solid tumor in 81.5% of the cases, lymphoma in 19.8%, and various hematologic malignancies in 4.3%. The second most common diagnosis was anemia not associated with cancer (8.6% of the cases). Admission to the QDU allowed to avoid conventional hospitalization for diagnostic studies in 71.5% of the patients, representing a mean freeing­up rate of 7 internal medicine beds per day. In a satisfaction survey, 97% of the patients were completely or very satisfied and 96% preferred the QDU to conventional hospitalization.  CONCLUSIONS:  A QDU may be a feasible alternative to conventional hospitalization for the diagnosis of otherwise healthy patients with suspected severe disease. Appropriately managed and supported, QDUs can lighten the burden of emergency departments and reduce the need for hospitals beds.

Standardizing admission and discharge processes to improve patient flow: a cross sectional study.

BACKGROUND: The aim of this study was to evaluate how hospital capacity was managed focusing on standardizing the admission and discharge processes. METHODS: This study was set in a 900-bed university affiliated hospital of the National Health Service, near Barcelona (Spain). This is a cross-sectional study of a set of interventions which were gradually implemented between April and December 2008. Mainly, they were focused on standardizing the admission and discharge processes to improve patient flow. Primary administrative data was obtained from the 2007 and 2009 Hospital Database. Main outcome measures were median length of stay, percentage of planned discharges, number of surgery cancellations and median number of delayed emergency admissions at 8:00 am. For statistical bivariate analysis, we used a Chi-squared for linear trend for qualitative variables and a Wilcoxon signed ranks test and a Mann-Whitney test for non-normal continuous variables. RESULTS: The median patients' global length of stay was 8.56 days in 2007 and 7.93 days in 2009 (p < 0.051). The percentage of patients admitted the same day as surgery increased from 64.87% in 2007 to 86.01% in 2009 (p < 0.05). The number of cancelled interventions due to lack of beds was 216 patients in 2007 and 42 patients in 2009. The median number of planned discharges went from 43.05% in 2007 to 86.01% in 2009 (p < 0.01). The median number of emergency patients waiting for an in-hospital bed at 8:00 am was 5 patients in 2007 and 3 patients in 2009 (p < 0.01). CONCLUSIONS: In conclusion, standardization of admission and discharge processes are largely in our control. There is a significant opportunity to create important benefits for increasing bed capacity and hospital throughput.

[The role of medical management in the involvement of the emergency department in the hospital]. / Papel de la dirección médica en el encaje de urgencias en el hospital.

The functional and structural reordering of the accident and emergency services is a priority for hospital management staffs. A true reordering must be based on the following questions: 1.Demand for accident and emergency care is predictable. 2.The way the hospital deals with this can be improved. 3.Hospitals have the responsibility of setting up patient control mechanisms as an alternative to conventional admission. The role of the centre's admissions unit in managing patients is basic in defining the functional regulations and procedures for managing admissions; in setting up a daily planning and decision making meeting with the active participation of the management, the admissions unit and the accident and emergency unit, as well as drawing up a daily map of hospitalisation needs. Other policies will facilitate a more efficient patient circuit from admission to discharge: -Setting up a 24 hour accident and emergency preadmission unit. -Implementing an effective system of bed assignment based on priorities. -Adapting urgent admissions and scheduled ones (for diagnostic tests, surgery) by implementing fast ambulatory diagnostic pathways and by implementing conventional hospital alternatives such as short stay units, home hospitalisation, preadmission units, convalescence units. -Implementing hospital policy on internal patient circulation. (internal movements, priorities in patients' location, discharges.).

Home hospitalization unit: an alternative to standard inpatient hospitalization from the emergency department.

OBJECTIVE: To assess the characteristics of the patients admitted to a home hospitalization unit (HHU) after a first emergency department (ED) visit. METHODS: This was a descriptive, retrospective study. The setting of the study was the ED of a 500-bed teaching hospital, which treats 125 000 emergency visits per year. HHU admits patients from the ED when hospitalization is imminent. Participants were all patients attending our ED from 1 January 2005 to 31 December 2005 and finally admitted to HHU. Variables were age, sex, diagnostic, mean length of stay, and readmission rate. RESULTS: A cohort composed of 250 patients admitted to HHU directly from the ED was identified. Mean age was 75 years. One hundred and fifty-eight were males (63%). The most common diagnoses were acute exacerbation of chronic obstructive pulmonary disease (127 of 250 patients, 50.8%), acute exacerbation of chronic heart failure (32 of 250 patients, 12.8%), pneumonia (24 of 250 patients, 9.6%), urinary tract infection (20 of 250 patients, 8%), and leg deep venous thrombosis (14 of 250 patients, 5.6%). Mean length of stay was 8 days. Readmission rate was 9%. CONCLUSION: A HHU proved to be effective and safe for acutely ill individuals who required hospitalization.

