Predictors of the presence of radiological abnormalities 6 months after severe COVID-19 pneumonia.

BACKGROUND: SARS-CoV-2 pneumonia can cause significant long-term radiological changes, even resembling pulmonary fibrosis. However, the risk factors for these long-term effects are unknown. This study aims to assess radiological abnormalities and their possible risk factors six months after hospital discharge due to COVID-19 pneumonia. MATERIAL AND METHODS: This cross-sectional study in a tertiary hospital included adults admitted for COVID-19 pneumonia from March 2020 to February 2021, who underwent high-resolution computed tomography (HRCT) scans of the chest six months after hospital discharge. The primary outcome was radiological abnormalities on HRCT, while the main explanatory variables were drawn from the patient's medical history along with the disease course, analytical indicators, and the treatment received during admission. RESULTS: The 189 included patients had a mean age of 61.5 years; 70.9% were male, and hypertension was the main comorbidity (45%). About two-thirds (67.2%) presented acute respiratory distress syndrome (ARDS). Most (97.9%) received systemic corticosteroid therapy, and 81% presented pathological findings on HRCT, most commonly ground glass (63.5%), followed by bronchial dilatation (36%) and subpleural bands (25.4%). The multivariable analysis showed that age was the main risk factor, associated with most radiological changes. Other factors were the duration of corticosteroid therapy for ground glass (adjusted odds ratio [aOR] 1.020) as well as a longer stay in the intensive care unit (ICU) (aOR 1.290) and high levels of IL-6 for bronchial dilation (aOR 1.002). CONCLUSION: Radiological involvement of the lungs six months after COVID-19 pneumonia is frequent, especially ground glass. Elderly patients with prolonged ICU admission and a significant inflammatory response measured by IL-6 are more likely to present worse radiological evolution and are candidates for radiological follow-up after COVID-19 pneumonia.

[Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)]. / Cambios en las características clínico-epidemiológicas de los nuevos casos de infección por el VIH-1 en Castellón (España) y su repercusión en la presentación tardía (1987-2011).

OBJECTIVE: To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS: Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS: There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (<2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS: The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies.

Presence of COVID-19 self-reported symptoms at 12 months in patients discharged from hospital in 2020-2021: a Spanish cross-sectional study.

The long-term effects of SARS-CoV-2 infection, and their determinants, are still unknown. This study aimed to assess symptoms one year after admission for COVID-19, according to the organ/system involved, and to identify factors. Cross-sectional study with retrospective data collection from March 2020 to February 2021. Inclusion criteria: aged ≥ 18 years and admitted for COVID-19. Exclusion criteria: death, not localized, refusal to participate, cognitive impairment or language barrier. A telephone survey was conducted on long COVID-related symptoms one year after hospital discharge. n = 486. The most frequent symptom groups were neurological (n = 225; 46.3%) and respiratory (n = 201; 41.4%). Multivariable analysis showed that a history of anxiety was significantly associated with psychiatric symptoms (ORa = 2.04, 95%CI = 1.02-4.06), fibromyalgia/chronic fatigue with general symptoms (ORa = 11.59, 95%CI = 1.47-9.34) and obesity with respiratory (ORa 1.90, 95%CI = 1.27-2.83) and musculoskeletal symptoms (ORa 1.96, 95%CI = 1.30-2.96). Male sex was associated with a significantly lower risk of neurological (ORa 0.64, 95%CI = 0.44-0.93), respiratory (ORa 0.45, 95%CI = 0.31-0.67), general (ORa 0.43, 95%CI = 0.29-0.63), psychiatric (ORa 0.34, 95%CI = 0.22-0.51), musculoskeletal (ORa 0.47, 95%CI = 0.32-0.70), dermatological (ORa 0.24, 95%CI = 0.14-0.42) and digestive (ORa 0.38, 95%CI = 0.20-0.73) symptoms. Advanced age (≥ 71 years) also had a protective effect against general (ORa 0.60, 95%CI = 0.39-0.95), psychiatric (ORa 0.39, 95%CI = 0.23-0.64), and dermatological (ORa 0.47, 95%CI = 0.24-0.92) symptoms. Patients admitted for SARS-CoV-2 infection frequently experience symptoms at one year, especially neurological and respiratory symptoms. Female sex, obesity, a history of anxiety and fibromyalgia/chronic fatigue were independent risk factors for presenting symptoms. Advanced age acted as a protective factor.