Impacto de un modelo centralizado de priorización de las camas hospitalarias como instrumento válido de gestión asistencial / Impact of a centralised model for prioritising bed assignment as a valid tool in hospital management

Objetivo: Demostrar la efectividad de un modelo de priorización en la adjudicación diaria de las camas hospitalarias centralizado en la unidad de admisiones y dependiente de la dirección del centro. Material y método: Este modelo de gestión se inició el 1 de junio de 2005 con la implementación de una serie de intervenciones: definición del manual de procedimientos de la unidad de admisiones; instauración de una reunión diaria decisoria de planificación; creación de la unidad de preingreso de urgencias de 24 h; ejecución del sistema de priorización en la asignación de camas, y adecuación de los ingresos urgentes y los ingresos programados para estudios diagnósticos. Se han utilizado ocho indicadores de gestión obtenidos de los sistemas de información del centro. Se han agrupado los datos en tres períodos anuales: 2004 (previo a la intervención), 2005 (intervención) y 2006 (tras la intervención). Resultados: Número de visitas de urgencias: 2004, 124.301; 2005, 123.390; 2006, 129.389). Número de ingresos urgentes: 2004, 13.629; 2005, 14.649; 2006, 11.690. Número de ingresos programados: 2004, 12.320; 2005, 12.791; 2006, 13.615. Tasa de ingreso de urgencias: 2004, 11%; 2005, 11,9%; 2006, 9,2% (p = 0,004). Presión de urgencias: 2004, 52,5%; 2005, 53,4%; 2006, 46,2% (p = 0,002). Media del tiempo de permanencia en urgencias por paciente: 2004, 9 h 45 min; 2005, 6 h 46 min; 2006, 5h 39 min. Número de pacientes pendientes de ingreso en urgencias sin cama a las 8.00: 2004, 5.341; 2005, 4.484; 2006, 2.787. Tasa de anulación de intervenciones quirúrgicas programadas: 2004, 3,4%; 2005, 3,7%; 2006, 2,6% (p = 0,002). Conclusiones: La gestión centralizada de las camas hospitalarias y su priorización por la unidad de admisiones ha mostrado su efectividad como instrumento válido de gestión asistencial

Objective: To determine the effectiveness of a model centred in the admission unit that prioritises the daily assignment of available hospital beds.Material and methods: This model started on June 1st 2005 with the implementation of a series of interventions: 1) Definition of the proceedings of the admission unit; 2) A daily planning decision-makingmeeting; 3) Opening of a 24-hour emergency department holding unit; 4) Priority bed assignment system; and 5) Appropriateness of emergency medical and elective surgical admissions. We used 8 parameters obtained from the hospital automated database. The data have been analysed in three different annual periods: 2004 (before intervention), 2005 (intervention) and 2006 (after intervention).Results: Number of emergencies seen: 2004 (124,301), 2005(123,390),2006 (129,389); number emergency admissions: 2004 (13,629), 2005 (14,649), 2006 (11,690); number of elective admissions: 2004 (12,320), 2005 (12,791), 2006 (13,615); ED admission rate: 2004 (11.0 %), 2005 (11.9 %), 2006 (9.2 %), P=.004; emergency pressure: 2004 (52.5 %), 2005 (53.4 %), 2006 (46.2 %), P=.002; ED mean length of stay per patient: 2004 (9h 45m), 2005 (6h 46m), 2006 (5h 39m); number of emergency admissions waiting for a hospital bed at 8 a.m: 2004 (5341), 2005(4484), 2006 (2787); elective surgical interventions cancellation rate: 2004 (3.4 %), 2005 (3.7 %), 2006 (2.6 %), P=.002.Conclusions: Centralized assignment of hospital beds by the admission unit has proved to be an effective tool for hospital management

[Not Available]. / Impacto de un modelo centralizado de priorización de las camas hospitalarias como instrumento válido de gestión asistencial.

OBJECTIVE: To determine the effectiveness of a model centred in the admission unit that prioritises the daily assignment of available hospital beds. MATERIAL AND METHODS: This model started on June 1st 2005 with the implementation of a series of interventions: 1) Definition of the proceedings of the admission unit; 2) A daily planning decision-making meeting; 3) Opening of a 24-hour emergency department holding unit; 4) Priority bed assignment system; and 5) Appropriateness of emergency medical and elective surgical admissions. We used 8 parameters obtained from the hospital automated database. The data have been analysed in three different annual periods: 2004 (before intervention), 2005 (intervention) and 2006 (after ntervention). RESULTS: Number of emergencies seen: 2004 (124,301), 2005 (123,390),2006 (129,389); number emergency admissions: 2004 (13,629), 2005 (14,649), 2006 (11,690); number of elective admissions: 2004 (12,320), 2005 (12,791), 2006 (13,615); ED admission rate: 2004 (11.0 %), 2005 (11.9 %), 2006 (9.2 %), P=.004; emergency pressure: 2004 (52.5 %), 2005 (53.4 %), 2006 (46.2 %), P=.002; ED mean length of stay per patient: 2004 (9h 45m), 2005 (6h 46m), 2006 (5h 39m); number of emergency admissions waiting for a hospital bed at 8 a.m: 2004 (5341), 2005 (4484), 2006 (2787); elective surgical interventions cancellation rate: 2004 (3.4 %), 2005 (3.7 %), 2006 (2.6 %), P=.002. CONCLUSIONS: Centralized assignment of hospital beds by the admission unit has proved to be an effective tool for hospital management.

Reclamaciones en un servicio de urgencias: estudio de 13 años en un hospital universitario / Complaints in an emergency department: a 13-year study in a university hospital

Introducción: Los servicios de urgencias hospitalarios (SUH) han sido concebidos para dar una respuesta óptima a las necesidades del ciudadano. Objetivos: En primer lugar, analizar las reclamaciones recibidas por el servicio de urgencias de un hospital universitario de tercer nivel para plantear recomendaciones para reducir su incidencia. En segundo lugar, determinar si existe asociación entre el tiempo de permanencia en urgencias y el número de reclamaciones recibidas. Material y método: Estudio descriptivo retrospectivo de las reclamaciones dirigidas al Servicio de Urgencias del Hospital Universitari de Bellvitge durante 13 años consecutivos, entre el 1 de enero de 1992 y el 31 de diciembre de 2004. Se trata de un hospital con capacidad para 960 camas, que atiende anualmente a 110.381 individuos adultos por consultas urgentes, excluyendo la obstetricia. Resultados: Durante los 13 años estudiados, el SUH recibió un total de 1.610 reclamaciones, de las que el 19,7% (n = 317) fueron verbales y el 80,3% (n = 1.293), escritas. El 51,2% (n = 824) de los reclamantes fueron hombres. Los motivos más frecuentes fueron demora excesiva para ser atendido en urgencias, con el 48,9% (n = 792), e insatisfacción con la asistencia, con el 14,7% (n = 102). La tasa media de reclamaciones fue de 1,2 cada 1.000 visitas urgentes. Encontramos una asociación moderada-intensa (rho de Spearman = 0,6; p < 0,005), entre el tiempo de permanencia en el SUH y el número de reclamaciones. Conclusiones: La mayoría de las reclamaciones en un SUH son sobre cuestiones organizativas y por insatisfacción con la asistencia. La información aportada por el análisis de las reclamaciones facilita la detección de oportunidades de mejora

Introduction: Emergency departments (ED) were founded to provide an optimal response to population demand. Objectives: Firstly, to analyze the complaints received by the ED of a tertiary teaching hospital during a 13-year period with a view of making recommendations to reduce their incidence. Secondly, to determine whether there is an association between length of stay in the ED and the number of complaints. Material and method: A descriptive, retrospective study of all the complaints sent to the ED of Bellvitge Hospital over 13 consecutive years, from January 1st, 1992 to December 31st, 2004 was performed. The hospital has 960 beds and attends a mean of 110,381 adult emergency visits per year, excluding obstetrics. Results: During the study period, the ED received 1610 complaints, of which 19.7% (n = 317) were oral and 80.3% (n = 1,293) were written. A total of 51.2% (n = 824) of the complainants were men. The most frequent reasons for complaints were excessive waiting time, with 48.9% (n = 792) of the complaints, and lack of satisfaction with the healthcare received, with 14.7% (n = 102) of the complaints. The mean complaint rate was 1.2 per 1000 emergency visits. A moderate-intense association (Spearman's rho = 0.6; p < 0.005) was found between length of stay in the ED and the number of complaints. Conclusions: Most complaints received in the ED concerned organizational procedures and the healthcare received. Information provided by analysis of these complaints can be used to detect opportunities for improvement

High mortality rates from medical problems of frequent emergency department users at a university hospital tertiary care centre.