One-year quality of life among post-hospitalization COVID-19 patients.

Introduction: The long-term effects of SARS-CoV-2 are unclear, as are the factors influencing the evolution. Objective: to assess health-related quality of life 1 year after a hospital admission due to COVID-19 and to identify factors that may influence it. Materials and methods: Retrospective observational study in a tertiary hospital from March 2021 to February 2022. Inclusion criteria: ≥18 years old and admitted for SARS-CoV-2 infection. Exclusion criteria: death, not located, refusal to participate, cognitive impairment, and language barrier. Variables: demographic data, medical history, clinical and analytical outcomes during hospital admission, treatment received, and vaccination against SARS-CoV-2 following admission. Participants were interviewed by phone 1 year after admission, using the SF-36 quality of life questionnaire. Results: There were 486 included patients. The domains yielding the lowest scores were general health (median 65%, interquartile range [IQR] 45-80), vitality (median 65%, IQR 45-80), and mental health (median 73.5%, IQR 60-100). Multivariable analysis showed that female sex and fibromyalgia/fatigue had a negative influence on all domains. Obesity was associated with worse outcomes in physical functioning, physical role, bodily pain, and vitality. Other factors associated with worse scores were an older age in physical functioning and high age-adjusted Charslon comorbidity in physical functioning and general health. Age was associated with better results in emotional role and High C-reactive protein at admission on vitality. Conclusion: One year after admission for COVID-19, quality of life remains affected, especially the domains of general health, vitality, and mental health. Factors associated with worse outcomes are female sex, fibromyalgia/chronic fatigue, and obesity.

[Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases]. / Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. INCLUSION CRITERIA: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.

Utilidad pronóstica de la escala qSOFA en pacientes ingresados en un servicio de Medicina Interna por enfermedades infecciosas / Prognostic utility of the qSOFA scale in patients admitted to an Internal Medicine service due to infectious diseases

INTRODUCCIÓN: La sepsis es una entidad grave siendo su sospecha y tratamiento precoces claves para el pronóstico. OBJETIVO: Analizar la utilidad pronóstica de la escala qSOFA en pacientes que ingresan por infección en un servicio de Medicina Interna. PACIENTES Y MÉTODOS: Estudio descriptivo, tranversal, de los pacientes ingresados con infección en el Hospital General de Castellón (España) de noviembre de 2017 a febrero de 2018. Criterio de inclusión: pacientes admitidos por la sospecha de un proceso infeccioso. Variable principal dependiente: mortalidad. Variable principal independiente: qSOFA. Variables secundarias: tiempo hasta primera valoración médica y hasta inicio de antibioterapia empírica en Urgencias (minutos), características demográficas del paciente, analíticas y evolutivas. RESULTADOS: Se analizó un total de 311 pacientes, 145 varones, edad media 78 años (DE 16,23). Setenta y cinco (24%) presentaron qSOFA ≥ 2. Se observó una mayor mortalidad en aquellos pacientes con qSOFA ≥ 2 (36 vs 11%, p = 0,00). CONCLUSIÓN: En pacientes admitidos con enfermedades infecciosas, un valor de qSOFA > = 2 se asoció a mayor mortalidad. Se requieren futuros estudios para comprobar su potencial utilidad diagnóstica.

BACKGROUND: Sepsis is a serious entity. Diagnosis and early treatment is important for the prognosis. AIM: To analyze the prognostic utility of the qSOFA scale as a predictor of mortality in patients admitted by infection in an Internal Medicine Service and describe its demographic characteristics and possible association with mortalilty. METHODS: Descriptive and cross-sectional study of patients admitted with diagnosis of acute infection at the General Hospital of Castellon (Spain) from November 2017 to February 2018. Inclusion criteria: patients admitted on suspicion of an infectious process. Main dependent variable: mortality. Independent main variable: qSOFA scale. Secondary variables: time until the first medical evaluation and the start of empirical antibiotic therapy, demographic characteristics of the patient, analytics and evolutional. RESULTS: A total of 311 patients were analyzed, 145 men with an average age of 78 (DE 16,23). Seventy five presented qSOFA ≥ 2. Higher mortality was observed in those patients with qSOFA ≥ 2 (36% vs 11%, p = 0.00). CONCLUSION: In patients admitted with infectious diseases, a qSOFA value > = 2 was associated with higher mortality. Future studies are required to verify its potential diagnostic utility.