BACKGROUND: Frequent emergency department (ED) users are a nebulous group of patients. A high degree of psychiatric problems and higher than expected mortality from medical illness have been reported in this population. STUDY OBJECTIVES: We sought to examine the pattern of ED use by adult patients identified as being heavy users of the ED, to examine their demographic characteristics and describe their clinical profile during a one-year period at one institution. METHODS: This was a descriptive, retrospective study that took place in the ED of a 1000-bed teaching hospital in Barcelona, Spain, with a population in the metropolitan area of 1.5 million, which attends approximately 110,000 emergency visits per year, excluding paediatrics and obstetrics. The ED computer registration database was used to identify all patients presenting to the hospital ED more than 10 times in a one-year period from 1 January to 31 December 2000. A cohort composed of 86 patients fitting these inclusion criteria was identified as making 1263 (1.1%) of the total 109,857 ED visits. All medical records for each patient were reviewed to determine the primary reason for repeated ED visits. RESULTS: Of the 86 patients enrolled, 58 were men (67.4%). The mean age was 55 years (range 18-91), but only six patients (6.9%) were older than 80 years. The median number of ED visits per patient was 14 throughout the year. Forty-five of the patients (52.3%) were classified as having primarily medical reasons for presenting to the ED, with diagnoses such as shortness of breath and chest pain being the chief symptoms. Seventeen patients (19.7%) had a surgical problem as the cause of their ED visits, and eight (9.3%) had psychiatric problems contributing to the ED visits. Other major reasons for presentation to the ED were as follows: ophthalmic, eight patients (9.3%); otolaryngological, four patients (4.6%); and trauma, four patients (4.6%). A total of 982 (77.8%) of the total ED visits resulted in home discharge. Hospital emergency admissions and outpatient clinics diversions occurred in 106 (8.3%) and 71 (5.6%) ED visits, respectively. The mortality rate was as high as 18.6% (16 frequent ED users died). CONCLUSION: These data show that there is a high incidence of medical problems in frequent ED users and a high incidence of mortality in patients with heavy ED use.

Corticosteroid therapy increases HDL-cholesterol concentrations in patients with active sarcoidosis and hypoalphalipoproteinemia.

BACKGROUND: We have previously reported that the decrease in high-density lipoprotein (HDL)-cholesterol that is observed in patients with untreated sarcoidosis is limited to those with active disease. AIM: To determine the effect of corticosteroids, used in the treatment of active sarcoidosis, on the reported lipoprotein metabolism abnormalities. METHODS: We studied 62 patients with biopsy-proven sarcoidosis, all of them with active disease. Sarcoidosis activity was evaluated by means of clinical, chest X-ray, gallium-67 scan, serum angiotensin-converting enzyme (peptidyl-dipeptidase A) values, and pulmonary function tests. A total of 40 patients were not treated with prednisone and 22 patients were treated with prednisone. The mean daily prednisone dosage in the treated patients with sarcoidosis was 20 mg and the mean duration of prednisone therapy was 6 months. Analysis of lipoprotein metabolism included: serum cholesterol, low-density lipoprotein (LDL)-cholesterol, HDL-cholesterol, HDL(2)-cholesterol, HDL(3)-cholesterol, apolipoprotein (apo) A-I, apo B, and triglyceride concentrations. RESULTS: When patients with active sarcoidosis not treated with prednisone were compared to those treated with prednisone, the former had significantly lower HDL-cholesterol (1.17+/-0.36 vs. 1.42+/-0.42 mmol/l; P=0.01) and HDL(2)-cholesterol (0.37+/-0.18 vs. 0.53+/-0.25 mmol/l; P=0.009) levels. Multiple regression analysis demonstrated that the HDL-cholesterol (P=0.004), HDL(2)-cholesterol (P=0.002), HDL(3)-cholesterol (P=0.02), and apo A-I (P=0.02) levels were the variables independently and significantly associated with steroid therapy. CONCLUSIONS: Corticosteroid therapy, used in the treatment of active sarcoidosis, increased HDL-cholesterol levels to those seen in inactive disease. These changes are manifestations of reducing disease activity.